Nur 448

Persons at Risk for Abuse and Violence

Rape

Non-consensual vaginal, anal, or oral penetration Force, threat, underaged, impaired

CrimeForce, domination, and humiliationAny forced sexual activityRape statistics are trending down

2002 216,000 victims• 13 % males• 70 % known to individual

Rape theories

Intrapersonal Rapist powerlessness and high stress 5 types of rape

Stranger Acquaintance Spousal Statutory Confidence

Interpersonal Rapist preoccupied with control

Social Learning Intimidation and force to achieve goals Violence is expression of power

Feminist Result of socioeconomic traditions

Rape Trauma Syndrome

Factors contributing to victim’s response Age of victim History of prior victimization Relationship to perpetrator Precrisis coping skills Ability to use support resources

Response factors related to the rape Severity Duration Frequency Number of offenders Degree of violence

Rape Trauma Syndrome

Acute phase Up to two weeks Two types of responses

Expressed Crying, restless, confused, tense, laughing

Controlled Confusion, disorientation, calm, shocked

Somatic Reaction-Acute phase

Bruises, sorenessHeadaches, sleep disturbancesN,V, & DPoor appetiteVaginal itching, discharge, or pain

Emotional Reaction-Acute Phase

FearDenialAnxietyShockHumiliationSelf-blameAngerGuilt-shame

Long-term Re-organization phase of Rape Trauma Syndrome

Occurs two weeks or more post rape Intrusive thoughts Increased motor activity Increased emotional lability Fears and phobias

Nursing Intervention for Rape

Before assessment Inform of rights Do not disturb clothing

Assessment Physical-STDs, HIV- Pregnancy Photographs

Nursing Diagnosis Rape trauma syndrome

Outcome identification Control over remembering Decreased flashbacks and nightmares Affect tolerance Symptom mastery Reconnecting

Planning and implementation Support defense mechanisms Give time to respond to questions Communicate knowledge and understanding of

responses to rape Community resources Group therapy

Where is Rape treatment center in Miami?Where is Rape treatment center in small

town?

Intrafamily violence

Domestic violenceBatteringSibling abuseChild abuse

Physical Shaken baby Neglect

Partner abuse Heterosexual homosexual

Elder abuse Psychological abuse

Emotional abuseAbuse of pregnant women

Stalking Following, viewing, communication

Cycle of violence Conflict escalates to violent episode Beg for forgiveness Promises of reforrm Perpetrators—jealous, possessive Victims—anxious, fearful, depressed

Cycle of Violence

Phase 1- Perpetrator is hostile, criticalPhase 2- Abuse occurs-up to 24 hoursPhase 3- Honey moon phase-guilt, shame,

remorse, promises, caring behavior Direct victimization Indirect victimization

Child victim

Singled out child-difficult becomes victimSelf blame for family conflictFear of perpetratorCheating, lying, underachievementDepression, helplessness

Partner as victim

Blames selfLow self-esteemSense of helplessnessIsolation from family and friendsViews self as subseriventDependence on partner

Theories

Neurobiological Genetic Decreased serotonin Increased norepinephrine

Intrapersonal Violence associated with personality 80% of abusers raised in abusive environment

Social learning theory Violence is learned Opportunity to abuse Conscious choice

Feminist theory Cultural influence Domestic violence is gender issue

Trauma responses

HyperarousalHypervigilenceAnxietyEmotional constrictionNumbingLow self-esteemLow sense of securityDecreased trust

Symptoms of Child Abuse

AggressionOppositional behaviorClingingHuyperactiveNightmaresEneuresis or encoproesisSchool problemsRegressed behavior

Nursing intervention

Non-judgmental attitudeMultiprofessional approachAssure physical safetyImprovement of communicationIdentify family dynamicsParenting skillsSurvivor center approach

Intra-family violence-sexual abuse

Incest Child is often “special” child Not necessarily to have physical violence Father is primary Sibling Step-father Uncle

Symptoms of incest

Age inappropriate sexual behaviorExcessive masturbationEscalation of negative behaviorRisk taking behaviorSexual acting outSubstancePrecursor to morbid obesityPrecursor to Diffuse Identity Disorder

Intervention for victims

Women Safety plan first Hotline number Domestic violence shelter

Children Will be removed from home immediately

Reporting is mandated

Florida coalition afainst domestic violence24 hour hotline 800 500 1119Call 911