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The problem knows no Boundaries 95% of all cases of reported domestic violence and sexual assault involve men abusing women …… but ………. Abuse can also include: Women against men Gay couples Remember: issue of POWER & CONTROL 2

The problem knows no Boundaries

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The problem knows no Boundaries. 95% of all cases of reported domestic violence and sexual assault involve men abusing women …… but ………. Abuse can also include: Women against men Gay couples Remember: issue of POWER & CONTROL. Societal Problem. - PowerPoint PPT Presentation

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Page 1: The problem knows  no Boundaries

The problem knows no Boundaries

95% of all cases of reported domestic violence and sexual assault involve men abusing women

…… but……….

Abuse can also include:• Women against men• Gay couples• Remember: issue of

POWER & CONTROL

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Page 2: The problem knows  no Boundaries

Societal Problem• Economics – increased use of healthcare

system.• Increased incidence of child maltreatment in

homes with IPV;• Furthers the cycle of violence; increased incidence

of criminal behavior.

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Page 3: The problem knows  no Boundaries

Reporting Requirements (general abuse mandate)

Registered nurses are mandated to report known or observed instances of abuse to the appropriate authorities– Professional capacity/within scope of employment– Failure to report is considered “unprofessional conduct”

[by BRN] and can lead to disciplinary action against license

– Failure to comply is a misdemeanor, punishable by up to 6 months in jail, a fine of $1000 or both

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Page 4: The problem knows  no Boundaries

Reporting Laws (1)

General Abuse: CPC 11160• Provider of medical

services for a physical condition that they know or reasonably suspect is the result of assaultive or abusive conduct

• Includes “adults, children, & others, (including spouses)”

• Report the incident to local law enforcement immediately or as soon as practically possible

• Prepare & send a written report to local law enforcementlwithin 2 working days

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Page 5: The problem knows  no Boundaries

Reporting Laws (obj. 1)

Child Abuse-[CPC 11166]• Knowledge• Observation• Reasonable suspicion

…that a child is the victim of child abuse

• Report to CPS immediately or as soon as practically possible by phone

• Prepare & send a written report to CPS within 36 hours of receiving the information about the incident

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Page 6: The problem knows  no Boundaries

The Face of the Victim• stress in household• Abused as a child• Married at a young age• self esteem• Helplessness or perceived helplessness• Financial dependence• Pregnancy a dangerous time

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Page 7: The problem knows  no Boundaries

Characteristics of the Abuser

• Abused or witnessed abuse as a child• Abuse of ETOH or drugs• Controlling behaviors• Pathologic jealousy• Verbal abuse physical abuse over time

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Page 8: The problem knows  no Boundaries

The Abuser• Use of isolation, intimidation, threats• Extreme jealousy or possessiveness• Controls access to $$$ & transportation• Low tolerance for frustration• Poor impulse control• Little insight into own behavior• Blames victim for the behavior

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Page 9: The problem knows  no Boundaries

Cycle of ViolenceWalker, Lenore (1979), The Battered woman.

1. Tension building• hostile behaviors• use of alcohol,

drugs• Victim tries to stay

out of the way; placates

2. Battering Incident• Abuser explodes into

violence– Hit– Burn– Beat– Rape

• Victim is powerless• Victim endures until incident

runs its course, usually 2-24 hours

• Self-esteem

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Page 10: The problem knows  no Boundaries

Cycle of Violence

Honeymoon Phase • Abuser remorseful• Abuser makes promises• Victim wants to believe

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Page 11: The problem knows  no Boundaries

Physical Evidence• Symmetrical bruises on

upper arms, wrists, neck• Nail marks or swatch of hair

missing from head• Black eyes, fx mandible,• Lacerations around eyes &

lips• Subdural hematomas• Rib fx• Bruises on breasts &

genitalia

• No single sign• Subtle signs• Injuries that do not

match the stated mechanism

• History of frequent admissions/ visits to health care provider

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Page 12: The problem knows  no Boundaries

High Index of Suspicion Abused watches partner for approval before

answering Abused edges to side of bed when abuser comes near Abused heart rate increases when abuser comes near Abusers refuse to allow a male nurse to care for

partner Abusers refuse to allow partner alone with caregivers Abusers refuse to leave the room

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Page 13: The problem knows  no Boundaries

Further Assessment

• Nurse must be alone with the patient when questions are asked– Asking when abuser is in the room

may trigger a battering incident!!• Open the subject as a routine

– FUND* recommendations:– All females > age 14, regardless of sx

of violence. • *Family Violence Prevention Fund

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Page 14: The problem knows  no Boundaries

CDC “RADAR” screening guideline

• R-routinely screen every patient• A-ask directly, kindly, w/o judgment• D-document findings• A-assess patient's safety• R-review options and provide referrals

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Page 15: The problem knows  no Boundaries

Assessment Tools

PVS – Partner Violence Screen• Have you ever been hit, kicked, punched or

otherwise hurt by someone in the past year?• Do you feel safe in your current relationship?• Does a partner from a previous relationship make

you feel unsafe now?• Benefits of Screening:

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Page 16: The problem knows  no Boundaries

Safety-Promoting Behaviors• Hide money, house key, car key• Code w/family or friends• Remove weapons• SSN• Birth certificates• Bank account numbers• Hidden bag w/extra clothing• Rent/utility receipts

• McFarlane, J. et al (2004), “Increasing the Safety-Promoting Behaviors of Abused Women”, AJN, 104(3) 40-50.

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Page 17: The problem knows  no Boundaries

Child MaltreatmentChild abuse is defined in the California State Penal Code to

include: • intentional physical injury to a child less than 18 years of age,

inflicted by another • sexual abuse • neglect• permitting to be or willfully endangering the person or health

of a child• unjustifiable physical pain or mental suffering• unlawful corporal punishment • abuse or neglect in out-of-home care

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Page 18: The problem knows  no Boundaries

Children who grow up with violence:

• learn that violence is an acceptable way to relieve stress, get what they want, and interact with the world and the people they love.

• They then incorporate these attitudes and values into their relationships as they grow up.

(Childabuse.stanford.edu)

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Page 19: The problem knows  no Boundaries

Childabuse.stanford.edu

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Page 20: The problem knows  no Boundaries

Parental Characteristics (obj.2)

• Childhood punishment was seen as unfair and severe

• Relationship with parents was negative

• Has difficulty controlling aggressive impulses

• Free expression of violence is consistent

• Socially isolated• Fewer support systems• Teenaged mothers• Low self esteem

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Page 21: The problem knows  no Boundaries

Child Characteristics (obj. 2)

“fit” between child’s temperament and parent’s ability to deal with that behavioral style

• Illegitimate• Unwanted• Brain damaged• Physically disabled• Hyperactive• Reminder• Prematurity• Difficult labor & delivery• Multiple births

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Page 22: The problem knows  no Boundaries

Environmental Characteristics

• Chronic stress– Divorce– Poverty– Poor housing– Frequent relocation– Alcoholism– Drug addiction

• All social strata• Poverty predisposes but

….• Concealed crises in

wealthy families

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Page 23: The problem knows  no Boundaries

Clinical Tipoffs• Serious injury – no hx of trauma• History inconsistent with severity of injury• Delay in seeking care for significant injury• History that changes during eval• Recurrent injuries w/poor explanation

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Page 24: The problem knows  no Boundaries

Talking with children• Private place• Do not promise not to tell• Required by law• Do not express shock or criticize family• Use their vocabulary• Avoid leading statements that can distort their report• Reassure them that they have done the right thing by

telling• Abuse is not their fault• Determine immediate need for safety• Prepare child about next steps

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Page 25: The problem knows  no Boundaries

Denial of Child Abuse

• The abuser, noninvolved parent, and child may deny the abuse

• Each may deny– The event– Awareness of the event– The impact of the event– Responsibility for the event

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