Abuse and Violence

Violence and other forms of abuse are most commonly understood as a

pattern of behaviour intended to establish and maintain control over family,
household members, intimate partners, colleagues, individuals or groups. While
violent offenders are most often known to their victims (intimate or estranged
partners and spouses, family members, relatives, peers, colleagues, etc.), acts of
violence and abuse may also be committed by strangers.
Child Abuse
Child abuse or maltreatment generally is defined as intentional injury of a
child.
Types of Child Abuse
Physical abuse
Physical abuse of children often results from unreasonably severe corporal
punishment or unjustifiable punishment such as hitting, burning, cutting, poking,
twisting limbs, or scalding with hot water.
Sexual abuse
Involves sexual acts performed by an adult on child younger than 18 years.
Example include incest, rape, and sodomy performed directly by the person or with
an object, oral-genital contact, and acts to molestation such a rubbing, fondling, or
exposing the adults genitals.
Psychological abuse
Includes verbal assaults, such as blaming, screaming, name-calling, and
using sarcasm: constant family discord characterized by fighting, yelling, and chaos.

Signs of physical abuse

Burns
Bruises
Severe skull fracture

Signs of sexual abuse

May have urinary tract infections
Bruises
Red or swollen genitalia
Tears of the rectum or vagina

Treatment and Intervention

The first part of treatment for child abuse is to ensure the childs safety and well-
being.

Elder Abuse
Is the maltreatment of older adults by family members or caregivers. It may
include physical and sexual abuse, psychological abuse, neglect, self-neglect,
financial exploitation and denial of adequate medical treatment.
Most victims of elder abuse are 75 years or older.
Signs of physical neglect includes:

Pervasive smell of urine or feces

Dirt
Rashes
Sores

Possible indicators of emotional or psychological abuse includes:

an elderly who is hesitant to talk openly to the nurse
fearful
withdrawn
depressed and
helpless

Possible indicators of self- neglect includes:

inability to manage money

inability to perform activity (personal care, shopping, food preparation and
cleaning).
changes in intellectual function (confusion, disorientation, inappropriate
responses, and memory loss and isolation).
Intervention

If you suspect that one of your patients is a victim of elder abuse, determine
if the patient is in imminent danger, can talk openly about suspected abuse
without fear of retribution, is cognitively able to make decisions about his or
her own care, or is likely to be abused again.
Identify any issues of safety and vulnerability such as consequences patients
face when they disagree with caregivers, episodes of uninvited physical
contact or being forced to do things they don't want to do, signing
documents without understanding what they are, and having possessions
taken without permission.
Assure privacy and confidentiality for both the patient and caregivers by
interviewing them separately, and interview and examine the patient first.
Rape and Sexual Assault
Rape is a crime of violence and humiliation of the victim expressed through
sexual means. Rape is the perpetration of an act of sexual intercourse with a
female against her will and without her consent, whether her will is overcome by
force, fear of force, drugs or intoxicants.
Rape most commonly occurs in a womans neighborhood, often inside or near
her home.
Male rape is significantly underreported crime. It can occur between gay partners
or strangers but is most prevalent in institutions such as prisons or maximum-
security hospitals.
Recent research has categorized male rapists into 4 categories:

Sexual sadists who are aroused by the pain of their victims.

Exploitive predators who impulsively use their victims as objects for
gratification.
Inadequate men who believe that no woman would voluntarily have sexual
relations with them and who are obsessed with fantasies about sex.
Men for whom rape is displaced expression of anger and rage.

Nursing Intervention

Establish trust and rapport.

Provide strict confidentiality.
Never use judgmental language.
Have someone stay with the client (friend, neighbor, or staff member) while
he or she waiting to be treated.
Encourage verbalization.
Approach the client in a nonjudgmental manner.