HC3: Mental Health- 4/16
VIOLENCE: DOMESTIC, SEXUAL, WORKPLACE
• Varcarolis:
o Chapter 21 pg. 352-365
o Chapter 22 pg. 366-376-365
o Chapter 24 pg. 388-401
• Highlights/Random
o Brain Dump w/ group
o Discussion
o Groups & Case Study- “Rural 16 yo female pt”
CHILD, PARTNER, ELDER ABUSE
• Child, Partner, and Elder Violence
o Family violence is prevalent among all social strata: ethnic, religious, age, and social and socioeconomic groups.
o Besides family abuse, trusted authority figures are part of the picture of violence in our society.
o Four Abuse Categories:
▪ Emotional (i.e., name calling, excessive criticism)
▪ Physical (i.e., kicking, hitting, choking, burning)
▪ Sexual (i.e., vaginal or anal rape, oral or manual touching)
▪ Neglect (i.e., inconsistent provision of basic needs)
• Indicators of Potential Family Violence:
o Recurrent emergency department (ED) visits for injuries attributed to being “accident prone”
o Presenting problems reflecting signs of high anxiety and chronic stress:
▪ Hyperventilation
▪ Panic attacks
▪ GI disturbances
▪ HTN
▪ Physical injuries
▪ Depression
▪ Insomnia
▪ Violent nightmares
▪ Anxiety
▪ Extreme fatigue
o There are various theories of how violent behaviors develop:
▪ Social Learning Theory:
♦ Learned violent behavior (intergenerational violence theory)—becomes the norm in
environment
♦ A child who witnesses abuse or is abused in the family learns that violence is an acceptable
reaction to stress
▪ Societal/Cultural Factors:
♦ Poverty
♦ inadequate resources
♦ Overcrowding
♦ social isolation of families
♦ Unemployment
♦ Substance abuse
♦ Early Parenthood
♦ Inadequate coping skills
♦ Family member with a chronic health condition
▪ Frustration-Aggression Hypothesis:
, ♦ Increased frustration r/t societal situations which leads to increased violence
▪ Patriarchal theory:
♦ Male dominance in political/economic structures enforce dominance
♦ Women are viewed as the property of men, are subservient, and are kept relatively powerless,
in part through violence
• CHILD ABUSE
o When a child is harmed by someone else
o Most states recognize four different types of abuse:
▪ Physical abuse
♦ 80% less than 4 years—majority were 1 yr or younger
♦ Parents usually perpetrators, but can be siblings
▪ Neglect (59% of all cases)
▪ Sexual abuse
♦ 1 in 4 girls; 1 in 6 boys
▪ Emotional or psychologic abuse
o Children younger than 4 years are most vulnerable
o Child Abuse and Prevention Act (CAPA) is defined by any recent act or failure to act on the part of the parent or
caregiver that results in death, serious physical harm, sexual abuse, or exploitation, or any act or failure to act that
presents an immediate risk of serious harm. Each state is responsible for its own definition of child abuse, but those
definitions must at least meet the minimum standards of CAPA.
▪ Spanking is acceptable, but not in the form of corporal punishment or leaving marks of any kind.
o The ED is usually where the first contact is made with the abused child and family. Each state mandates that
suspected abuse or neglect must be reported. Nurses are legally responsible for reporting child abuse to the
appropriate child protective agency. Social workers, medical and mental health professionals, teachers, and
childcare providers are also legally responsible.
o Signs of Abuse:
, o Assessment:
▪ Reassure children that they did not do anything wrong.
▪ Children should not feel pressured to talk.
▪ Experience should be nonthreatening and supportive.
▪ Interview should not resemble trial or inquisition.
▪ Children may express experiences through playing out the incident with dolls or drawings.
▪ Do not suggest answers.
▪ Do not promise that everything is confidential (abuse must be reported).
▪ Do not react with shock to anything; do not force a child to undress or be examined.
o Do’s & Don’ts:
▪ Do’s:
♦ Private interview
♦ Be direct/honest/professional
♦ Be attentive/understanding
♦ Inform that you must report to Child Protective Services and what that entails
o Open ended questions are best for both children & caregivers.
VIOLENCE: DOMESTIC, SEXUAL, WORKPLACE
• Varcarolis:
o Chapter 21 pg. 352-365
o Chapter 22 pg. 366-376-365
o Chapter 24 pg. 388-401
• Highlights/Random
o Brain Dump w/ group
o Discussion
o Groups & Case Study- “Rural 16 yo female pt”
CHILD, PARTNER, ELDER ABUSE
• Child, Partner, and Elder Violence
o Family violence is prevalent among all social strata: ethnic, religious, age, and social and socioeconomic groups.
o Besides family abuse, trusted authority figures are part of the picture of violence in our society.
o Four Abuse Categories:
▪ Emotional (i.e., name calling, excessive criticism)
▪ Physical (i.e., kicking, hitting, choking, burning)
▪ Sexual (i.e., vaginal or anal rape, oral or manual touching)
▪ Neglect (i.e., inconsistent provision of basic needs)
• Indicators of Potential Family Violence:
o Recurrent emergency department (ED) visits for injuries attributed to being “accident prone”
o Presenting problems reflecting signs of high anxiety and chronic stress:
▪ Hyperventilation
▪ Panic attacks
▪ GI disturbances
▪ HTN
▪ Physical injuries
▪ Depression
▪ Insomnia
▪ Violent nightmares
▪ Anxiety
▪ Extreme fatigue
o There are various theories of how violent behaviors develop:
▪ Social Learning Theory:
♦ Learned violent behavior (intergenerational violence theory)—becomes the norm in
environment
♦ A child who witnesses abuse or is abused in the family learns that violence is an acceptable
reaction to stress
▪ Societal/Cultural Factors:
♦ Poverty
♦ inadequate resources
♦ Overcrowding
♦ social isolation of families
♦ Unemployment
♦ Substance abuse
♦ Early Parenthood
♦ Inadequate coping skills
♦ Family member with a chronic health condition
▪ Frustration-Aggression Hypothesis:
, ♦ Increased frustration r/t societal situations which leads to increased violence
▪ Patriarchal theory:
♦ Male dominance in political/economic structures enforce dominance
♦ Women are viewed as the property of men, are subservient, and are kept relatively powerless,
in part through violence
• CHILD ABUSE
o When a child is harmed by someone else
o Most states recognize four different types of abuse:
▪ Physical abuse
♦ 80% less than 4 years—majority were 1 yr or younger
♦ Parents usually perpetrators, but can be siblings
▪ Neglect (59% of all cases)
▪ Sexual abuse
♦ 1 in 4 girls; 1 in 6 boys
▪ Emotional or psychologic abuse
o Children younger than 4 years are most vulnerable
o Child Abuse and Prevention Act (CAPA) is defined by any recent act or failure to act on the part of the parent or
caregiver that results in death, serious physical harm, sexual abuse, or exploitation, or any act or failure to act that
presents an immediate risk of serious harm. Each state is responsible for its own definition of child abuse, but those
definitions must at least meet the minimum standards of CAPA.
▪ Spanking is acceptable, but not in the form of corporal punishment or leaving marks of any kind.
o The ED is usually where the first contact is made with the abused child and family. Each state mandates that
suspected abuse or neglect must be reported. Nurses are legally responsible for reporting child abuse to the
appropriate child protective agency. Social workers, medical and mental health professionals, teachers, and
childcare providers are also legally responsible.
o Signs of Abuse:
, o Assessment:
▪ Reassure children that they did not do anything wrong.
▪ Children should not feel pressured to talk.
▪ Experience should be nonthreatening and supportive.
▪ Interview should not resemble trial or inquisition.
▪ Children may express experiences through playing out the incident with dolls or drawings.
▪ Do not suggest answers.
▪ Do not promise that everything is confidential (abuse must be reported).
▪ Do not react with shock to anything; do not force a child to undress or be examined.
o Do’s & Don’ts:
▪ Do’s:
♦ Private interview
♦ Be direct/honest/professional
♦ Be attentive/understanding
♦ Inform that you must report to Child Protective Services and what that entails
o Open ended questions are best for both children & caregivers.
