ABUSE

 wrongful use and maltreatment of another person

 most abuse is precipitated by someone known to

the victim it can be spouse, or partner, child and

elderly or parent

 A.Child Abuse
 B.Elderly Abuse
 C.Rape and Sexual Assault

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 A. Child Abuse or Maltreatment
 Generally defined as the intentional injuring of
a child; can be physical abuse, neglect or
failure to prevent harm, failure to provide
adequate physical or emotional care,
abandonment, sexual assault and overt
torture or maiming

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TYPES OF CHILD ABUSE
1. Physical Abuse

2. Sexual Abuse

3. Neglect

4. Psychological/ Emotional Abuse

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Types Of Child Abuse

 Physical Abuse of children

-often the result of unreasonably
severe corporal punishment and the
victim often has evidence of old
injuries that were not treated

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Sexual Abuse involves a
sexual act performed by an
adult on a child <18 years of
age

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Neglect is a malicious or
ignorant withholding of
physical, emotional, educational
necessities for the child’s well-
being.

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 Psychological or Emotional Abuse
 Verbal assault such as blaming, screaming,
name-calling, and using sarcasm
 Constant family discord - fighting, yelling and
chaos
 Emotional deprivation or withholding of
affection

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 Spouse Or Partner Abuse
- mistreatment or misuse of one person
by another in the context of an intimate
relationship

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Types of Spouse or Partner Abuse:
 Emotional/psychological abuse - includes

name-calling, belittling, yelling, screaming,

making threats
 Physical abuse - ranges from shoving and

pushing to severe battering and choking

 Sexual abuse-assaults during sexual relation

such as biting nipples, pulling hair, slapping,

hitting
 Dependency - trait commonly found in

abused wives

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 Cycle Of Abuse And Violence

Violent Behaviors

Tension Building

Period of
Remorse or Contrition

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 Assessment
 nurses must be able to help identify

abused women
 some victims may be seeking

treatment for other medical condition

not directly related to the abuse

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Treatment And Intervention:
 A woman who is a victim can obtain

restraining order (legally prohibits the abuser

from approaching or contacting her)
 shelters for battered wife, temporary housing,

food and their children are provided

 counseling group therapy-helps abused

women deal with trauma in their life

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B. ELDER ABUSE
 the maltreatment of older adults by family

member or caretaker
 victims are 75 years old and above

 abuser can be a wife or husband or adult

child, usually a son

 may be physical/sexual abuse, psychological,

abuse neglect, financial exploitation and

denial of adequate medical treatment

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 Assessment
 - careful assessment of elderly person and
their care giving relationship

Indicators Of Elder Abuse:

 Physical abuse indicators- unexplained injuries,
reluctant to seek medical help, fear in the presence of
caregiver
 Psychological or emotional abuse indicators-
helplessness hesitance to talk openly, anger
 Financial abuse indicators- unusual or inappropriate
activity in bank, etc.
 Neglect indicators-dirt, fecal, urine smell, rashes,
sores, etc.
 Indicators of self-neglect- inability to manage personal
finances, inability to manage activity
 Warning indicators from caregiver- elder is not given
opportunity to speak for self, defensiveness
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Nursing Diagnosis
 Self-concept

 Body image

 Self-ideal

 Self-esteem

 Role performance

 Personal identity/healthy personality

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 Planning/Implementation
 promote client’s safety
 help client cope with stress and emotions
 help promote client self-esteem

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 Evaluation
 Gradual progress in being able to keep self
safe
 Learn to manage stress and emotions
 Able to function in daily life

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C. RAPE AND SEXUAL ASSAULT
 Rape - a crime of violence and humiliation of

the victim expressed through sexual means

- perpetration of an act of sexual intercourse

with a female against her will

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4 Categories Of Male Rapist:

1. Sexual sadist who is aroused by the pain of

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

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Treatment/Intervention
 refer the victim to rape treatment agency

 prophylactic treatment for STD

 refer to rape crisis therapy

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PSYCHIATRIC DISORDERS RELATED TO
ABUSE AND VIOLENCE

A. Post traumatic stress disorder

B. Dissociative disorder

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Post Traumatic Stress Disorder

 a disturbing pattern of behavior

demonstrated by someone who has
experienced a traumatic event

 the symptoms occur 3 months or more

after the trauma

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 3 cluster of symptoms:
 reliving the symptom
 avoiding reminder of the event
 being on guard or hyperarousal

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Dissociative Disorder
 Dissociation - a subconscious defense
mechanism that helps a person protect
his or her emotional self from
recognizing the full effects of some
horrific or traumatic event by allowing
the mind to forget or remove itself from
painful situation or memory

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Dissociative Disorder
 Have the essential feature of a disruption in

the usually integrated function of

consciousness, memory, identity, or
environmental perception
 -Interferes with the person’s relationships,

ability to function in daily life, ability to cope

with the realities of the abusive or traumatic
event
 It may be sudden or gradual, transient or

chronic
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Types Of Dissociative Disorder:
1. Dissociative amnesia
 Client cannot remember important

personal information usually of

traumatic or stressful nature

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2. Dissociative fugue
 Client has episodes of suddenly leaving

the home or place of work without any

explanation, traveling to another city,
being unable to remember his/her past
or identity
 Client may assume new identity.

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3. Dissociative Identity Disorder
(Multiple Personality Disorder)
 Client displays 2 or more distinct identities or

personality states that recurrently take control

of his behavior.
 Client has inability to recall important personal

information

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4. Depersonalization Disorder
 Client has persistent or recurrent feeling of

being detached from his mental processes or

body
 Intact reality testing -- client is not psychotic

or out of touch with reality

 Common in patient with childhood physical

and sexual abuse (repressed memories)

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5. False Memory Syndrome
 Remembering abuse that really did not

happen

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Treatment
 medication- Zoloft/ Paroxetine

 group therapy/ individual therapy

 cognitive behavioral therapy- dealing with

thoughts

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Assessment
 History-history of trauma
 Gen. appearance/motor behavior- client appear alert
and react even to small environmental noise with
startle response
 Mood/affect- client may look frightened or scared
 Thought process and content - due to trauma, it
interferes with client’s ability to think
 sensorium and intellectual process - client is unable to
talk or communicate, with memory gap
 Judgment/insight -making decision and solving
problem is impaired
 Self-concept - usually client has low self-esteem, view
self as hopeless, helpless, worthless
 Role and relationship

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Nursing Diagnosis
 Risk for self mutilation

 Ineffective coping

 Post-trauma response

 Chronic low self-esteem

 Powerlessness

 Disturbed sleep pattern

 Social isolation

 Sexual dysfunction

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Outcome Identification
 Client will be physically safe

 Client distinguishes ideas of self-harm and

taking action on those ideas
 Client will demonstrate healthy effective way
of dealing with stress
 Client will express emotions nondistinctively

 Client will establish a social support system in

the community
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Intervention
 Promoting client safety
 Helping the client cope with stress and
emotion
 *Guiding technique - remind the client that he

or she is in the present, as an adult, and is

safe
 Helping to promote the client’s self-esteem
 Establishing social support

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Evaluation
 Gradual progress in protecting themselves
 Learning to manage stress and emotion
 Being able to function in their daily life
 Learn to manage their feeling and response

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 thank you!

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