Chapter 9
Violence and Abuse
Prof. F. Jones
Intimate Partner Violence #1
Actual or threatened physical or sexual violence, or
psychological/emotional abuse
o It includes threatened physical or sexual
violence when the threat is used to control a
person’s actions
o Other descriptive terms:
 Domestic abuse, domestic violence
 Gender-based violence, spouse abuse
 Battering, rape
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Intimate Partner Violence #2
Characteristics
o Use and abuse of substances
o Negative affect
o History of childhood abuse (refer to EvidenceBased Practice 9.2)
o Characteristics of perpetrator’s partner
o Traditional gender role expectations
Generation-to-generation continuum of violence
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Risk Factors for Committing Intimate
Partner Violence
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Question #1
Is the following statement true or false?
The tendency for violence is inherited.
a. True
b. False
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Answer to Question #1
b. False
Violence is a learned behavior that, without
intervention, is self-perpetuating.
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Cycle of Violence
Phase 1: Tension-building
Phase 2: Acute battering
Phase 3: Honeymoon
The cycle increases in intensity over time
Refer to Box 9.1
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Types of Abuse
Emotional abuse
Physical abuse
Financial abuse
Sexual abuse
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Abuse Profiles
Victims
o Rarely describe selves as abused; battered
woman syndrome
o May feel they have a personality flaw or
inadequacy
o Many abused as children
Abuser
o Feelings of insecurity, powerlessness, and
helplessness
o Refusal to share power; violence to control
victim
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Question #2
Is the following statement true or false?
Most women experiencing intimate partner violence
do not describe themselves as being abused.
a. True
b. False
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Answer to Question #2
a. True
Victims of abuse rarely describe themselves as
abused.
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Violence Against Pregnant Women
Time of escalating violence in already troubled
relationship
Factors leading to battering during pregnancy
Threats to maternal and fetal well-being
Signs of abuse emerging during pregnancy
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Violence Against Older Women
Physical abuse
Neglect
Emotional abuse
Sexual abuse
Financial/exploitation abuse
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Types of Sexual Violence
Intimate partner violence
Human trafficking
Incest
Female genital cutting
Prostitution, bondage
Exploitation, neglect
Infanticide
Sexual assault
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Types of Rape
Rape: penetration of the vagina or anus with any
body part or object, or oral penetration by a sex
organ of another person without the consent of the
victim
Acquaintance rape: forced sex by a person the
victim knows
Date rape: assault occurs within a dating or
marriage situation (refer to Teaching Guidelines 9.2)
Statutory rape: sexual activity between an adult and
person under 18 years
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Incidence of Rape/Violence in the United
States
Nearly three in 10 women and one in 10 men have
experienced rape, physical violence, or stalking by a
partner
Violence against women is a growing problem
40% to 60% of murders in North America are
committed by intimate partners
In the United States, one woman is being battered
every 12 seconds
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Rape #1
Expression of violence; legal term
Myths and facts (see Table 9.2)
Acquaintance rape (includes date rape)
o Date rape drugs
o Risk reduction (see Teaching Guidelines 9.2)
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Four Phases of Rape Recovery
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Rape #2
Nursing management
o Early intervention and immediate counseling
o Supportive care
o Evidence collection and documentation
o STI assessment
o Pregnancy prevention
o PTSD assessment
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Question #3
Which of the following would the nurse identify as
indicative of hyperarousal associated with PTSD?
a. Reports of being emotionally numb
b. Complaints of difficulty sleeping
c. Difficulty recalling exactly what happened
d. Reports of recurring nightmares
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Answer to Question #3
b. Complaints of difficulty sleeping
Difficulty sleeping would indicate hyperarousal.
Emotional numbing and trouble recalling the events
reflect avoidance. Nightmares indicate intrusion.
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Female Genital Cutting
Female circumcision
Reflects the ideology and cultural values of the
community that practices it
Types (see Box 9.5)
Health risks
Nursing management
o Self-awareness of feelings related to practice
o Impact on women’s reproductive health
o Education
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Human Trafficking
Global and domestic problem
Victims primarily women and children lacking
education, employment, and economic opportunities
in own country
Exposure of victims to serious and numerous health
risks
Implications for nurses
o Recognition of cues (see Box 9.6)
o Violation of human rights; notification of law
enforcement and regional social service
organization
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Nursing Management of Abused Victims
#1
Assessment: routine screening for indicators of
abuse
o Screening during every health care visit (see
Box 9.2 and Evidence-Based Practice 9.1)
o Immediate isolation from family if abuse
detected
o Direct and indirect questions about abuse
o Immediate safety assessment
o Documentation and reporting of findings (see
Figure 9.2 and Boxes 9.3 and 9.4)
Nursing diagnosis
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SAVE Model
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Nursing Management of Abused Victims
#2
Interventions: goal to enable victim to gain control
of life
o Primary prevention: breaking the abuse cycle
through community initiatives
o Secondary prevention: dealing with victims and
abusers in early stages to prevent progression of
abuse
o Tertiary prevention: helping severely abused
women and children recover and become
productive members of society and rehabilitating
abusers to stop the cycle of violence
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Nursing Management of Abused Victims
#3
Interventions (cont.)
o Educate the woman about community services
o Provide emotional support
o Offer a safety plan (see Teaching Guidelines 9.1
and Box 9.5)
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Question #4
Which of the following would best describe the
primary focus of nursing interventions for a woman
who is a victim of intimate partner violence?
a. Providing reassurance
b. Educating the woman about resources available
c. Documenting assessment findings
d. Assisting the woman to gain control of her life
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Answer to Question #4
d. Assisting the woman to gain control of her life
Although all the interventions listed are important,
the primary goal of nursing interventions is to
enable the victim to gain control of her life by
providing sensitive, predictable care in an accepting
setting.
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The ABCDES of Caring for Abused Women
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