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Nur 448
Persons at Risk for Abuse and Violence
Rape
Non-consensual vaginal, anal, or oral penetration Force, threat, underaged, impaired
CrimeForce, domination, and humiliationAny forced sexual activityRape statistics are trending down
2002 216,000 victims• 13 % males• 70 % known to individual
Rape theories
Intrapersonal Rapist powerlessness and high stress 5 types of rape
Stranger Acquaintance Spousal Statutory Confidence
Interpersonal Rapist preoccupied with control
Social Learning Intimidation and force to achieve goals Violence is expression of power
Feminist Result of socioeconomic traditions
Rape Trauma Syndrome
Factors contributing to victim’s response Age of victim History of prior victimization Relationship to perpetrator Precrisis coping skills Ability to use support resources
Response factors related to the rape Severity Duration Frequency Number of offenders Degree of violence
Rape Trauma Syndrome
Acute phase Up to two weeks Two types of responses
Expressed Crying, restless, confused, tense, laughing
Controlled Confusion, disorientation, calm, shocked
Somatic Reaction-Acute phase
Bruises, sorenessHeadaches, sleep disturbancesN,V, & DPoor appetiteVaginal itching, discharge, or pain
Emotional Reaction-Acute Phase
FearDenialAnxietyShockHumiliationSelf-blameAngerGuilt-shame
Long-term Re-organization phase of Rape Trauma Syndrome
Occurs two weeks or more post rape Intrusive thoughts Increased motor activity Increased emotional lability Fears and phobias
Nursing Intervention for Rape
Before assessment Inform of rights Do not disturb clothing
Assessment Physical-STDs, HIV- Pregnancy Photographs
Nursing Diagnosis Rape trauma syndrome
Outcome identification Control over remembering Decreased flashbacks and nightmares Affect tolerance Symptom mastery Reconnecting
Planning and implementation Support defense mechanisms Give time to respond to questions Communicate knowledge and understanding of
responses to rape Community resources Group therapy
Where is Rape treatment center in Miami?Where is Rape treatment center in small
town?
Intrafamily violence
Domestic violenceBatteringSibling abuseChild abuse
Physical Shaken baby Neglect
Partner abuse Heterosexual homosexual
Elder abuse Psychological abuse
Emotional abuseAbuse of pregnant women
Stalking Following, viewing, communication
Cycle of violence Conflict escalates to violent episode Beg for forgiveness Promises of reforrm Perpetrators—jealous, possessive Victims—anxious, fearful, depressed
Cycle of Violence
Phase 1- Perpetrator is hostile, criticalPhase 2- Abuse occurs-up to 24 hoursPhase 3- Honey moon phase-guilt, shame,
remorse, promises, caring behavior Direct victimization Indirect victimization
Child victim
Singled out child-difficult becomes victimSelf blame for family conflictFear of perpetratorCheating, lying, underachievementDepression, helplessness
Partner as victim
Blames selfLow self-esteemSense of helplessnessIsolation from family and friendsViews self as subseriventDependence on partner
Theories
Neurobiological Genetic Decreased serotonin Increased norepinephrine
Intrapersonal Violence associated with personality 80% of abusers raised in abusive environment
Social learning theory Violence is learned Opportunity to abuse Conscious choice
Feminist theory Cultural influence Domestic violence is gender issue
Trauma responses
HyperarousalHypervigilenceAnxietyEmotional constrictionNumbingLow self-esteemLow sense of securityDecreased trust
Symptoms of Child Abuse
AggressionOppositional behaviorClingingHuyperactiveNightmaresEneuresis or encoproesisSchool problemsRegressed behavior
Nursing intervention
Non-judgmental attitudeMultiprofessional approachAssure physical safetyImprovement of communicationIdentify family dynamicsParenting skillsSurvivor center approach
Intra-family violence-sexual abuse
Incest Child is often “special” child Not necessarily to have physical violence Father is primary Sibling Step-father Uncle
Symptoms of incest
Age inappropriate sexual behaviorExcessive masturbationEscalation of negative behaviorRisk taking behaviorSexual acting outSubstancePrecursor to morbid obesityPrecursor to Diffuse Identity Disorder
Intervention for victims
Women Safety plan first Hotline number Domestic violence shelter
Children Will be removed from home immediately
Reporting is mandated
Florida coalition afainst domestic violence24 hour hotline 800 500 1119Call 911