11 ABUSE ANDVIOLENCE 233
➤ KEY POINTS
- The U.S. Department of Health and Human
Services has identified violence and abusive
behavior as national health concerns. - Women and children are the most likely
victims of abuse and violence. - Characteristics of violent families include an
intergenerational transmission process,
social isolation, power and control, and the
use of alcohol and other drugs. - Spousal abuse can be emotional, physical,
sexual, or all three. - Women have difficulty leaving abusive rela-
tionships because of financial and emotional
dependence on the abuser and the risk of
suffering increased violence or death.- Nurses in various settings can uncover
abuse by asking women about their safety
in relationships. Many hospitals and clinics
now ask women about safety issues as an
integral part of the intake interview or
health history. - Rape is a crime of violence and humiliation
through sexual means. Half of reported
cases are perpetrated by someone known to
the victim. - Child abuse includes neglect and physical,
emotional, and sexual abuse. It affects
3 million children in the United States. - Elder abuse may include physical and
sexual abuse, psychological abuse, neglect,
exploitation, and medical abuse. - Survivors of abuse and trauma often
experience guilt and shame, low self-
esteem, substance abuse, depression, post-
traumatic stress disorder, and dissociative
disorders. - Posttraumatic stress disorder is a response
to a traumatic event. It can include flash-
backs, nightmares, insomnia, mistrust,
avoidance behaviors, and intense
psychological distress. - Dissociation is a defense mechanism that
protects the emotional self from the full
reality of abusive or traumatic events during
and after those events.
I NTERNET R ESOURCES
Resource Internet Address
◗Community support groups http://www.clinicaltrials.com
◗National Center on Child Abuse http://www.acf.dhhs.gov/programs/cb
◗Centers for Disease Control http://www.cdc.gov
◗American Medical Association http://www.ama.org
◗Agency on Aging http://www.aoa.dhhs.gov
◗Commission on Domestic Violence http://www.abanet.org/domviol
◗Trauma Anonymous (PTSD support group) http://www.bein.com/trauma/index.html*All of the Websites have multiple links to other sites on the topic.Critical Thinking Questions
1.Is spanking a child an acceptable form of dis-
cipline, or is it abusive? What determines the
appropriateness of discipline? Who should
make these decisions, and why?
2.How can the nurse continue to have a positive
relationship with the client who returns to an
abusive relationship? What should the nurse
say to the client who has decided to return to
an abusive relationship?
3.A client has just told the nurse that in the
past he has lost his temper and has beaten his
child. How should the nurse respond? What
factors would affect the nurse’s response?