One of the most disturbing aspects of family violence or victimization is the horrifying legacy of violence. Physical and psychological trauma causes long-lasting and devastating damage to people’s lives, their children’s lives, and the lives of generations to come. Violence has moved from the home to schools, the workplace, neighborhoods, the road, and air travel; it touches every corner of community life. This chapter deals with child, partner, and elder abuse.

Sexual Assault Response Teams (SARTs) are available in the United States to help survivors of sexual violence cope with the present and aftermath of sexual violence. Sexual Assault Nurse Examiners (SANEs) are forensic nurses who have been certified to work with victims of sexual violence. Some other functions of the SANE are to perform a physical examination of the survivor, collect forensic evidence, provide expert testimony regarding forensic evidence collected, support the psychological needs of the survivor, and be part of the sexual assault response team (SART). Incest and sexual assault are frequently a component of other types of violence (neglect, emotional abuse, and battering).

Issues of family violence are complex and can be emotionally difficult for nurses. The following are guidelines for nursing interventions. All of these areas of family violence may need a great deal of support from community programs, shelters, attorneys, mental health agencies, law enforcement personnel, rape crisis advocates, and so on. In any case, the general nurse is responsible for knowing the laws in his or her state in terms of reporting child, partner, elder abuse and following through. Often the general nurse is the one that refers or contacts other agencies and reports to her treatment team in order to get needed support. Nurses (especially new nurses to this area) often need support from more experienced nurses to help with debriefing their feelings and gaining new perspectives. Working with victims of violence is difficult in the best situations. Caring for victims of abuse often brings up traumatic events in the nurse’s past that he or she has experienced or witnessed that have not been totally resolved.

Victims of abuse are often debilitated when their ability to cope is overwhelmed. Over the course of a lifetime few escape traumatic events. However, the victims of child, partner, and elder abuse often are left to deal with the devastating consequences by themselves.

The nurse is often the first point of contact for individuals experiencing family violence and is in the ideal position to contribute to prevention, detection, and effective intervention. All forms of interpersonal abuse can be devastating. Abuse can take the form of emotional, physical, and/or sexual abuse, as well as neglect. Emotional abuse kills the spirit and impairs the ability to succeed later in life, to feel deeply, or to make emotional contact with others. Physical abuse includes emotional abuse in addition to the potential for long-term physical deformity, internal damage, and acute painful tissue damage, bone damage, and, in some cases, death. The consequences of being sexually abused as a child are devastating and often never ending. Survivors of sexual abuse experience low self-esteem, self-hatred, affective instability, poor control of aggressive impulses, and disturbed interpersonal relationships compounded by an inability to trust and difficulty in protecting themselves. Sexual abuse occurs all too often in conjunction with partner abuse and elder abuse.

2. Child: Does the child appear well nourished, appropriately dressed, clean, and appropriately groomed?

3. Adult woman: Does she have a history of abuse as a child?

4. Adult man: Does he have a history of abuse as a child?

5. Elder: Is there a history of unexplained “accidents” or physical injuries?

6. Elder: Does the elder have a history of being abused as a child or abusing his or her children?

ALL:

2. Does the patient re-experience the abuse through flashbacks, dreams or nightmares, or intrusive thoughts?

3. Does the patient or other family member state that he or she has had suicidal or homicidal thoughts in the past?

• Repeated emergency room or hospital visits

• Vague complaints, including insomnia, abdominal pain, hyperventilation, headache, or menstrual problems

• Poorly explained bruises in various stages of healing

• Injuries (bruises, fractures, scrapes, lacerations) that do not seem to fit the description of the “accident”

• Frightened, withdrawn, depressed, and/or despondent appearance

The nurse uses a variety of therapeutic techniques to obtain the answers to the following questions. Use your discretion, and decide which questions are appropriate to complete your assessment.

2. “Who takes care of you?” (for children or dependent elder)

3. “What happens when you do something wrong?” (for children)

4. “How do you and your partner/caregiver resolve disagreements?” (for women and elders)

5. “What do you do for fun?”

6. “Who helps you with your children? Parent?”

7. “How much time do you have for yourself?”

2. “Do you feel safe in your current relationship?”

3. “Is there a partner from a previous relationship who is making you feel unsafe now?”

2. “How do you discipline your child?”

3. “When your infant cries for a long time, how do you get him or her to stop?”

4. “What about your child’s behavior bothers you the most?”

During your assessment and counseling, maintain an interested and empathetic manner. Refrain from displaying horror, anger, shock, or disapproval of the perpetrator or the situation. Assess for:

3. Physical, sexual, and/or emotional abuse and neglect and economic maltreatment in the case of elders

4. Family coping patterns

5. Patient’s support system

6. Drug or alcohol use

7. Suicidal or homicidal ideas

8. Posttrauma syndrome

9. If the patient is a child or an elder, identify the protection agency in your state that will need to be notified.

Violence brings with it pain, psychological and physical injury and anguish, the potential for disfigurement, and the potential for death. Therefore, Risk for Injury is a major concern for nurses and other members of the health care team.

Within all families in which violence occurs, severe communication problems are evident. Coping skills are not adequate to handle the emotional and environmental events that trigger the crisis situation. Inadequate coping skills among family members result in family members not having their needs met, including the need for safety, security, and sense of self. Therefore, there exists Ineffective Role Performance within the family.

There are many other nursing diagnoses the nurse can use in caring for children and adults who are suffering from abuse at the hands of others. Some include Anxiety, Fear, Disabled Family Coping, Posttrauma Syndrome, Powerlessness, Caregiver Role Strain, Disturbed Body Image, Chronic Low Self-Esteem, Impaired Parenting, and Acute/Chronic Pain.

This chapter discusses Risk for Injury for the child, adult, and elder and Ineffective Role Performance geared toward the abuser.

2. Reassure the patient that he or she did nothing wrong.

3. Allow the patient to tell his or her story without interruptions.

4. If the patient is an adult, assure him or her of confidentiality, and that any changes are his or hers to make.

5. If the patient is a child, report abuse to appropriate authorities designated in your state.

6. If the patient is an elder, check with state laws for reporting information.