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Elder Abuse and Domestic Violence actual class notes.docx

11 Pages

Course Code
NURS 1030
Heather Helpard

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Elder Abuse and Domestic Violence Definition of Domestic Violence The use of physical, sexual, economic, and/or emotional abuse by one person in an intimate relationship in order to establish and maintain power and control over the other person Incidence of Domestic Violence in Canada - An estimated 653,000 women and 546,000 men encounter some form of violence. - 7% of Women and 6% of Men End Up Abused by their Current or Former Partners. (More Severe for Women) - Highest Among People 15-24, People in Relationships of Less Than 3 Years, People Who Were Separated and Common Law Unions. THE VICTIMS - Domestic violence happens between people who are dating, married, separated, and divorced. - It occurs in heterosexual as well as in homosexual relationships and in adolescent dating relationships. Who Are the VICTIMS? Victims cross all socio-economic, religious, racial, ethnic, age groups!! DYNAMICS OF DOMESTIC VIOLENCE Power and Control DOMESTIC VIOLENCE and the Emergency Department -30% of all female trauma patients -22-35% of all females presenting to the Emergency Department (most are repeat) -20% 11 or more abuse related visits -23% 6-10 abuse related visits DOMESTIC VIOLENCE SEQUELAE (is COSTLY!!) In the 12 month period following violence: - Victims use health care services twice as often as non-victims - Healthcare costs were 2.5 times higher for victims - Victimization was the single best predictor of total yearly physician visits and of outpatient health care costs Why is Elder Abuse a Concern? 1. The Projected Increase in the Aging Population 2. The Increase in Chronic Disabling Diseases (increased caregiver stress) 3. The Increase Involvement of Families in Care giving Relationships with Seniors Incidence of Elder Abuse in Canada -4% of Elderly Canadians Reported Being Abused in Surveys in the 1990s -Financial Abuse is the Most Common Form of Elder Abuse in Canada (Exam question) Most difficult to assess -Psychological Abuse: Over 34,000 reported -Physical Abuse: Over 12,000 cases reported -18,000 Reported More Than One Type of Abuse Profile of Elderly Victims of Abuse **Tip- chances increase for anything that may increase caregiver stress 1. Gender (older women more likely, although some say it is equal) 2. Marital Status (married more likely) 3. Poor Health (especially with physical and mental impairments) 4. Substance Abuse/Disruptive Behaviour (increased abuse with drugs for victim and caregiver). 5. Psychological Factors/Cognitive Impairment (especially AZ/ Dementia, increased caregiver stress) 6. Social Isolation/Living Arrangements (withdrawn and if there is no space/privacy/ seen as an inconvenience) 7. Dependency/ History of Abuse in Family (chances of abuse increase if they are fully dependent) THE DYNAMICS OF ABUSE AND TYPES OF ABUSE -A pattern of assaultive and coercive behavior 1. Physical 2. Sexual 3. Psychological (more damaging than physical) a. threats b. intimidation c. emotional abuse d. isolation 4. Economic 5. Neglect 1. Passive Neglect- not intentional, usually the result of not having the education/support 2. Active Neglect- intentional, they know better 3. Self Neglect- the person engages in things they know are harmful (e.g. alcohol) Signs of abuse: 1. Abuser answers for the victim 2. Abuser has an intimidating stance 3. Victim is quiet and withdrawn 4. The abuser does not want to leave the room Who are the ABUSERS? They cross all socio-economic, religious, racial, ethnic, age groups. It is a learned behaviour. Characteristics of Batterers 1. Sense of Entitlement – very ‘me’ focused, their needs come first 2. Controlling – with dialogue, wont leave the room 3. Manipulative – lie to get what they want 4. Frequently Charming – seem likeable 5. Uninvolved parent 6. Show contempt for others – critical of others What Makes Batterers So Powerful? 1. Isolation of victim- no one around to help 2. Societal Denial- especially when the abuser/victim is in prestigious positions or high SES 3. Use of Religious Issues – use it as a rationale for things 4. Use of Cultural Issues –“ this is how we do it in our culture” 5. Threats of Retaliation –“ if you tell, it will be worse for you!” Profile of the Elder Abuser (catalysts for abuse) 1. Substance Abuse 2. Mental/Emotional Illness 3. Senile Dementia 4. Lack of Care giving Experience 5. Stress and Burden/Multigenerational Demands 6. Personality 7. Lack of Social Support/Finances DOMESTIC VIOLENCE and ELDER ABUSE Barriers to Detection (for HCPs) 1) Lack of knowledge – Don’t know a lot about abuse, what to look for or resources to help 2) Lack of Confidence in Intervention- what do you do after you find out? Unsure 3) Lack of time- Only have 10 minutes to make an assessment, find out they are abused, then what? FAILURE TO DIAGNOSE DOMESTIC VIOLENCE AND ELDER ABUSE 1. Inappropriate treatment – Come in for a bruise, miss it and then have repeat visits 2. Increase victim’s sense of helplessness and entrapment- they are hoping someone will see and help 3. Lost opportunity to refer to appropriate community resources – could get people help 4. Increase danger to the patient – they are in harms way again/could be worse Opening Pandora’s Box: Why Health Care Providers do not ask clients. Great exam question! 1. Not enough time -71% 2. Fear of offending the patient-55% 3. Powerlessness to intervene -50% 4. No control over patient behavior 42% 5. Too close for comfort -39% Conducting the Client Interview 1. If Possible, Conduct the Interview Privately 2. Documentation is Accurate, Detailed and Objective 3. Simple and Direct Questions 4. Be Nonthreatening and Nonjudgmental 5. Actively Listen to the Client 6. History of Illness and Injury Assessment of Suspected Physical Abuse 1. Document Size, Shape and Appearance of Bruises, Lacerations and Injuries in Unusual Locations 2. Look for Pattern Injuries – like cigarette burns/fingers 3. Look for Parallel Injuries – same injury on both sides of the body, hairline fractures 4. Look for Burns 5. Consult with Other Health Care Professionals Assessment of Suspected Psychological Abuse 1. Document the Witnessing of Threats, Insults or Humiliation by the Potential Abuser 2. Domineering, Indifferent or Angry Attitudes of the Caregiver 3. Client Seems Withdrawn, Demoralized or Fearful Assessment of Suspected Financial Abuse 1. Observation That the Client May Not Have Enough Food or Necessities 2. Inability for the Client to Access Money 3. Domineering Caregiver Assessment of Suspected Neglect -Range from Observations That There is an Omission of Behaviours to Meet: 1. Basic Nutritional and Hygenic Needs, 2. Financial Responsibilities, 3. Emotional Needs, 4. Accessibility to Services What Do I Do If the Client Says Yes or There is a Strong Suspicion of Abuse? ACKNOWLEDGE - You Have Heard What the Patient Said 1. Use supportive statements: “You don’t deserve this” & “NO ONE DESERVES TO BE HURT LIKE THAT” 2. Affirm autonomy and right to control decision-making. Possible Nursing Interventions 1. Refuses Treatment: 1. Remain Nonjudgmental; 2. Educate About Services and the Severity of Abuse Increasing Over Time; 3. Provide Emergency Contact Numbers; 4. Document 2. Accepts Treatment: 1. Educate About the Aspects of Change; 2. Discuss Safety Options; 3. Refer to Appropriate Professionals/Services; 4. Listen to Client’s Feelings Examples of Abuse in an Institution 1. Failure to Provide a Clean Environment 2. Failure to Provide Nutritious Food/Hygiene 3. Failure to Provide Sufficient Space for Bathroom Privacy 4. Verbal Abuse and Unequal Treatment 5. Excessive Use of
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