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Lecture 9

NURS 3524- Mental Health wk 10.docx


Department
Nursing
Course Code
NURS 3524
Professor
Mavoy Bertram
Lecture
9

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NURS 3524 Mental Health wk 10
NURS 3524 Mental Health Health & Healing: Client Centred Care of Individuals
and Families in Child and Mental Health Settings
Week 4
Course Director: Dora Antwi RN BScN MScN
Class Objectives
Analyze and discuss the nursing implications of abuse and interpersonal violence across
the lifespan
Analyze and discuss the nursing implications of patient safety
Analyze and discuss the nursing implications of trauma informed care
IMPORTANT!!
Abuse, trauma and violence affect a large number of people of all ages and in all socio-
economic spheres
Many of you will have personal knowledge and experience of abuse, trauma, and
violence
Self awareness is a key aspect of practising effectively as a nurse
Self Care essential
Please utilize student health services as needed
History of Child Maltreatment
Children have been in some cultures “sacrificed to the gods”
ill children have been deemed possessed
“Rights” of the child non-existent
“Discipline” seen as “beating sense into” rather than “teaching”
Child labour laws are very recent
Early marriage of girls acceptable in case of pregnancy
Child Abuse
Also known as child maltreatment
Refers to harm or threats of harm in which a child or youth may experience when in the
care of a person they trust and/or depend on, a family member, parent, sibling, teacher,
caregiver or guardian
Harm may occur with direct action by the person or through the person’s act of neglect to
provide the care necessary for healthy child growth and development
Child Abuse
Violence against children encompasses sexual abuse, emotional abuse, physical abuse
and neglect
exposure of children to family violence was considered to be a form of emotional harm
Legislation on child maltreatment now defines family violence as a form of abuse, even if
the child is not the recipient
Child Abuse Prevalence
Sexual abuse-under age 18 yrs
5%-62% of females, 3%-31% of males
In populatons with mental illness, 44%-88%

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NURS 3524 Mental Health wk 10
Most studied form of abuse
Physical Abuse-under age 18 yrs
Emotional Abuse-under age 18 yrs
Neglect-under age 18 yrs
Few endure only one form of abuse
Types of Child Maltreatment and Examples of Abusive Behaviours
Health Effects of Child Abuse
Physical System
Stress during childhood may produce an activation of the hypothalamic-pituitary-
axis which influences the hypothalamic-pituitary-gonadal axis, affecting
sexualization and puberty
Increased sympathetic and adrenocortical activation
All experience encoded neurobiologically
Impact of Abuse on a Growing Child
Brain reaches 90% of its adult size by the time a child is three years old
Brain abnormalities associated with the abuse
Limbic irritability, deficient development and differentiation of left hemisphere,
deficient left-right integration, and abnormal activity in cerebellar vermis
Rate of temporolimbic dysfunction
38% higher for Physical Abuse; 49% higher for sexual abuse
118% higher where both present
Left hemisphere development arrested, with the temporal region most affected
“Child abuse causes irreversible brain damage”
Teicher (2000)
Impact on Brain Development and Learning
Chronic stress sensitizes neural pathways and overdevelops those regions of the brain
involved in responses to anxiety and fear
children who experience the stress – in the form of physical or sexual abuse or chronic
neglect – will focus their resources on survival and responding to threats in the
environment
chronic stimulation of the brain’s response to fear means that particular regions of the
brain will frequently be activated
end result may be that regions of the brain not connected to the fear response are not
“available” to the child for learning
Impact of Abuse on a Growing Child
Belief System

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NURS 3524 Mental Health wk 10
Language, verbal and non-verbal, is a body of shared symbols that convey
meaning
How we know ourselves, our world, and our relationship when it come out of
interactions with others
Abuse teaches that others come first, the child exists to submit to others, self
esteem is lowered, unassertive behaviors learned, health care practices and self
care practices are not valued
The child learns the “problem” rests with them
Immediate Health Effects of Child Abuse
Physical injuries
fractures, contusions
Physical Illness and development of chronic diseases
Infections, obesity
Pregnancy
Running Away
Physical disability
Death
Direct result of abuse, suicide, homicide
Emotional Damage
Mental Health and Behavioral Problems
Immediate and Long Term Effects Children with Abuse
Victims of child abuse often suffer from depression, substance abuse, self-mutilation,
eating disorders, or dissociative disorders
60-85% of children and adults who experienced abuse suffer from PTSD
Depersonalization, dissociation,and denial are common defense mechanisms expressed
by victims in an effort to cope with the abuse.
Victims tend to blame themselves for the trauma
Long Term Effects of Abuse
Frequent users of health care system, susceptibility to physical and mental illness
Women who suffer from sexual abuse consume the most services of the health care
system
Social costs to child may include a life of crime in adulthood
Never been studied to understand the true economic and social costs of child abuse
WHO
Long Term Health Effects
Physical
Seizures were identified as a result of sexual abuse by Galen, 2nd century
Onset of coitus before age 17 yrs is the most powerful predictor of cervical
cancer
Menarche occurs 2 yrs earlier on average
Idiopathic bladder
Bowel Problems
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