Chapter 28:

Child, Olde
Adult, Intimat
Partner Abuse
McClean AM Group- Gillian Smith, Katel
Grant, Anthony Bergeron, Arian
Pasciuto, Matthew Scarborough, a
Paulina
 Objectives
•• Identify
Identify the
the nature
nature and
and scope
scope ofof family
family violence
violence and
and factors
factors contributing
contributing to
to its
its
occurrence.
occurrence.
•• Identify
Identify three
three indicators
indicators ofof a)
a) physical
physical abuse,
abuse, b)
b) sexual
sexual abuse,
abuse, C)
C) neglect,
neglect, and
and
d) emotional
d) emotional abuse.
abuse.
•• Describe
Describe risk
risk factors
factors for
for both
both victimization
victimization and
and perpetrator
perpetrator of
of family
family violence.
violence.
•• Describe
Describe four
four areas
areas to
to assess
assess when
when interviewing
interviewing aa person
person who
who has
has
experienced abuse.
experienced abuse.
•• Identify
Identify two
two common
common emotional
emotional responses
responses the
the nurse
nurse might
might experience
experience when
when
faced with
faced with aa person
person subjected
subjected to to abuse.
abuse.
•• Formulate
Formulate four
four nursing
nursing diagnoses
diagnoses for for the
the survivor
survivor of
of abuse
abuse and
and list
list
supporting data
supporting data from
from the
the assessment.
assessment.
 Objectives (con’t)

• Write out a safety plan for a victim of intimate partner abuse.

• Discuss the legal and ethical responsibilities of nurses when working with
families experiencing violence.
• Compare and contrast primary, secondary and tertiary levels of intervention.
• Describe at least three possible referrals for an abusive family including the
telephone numbers of appropriate agencies in the community.
• Discuss three therapeutic modalities useful in working with abuse families.
Types of abuse: Vocabulary Words
•Any infliction of physical pain or bodily harm. 
Physical Abuse
•Ex: hitting, restraining, pushing. 

•Any form of sexual contact or exposure without consent, or if a victim is

Sexual Abuse incapable of giving consent. 
• Also called: sexual assault and rape. 

• Undermining a person’s self-worth. 

Emotional Abuse •Ex: constant criticism, humiliating, isolating, name-calling. 

• Failure to provide for physical, emotional, educational, and medical

Neglect needs. 

•Controlling a person’s access to economic resources making an

Economic Abuse  individual financially dependent. 
•Ex: forbidding school attendance or employment.

Crisis Situation • Anyone who might be at risk

 Who is involved?
• Any member of a family who is
violent towards another member;
such as partners, siblings, and
Perpetrator extended family members. 
: • They think their needs are more
important, and they think they
have more skills. 

• Family member whom the abuse

Vulnerable is being perpetrated. 
Person:  • Victim, survivor.
 Child Abuse 
The most common forms of child abuse are neglect, physical abuse, and sexual abuse. 

Other types include: emotional and threatened abuse, parent drug/alcohol abuse, or lack of supervision.

Child abuse can take the form of something improper that is done to a child, which is an act of commission.

Girls are more likely to be abused.

Younger children are more vulnerable to abuse.

Sexual abuse is the hardest type of child abuse to determine, because oftentimes the children are unable to
describe their experience of abuse. About 40% of children do not even exhibit clear signs of sexual abuse.

92% of child abuse perpetrators are the victim’s parents. Females are somewhat more likely to abuse
children.
Risk Factors For Child
Abuse
- Below the age of 4.
- Being perceived as different due to temperamental traits,
congenital abnormalities, or chronic disease.
- If the child reminds the parents of someone they do not like.
Children who do not live up to the parent’s fantasy of what the
child should be like.
- Interference with emotional bonding between parents and
child. (Ex: premature birth, prolonged illness requiring
hospitalization.)

Comorbidity:
Abuse can result in a comorbidity later in life such as:
Anxiety
Depression
Suicidal thoughts
PTSD 

As well as: poorer coping and social skills, higher incidence of

dissociative identity disorder, and poorer impulse control.
Intimate Partner Violence (IPV)

“Partner” can include: spouse, boyfriend/girlfriend, dating partner, ongoing or sexual

partner. 
“IPV” or “IPA” includes: physical violence, rape, stalking, and psychological aggression. 
Females between the ages of 18-34 experience the highest rate of intimate partner violence.
1 in 4 women widespread experience IPA over their lifetime (Mclaughlin, J., O'Carroll, R., &
O'Connor, R., 2012, 678). 

Article on IPA that shows the relationship between IPA and mental health disorders-
including increased likelihood of suicide attempts.

“Studies have shown relationships between IPA and physical injuries, disabilities, homicide,
sexual assaults, complications of pregnancy, alcohol and drug abuse, economic losses,
employment status, depression, and suicide” (Mclaughlin, J., O'Carroll, R., & O'Connor, R.,
2012, 678).
 
“Psychological distress, hopelessness, substance use, coping skills and social support are key
factors involved in the relationship between IPA and suicide attempts” (Mclaughlin, J.,
 Tension Building Stage:
• Minor incidents occur, such as pushing or

Cycle of Violence verbal abuse. The victim often ignores or

accepts its behavior due to fear of
escalation. 
•Abusers can rationalize their behavior, and
both participants could try to reduce tension
Honeymoon Stage: by minimizing the importance of the
incidents.
• “Period of calm.”
• The abuser demonstrates
kindness, loving behavior.
• He/She seems remorseful and
makes promises.
• The victim could feel Tension
Honeymoon
Building
Stage
Stage
needed/loved and hopes for Acute Battering Stage
change.

Acute Battering Stage:

• Tension peaks, which is usually
triggered by an external event or the
abuser’s emotional state.
•Some experts believe the victims may
provoke the abuser or incident to
remove the tension and fear, and to be
able to move on to the next stage. 
Risk Factors for IPV

The desire to control the

Men who abuse could Jealousy, pregnancy can
household or individual
feel the need to be in trigger abuse, and
emotionally, physically,
charge/male dominance. substance use.
and financially.
Older Adult Abuse
 Defined as “intentional actions that
cause harm or creates a risk of harm
to a vulnerable person.”

 Older adults already feel pain,

anxiety, poverty, and stress due to
the natural aging process and life
changes. 

 The main form of abuse in older

adults is financial, especially from
caretakers. They can steal money,
objects, transfer property and
accounts, mediations, vehicles, and
food stamps.
RISK FACTORS FOR OLDER ADULT ABUSE

Poor mental or physical health

Alzheimer’s Disease

Increased dependency on another individual

If they abused their own children, they are likely to be targets from
their offspring

Abuse from spouses due to failing health

Self-neglect on their own health (as they age.)

ASSESSMENT OF ABUSE

Symptoms
may be Include
Attention to vague questions
Setting and including: about Hx of:
Assess victim chronic pain, Sexual Abuse
Interview
Process are ALONE insomnia, Family
hyperventilatio Violence
CRITICAL
n, Drug
gynecological Use/Abuse
problems
 Display horror, shock,
anger or disapproval of the

INTERVIEW PROCESS AND SETTING

perpetrator or situation

Be direct, honest, Don't assume an DO

individual's sexual
professional
orientation NOT’s
Try to
Place blame or “prove”
make abuse by
Use the term
Interview should be
judgements accusations
“partner” when or demands
non- threatening
asking about
and supportive. 
relationship 

Ask about ways of

solving
Sit near the patient
to establish DO’s disagreements or
methods of
trust. Establishing disciplining children
trust is crucial for rather than to use the
patient to feel words “abuse” or
comfortable enough “violence” 
to self-disclose.
VERBAL APPROACHES
Example Questions:

Tell me what happened to you? 

Who takes care of you?

What happens when you do something wrong? 

How do you and your partner/caregiver resolve disagreements?

What do you do for fun?

Who helps you with your children?

What time do you have for yourself? 

What about your child’s behavior bothers you the most? 

What arrangements do you make when you have to leave your child
alone?
TYPES OF ABUSE (Physical)
Minor complaints include→ headaches, back trouble, dizziness, and
accidents (especially falls) may be indicators of violence

Major signs of battering include→ bruises, burns, and other wounds in various
stages of healing (particularly around face, arms, legs, genitalia, back, buttocks).
If explanation does not match the injury seen or if the patient minimizes the
seriousness of the injury you should suspect abuse 

Make sure to ask the patient directly if someone has harmed them. Observe the
nonverbal response such as hesitation or lack of eye contact.
Ask specific questions like: How often does this happen? In what ways were you
hurt?

Any bruises in an infant 6 months or younger is suspicious 

Shaken baby syndrome is the leading cause of death as a result of physical
abuse
TYPES OF ABUSE (Sexual)
• Sexualized behavior in children is the most common symptom of sexual abuse
occurrence in children 
• Precocious sexual knowledge 
• Drawing sexually explicit images 
• Demonstrate sexual aggression 
• One indication abuse has occurred is the child acts out sexual interactions in
play (etc. dolls)
• Masturbation may be excessive in sexually abused children 
• Strong connection between sexual abuse and later promiscuity 
• PTSD is common in children who are sexually abused 
• Nightmares 
• Somatic complaints 
• Feelings of guilt 
• Depression is common in adults with a past history of sexual abuse 
• Anxiety, suicide, aggression, chronic pain and obesity are other consequences
of sexual abuse
 TYPES OF ABUSE (Emotional)
Emotional Abuse:
• May exist on its own or in conjunction with physical or sexual abuse
• You can assess through indicators such as low self esteem, reported feelings of
inadequacy, anxiety and withdrawal, learning difficulties and poor impulse control
• 
Neglect: 
• Often appear undernourished, dirty, and poorly clothed 
• Manifested by inadequate medical care 
• Lack of immunizations and untreated medical or dental conditions
• 
Economic abuse: 
• May take the form of failure to provide for the needs of the victim when adequate funds are available 
• Bills may be left unpaid by the person left in charge of finances 
• In the case of spousal abuse→ may prevent the victim from pursuing education ro finding a job,
thereby ensuring dependency
Factors That Affect Victims/Abusers
Anxiety and Poor
Disrupted Family
Coping Support Systems: Suicidal Potential
Coping Patterns 
Responses
• Anxiety can be • Living with • Victims can be • Someone
seen as poor eye children and dependent on an desperate to
contact, older adults can abuser for life leave yet trapped
hesitation, and cause frustration. support, in a relationship
vague • Lack of stress children’s options could turn to
statements.  outlets can lead are especially suicide as a way
• Coping to abuse.  limited.  out.
mechanisms can
often prevent
termination of the
relationship by
the victim. 
Factors That Affect Victims/Abusers (Con’t)
Drug and Alcohol Maintain Accurate
Homicide: Use: Records: Self-Assessment:

• Homicide of the • Affects the • Could be • Becoming aware

victim (by hands thought process beneficial for of someone’s
of the abuser) or of those using- possibility of own feelings
abuser (by hands can lead to future legal about the
of victim as a violence.  action by the situation. 
way out) is more • Could also be victim in order to • Negative feelings
likely to happen if used as a way of leave the could potentially
there are escaping an situation. cloud judgement
weapons or intolerable of the situation.
drugs in the situation.
home.
NURSE’S ROLE
Nurses are legally mandated to report suspected or actual
cases of child and vulnerable adult abuse 

Education about counseling support and community support

for the victim in order to help come up with a safety plan
(plan for rapid escape) or safe houses. Involve case
managements when needed to deliver services for victims
and perpetrators of abuse in order to change the cycle. 

Be culturally aware of victim’s coping methods because they

can revert back to their cultural past after a stressful event
HEALTH TEACHING AND HEALTH
PROMOTION
Include meeting with both the individual and the family to help them learn to
recognize behaviors and situations that might trigger violence

Explain normal developmental and physical changes to enable family

members to gain a more positive view of the victim and crisis situation

Education about effective parenting and coping techniques

Inform healthcare team about patients who require appropriate monitoring

and follow up
HEALTH TEACHING AND HEALTH
PROMOTION (Con’t)
Nurses can make referrals to community
resources including:
Respite programs
in which
Numbers of 24- volunteers take a
Emergency Emergency
hour crisis child for an
childcare telephone
centers or occasional
facilities  numbers
hotlines  weekend so the
parents can get
relief 

Community health nurses can make home visits to identify risk factors of abuse in
the first few months of life to see the parent-infant interaction
 Prevention of Abuse
Primary
• Measures taken to prevent the occurrence of abuse,
• Identifying those who are at risk, providing teaching, and providing support systems is important.
• Strategy examples include: reducing stress and influence of risk factors, increasing self-esteem, and
increasing social support.

Secondary
• Early intervention in abusive situations to minimize long-term effects of abuse.
• Nurses can establish screening programs for those at risk, involve medical treatment to injuries, and
provide community services. 
• Counseling and education, as well as placing the patient in a more appropriate setting are important
strategies.

Tertiary
• Often occurs in mental health settings. 
• Nurses create a healing and rehabilitative environment with support groups.
• The focus is on legal advocacy, safety, health, and well-being.
Advanced Practice Interventions
These are most effective after crisis intervention when the situation is less chaotic and
tumultuous. A variety of therapeutic modalities are available for treatment of abusive
families.
Individual • goals of individual therapy are empowerment, the
ability to recognize and choose productive life

Psychotherapy
options, and the development of a solid sense of
self.

• expected outcomes are that the perpetrator will

Family recognize destructive patterns of behavior,

learn alternative responses, control impulses, and
refrain from abusive behavior. Intermediate

Psychotherapy goals are that members of the family will openly

communicate
another.
and learn to listen to one

Group
• provides assurances that one is not alone and
that change is possible. Can help diminish
feelings of isolation, strengthen feelings of self-

Psychotherapy
esteem and self-worth, and increase the
potential for realistic problem solving in a
supportive atmosphere.
RESOURCES

The websites for the

National Domestic Violenc
e Hotline
and loveisrespect.org
National Loveisrespect.o
have a host of resources
including: Domestic rg Hotline:
• Safety Planning
• How to Talk To Your Kids
Violence 1-866-331-
About Domestic Violenc
e
Hotline: 9474 
 
• Firearms Safety Tips 1-800-799-
• Videos 7233
References
Get Help For Yourself: Safety Planning. (2017). Retrieved from https://www.loveisrespect.org/for-
yourself/safety-planning/

Halter, M.J. (2014).  Varcarolis’ Foundations of Psychiatric Mental Health Nursing, A Clinical
Approach (8th ed). Saunders: Elsevier.

Mclaughlin, J., O'Carroll, R., & O'Connor, R. (2012). Intimate partner abuse and suicidality: A
systematic review. Clinical Psychology Review, 32(8), 677-689.

National Domestic Violence Hotline: Get Help Today: 1-800-799-7233. (2019, November 22).
Retrieved from https://www.thehotline.org/
 CLASS QUESTION 1
A woman is becoming wary of her boyfriend’s increasing negative mood.
She intentionally burns his dinner, forgets to do his laundry, and comments
about his poor appearance and attitude. What stage in the cycle of violence
is this woman currently in?
 

a. Tension-Building Stage
b. Acute Battery Stage 
c. Tension-Relieving Stage 
d. Honeymoon Stage
 CLASS QUESTION 2
During the interview process, a nurse asks a 68 yo patient how her home
life is. She responds, “it’s good, I just have a tough time with coordination.”
To which you notice large bruises on her arms and legs. You then ask, “Are
you feeling safe?” to which she responds with “absolutely.” What are your
next steps? (Select all that apply)

a. Reassure her that this is a safe space and that it is confidential

b. Inform her that she won’t receive that help she needs if she continues to lie to healthcare providers. 
c. Ask if she has any resources to reach out to in case things at home change 
d. Document the bruising and continue with vitals without reporting it