Discuss the historical trends and current conceptions of the cause and treatment of substance abuse.
Describe the ethical and legal implications of substance abuse.
Identify at-risk populations for violence and the role of public health in dealing with the epidemic of violence.
Chapter 26
Substance Abuse
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
More deaths, illnesses, and disabilities are
attributed to substance abuse than to any
other preventable health conditions in the
United States.
– Substance Abuse and Mental Health
Services Administration (SAMSHA)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Social Consequences of Substance
Abuse
Crimes while under the influence of drugs,
alcohol, or both
Need for money to buy substances
Specific theft of drugs
Almost 75% of inmates report prior drug use
All aggregates in society are potentially
affected by substance abuse problems
regardless of age or economic level
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
Etiology of Substance Abuse
Numerous theories try to explain it
➢
Combination of many factors
➢ Genetics within families
➢ Individual (impulsivity and ease of disinhibition)
➢ Environmental factors
➢ Medical models
➢ Biopsychosocial models
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4
Historical Overview of Alcohol and
Illicit Drug Use
Alcohol use has gained
more social acceptance
than other drug use.
Public attitudes and
governmental policies have
also influenced the history
of illicit drug use.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Historical Overview of Alcohol and
Illicit Drug Use (Cont.)
Consumption and laws affected by:
➢
➢
➢
➢
➢
➢
➢
➢
Alcohol-related deaths after lowered drinking age
Less tolerant national attitudes toward drinking
Increased societal and legal pressures and
actions against drinking and driving
Increased health concerns among Americans
Knowledge of addictive properties
Counterculture acceptance of hallucinogens,
cannabis, and heroin
The “War on Drugs”
Renewed interest in prevention/treatment efforts
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6
Laws Impacting Substance Abuse
Anti–Drug Abuse Acts of 1986 and 1988
➢
➢
➢
Increased funding for treatment and rehabilitation
Created the Office of National Drug Control Policy (“drug
czar”)
Worked on a public health approach to drug control
National Institute on Drug Abuse (NIDA)
➢
Science on drug abuse and addiction
• Prevention
• Treatment
• Decreasing the spread of HIV/AIDS
• Other priority areas
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Laws Impacting Substance Abuse
(Cont.)
Substance Abuse and Mental Health Services
Administration (SAMHSA)
➢
Builds and sustains programs, policies,
information and data, contracts, and grants toward
helping the nation act on the knowledge that
promotes behavioral health treatment through all
levels of prevention
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Prevalence, Incidence, and Trends
Alcohol use by persons aged 12 or older:
➢
Slightly more than half (52.8%) drink alcohol
➢ Binge drinking at least once in prior 30 days—
(22.6%)
➢ Heavy drinking—6.2%
➢ Young adults ages 18-25 had highest prevalence
of binge and heavy drinking—39.8%
➢ Drove under the influence of alcohol at least once
in past year—11.1%
– SAMHSA (2011)
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9
Prevalence, Incidence, and Trends
(Cont.)
Illicit drug use by persons aged 12 or older:
➢
About 8.7% were current drug users, used an illicit
drug during the past month
Illicit drugs used
➢
➢
Marijuana was the most commonly used drug
Others included cocaine (including crack), heroin,
hallucinogens, inhalants, or prescription-type
psychotherapeutics (pain relievers, tranquilizers,
stimulants, and sedatives) used nonmedically
– SAMHSA (2011)
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10
Prevalence, Incidence, and Trends
(Cont.)
Nonmedical use of prescription-type
psychotherapeutics
➢
There is a significant increase in the lifetime
nonmedical use of pain relievers—specifically
Percocet®, Percodan®, Vicodin®, Lortab®,
Darvocet®, Darvon®, Tylenol® with Codeine,
Propoxyphene, or Codeine Products, Oxycodone,
and Hydrocodone
– NIDA (2010)
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11
Prevalence, Incidence, and Trends
(Cont.)
Hallucinogen, inhalant, and heroin use
➢
LSD (d-lysergic acid diethylamide)
➢ Peyote cactus
➢ Psilocybin
➢ PCP (phencyclidine)
➢ Inhalants of choice are amyl nitrite, “poppers,”
followed by glue, shoe polish, or toluene;
correction fluid, degreaser, or cleaning fluid;
gasoline or lighter fluid; and spray paints and other
aerosols.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Prevalence, Incidence, and Trends
(Cont.)
Gender difference
➢
➢
Geographic trends
➢
Males more likely to be current illicit drug users
Female illicit drug use (12 and older) increasing
Highest in West > Midwest > Northeast > South
Racial/ethnic groups
➢
Highest among American Indians or Alaska
natives > African Americans> whites > Hispanics
> Asians
– SAMHSA (2010)
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13
Trends in Substance Abuse
May or may not relate to classically or
clinically defined dependence or addiction.
Many are turning to recovery before they
have developed physiological dependence.
Need to differentiate between use and
misuse/abuse.
Use of harmful substances is indirectly and
directly related to all of the leading health
indicators targeted in Healthy People 2020.
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14
Methamphetamine (MA)
Most widely produced controlled substance in
the United States.
Illegal street names of the drug (crank, crystal,
meth, ice, or glass).
Can be injected, inhaled, taken orally, or
smoked.
Used predominantly by white young persons,
with an overrepresentation of females.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Methamphetamine (MA) (Cont.)
Pleasurable effects are caused by the release
of high levels of dopamine in the brain,
leading to increased energy, a sense of
euphoria, and increased productivity.
➢
➢
Short-term effects: increased heart rate, insomnia,
excessive talking, excitation, and aggressive
behavior
Prolonged use results in tolerance and
physiological dependence
Negative consequences range from anxiety,
convulsions, and paranoia, to brain damage.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Methamphetamine (MA) (Cont.)
The impact of MA abuse on communities,
families, and social networks is considerable.
➢
Young children of users are at risk for abuse and
neglect.
➢ Prenatal use puts children at risk for
developmental problems, aggression, and
attention disorders.
➢ Exposure to combustible second-hand fumes.
➢ Associated with increased incidence of violence
(e.g., domestic abuse, homicide, and suicide)
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17
Steroids
Anabolic steroids are synthetic variants of male
sex hormone testosterone
➢
➢
Build muscle and said to be androgenic
Most commonly used in athletes and other
individuals willing to risk potential and irreversible
health consequences to build muscle
Potentially fatal risks
➢
➢
Blood clots, liver damage, premature cardiovascular
changes, increased cholesterol
Increased potential for suicide and aggressive and
risky behaviors
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18
Inhalants
Contain volatile components with
psychoactive properties
➢
Many products found in home or workplace (e.g.,
spray paints, markers, glues, and cleaning fluids)
Produce a rapid high that may resemble
alcohol intoxications; may progress to loss of
sensation and even unconsciousness
Irreversible effects:
➢
Hearing loss, limb spasms, CNS or brain damage,
or bone marrow damage; may result in death from
heart failure or suffocation
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19
Adolescent Substance Abuse
Highest prevalence of illicit drug use during
lifetime between 18 and 25 years
➢
Teen use of cigarettes and smokeless tobacco has
declined
➢ Nearly half of teens try marijuana before they
graduate—skepticism about drug’s danger
As harmful, illicit substances come in and out
of vogue, CHN needs a good understanding
of drug culture, terminology, and differing
signs and symptoms
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20
Conceptualizations of Substance
Abuse
Conceptualizations have changed over the
years, often for political and social reasons
rather than for scientific reasons.
“Dependence” or “abuse”
What substances can be abused?
➢
APA focuses on alcohol, amphetamines, caffeine,
cannabis, cocaine, hallucinogens, inhalants,
nicotine, opioids, phencyclidine, sedatives, and
hypnotics or anxiolytics
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21
Defining Substance Abuse
Substance abuse: a maladaptive pattern of
substance use that is manifested by recurrent
and significant adverse consequences related
to repeated use of a substance.
➢
➢
➢
➢
Failure to fulfill major role obligations
Repeated use in physically hazardous situations
Multiple legal problems
Recurrent social and interpersonal problems
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22
Defining Substance Abuse (Cont.)
Dependence: a cluster of cognitive,
behavioral, and physiological symptoms that
indicate continued use of the substance
despite significant substance-related
problems
➢
➢
➢
➢
Pattern of repeated, self-administered use
Tolerance, withdrawal, and compulsive drug-taking
behaviors
A craving or strong desire for the substance
Preoccupation with supply, money to purchase,
and getting through time between periods of use
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23
Sociocultural and Political Aspects of
Substance Abuse
Determined largely by economic, cultural, and
political conditions of potential users
Cultural conditions create ambiguity in clearly
determining when a problem exists.
Competing value systems lead to cultural
disintegration and a sense of powerlessness
and hopelessness.
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24
Course of Substance-Related
Problems
Path from initiation to dependency is
multidimensional.
➢
Person + substance + context/environment
Progression varies—from initiation to continuation,
transition to abuse, and finally, addiction and
dependency
Critical point is transition from use to abuse
Addiction/dependency marked by changes in both
behavior and cognition
Once addiction is established, withdrawal symptoms
are strong motivators to continue use
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25
Legal and Ethical Concerns
U.S. policy based on prohibition and criminal
sanctions against use and sale of illicit drugs
➢
➢
➢
Criminal activities (violence and drug trafficking)
Drinking and driving, working while intoxicated
Impact on fetus (FAS)
Modes of intervention
➢
➢
➢
➢
Limit access
Media campaigns
Educational programs
National organizations that promote community education,
research, and support
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26
Prevention Strategies
Primary prevention
➢
➢
➢
➢
➢
➢
➢
➢
Needs assessment to identify high-risk situations
and potential problems
Decriminalization and legalization of drugs(?)
Community-based programs
Training of health professionals
Faith-based initiatives
Volunteer consumer groups
Organized sports programs
Employer programs
Often overshadowed by “War on Drugs”
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27
Prevention Strategies (Cont.)
Secondary prevention
➢
➢
➢
➢
Screening and finding resources
• CAGE: an alcoholism screening test
• Clinical Institute Withdrawal Assessment (CIWA)
• Use evidence-based programs
Efforts should be specific to aggregates, rather
than directed at the “general public”
Incorporate culturally sensitive and appropriate
interventions and strategies
Work toward improving individuals’ general
competencies, communication skills, and selfesteem
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28
Treatment
For individuals, consider:
➢
Cultural and educational
background
➢ Resources of the person
➢ Attitudes of significant others
➢ Degree of invasiveness of the
effects of the substance use The
existence of alternatives
➢ Relapse prevention
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29
Treatment (Cont.)
Inpatient and outpatient treatment programs
➢
May or may not include detoxification component
➢ Voluntary vs. compulsory
➢ Pharmacologically based vs. drug free
➢ Treatment approaches and models vary
Assessment process is of primary importance.
Therapeutic relationship based on trust is
essential.
Physical examination is a valuable tool.
Nonjudgmental attitude minimizes
defensiveness.
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30
Treatment (Cont.)
Programs usually include:
➢
Group and individual therapy and counseling
➢ Motivational interviewing
➢ Family counseling
➢ Education
➢ Socialization into 12-step mutual self-help groups
➢ Integrate psychotherapy with pharmacotherapy
➢ May include other strategies:
• Hypnosis, occupational therapy, confrontation,
assertiveness training, blood alcohol level discrimination
training, behavior modification approaches
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31
Treatment (Cont.)
Pharmacotherapies
➢
Mutual help groups
➢
Used in detoxification, stabilization, maintenance,
as antagonists, and as treatment for coexisting
disorders
Operate through face-to-face supportive
interaction focusing on a mutual goal; AA was first
Harm reduction
➢
Elimination of the more harmful effects of
substance use through behavior and policy
modifications
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32
Social Network Involvement
Therapy that involves the family has proved to
be most effective in aiding recovery.
Family and friends
➢
Highly influential or aid and abet
➢ Codependency and enabling
Effects on the family
➢
➢
Functional or dysfunctional families
Psychological and financial burdens
Professional enablers
➢
➢
Treatment of symptoms by medication
Reluctant to bring up this taboo subject
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33
Vulnerable Aggregates:
Preadolescents and Adolescents
Times of experimentation, searching, confusion,
rebellion, poor self-image, alienation, and insecurity
Use of legal substances (e.g., tobacco, alcohol)
almost always precedes use of illegal drugs.
Poor school performance and drug use among peers
are strongest predictors of subsequent drug
involvement, followed by lack of strong family bond.
The younger the initiation, the greater the probability
of prolonged and accelerated use.
Feeling of powerlessness; selling drugs seen as a
viable economic solution to poverty.
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34
Vulnerable Aggregates: Preadolescents
and Adolescents (Cont.)
Primary prevention focuses on:
➢
➢
➢
➢
➢
➢
➢
Advocating for these vulnerable children
Educating teachers on the vital importance of
maintaining a validating, nonjudgmental attitude
toward these students
Supporting strong families in the community
Improving knowledge through education and
media
Early detection of predisposing factors
Providing structured clubs and organizations
Facilitating school success, career skills, family
communication skills, and conflict resolution
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35
Vulnerable Aggregates: Elderly
Elderly experience
➢
Diminished physiological tolerance
➢ Increased use/misuse of medically
prescribed drugs
➢ Cultural and social isolation
Misuse of prescription drugs may be the most
common form of drug abuse among the
elderly
➢
Use prescription medications approximately three
times as frequently as general population
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36
Vulnerable Aggregates: Women
Alcohol use and abuse affects women much
differently than men.
Women absorb and metabolize alcohol
differently.
➢
➢
Body composition differences and production of
less gastric alcohol dehydrogenase
Metabolize alcohol at a different rate
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37
Vulnerable Aggregates: Women
(Cont.)
Increased risk stems from economic, social,
and cultural factors.
➢
Marginalization of certain groups
➢ History of child abuse
➢ Physical and medical problems related to
reproductive systems
➢ Use during pregnancy has long-term
developmental consequences for the newborn
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38
Vulnerable Aggregates: Ethnocultural
Considerations
African Americans, Hispanics, and Native
Americans—increased risk for substance abuse.
➢
➢
➢
➢
➢
➢
Economically disenfranchised groups
Discrimination and racism
Socioeconomic, political, and historical realities
Myths and stereotypes
Social support—positive effect on treatment/outcome
Environmental cues and conditioned reinforcement
Treatment poses special challenges.
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39
Vulnerable Aggregates: Other
Aggregates
Substance abuse is most common
psychopathological problem in the general
population.
➢
➢
➢
➢
Dual-diagnosis individuals
• Psychiatric disorder + substance abuse disorder
Risk for multiple vulnerabilities in one individual
Impact of substance abuse on STDs
Substance abuse among health care
professionals
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40
Nursing Interventions in the
Community
Understand own experiences and prejudices.
Routinely assess substance use patterns
when performing client histories.
Be alert to environmental cues in the home
that indicate substance abuse.
Increase the individual’s and family’s
awareness of the problem.
Involve the social network in getting the client
into treatment.
Develop a caring nursing relationship.
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41
Other Traditional Nursing Roles and
Interventions
Health teaching regarding addictive illness and
addictive effects of different substances
Advocating that EBP treatment works in special
populations through problem-solving courts (drug
courts), specialized adolescent treatment, and other
community case management programs.
Providing direct care for abuse- and dependencerelated medical problems
Educating clients and families about problems related
to substance abuse
Collaborating with other disciplines to ensure
continuity of care
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42
Other Traditional Nursing Roles and
Interventions (Cont.)
Coordinating health care services for the client to
prevent prescription drug abuse and avoid
fragmentation of care
Providing consultation to nonmedical professionals
and lay personnel
Facilitating care through appropriate referrals and
follow-up
Knowing how to use community resources for
working with substance abuse, mental health, and
other issues
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43
Chapter 27
Violence
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Overview of Violence
Violence is a national public health problem.
WHO (2013) defines violence as “the
intentional use of physical force or power,
threatened or actual, against oneself, another
person, or against a group or community
which either results in or has a high likelihood
of resulting in injury, death, psychological
harm, maldevelopment, or deprivation.”
Injuries from violence are referred to as
intentional injuries.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Factors That Contribute to Violence
Poverty, unemployment, economic dependency
Substance abuse
Dysfunctional family and/or social environment and
lack of emotional support
Mental Illness
Media influence (e.g., violent video games, television
shows, and movies)
Access to firearms
Political and/or religious ideology
Intolerance and ignorance
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
History of Violence
Long history of human violence.
➢
In the Bible, Cain killed his brother Abel out of
jealousy and anger
➢ Audience pleasure (e.g., gladiators in Rome)
➢ Infanticide—if child was female, a twin, sickly, or
deformed
➢ Children, especially firstborn, sacrificed for
religious reasons
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4
History of Violence (Cont.)
Corporal punishment used to control children
➢
➢
➢
Spousal abuse/marital rape
➢
➢
➢
“Spare the rod and spoil the child” (Proverbs, 13:24)
“Beating some sense into him”
First legal protection in the United States in 1874
“Rule of thumb”
“Wives be subject to your husband” (Ephesians, 5:22)
Assault against women not explored until 1960s
Elder abuse
➢
➢
Often undetected because of lack of awareness of HCP
Lack of mandatory reporting
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5
Interpersonal Violence
Crosses all ethnic, racial, socioeconomic, and
educational lines
Interpersonal Violence (IPV) is about control,
not anger.
Includes:
➢
Homicide and suicide
➢ Intimate partner violence
➢ Child maltreatment
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6
Interpersonal Violence: Homicide
Homicide
➢
One of the leading causes of death in the
United States.
• For black males aged 15 to 34, homicide is the
leading cause of death.
➢
➢
Young people, women, and African American
and Hispanic males at higher risk than the
general population.
African Americans were more likely to
commit homicide than whites and were more
likely to be victims of homicide than whites
(2010 data)
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7
Interpersonal Violence: Suicide
Suicide is 10th leading cause of death for all
Americans in all age groups (2010)
More people die from suicide than homicide.
➢
➢
Men often use firearms.
Women use poisoning.
In Native Americans and Alaska Natives,
suicide is the second leading cause of death
in persons 15 to 34 years of age.
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8
Interpersonal Violence: Suicide
(Cont.)
Risk factors for suicide
➢
Psychiatric disorders such as major depression,
bipolar disorder, and/or schizophrenia
➢ Substance abuse
➢ Posttraumatic stress disorder (PTSD)
➢ Bulimia or anorexia nervosa
➢ Past history of attempted suicide
➢ Genetic disposition to suicide
➢ Age, such as elderly, and white males (highest
rate)
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9
Interpersonal Violence: Partner
Intimate partner violence (IPV)
➢
➢
➢
A pattern of coercive behaviors
perpetrated by someone who is or was
in an intimate relationship with the
victim
May include battering, resulting in
physical injury, psychological abuse,
and sexual assault to progressive social
isolation and intimidation of the victim
Typically repetitive and often escalates
in frequency and severity
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10
Interpersonal Violence: Partner
(Cont.)
Risk factors for IPV
➢
Low self-esteem
➢ Poverty
➢ Risky sexual behavior
➢ Eating disorders and/or depression
➢ Substance abuse
➢ Trust and relationship issues
Victims often suffer in silence and accept
abuse as a transgenerational pattern of
normal behavior
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11
Interpersonal Violence: Partner
(Cont.)
Pregnancy
➢
➢
May increase stress within the family
All pregnant women should be routinely screened
for abuse for commons sign of IPV
• Delay in seeking prenatal care
• Unexplained bruising or damage to breasts or abdomen
• Use of harmful substances (cigarettes, alcohol, drugs)
• Recurring psychosomatic illnesses
• Lack of participation in prenatal education
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12
Interpersonal Violence: Dating
Abusive, controlling, or aggressive behavior in an
intimate relationship that takes the form of emotional,
verbal, physical, or sexual abuse
➢
➢
May involve the use of date rape drugs
Studies have linked alcohol with dating violence
Stalking—a pattern of repeated and unwanted
attention, contact, harassment, or any type of
conduct directed at a person that instills fear
Bullying—a repeated oppression, psychological or
physical, of a less powerful person by a more
powerful person or group of persons
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13
Wheel of
Power
and
Control
Figure 27-1
Developed by the Domestic Abuse Intervention Project.
206 West Fourth Street, Duluth, MN 55806. Used with
permission.
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14
Impact of Interpersonal Violence
Victims often experience…
➢
➢
➢
Chronic fatigue and tension
Disturbed sleeping and eating patterns
Vague gastrointestinal and genitourinary
complaints
Misdiagnosis often occurs because of the
obscurity of symptoms and/or failure to
adequately assess
Victims stay in abusive relationships because
of cultural, religious, and economic factors
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15
Impact of Interpersonal Violence
(Cont.)
Victims who are most likely to leave a
battering situation:
➢
Have resources and power
➢ No children
➢ No personal history of abuse (themselves or their
mother)
Most dangerous time for victim is when he or
she leaves or attempts to leave the
relationship
➢
More likely to be killed at this time than any other
time in the relationship
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16
Interpersonal Violence: Child
Child maltreatment
➢
Most child maltreatment occurs within the family.
➢ More often abused by parents than other relatives
or caregivers.
➢ More commonly seen in families in poverty,
families in disorganization, or with parents who are
younger and who are substance abusers.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Interpersonal Violence: Child (Cont.)
Child maltreatment
➢
Risk factors include but are not limited to
• Special needs children
• Children less than 4 years of age
• Family history of violence
• Substance abuse
• Poverty
• Social isolation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Interpersonal Violence: Child (Cont.)
Child maltreatment
➢
Four types of child abuse:
1. Neglect
2. Physical abuse
•
•
Includes beating, burning, biting, and bruising
Abusive head trauma/shaken baby syndrome is
leading cause of death in the United States from
abuse
3. Emotional abuse
4. Sexual abuse
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Interpersonal Violence: Elderly
Elder abuse
➢
Society fails to recognize the cruelty many older
adults experience.
• Elders are an “invisible” segment of the population.
➢ Reasons for underreporting of elder abuse
• Shame on part of victim
• Social and physical isolation from resources
• Failure of health care provider to routinely assess during
points of contact
• No uniform reporting system
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Interpersonal Violence: Elderly
(Cont.)
Elder abuse
➢
Types of abuse and neglect
• Physical abuse
• Psychological-emotional abuse
• Sexual abuse
• Neglect
• Financial exploitation
• Health care fraud and abuse
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Community Violence
Community violence usually occurs suddenly
and without warning and can potentially
destroy entire segments of the population
Community violence includes
➢
Workplace violence
➢ Youth violence
➢ Gang-related violence
➢ Hate crimes
➢ Terrorism
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Community Violence: Workplace
Workplace violence includes physical assaults,
muggings, and verbal and written threats
Risk factors include:
➢ Increasing number of
acute and chronically
mentally ill patients
➢ Working alone
➢ Availability of drugs
at worksite
➢ Low staffing levels
➢
➢
➢
➢
➢
Poorly lit parking
areas and corridors
Long waits for
service
Inadequate security
Increasing number of
substance abusers
Access to firearms
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Community Violence: Youth
Youth-Related Violence
➢
➢
➢
➢
Concentrated in minority communities and inner
cities, causing a disproportionate burden on
these communities
Adolescents and youth increasingly use violence
to settle disputes.
Even when taught peaceful ways of resolving
differences, learn by what they observe at home,
on television, and in movies.
Schools have become common sites for
violence.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Risk Factors for Youth Violence
(from Textbook, Table 27-3)
Individual Risk Factors
Involvement with drugs,
alcohol, or tobacco
Antisocial beliefs and attitudes
Low IQ
History of violent victimization
History of early aggressive
behavior
Community Risk Factors
Diminished economic
opportunities
High concentration of poor
residents
High level of family
disruption
Low levels of community
participation
Socially disorganized
neighborhoods
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Risk Factors for Youth Violence
(from Textbook, Table 27-3—Cont.)
Individual Risk Factors
Attention deficits, hyperactivity, or
learning disorders
Poor behavioral control
Deficits in social, cognitive or
information-processing abilities
Exposure to violence and conflict in the
family
High emotional distress
History of treatment of emotional
problems
Community Risk
Factors
High level of
transiency
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
26
Risk Factors for Youth Violence
(from Textbook, Table 27-3—Cont.)
Family Risk Factors
Poor family functioning
Low emotional attachment to
parents of caregivers
Low parental education and
income
Parental substance abuse or
criminality
Poor monitoring and supervision
of children
Harsh, lax, or inconsistent
disciplinary practices
Authoritarian childrearing
practices
Peer/Social Risk Factors
Association with delinquent
peers
Involvement in gangs
Social rejection by peers
Lack of involvement in
conventional activities
Poor academic performance
Low commitment to school and
school failure
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
27
Community Violence: Gangs
Reasons that young people join gangs:
➢
Believe that gangs will protect them
➢ Peer pressure
➢ The need for respect
➢ A sense of belonging
Increasingly responsible for crimes and
violence throughout the United States
➢
Crimes include illegal alien smuggling, armed
robbery, assault, auto theft, drug and weapon
trafficking, identity theft, and murder.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
28
Community Violence: Prison
Prison violence
➢
➢
➢
➢
The United States has one of the world’s
highest rates of incarceration
Inmates are both victims and perpetrators of
violence.
Includes allegations of physical abuse and reports
of rape by corrections officers and inmates
Little sympathy for this population for a variety of
reasons, including indifference, disbelief, and
denial
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
29
Community Violence: Trafficking
Human trafficking is a global problem and a
public health issue.
Involves:
➢
Prostitution
➢ Sexual exploitation
➢ Forced labor
➢ Slavery
➢ Removal of organs
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
30
Community Violence: Hate Crimes
Crimes in which
offender is motivated
by
An individual’s race*1
➢ Sexual orientation*3
➢ Religious beliefs*2
➢ Ethnic background
➢ National origin
➢
*Rank—most commonly
reported
Hate crimes may
include
➢
Murder
➢ Rape
➢ Sexual or physical
assault
➢ Harassment
➢ Attacks on homes or
on places of worship
➢ Vandalism
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
31
Community Violence: Terrorism
“The calculated use of unlawful violence or
threat of unlawful violence to inculcate fear;
intended to coerce or to intimidate
governments or societies in the pursuit of
goals that are generally political, religious, or
ideological.”
(Department of Defense)
All terrorist acts include at least three key
elements—violence, fear, and intimidation.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
32
Factors Influencing Violence
Firearms
A gun in the home…
• …triples the risk for homicide in the home
• …increases the risk for suicide 3 to 5 times
• …increases risk for accidental deaths by 4
➢ Firearms are the number one weapon of choice in
homicides in the United States.
➢ Direct and indirect costs are staggering.
➢ “Right to bear arms” arguments persist.
➢
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
33
Factors Influencing Violence (Cont.)
Media violence includes exposure to and
participation in …
➢
➢
➢
…violent video games
…music and music videos that depict date rape or
violence
…virtual violence that allows subscribers to harm
or kill victims
Repeated exposure to media violence leads
to emotional desensitization to real-life
violence
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
34
Factors Influencing Violence (Cont.)
Mental illness is considered by many to be a
major factor in violence.
➢
Studies are inconclusive that all violence is
committed by mentally unstable persons.
Increasing push for legislation to fund public
health strategies that identify and treat mental
illness across the country
➢
Funding issues have forced states to eliminate or
reduce availability of mental health services
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
35
Violence Is a Public Health Epidemic
The public health system is challenged to go
beyond its traditional programs to include
prevention and management of violence.
Efforts being made with
➢
➢
➢
Public health strategies
Community approaches
Local, state, and federal governments
Addressed by Healthy People 2020
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
36
Prevention of Violence: Primary
Prevention
Goal: to stop violence, abuse, or neglect
before it occurs
Education may include life skills training:
➢
➢
➢
Parenting and family wellness
Anger management
Conflict resolution
Nurses should:
➢
➢
➢
Increase awareness of violence
Identify cases
Work with the community
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
37
Prevention of Violence: Primary
Prevention (Cont.)
Must begin at community level to change
attitudes
Focuses on stopping transgenerational
aspect of abuse
➢
➢
Start with young children
Continue across the lifespan
Mentoring and peer programs to promote
healthy relationships and decrease conflict
Work with high-risk individuals
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
38
Prevention of Violence: Secondary
Prevention
Goal: assess, diagnose, and treat victims and
perpetrators of violence.
➢
Consideration of safety of potential victim is critical
Begins with assessment
Once identified, victims must be offered…
➢
➢
Resources to increase their safety
Legal options and how to access them
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
39
Prevention of Violence: Secondary
Prevention (Cont.)
Nurses must screen for abuse. Ask questions
➢
➢
➢
Within the last year, have you been hit, slapped,
kicked, or otherwise physically hurt by someone?
Since you’ve been pregnant, have you been hit,
slapped, kicked, or otherwise physically hurt by
someone?
Within the last year, has anyone forced you to
have sexual activities?
Intervene when essential
Interdisciplinary approach leads to optimal
outcomes.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
40
Prevention of Violence: Tertiary
Prevention
Goal: Aimed at rehabilitation of individuals,
families, groups, or communities and includes
both victims and perpetrators of violence
May take months or even years
Nurses must work in conjunction with a
variety of mental health professionals and
social service agencies to provide
coordinated care
➢
Self-care and recognition of own limitations and
needs
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
41
Chapter 27
Violence
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
Overview of Violence
Violence is a national public health problem.
WHO (2013) defines violence as “the
intentional use of physical force or power,
threatened or actual, against oneself, another
person, or against a group or community
which either results in or has a high likelihood
of resulting in injury, death, psychological
harm, maldevelopment, or deprivation.”
Injuries from violence are referred to as
intentional injuries.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
2
Factors That Contribute to Violence
Poverty, unemployment, economic dependency
Substance abuse
Dysfunctional family and/or social environment and
lack of emotional support
Mental Illness
Media influence (e.g., violent video games, television
shows, and movies)
Access to firearms
Political and/or religious ideology
Intolerance and ignorance
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
3
History of Violence
Long history of human violence.
➢
In the Bible, Cain killed his brother Abel out of
jealousy and anger
➢ Audience pleasure (e.g., gladiators in Rome)
➢ Infanticide—if child was female, a twin, sickly, or
deformed
➢ Children, especially firstborn, sacrificed for
religious reasons
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
4
History of Violence (Cont.)
Corporal punishment used to control children
➢
➢
➢
Spousal abuse/marital rape
➢
➢
➢
“Spare the rod and spoil the child” (Proverbs, 13:24)
“Beating some sense into him”
First legal protection in the United States in 1874
“Rule of thumb”
“Wives be subject to your husband” (Ephesians, 5:22)
Assault against women not explored until 1960s
Elder abuse
➢
➢
Often undetected because of lack of awareness of HCP
Lack of mandatory reporting
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
5
Interpersonal Violence
Crosses all ethnic, racial, socioeconomic, and
educational lines
Interpersonal Violence (IPV) is about control,
not anger.
Includes:
➢
Homicide and suicide
➢ Intimate partner violence
➢ Child maltreatment
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
6
Interpersonal Violence: Homicide
Homicide
➢
One of the leading causes of death in the
United States.
• For black males aged 15 to 34, homicide is the
leading cause of death.
➢
➢
Young people, women, and African American
and Hispanic males at higher risk than the
general population.
African Americans were more likely to
commit homicide than whites and were more
likely to be victims of homicide than whites
(2010 data)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
7
Interpersonal Violence: Suicide
Suicide is 10th leading cause of death for all
Americans in all age groups (2010)
More people die from suicide than homicide.
➢
➢
Men often use firearms.
Women use poisoning.
In Native Americans and Alaska Natives,
suicide is the second leading cause of death
in persons 15 to 34 years of age.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
8
Interpersonal Violence: Suicide
(Cont.)
Risk factors for suicide
➢
Psychiatric disorders such as major depression,
bipolar disorder, and/or schizophrenia
➢ Substance abuse
➢ Posttraumatic stress disorder (PTSD)
➢ Bulimia or anorexia nervosa
➢ Past history of attempted suicide
➢ Genetic disposition to suicide
➢ Age, such as elderly, and white males (highest
rate)
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
9
Interpersonal Violence: Partner
Intimate partner violence (IPV)
➢
➢
➢
A pattern of coercive behaviors
perpetrated by someone who is or was
in an intimate relationship with the
victim
May include battering, resulting in
physical injury, psychological abuse,
and sexual assault to progressive social
isolation and intimidation of the victim
Typically repetitive and often escalates
in frequency and severity
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
10
Interpersonal Violence: Partner
(Cont.)
Risk factors for IPV
➢
Low self-esteem
➢ Poverty
➢ Risky sexual behavior
➢ Eating disorders and/or depression
➢ Substance abuse
➢ Trust and relationship issues
Victims often suffer in silence and accept
abuse as a transgenerational pattern of
normal behavior
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
11
Interpersonal Violence: Partner
(Cont.)
Pregnancy
➢
➢
May increase stress within the family
All pregnant women should be routinely screened
for abuse for commons sign of IPV
• Delay in seeking prenatal care
• Unexplained bruising or damage to breasts or abdomen
• Use of harmful substances (cigarettes, alcohol, drugs)
• Recurring psychosomatic illnesses
• Lack of participation in prenatal education
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
12
Interpersonal Violence: Dating
Abusive, controlling, or aggressive behavior in an
intimate relationship that takes the form of emotional,
verbal, physical, or sexual abuse
➢
➢
May involve the use of date rape drugs
Studies have linked alcohol with dating violence
Stalking—a pattern of repeated and unwanted
attention, contact, harassment, or any type of
conduct directed at a person that instills fear
Bullying—a repeated oppression, psychological or
physical, of a less powerful person by a more
powerful person or group of persons
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
13
Wheel of
Power
and
Control
Figure 27-1
Developed by the Domestic Abuse Intervention Project.
206 West Fourth Street, Duluth, MN 55806. Used with
permission.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
14
Impact of Interpersonal Violence
Victims often experience…
➢
➢
➢
Chronic fatigue and tension
Disturbed sleeping and eating patterns
Vague gastrointestinal and genitourinary
complaints
Misdiagnosis often occurs because of the
obscurity of symptoms and/or failure to
adequately assess
Victims stay in abusive relationships because
of cultural, religious, and economic factors
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
15
Impact of Interpersonal Violence
(Cont.)
Victims who are most likely to leave a
battering situation:
➢
Have resources and power
➢ No children
➢ No personal history of abuse (themselves or their
mother)
Most dangerous time for victim is when he or
she leaves or attempts to leave the
relationship
➢
More likely to be killed at this time than any other
time in the relationship
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
16
Interpersonal Violence: Child
Child maltreatment
➢
Most child maltreatment occurs within the family.
➢ More often abused by parents than other relatives
or caregivers.
➢ More commonly seen in families in poverty,
families in disorganization, or with parents who are
younger and who are substance abusers.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
17
Interpersonal Violence: Child (Cont.)
Child maltreatment
➢
Risk factors include but are not limited to
• Special needs children
• Children less than 4 years of age
• Family history of violence
• Substance abuse
• Poverty
• Social isolation
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
18
Interpersonal Violence: Child (Cont.)
Child maltreatment
➢
Four types of child abuse:
1. Neglect
2. Physical abuse
•
•
Includes beating, burning, biting, and bruising
Abusive head trauma/shaken baby syndrome is
leading cause of death in the United States from
abuse
3. Emotional abuse
4. Sexual abuse
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
19
Interpersonal Violence: Elderly
Elder abuse
➢
Society fails to recognize the cruelty many older
adults experience.
• Elders are an “invisible” segment of the population.
➢ Reasons for underreporting of elder abuse
• Shame on part of victim
• Social and physical isolation from resources
• Failure of health care provider to routinely assess during
points of contact
• No uniform reporting system
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
20
Interpersonal Violence: Elderly
(Cont.)
Elder abuse
➢
Types of abuse and neglect
• Physical abuse
• Psychological-emotional abuse
• Sexual abuse
• Neglect
• Financial exploitation
• Health care fraud and abuse
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
21
Community Violence
Community violence usually occurs suddenly
and without warning and can potentially
destroy entire segments of the population
Community violence includes
➢
Workplace violence
➢ Youth violence
➢ Gang-related violence
➢ Hate crimes
➢ Terrorism
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
22
Community Violence: Workplace
Workplace violence includes physical assaults,
muggings, and verbal and written threats
Risk factors include:
➢ Increasing number of
acute and chronically
mentally ill patients
➢ Working alone
➢ Availability of drugs
at worksite
➢ Low staffing levels
➢
➢
➢
➢
➢
Poorly lit parking
areas and corridors
Long waits for
service
Inadequate security
Increasing number of
substance abusers
Access to firearms
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
23
Community Violence: Youth
Youth-Related Violence
➢
➢
➢
➢
Concentrated in minority communities and inner
cities, causing a disproportionate burden on
these communities
Adolescents and youth increasingly use violence
to settle disputes.
Even when taught peaceful ways of resolving
differences, learn by what they observe at home,
on television, and in movies.
Schools have become common sites for
violence.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
24
Risk Factors for Youth Violence
(from Textbook, Table 27-3)
Individual Risk Factors
Involvement with drugs,
alcohol, or tobacco
Antisocial beliefs and attitudes
Low IQ
History of violent victimization
History of early aggressive
behavior
Community Risk Factors
Diminished economic
opportunities
High concentration of poor
residents
High level of family
disruption
Low levels of community
participation
Socially disorganized
neighborhoods
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
25
Risk Factors for Youth Violence
(from Textbook, Table 27-3—Cont.)
Individual Risk Factors
Attention deficits, hyperactivity, or
learning disorders
Poor behavioral control
Deficits in social, cognitive or
information-processing abilities
Exposure to violence and conflict in the
family
High emotional distress
History of treatment of emotional
problems
Community Risk
Factors
High level of
transiency
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
26
Risk Factors for Youth Violence
(from Textbook, Table 27-3—Cont.)
Family Risk Factors
Poor family functioning
Low emotional attachment to
parents of caregivers
Low parental education and
income
Parental substance abuse or
criminality
Poor monitoring and supervision
of children
Harsh, lax, or inconsistent
disciplinary practices
Authoritarian childrearing
practices
Peer/Social Risk Factors
Association with delinquent
peers
Involvement in gangs
Social rejection by peers
Lack of involvement in
conventional activities
Poor academic performance
Low commitment to school and
school failure
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
27
Community Violence: Gangs
Reasons that young people join gangs:
➢
Believe that gangs will protect them
➢ Peer pressure
➢ The need for respect
➢ A sense of belonging
Increasingly responsible for crimes and
violence throughout the United States
➢
Crimes include illegal alien smuggling, armed
robbery, assault, auto theft, drug and weapon
trafficking, identity theft, and murder.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
28
Community Violence: Prison
Prison violence
➢
➢
➢
➢
The United States has one of the world’s
highest rates of incarceration
Inmates are both victims and perpetrators of
violence.
Includes allegations of physical abuse and reports
of rape by corrections officers and inmates
Little sympathy for this population for a variety of
reasons, including indifference, disbelief, and
denial
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
29
Community Violence: Trafficking
Human trafficking is a global problem and a
public health issue.
Involves:
➢
Prostitution
➢ Sexual exploitation
➢ Forced labor
➢ Slavery
➢ Removal of organs
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
30
Community Violence: Hate Crimes
Crimes in which
offender is motivated
by
An individual’s race*1
➢ Sexual orientation*3
➢ Religious beliefs*2
➢ Ethnic background
➢ National origin
➢
*Rank—most commonly
reported
Hate crimes may
include
➢
Murder
➢ Rape
➢ Sexual or physical
assault
➢ Harassment
➢ Attacks on homes or
on places of worship
➢ Vandalism
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
31
Community Violence: Terrorism
“The calculated use of unlawful violence or
threat of unlawful violence to inculcate fear;
intended to coerce or to intimidate
governments or societies in the pursuit of
goals that are generally political, religious, or
ideological.”
(Department of Defense)
All terrorist acts include at least three key
elements—violence, fear, and intimidation.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
32
Factors Influencing Violence
Firearms
A gun in the home…
• …triples the risk for homicide in the home
• …increases the risk for suicide 3 to 5 times
• …increases risk for accidental deaths by 4
➢ Firearms are the number one weapon of choice in
homicides in the United States.
➢ Direct and indirect costs are staggering.
➢ “Right to bear arms” arguments persist.
➢
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
33
Factors Influencing Violence (Cont.)
Media violence includes exposure to and
participation in …
➢
➢
➢
…violent video games
…music and music videos that depict date rape or
violence
…virtual violence that allows subscribers to harm
or kill victims
Repeated exposure to media violence leads
to emotional desensitization to real-life
violence
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
34
Factors Influencing Violence (Cont.)
Mental illness is considered by many to be a
major factor in violence.
➢
Studies are inconclusive that all violence is
committed by mentally unstable persons.
Increasing push for legislation to fund public
health strategies that identify and treat mental
illness across the country
➢
Funding issues have forced states to eliminate or
reduce availability of mental health services
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
35
Violence Is a Public Health Epidemic
The public health system is challenged to go
beyond its traditional programs to include
prevention and management of violence.
Efforts being made with
➢
➢
➢
Public health strategies
Community approaches
Local, state, and federal governments
Addressed by Healthy People 2020
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
36
Prevention of Violence: Primary
Prevention
Goal: to stop violence, abuse, or neglect
before it occurs
Education may include life skills training:
➢
➢
➢
Parenting and family wellness
Anger management
Conflict resolution
Nurses should:
➢
➢
➢
Increase awareness of violence
Identify cases
Work with the community
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
37
Prevention of Violence: Primary
Prevention (Cont.)
Must begin at community level to change
attitudes
Focuses on stopping transgenerational
aspect of abuse
➢
➢
Start with young children
Continue across the lifespan
Mentoring and peer programs to promote
healthy relationships and decrease conflict
Work with high-risk individuals
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
38
Prevention of Violence: Secondary
Prevention
Goal: assess, diagnose, and treat victims and
perpetrators of violence.
➢
Consideration of safety of potential victim is critical
Begins with assessment
Once identified, victims must be offered…
➢
➢
Resources to increase their safety
Legal options and how to access them
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
39
Prevention of Violence: Secondary
Prevention (Cont.)
Nurses must screen for abuse. Ask questions
➢
➢
➢
Within the last year, have you been hit, slapped,
kicked, or otherwise physically hurt by someone?
Since you’ve been pregnant, have you been hit,
slapped, kicked, or otherwise physically hurt by
someone?
Within the last year, has anyone forced you to
have sexual activities?
Intervene when essential
Interdisciplinary approach leads to optimal
outcomes.
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
40
Prevention of Violence: Tertiary
Prevention
Goal: Aimed at rehabilitation of individuals,
families, groups, or communities and includes
both victims and perpetrators of violence
May take months or even years
Nurses must work in conjunction with a
variety of mental health professionals and
social service agencies to provide
coordinated care
➢
Self-care and recognition of own limitations and
needs
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
41
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