Nursing Process for Client Domestic Violence.Silvy

Nursing Process for Client with Domestic Violence

Domestic violence within the family occurs at all levels of society. The mythis that violence occurs only among the poor and undereducated, but the reality is that violence occurs also among the middle and upper classes and profesional elite. In the past, these problems among wealthy or prominent people were kept hidden from the general public. With an increase in national concern, however, more publicity is being given to cases of domestic violence at all socioeconomic levels.

“Family” refers to any one of these three categories : those who are related by birth, adoption, or marriage ; those in an intimate relationship, that is, sharing the same household. Although, the image of the American family is one happiness and harmony, this ideal is often in conflict with the underlying reality of domestic violence. The home is the most frequent place for violence of all types.

Abuse, interchangeable with violence refers to a pattern of behavior that dominates, controls, lowes self esteem, or takes away freedom of choice. It is systematic persecution of another individual ranging from subtle words or actions to violent batthering acts of commission.

The incidence of domestic violence can only be estimated. Studies often include only those people who are willing to respond to surveys. Typically underreoresented in such studies are those who do not speak English, the very poor, the homeless, and those who are hospitalized or incarcerated at the time of the survey. The actual rates of domestic violence are probably much higher than reported.

In all 50 states, nurses are required by law to report suspected incidents of child abuse, and in every state, there is a penalty-civil, criminal, or both-for failure to report child abuse. State laws vary for reporting the abuse of adults and the elderly. In 1994 the Violence Againts Women Act made it a federal crime againts which the victim has the right to be protected and for which the perpetrator can be arrested and prosecuted.

Assessment

Given the incidence of abuse. it is logical to assume that you will encounter victims in a variety of clinical settings. Although one-third of all women’s visits to emergency departements are caused by domestic violence, fewer than 10% are identified. There are clues that you need to recognize that would indicate the possibility of domestic violence. One the behaviors to look for is the man speaking for the woman in response to questions about the injury. She may seek his approval before answering questions. He may criticize or correct her answers. Often, he msy not want health care professionals to talk to the woman alone ( Bicehouse and Hawker, 1995 ).

During the assessment of every client, one or two introductory questions should be asked. In assessing a child, say, for example. “Moms and dads try to help their children learn how to behave well. What happens to you when you do something wrong?” Or ask, “What is the worst punishment you ever received?” In assessing adults, you may begin with this approach : “One of the sources of stress in our lives is family disagreement. Could you describe how disagreement affect you? What happens when you disagree?” If the respons to these questions are indicative of violence, a focused nursing assessment must be conducted ; see the Focused Nursing Assessment table. Obviously, the assessment questions must be adapted to the client’s age, gender, and family situation.

Focused Nursing Assessment

Victim of Domestic Violence

Diagnosis

Priority must be given to critical and serious physical injuries. The severity and potential fatality of the situation must be considered, as well as the needs of dependent children and legal issues surrounding the case. Consider the following nursing diagnosis when analyzing your assessment data :

· Ineffective family coping, disabling, related to an inability to manage conflict without violence

· Ineffective individual coping related to being a victim to violence

· Altered parenting related to the physical abuse of children

· Powerlessness related to feelings of being dependent on the abuser

· Self-esteem disturbance related to feeling guilty and responsible for being a victim

· Social isolation related to shame about family violence

· High risk for violence, directed at others, related to a history of the use of physical force within the family

Outcome Identificatiion

Once you have established diagnosis, you and the client mutually identify goals for change. Client outcomes are specific behavioral measure by which you, clients, and significant others determine progress toward goals. The following are example of some of the outcomes appropriate to people who are victims of domestic violence :

· remains safe and free from harm

· develops an escape plan

· manages conflict appropriately

· verbalizes an internal locus of control

· verbalizes an understanding of normal growth and development of children

· implements appropriate and safe parenting techniques

· utilizes community resources

Nursing Interventions

Most victims of domestic violence would like it to end, but they may not know how to seek the help they need. It is axtremely importent that you be nonjudgmental in your interactions with all family members. Initialy, clients may be unwilling to trust you because of family shame and fears og being accused for remaining in the violent situation. It is vital that you not impose your own values by offering quick and easy solutions to the very complicated problem of domestic violence. See the accompanying box for the nursing interventions classification (NIC). Treatment of families experiencing violence requires a multidisciplinary approach, with a broad range interventions. Nurses, social workwrs, physicians, family therapists, vocational trainers, police, protective service personnel, and lawyers must coordinate to intervence effectively in a domestic violence situation.

Nursing Interventions Classification

Victim and perpetrators of domestic violence

Evaluation

Nurses in acute care settings may not have the opportunity for long term evaluation of the family system. Stark and Flitcraft (1996) state that short term evaluation focuses on :

1. The identifications of domestic violence.

2. The family’s ability to recognize that a problem exists.

3. The willingness of the family to accept assistence by following through with referrals.

4. The removal of the victim from a volatile situation.

Nurses in long term settings or within the community have an opportunity to evaluate the effectiveness of multidisciplinary treatment plan over an extended period of time. When violence no longer exists within the family system, the plan has succeeded. Sharing in the process of family growth and adaptation can be a tremendous source of profesional satisfaction. Achievement of the following outcome criteria is evidence that the plan of intervention was successful.

The victims have :

1. Recognized that they are not to blame for the violence of others.

2. Ended the denial and minimization of domestic violence.

3. Demonstrated an awareness of strengths, skilla, and competence.

4. Re-established a sense of power over their own lives.

5. Verbalized their right to express their own needs and to satisfy them.

6. Established social networks to decrease isolation and secrecy.

All nurses should evaluate their professional obligations and practice in counteracting those aspects of society that foster domestic violence. Domestic violence is a mental health problem of national and international importence, and nurses should be leaders in helping prevent it in future generations.

Primary prevention includes educating the general population on the existence of domestic violence and its devastating effects. Nursing interventions include parent education, family life education and conflict resolution program in schools, referral for appropriate child or elder care, estalishment for support groups, and education of fellow nurses about the problem of domestic violence. As a proffesional you can monitor the media and keep the preassure on to decrease the amount of violence that is portrayed. Similiar to the seat belt campaign, state and federal campaigns should be developed for zero tolerance againts domestic violence

Secondary prevention includes working with children who are victims or who have seen their mothers beaten, and making refferals for multidiscplinary intervantion. Nurses must be community advocates in supporting hotlines, crisis centers, and shelters for victims of domestic violence. On the political level, nurses must make their voices heard in regard to policies and laws affecting children, women, and older people. Question to guide have evaluation of nursing practice include the following :

· What action have i taken to decrease violence in the media?

· Have i been an advocate for gun control?

· Have i confronted the use of physical punishment within families?

· Hane i volunteered to teach parenting classes at grade schools and high schools?

· Have i written to legislators to protest funding cuts in programs designed to help children, women, and other people?

· Have i spoken out on the need to increase the number of bilingual/biculturals counselors, lawyers, nurses, and physicians to attend to the needs of ethnic families?

Daftar Pustaka :

Fontaine, Karen Lee. 1943. Mental Health Nursing 4th edition

Videbeck, Sheila L. Psychiatric. Mental Health Nursing 2nd ed. Philadelphia : Lippincott Williams & Wilkins

Wiscarz Stuart, Sandra J. Sunden. 1991. Principles & Practice of Psychiatric Nursing 5th ed. St. Louis : Mosby Year Book