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Interpersonal Violence: Finding the way out

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Asma Ali

on 12 July 2014

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Transcript of Interpersonal Violence: Finding the way out

Interpersonal Violence: Finding the way out...
But first…
HCPs need to understand the problem!

Low self-esteem
Fear, Dependency or Love
Embarrassment (stigma)
Inability to communicate in dominant language
How does this relate to us as nurses??
Forms of interpersonal violence
Historical perspectives
Statistics in the Canadian context
Understanding violence
Impact on health/healthcare system
Issues for nurses and the nursing profession
Barriers to resolution
Strategies for resolution
Perpetrator in a high position
Idea of sanctity of the home
Power differences
Complex situation

Forms of Interpersonal violence
• Up to 70% of children are abused in families in which women are abused (Folsom et al., 2003)

• Most common forms abuse
-emotional abuse

• Bullying at school

Violence Against Women
7% of people married or in common-law partnership reported they were abused by their partners with similar rates for men and women (General Social Survey, 2004)


Women suffer the most severe violence and abuse
4x more likely to be victims of spousal homicide
2x as likely to be beaten
4x as likely to be choked
2x as likely to experience chronic, ongoing assaults
Violence in Gay and Lesbian Relationships

Higher rates of violent victimization than heterosexuals (GSS, 2004)

Few studies until recent decades
• GSS first asked to identify sexual to orientation in 2004
• Power and control
• Social stigma
Older Adult Canadian Abuse

• 67% more likely to be abused by strangers
(Bunge & Locke, 2000)
• 4% reported financial, material and verbal abuse
(Podnieks et al., 1990)
• 7% experience emotional abuse
(Bunge & Locke, 2000)

Elder abuse and neglect encompasses
• Violence in the home
• Violence in institutions
• Self-neglect

Statistics in the Canadian Context
NOTE: Studies are hindered by....
Under reporting of abuse and violence
Measurement of violence
Collection of data

Violence in Aboriginal Communities
• 8x more likely to be killed by their partners than non-aboriginal women
(Statistics Canada, 2007)

• 24% of aboriginal women experience spousal abuse
(GSS, 2004)

• Higher rates of violence and abuse

• Why?
o Colonizing processes
o Discrimination and racialization
o Poverty
o Social and economic marginalization
o Lack of trust
o Fear of repercussion

Dating Violence
• Women suffer the most in dating relationship
o 45% of women sexually abused
o 79% psychologically abused
o 35% physically abused
(Dekerseredy & Kelly, 1993)

Violence in the Workplace
• International Council of Nurses, 1999
– 95% bullied at work
– 72% of nurses do not feel safe at work
– 97% knew a colleague who has been physically assaulted at work

• Canadian Public Health Association, 1994
– Up to 70% of nurses abused or threatened on the job

• Affects recruitment and retention

Within relationships (intimate partner violence)

Includes all types of violence

Interpersonal Violence...
Forms of Interpersonal Violence
Physical Neglect

Gender Differences
Men and women experience violence differently

Men more likely to be injured by strangers

Women more likely to experience violence from partners and sexual violence (Johnson, 2006)

History of violence against
• Women
• Children
• Sacrificing to appease the gods
• Handicapped children killed
• Beaten to rid them of demons
• Beaten to educate
Theoretical Perspectives
• Persistent underreporting of child abuse cases.

• Need for prevention and recognition of abuse of elders who live in their own homes.

• Need for comprehensive approaches to interpersonal violence within healthcare settings.

• Ongoing lack of reporting violence against nurses in the workplace.

• Use gender-neutral language when discussing all types of interpersonal violence.

• Language can obscure and slant perceptions of what really is happening in violent and abusive relations.

• Labels reduce people to their experience of violence.
Myths about violence and abuse affect how HCPs respond to and treat victims
• Ex.: It is mainly people living in poverty who act violently towards others.

• Ex.: People from certain racial groups are inherently more violent.

• Critical to recognize that it is a mistaken to use population statistics.
Psychiatric/Intraindividual Model (Gelles, 1980)
• Abusive men as psychopaths, female victims as masochists
• “Masochism Myth”
• Blames the victim- provocation
• Excuses the abuser
• Importance of the social context:
confine abuse to accepted environment

Social-Psychological Model (Gelles, 1980)
• Interaction of environment with the individual and family
• Interaction predisposes towards violence
• Social Learning Theory:
“Growing up in a violent home predisposes children toward violent behavior”
• Intergenerational transmission of violence
Evidence is questionable

Sociological Model (Gelles, 1980)
• Violence occurs in environments that tolerate
and foster it
• Incorporates:
• Societal beliefs and values
• Poverty
• Social supports
• Others' reactions

Feminist Perspective
• Patriarchal culture legitimizes male violence against women and children
• Male power in the world facilitates male dominance in the home
• Ensures control over women
• Examines females' experience in society related to:
• Race
• Culture
• Disability
• Social class
• Age
• Sexual Orientation

• Violence in same-sex relationships focuses on the issues of power and control

• Simultaneous effects of multiple factors:

• **GENDER **
• Economic class
• “Race”
• Sexual orientation
• “Ability”
• Helps explain why certain populations are more susceptible to experiencing violence and also facing barriers to social support

Intersectional Analysis
Intervention programs require victims’ trust and confidence
Current Response to Care
• Focus is on treating physical injuries

• Nurses/MDs avoid asking questions

• HCPs are judgmental, uncaring, unhelpful

Current Response to Care
Battered women would like healthcare providers to:

1. Show concern; be nonjudgmental and supportive

2. Directly ask if they are in an abusive situation

3. Listen and validate the abuse that is going on

4. Make referrals to shelters, counseling, and legal services
(Sleutel, 1998)

Nurses are in a position to…
Promote healthy relationships
Identify abuse/violence

Interdisciplinary Education
So, why has development of an interdisciplinary curricula been so slow?
Need for comprehensive prevention and intervention program
Participation of all HCPs is a necessity
Zero tolerance (CNA, 2002; International Council of Nurses, 1999)
Other organizations recognize need for further education of HCPs


Focus is on the short-term treatment of the physical effects of violence
- No demand for change within society
- No requirement for HCPs to address broader issue of interpersonal violence

What needs to happen?
- Continued joint efforts of professional associations
Ex.: Nursing Network on Violence Against Women.
- Collaboration between HCPs and community members
- Collaboration between HCPs across disciplines
- Members of each healthcare discipline to advocate for these programs

In a married or common-law relationship, women are more likely to be abused than men.
Children are more likely to be abused in homes where the women are also abused.
Older Canadians are more likely to be abused by strangers than family members.
Aboriginal women are eight times more likely to be killed by their partners than non-aboriginal women.
Child Abuse
Campaigns, education and legislation against
• “battered child syndrome”- coined 1962; beginning of campaigns to protect children
Awareness due to interaction of:
• US/Vietnamese conflict
• Rising homicide rates in the US
• Women’s movement- battered women awareness
• Society for the Prevention of Child Abuse and Neglect- est. 1977
• Child abuse and exploitation prohibited by Criminal Code in Canada
• “Child Welfare in Canada 2000”: Reporting of child abuse mandatory

Women are less likely to be abused while dating than in married relationships.
• Support for abuse of female partners in religion

• Manifestation and cause of gender inequality

Risk factors (WHO, 2002):
• Economic inequality between men and women
• Levels of female mobility and autonomy
• Attitudes towards gender roles and violence against women
• Extent to which family, friends and neighbors intervene
• Levels of male-male aggression and crime
• Social capital - the expected collective or economic benefits derived from the preferential treatment and cooperation between individuals and groups.

In 1999, the International Council of Nurses reported that 95% of nurses have been bullied at work.

• Began to be recognized in 1970s

• Manitoba Association on Gerontology-
first to develop guidelines to identify elder abuse

• Elizabeth Podnieks- RN-
pioneer in leading studies on elder abuse

Sexual orientation does not affect the victimization rate.
Impact on Health Care and the Health Care System
Barriers to Resolution
Strategies to Resolution
Impact of violence on health and healthcare system:
1- Physical injuries
2- Chronic health problems
3- Mental health problems
Impact of violence on expenditure:
1- Healthcare system
2- Criminal justice
3- Social services
Impact of violence on children:
1- Difficulty concentrating
2- Little anger control
3- Eating disorders
4- High risk of dropping out of school
5- Risk of self-imposed injuries; suicide
Issues for Nurses and the Nursing Profession
Children who witness abuse are at risk of

Developing PTSD
Decreased school performance
Disturbed sleeping patterns
Increase worry for the mother
Decreased cognitive development
Separation anxiety

Lack of Understanding
Other Issues
Benefits of routine universal screening

Increased opportunities for disclosure;
Increased opportunities for nurses to identify victims of abuse;
positioning violence as a legitimate health concern;
Providing early intervention;
Reducing victims' sense of isolation;
Affording opportunities to assist children of abused women;
Giving a strong message that abuse is wrong;
Informing individuals about services available;
*Fostering healthy communities*

(Registered Nurses Association of Ontario, 2005)

As a nurse, what should your next step be when a woman is suspected of being abused but declines to disclose any information or seek help?

A) Discuss what you observed and explain why you are still concerned about her health. Offer educational information and referral services, and document her response

B) Keep pressuring the woman until she admits to being abused.

C) Offer educational information about the effects of abuse, provide referral services, and document her response

D) Call 911 on behalf of the woman when you suspect abuse
What can you do if the woman shares with you her experience of being abused by her husband but chooses not to report it to the police?

A) The nurse can report it only if the woman gives consent

B) The nurse is obligated to report it

C) The nurse should advise the woman respectfully, but advocate for the woman's right to choose

D) A and C

What should you do if you suspect that a child is being abused or that he/she is witnessing abuse?

A) Call 911

B) Report it to Children's Aid Society

C) Do nothing unless the child admits to being abused
• Multiple myths about violence and abuse affect how healthcare professionals respond to and treat people involved in violent situations
• One myth that continues to pervade society is that it is mainly people living in poverty who act violently towards others.
• Poor people may be stereotyped as violent and the effects minimized as being part of the culture.
• A related myth is that people from certain racial groups are inherently more violent.
• It is critical for nurses to recognize that is it mistaken to use population statistics.

Bunge, V, P., & Locke, D. (2000). Family violence in Canada: A statistic profile. Ottawa, ON: Minister of Industry. Retrieved from http://www.statcan.ca

Canadian Nurses Association. (2008, June). Code of ethics for registered nurses. Retrieved from http://www.cna-aiic.ca/en/on-the-issues/best-nursing/nursing-ethics

Canadian Public Health Association. (1994). Violence in society: A public health persepective (Issue paper). Ottawa, ON: Author.

DeKerseredy, W. S., Kelly, K. (1993). The incidence and prevalence of woman abuse in Canadian university and college dating relationships. Canadian Journal of Sociology, 18(2), 137-159.

Folsom, W., Christensen, W., Avery, L., & Moore, C. (2003). The co-occurrence of child abuse and domestic violence. Child and Adolescent Social Work Journal, 20(5), 375-387.

Gelles, R.J. (1980). Violence in the Family: A review of research in the seventies. Journal of Marriage and the Family, 42, 873-885.

International Council of Nurses. (1999). Increasing violence in the workplace is a threat to nursing and the delivery of healthcare. Retrieved from http://www.icn.ch.

International Council of Nurses (2007). Guidelines on coping with violence in the workplace. Retrieved from http://www.icn.ch/publications/guidelines/

Johnson, H. (2006). Measuring violence agains women: Statistical trends. Ottawa, ON: Statistics Canada.

McIntyre, M., & McDonald, C. (2014). Realities of Canadian nursing: Professional, practice, and power issues (4th ed.). Philadelphia: Walters Kluwer Lippincott, Williams & Wilkins.

Podnieks, E., Pillemer, K., Nicholson, J. P., Shillington, T., & Frizzel, A. (1990). National survey of abuse of the elderly in Canada. Toronto, ON: Ryerson Polytechnical Institute.

Registered Nurses Association of Ontario (2005, March). Woman abuse: Screening, identification and initial response. Retrieved from http://rnao.ca/bpg/guidelines/ woman-abuse-screening-identification-and-initial-response

Sleutel, M.R. (1998). Women’s experiences of abuse: A review of qualitative research. Issues in Mental Health Nursing, 19, 525-539.

Statistics Canada. (2007). Family violence in Canada. Retrieved from http://www.statcan.ca/english/freepub/85-224-XIE/85-224-XIE2007000.pdf

World Health Organization (2002). World report on violence and health. Geneva: World Health Organization.

Scenario #1
Scenario #2
Scenario #3
Comparison of the 5 Theories

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