Nursing Considerations, Assessment and Interventions

Describe about the Family and domestic violence?

Family and domestic violence is considered as a methodical way in which there is repeated abuse of psychological and socio-emotional front of a human, it may lead to social isolation of a human and may cause injury, and sexual stabbing of a person. All this result in the intention of punishing, abusing and to control the action, belief and thoughts of the victim. Domestic or family violence may have a deep impact on mental health of the victim. It is as well acknowledged and established that child abuse and adult abuse is the main reason for developing depression, anxiousness and other mental health disorder which may cause insomnia and sleep disorders, suicide attempts, eating disorders and substance abuse.

According to nursing curriculum of American association of Colleges of Nursing and American Nurses Association (2008), it is mentioned in their syllabus and curriculum about need to develop interpersonal violence and necessary integration of violence content, to identify it and address it (Burgess & Hartman, 2009, pp 361-376).

Nursing is considered as a deed which plays an important impact on the care of the victim and in solving the problem of family violence. Caring is the spirit in nursing which helps in building a bond of responsibility and association which helps in developing strength of all the individuals, along with their relatives  and community which supports them in building a healthy life again.

Nurses have skills to respond to their victims about the domestic violence and all types of other occurring violence, they respond very sensibly which requires sensitivity deep rooted in the understanding in the way it is different from other violence. Difference between other violence and family violence:

1. Both the victim and the doer have intimate knowledge of one another.
2. Doer ongoing way in to the victim.
3. The problem between the two remains secret as it happens out of the view of public.
4. Doer have the ability for not to be caught for the doing.
5. Doer always tries to influence the consequences after being caught.

When nurses work with victims of family violence, they should always try to first listen the point view of the victim and understand it, rather than try to impose self point of view on them. The responsibility and role of the nurses is most importantly to provide the support and understanding to the victim condition and to provide optimum resources to them. Patients may make their decisions and inform to the nursing staff, but nurses may take decisions for children and the exposed adults who are victim of domestic violence, nurses have proper right to intervene into it.

Nursing should include understanding the position of their victims and to develop a trusting relationship with their victim by going through depth of domestic violence and abusive relationships. Nurses by providing the sympathetic support to their victims may help them to become a survivor from victim. Difference between survivor and victim is that survivor makes an accomplishment by overcoming from violence. Doers of domestic violence may also have become sometimes the victims of domestic violence, so nurses should provide their care to doers as well as victims both, and should learn to provide helpful nursing response to all.

Women who are abused by domestic violence are surveyed as three times more likely to experience the depression or fretfulness disorder then other women (Pavlovich, 2007, pp 281-295). Most of the females who have faced domestic violence led to one third more suicide attempts of all the other suicide attempted suicides, other minority women who are victims have attempted suicide more than double of not-victim women. Women who have faced domestic violence have been seen to take double the mental health services than women in not- victim population. More than 70% of women who are victim of family violence are in psychiatry for treatment and 80% of in secure settings are victim of domestic violence including sexual assault. Children who live in domestic violence are more at risk of problems in behaviour and in trauma of emotional changes. According to an audit by American Academy of paediatrics(2011) in Greenwich it is found that 60% of the mental health services in Leeds are being used by victims of domestic violence or by people who have some or other experience domestic violence in their life and other 25 % of patients belong to sexually assaulted group.

Conclusion

When a victim of domestic violence is diagnosed with a mental health disorder, than the situation becomes more vulnerable and it becomes very difficult and hard to report domestic violence than other women who does not suffer from violence. It too becomes difficult to face the society because it feels as a feeling of shame because of stigma prevalent in society about mental health patient which weaken the position and become helpless. In turn the health providers also become insensitive and problematic due to prevalence of stigma of mentally ill. At this stage of mental disorder it is very essential to provide proper and sensible nursing care so that victim does not attempt any suicide. It is the sole responsibility of care provider or psychiatric nurse to make victim understand that “don’t blame yourself, you are not responsible for this, the doer is responsible”. Nurses should help the victim to come out of trauma and provide additional support to them so that they do not get into depression.

Despite of having common characteristics between domestic violence and mental disorder, most of the mental health professionals ignore the domestic violence victims and issue of abuse to take care of (Barnett et al., 2007). They usually do not talk about it to the victim and victim also hesitates in sharing about it. What the professionals do is they prescribe you with some anti- depressants, sleeping pills etc rather than giving victim an opportunity to talk about all that has happened to them.

Some mental health professional do take family violence into consideration but they are unable to solve and cure their condition and provide appropriate treatment to them. For example some of the practitioners suggest treatment given to patients of Post traumatic stress disorder (patients who are suffering in wars or some kind of naturally occurring disaster such as fire or earthquake) and is considered same as domestic violence cases ( Princeton University, 2014). Slowly victim comes out of the depression when she is no longer abused, but this also took time and to accomplish this nursing care plays an important role. Nurses may help by building confidence level of the victims so that they stop blaming themselves.

Primary care for mental illness is provided by Nurses and plays a vital role as she manages and helps in the existing physical conditions by assessing victim physically (American Psychiatric Nurses Association (APNA), taking its diagnosis differentially and having drug assessment. President commission on the Mental Health (2008) have recognized that the primary medical providers are giving more than half of the same treatment as to the commonly occurring mental disorders and prescribe the psychotropic drugs as they are not aware and untrained in treating the psychiatric situation and also faces time shortage.

Nursing interventions in a primary health care setting have included participation of the victim in planning treatment for them (Richards et al. 2009, pp 28-32). Some of the medical patients who are referred to mental services, 50% of them do not follow through with their referrals. Some of the major barriers which come across the treatment are difficulty, problems in transportation, stigma and outlay. Recovery rate of the victim increases if the victim receives early treatment and evidence based strategies for it which also reduces overall cost.

Conclusion

Domestic violence is a lethal and detrimental type of violence which not only declines the person who is abused, along with it led to declination of whole family. So it is very essential that the victim gets proper health consideration which would help them to recover early. A nurse plays a significant role in doing so as they not only help in prescribing, deciding and judging the treatment for the victim, but also partner the victim so that they are able to provide the whole information and resources for the informed conclusion. The patient self determination is utmost important to take care of. Nurses who work with the people who are in some kind of abusive relation, one of the most uttered statements are “you have to get out of it” approach. This way is not correct as nurses should not be judgemental about victim. Nurses should act in partnership by talking victim about what happened privately, should always accept patient choice in a non- judgemental way, always express concern for them and say supporting sentences and offer full assistance and help to the victim (Stuart, Laraia., 2009). Nurses should not impose their judgment on victim and neither blames the victim for all what occurred. Proper medical and mental health setting should be done so that victim comes out of depression and led a normal life.

References

1. American Psychiatric Nurses Association (APNA) https://www.apna.org – See more at:https://www.nursingcenter.com/lnc/journalarticle?Article_ID=636583#sthash.EU1xfdva.dpuf

2. Burgess, A., & Hartman, C. (2009). Nursing interventions with children and adolescents experiencing sexually aggressive responses. In P. West, et al., Psychiatric and mental health nursing with children and adolescents (pp. 361-376).

3. American Academy of Paediatrics (2011). Policy statement on media violence. Elk Grove, IL: American Academy of Paediatrics.

4. American nurses association (2010). Culturally competent assessment for family violence. Washington, DC: Author.

5. Barnett, O.W., Miller-Perrin, C.L. & Perrin, R.D. (2007). Family violence across the lifespan: An introduction. Thousand Oaks, CA: Sage Publications.

6. Princeton University. Retrieved May 4, 2014, from [ordnetweb.princeton.edu/perl/webwn?s=mental+health&sub=Search+WordNet&o2=&o0=1&o8=1&o1=1&o7=&o5=&o9=&o6=&o3=&o4=&h= Princeton.edu]

7. Pavlovich, K. (2007). The development of reflective practice through student journals. Higher Education Research & Development, 26(3), 281-295.

8. President’s New Freedom Commission on Mental Health, 2008 https://www.mentalhealthcommission.gov/reports/reports.htm – See more at: https://www.nursingcenter.com/lnc/journalarticle?Article_ID=636583#sthash.EU1xfdva.dpuf

9. Richards L, et al. A new frontier: Psychologists practicing in primary care settings. Behavioral Healthcare Tomorrow. 13(6):28-32, December 2004.

10. Stuart GW, Laraia MT. Principles and Practice of Psychiatric Nursing, 8th edition. New York, N.Y., Elsevier, 2009.