Selected Specific Crisis Situations: Problems Related to Abuse

  1. Domestic Violence: Battered Woman
    1. Characteristics
      1. Victims: feel helpless, powerless to prevent assault; blame themselves; ambivalent about leaving the relationship.
      2. Abusers: often blame the victims; have poor impulse control; use power (physical strength or weapon) to threaten and subject victims to their assault.
      3. Cycle of stages, with increase in severity of the battering:
        1. Buildup of tension (through verbal abuse): abuser is often drinking or taking other drugs; victim blames self.
        2. Battering: abuser does not remember brutal beating; victim is in shock and detached.
        3. Calm: abuser “makes up,” apologizes, and promises “never again”; victim believes and forgives the abuser, and feels loved.
    2. Risk factors
      1. Learned responses: abuser and victim have had past experience with violence in family; victim has “learned helplessness.”
      2. Pregnant women and those with one or more preschool children, who see no alternative to staying in the battering relationship.
      3. Women who fear punishment from the abuser.
    3. Assessment:
      1. Injury to parts of body, especially face, head, genitals (e.g., welts, bruises, fracture of nose).
      2. Presents in the emergency department with report of “accidental injury.”
      3. Severe anxiety.
      4. Depression.
    4. Analysis/nursing diagnosis:
      1. Risk for injury related to physical harm.
      2. Posttraumatic response related to assault.
      3. Fear related to threat of death or change in health status.
      4. Pain related to physical and psychological harm.
      5. Powerlessness related to interpersonal interaction.
      6. Ineffective individual coping related to situational crisis.
      7. Spiritual distress related to intense suffering and challenged value system.
    5. Nursing care plan/implementation:
      1. Provide safe environment; refer to community resources for shelter.
      2. Treat physical injuries.
      3. Document injuries
      4. Supportive, nonjudgmental approach: identify woman’s strengths; help her to accept that she cannot control the abuser; encourage description of home situation; help her to see choices.
      5. Encourage individual and family therapy for victim and abuser.
    6. Evaluation/outcome criteria:
      1. Physical symptoms have been treated.
      2. Discusses plans for safety (for self and any children) to protect against further injury.