Trauma and violence

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  1. Effects of violence
    • emotional violation
    • trauma
    • loss of trust and loss of control
    • emtional reactions vary greatly accordfing to the individual, situation, and how the violence is perceived
  2. Types of abuse
    • workplace violence
    • verbal abuse
    • sexual harassment
    • physical abuse
    • emotional abuse
  3. Typical reactions to violence
    • denial
    • fear
    • anger
    • powerlessness
    • depression
    • sense of failure and guilt
    • ashamed and unworthy
  4. recovery from abuse and trauma (impact)
    • can last from a few minutes to days according to the severity of the trauma and how it is internalized
    • initial since of shock
    • Common response:
    • shock
    • denial
    • disbelief
    • confusion
    • there might also be fear, hysteria, horror, anger, rage, shame, guilt, a sense of helplessness and vulnerability

    • Physiologic responses:
    • disturbed sleeping, eating
    • may look calm organized and rational
    • later victims might have dissociative symptoms
    • amnesia
    • depersonalization
    • numbing detachment
    • night mares
    • flashbacks
    • severe anxiety
    • (these are all signs of acute stress disorder)

    Interventions: use clear simple direction, number 1 emotional and physical saftey resotre elequliberum
  5. recovery from abuse and trauma (recoil)
    • struggle to adapt, inital fear is over, great deal of emotional stress remains
    • struggle to adapt

    may look and act normal and are able to carry out daily routines at home and work

    activity supress fears, anger, and sadness

    later desire to talk about all the details and feelings of what happened

    need for support

    fantasies of revenge for the crime are natural during this stage

    become aware of the impact of the crime on their lives
  6. recovery from trauma (reorganization)
    • Might take months to years
    • reviewing and organizing what happend and why

    • "Why me"
    • "Why did act the way I did then and since then"
    • regaing sense of control and self-protection
    • GOAL: Move to survivor status
  7. Nurse-patient relationship during the stages of recovery from trauma
    impact stage: focus on survivor's physical safety and emotional security

    recoil stage: need for validation or worth and rights referrals can be made to victims assistance programs, support groups (short term : 6-8weeks, or long term)

    reorganization: appropriate humor might be good here to decrease the anxiety goal is to move to survivor status
  8. Terroism
    • biologic and chemical warfare
    • large-scale bombings
    • other disasters
    • involves anyone who witnessed the tragedy (directly or through the media
    • GOAL: regain some sense of trust, safety, and secutiry whil acknowledging that future terrorist attacks are possible
  9. Torture, ritual avuse, mind control and human trafficking
    involves physical, psychological, pharmacologic, mind control, sexual manipulation or any combination of these aimed at damaging the victims identity, personality, emotional stability, spirit and physical integrity

    effects: injury to the head, teeth, and genitals, as well as bone fractures, dislocations, scars, burns, pain, cronic headaches, and forced pregnancies/abortions, malnutrition, damaged relationships

    are more severe and longer lasting than those caused by other crimes

    • dehymanization, humiliation, horrificarion, compulsive spending, guilt about harming others or animals, identity and personaility changes
    • trauma specific fears: small dark places, nuditiy hypersexuality and obsession with rituals

    • Goals:
    • decreasing and eventually eliminating self-destructive behaviours
    • developing emotion management skills and acknowledging the thoughts, feelings, and behaviour as normal reactions to abnormal situations
    • expressing and dealing appropriately and safely with the intense emotions, especially anxiety, guilt, anger, rage, and desire for revenge
    • becoming aware of suppressed or repressed thoughts oand feelings, positive emotions, and body memories and reactions
    • allowing oneself to grieve
    • developing or reestablishing healthy relationships with family, friends, and the community
    • regaining a sense of hope, personal power, and control over oneself and one's life
  10. specific responses resulting from terrirism, torture, serial rital abuse, mind control and human trafficking
    these are all on the chart 39-1 page 438 in the psychiatric nursing book a person may act out with impulsive behaviours, hypersexuality, fear, anxiety, suicidal or homicidal ideation, self mutilation, they may be suspious of others, parinoid
  11. Rape and sexual assult
    • Rape involves forcible penetration of the victims body by the perpertators penis, fingers, or object without consent
    • any other form of forced sexual contact is considered sexual assult

    • not sexually motivated it is a desire for power and control, a wish to hamiliate the victim, and the playing out of sexual fantasy
    • effects: similar to other crimes (impact, recoil, reorganization)

    • Rape trauma symptoms:
    • sleep disturbances, nightmares,, loss of apppetite, somatic symptims, fears, anxiety, phobias, suspicion, decreased activities, motivation, disruption in relationships with partner, family, friends, self-blame, lowered self-esteem, feelings of worthness
    • number one goal is to make the victim feel safe
  12. Childhood sexual abuse
    • not usually one time occurrence and perpetrators are known and trusted
    • non violent
    • use of coercion
    • maintian the secret (family affair, use fear to force the child to keep the secret)

    • interventions: contract for safety
    • set limits on self-destruction or self-harm patterns
    • establish a trusting environment
    • accept feelings and reactions as normal
    • ask permission before touching suvivors
    • reinforce recovery is possible
    • educate about recovery processes
    • assist understanding of current behaviors
    • facilitate reevaluation of sexual abuse, circumstances, and effects but do not pressure survivor to talk about them
    • discuss safeguarding other children
    • support choices about disclosures, confrontation, or reporting the incident
    • be aware of family members and others split loyality
    • decrease feelings of isolation shame, and stigma
    • encourage self-acceptance
    • management of anger and stress management
    • limit acting out of revenge fantasies
    • change from victim to survivor status
    • refer to chart on page 448 key nursing interventions for survivors of child hood abuse
  13. Effects of sexual abuse on the child
    • disturbed growth and development
    • ambivalence (no emotion)
    • denial
    • sleep and eating disorders, anxiety, aggersssion, poor impulse control, running away and truancy
  14. Effects of sexual abuse on the adolescent
    • dysfunctional coping
    • acting-out
    • violence
    • self-mutilation
    • suicide attempts
    • running away
    • prostitution, early marriage and early pregnancy
    • regression, disassoiation
  15. Effectes of sexual abuse on adults
    • Chart 39-1 page 445
    • memory disturbances
    • keeping unnesessary sevrets
    • relationship issues
    • body symptoms (vague and transient pains, memories of physical pain, chronic pain, or migraine headaches gagging, nausea,vomiting, negitive body image ect...)
    • anger issues
    • anxiety issues
    • addiction issues
    • intrusive thoughts and memories
    • detachment issues
    • control issues
    • identity issues
    • sexual issues
    • self-punisment
    • other feelings (low self-esteem, guilt, shame, fear of feelings, feeling stuck, feeling of failure, frozen emotions ect...)
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Trauma and violence
2011-11-09 15:33:36
childhood adolescent disorders

Trauma and childhood and adolescent disorders
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