Abuse Slideshow Transcript
Slide 1: Maladaptive Behavior Patterns— personality disorders and abuse What sort of future is coming up from behind, I really don’t know. But the past, spread out ahead, dominates everything in sight. R.M Pirsig from Zen and the Art of Motorcycle Maintenance
Slide 2: People with Personality Disorders have long term: Low frustration tolerance Pain intolerance Over reaction to life events Lack of impulse control Immature coping strategies (over use of defense mechanisms) Impaired personal relationships
Slide 3: Nursing Issues with all PD: Balance in your expectations for change —hope, but not a quick fix Be authentic, patient, trustworthy Have good limit setting skills Have good ego boundaries Have good team communication, to decrease splitting
Slide 4: The Odd/Eccentric Group: Schizoid, Paranoid, Schizotypal Some nursing issues include: ineffective individual coping social isolation defensive coping
Slide 5: Paranoid Personality D/O Fear others will harm or exploit Hypervigilant and tend to be hostile (as a response to perceived threat) Can become psychotic if stressed Nursing—be consistent, truthful, out in the open. Approach with care and tell what is happening, what you are doing
Slide 6: Schizoid Personality D/O Doesn’t want relationships Flat affect, little emotion seen, not aware there is a problem with this Few relationships, can become delusional if stressed Nursing-build trust slowly, consistent, not overly emotional or smothering
Slide 7: Schizotypal PD Has social anxiety. Wants relationships but not skilled at getting them. Often has eccentric thinking and/or behavior Nursing-be consistent, trustworthy, keep clear boundaries, help ct. with very gradual change in social bx.
Slide 8: Dramatic/ Emotional PDs Includes Antisocial, Borderline, Histrionic, and Narcissistic Focus more study energy on Antisocial and Borderline Sample nursing diagnoses include: Altered family process, ineffective individual coping, self mutilation, risk for violence, low self esteem
Slide 9: Antisocial PD (more men) Feels entitled, acts charming to get way Deceitful, manipulative, vengeful Seeks risks, stimulation (drugs, sex, crime, gambling) Has no conscience or empathy Irresponsible and unsafe
Slide 10: Borderline PD (more women) Overwhelmingly emotionally needy, despairing. Angry, dysphoric, labile Lives in a crisis and creates a crisis if too calm Abandonment issues are key Self destructive behavior and mutilation occur Splitting, dichotomous thinking
Slide 11: Histrionic PD Dramatic, flambouyant Charming, intense, but shallow in relationships Center of attention, if not gets upset and creates stir May have dramatic ups and downs.
Slide 12: Narcissistic PD Self absorbed and self centered Overestimates own self worth as a defense to cover self doubt Grandiose. Wants attention, praise, admiration. If this doesn’t happen, becomes upset/angry/vengeful Very critical. Little tolerance for imperfection
Slide 13: Anxious and Fearful PD: avoidant, dependent, and obsessive compulsive Of all three, dependent is most common Nursing diagnosis can include: Self esteem disturbance Anxiety Hopelessness powerlessness
Slide 14: Avoidant PD Often co-occurs with social phobias See social isolation Very sensitive to criticism and afraid of being judged negatively Feels rejected a lot, fears being rejected Low self esteem
Slide 15: Dependent Personality D/O Passive, submissive, self sacrificing Few self initiated behaviors Little decisionmaking Tolerates maltreatment, being bossed Urgent need to be in relationship in which someone else is in control
Slide 16: Obsessive Compulsive PD R/t OCD Thrifty, saving, verbose, organized Critical of self and others Rigid emotionally; taskmasters, have a hard time expressing emotion
Slide 17: Abuse: Incidence is high 1.8-2.9 million battered women each yr in US. Battering is single most common cause of injury to women. 8% women are battered before or during pregnancy. 2 million reported cases of child abuse each yr in US (2000-5000 die) 0.5-1 million cases of elder abuse in US yearly.
Slide 18: Why abuse continues ( a few reasons) Society legitimizes violence and privacy Intergenerational –acting like we have seen growing up Structural inequality of abused persons Stockholm syndrome (discuss)
Slide 19: Power and Control Issues- ways abusers act Threats and coercion Economic restriction Intimidation(pets, weapons, breaking) Emotional abuse Isolate the abused person Denial Threaten loved ones (esp. children)
Slide 20: Cycle of Violence Tension building—tension, blaming, aggression in abuser Abuse (battering) episode—acute episode of abuse Calm/honeymoon—acts calmer, nicer, may apologize/gifts/promises. In severe abuse this may be minimal
Slide 21: Myths that create problems in stopping abuse If it weren’t for drugs If the abuse was that and alcohol, the abuse bad the victim would tell wouldn’t have occurred or get out Victims are lying or Victim deserves it exaggerating to get Abuse only occurs attention among the poor and Batterers are uneducated uneducated men who can be spotted easily Families should be kept Families should always together at all costs be kept together
Slide 22: Abusers typically: Low frustration Victims of abuse in tolerance youth Angry, violence Lack empathy, and focused minimize Attribute failure to seriousness of abuse others’ behavior Controlling Traditional views Jealous Often alcohol/drug Impulsive abuse
Slide 23: Some Assessment findings that hint at abuse: Alcohol or other Frequent ER visits drug abuse Withdrawn/depresd One car accident Inconsistent physical Delay in seeking findings medical care Multiple suicide Injury to head, attempts sexual organs Overprotective Injuries in various family member stages of healing
Slide 24: Some assessment questions What happened? Are you involved in an abusive Have you been in a fight? Tell me about relationship? Tell me it. about it. The injuries you have look like the kind I have seen when___. Have you been hurt in this way?
Slide 25: Some nursing interventions Make time and If abuse is privacy to talk suspected but Listen and validate, denied, give info not judge anyway (privately) Document Assist with practical impartially and needs completely Remember the legal Ask. Don’t assume issues involved with info will be offered children and elders
Slide 26: Educational Interventions Cycle of violence Community resources Danger of homicide, esp re leaving the abuser Safety planning Self esteem issues—redefine self as the survivor
Slide 27: Safety Plans-a few basics Cash, checks, keys, credit card, essentials bag, hidden out of home Copies of all vital docs hidden out of home Code system, older kids involved Route of escape, tell trusted people
Slide 28: Security Plan if you leave Bring kids with you or go back for them with police Lock everything, all the time Private mail/phone Picture of abuser to people who may see Don’t keep it a secret, it is not your fault
Slide 29: Some other Intervention Issues Be wary of marriage counseling, people who advise to stay with abuser, abusive parent at all costs Note, there are mandatory reporting laws for children and elders. Can’t heal trauma well when still under future risk. Safety is paramount.
Slide 30: Post-traumatic Stress Disorder Exposure to trauma Re-experiencing traumatic event Numbing Avoidance of reminders of event Anxiety/arousal responses Distress in important areas of functioning
Slide 31: Re-experiencing the event Intruding reminders/memories/flashbacks Nightmares Acting or feeling like the event(s) re- occurring Leads to anxiety and acute distress
Slide 32: Types of Avoidance Thought/feelings/conversations about the event Stays away from people and places associated with event Repression Lack of participation with others, detachment, short sense of future
Slide 33: Treatment of PTSD Antianxiety agents for short term relief Antidepressants, particularly SSRI’s At risk for developing substance abuse due to self-medication for distress
Slide 34: Rape-types Blitz rape—out of the blue, fast Confidence rape—more of a set up involved, may know victim and repeat, use threats Inability to consent issue— Aggression or Sexual Expression?
Slide 35: Rape Intervention-a few points Collecting Evidence while maintaining dignity, respect in initial response Privacy, time to talk, one to one contact, rape counselor, follow up Anticipatory Guidance Community Resources
Article copyright NurseReview.org - #1 source of information to update nurses all over the world. All rights reserved. No part of an article may be reproduced without the prior permission.