Assessing Victims

of Violence
Sherwyn U. Hatab RN.

Sherwyn Uy Hatab RN.

 Violence is an “execution of
force used so as to injure
Violence or abuse” (Merriam-
Webster, 2005).

Sherwyn Uy Hatab RN.

 Family Violence

• Family violence can be defined as the controlling, coercive

behaviors seen through the intentional acts of violence
inflicted on those in familial or intimate relationships and
includes:
 intimate partner violence
child abuse
elder mistreatment.
Sherwyn Uy Hatab RN.
Categories of Family
Violence
• Intimate partner violence (IPV)
includes a range of behaviors
including physical abuse, emotional
abuse, economic abuse,
psychological abuse, and sexual
assault.
• Over time, IPV escalates in both
severity and frequency unless
intervention occurs.

Sherwyn Uy Hatab RN.

 Categories of Family Violence

• Child abuse is “physical or mental injury,

sexual abuse, negligent treatment or
maltreatment of a child under the age of 18
by a person who is responsible for the child’s
welfare under circumstances that indicate
that the child’s health or welfare is harmed.”
(The Child Welfare Information Gateway
2008)
• There are four broad categories of child
abuse: neglect, emotional abuse, sexual
abuse, and physical abuse.

Sherwyn Uy Hatab RN.

 REPUBLIC ACT NO. 9262
• "Anti-Violence Against Women and Their Children Act of 2004.“
• Section 3: definition of terms
• "Violence against women and their children" refers to any act or a series
of acts committed by any person against a woman who is his wife,
former wife, or against a woman with whom the person has or had a
sexual or dating relationship, or with whom he has a common child, or
against her child whether legitimate or illegitimate, within or without the
family abode, which result in or is likely to result in physical, sexual,
psychological harm or suffering, or economic abuse including threats of
such acts, battery, assault, coercion, harassment or arbitrary deprivation
of liberty.
Sherwyn Uy Hatab RN.
Categories of Family Violence

• Elder mistreatment, formerly known

as elder abuse includes physical
abuse, neglect, exploitation,
abandonment or prejudicial attitudes
that decreases one’s quality of life
and is demeaning to those over the
age of 65 years.

Sherwyn Uy Hatab RN.

House Bill 7030
• “Anti-Elder Abuse Act,” principally authored by Rep. Victor Yap of
Tarlac, aims to protect senior citizens from violence. The bill, which
defines elder abuse and prescribe penalties for offenders, was
approved.
• The bill defines elder abuse or abuse against senior citizens as the
following: (a) physical abuse, (b) psychological, mental or emotional
abuse, (c) economic or financial abuse and material exploitation, (d)
sexual abuse or non-consensual sexual contact of any kind, (e)
neglect by refusal or failure to fulfill obligations who has
responsibilities to provide care, as well as (f) abandonment or
desertion by leaving a senior citizen unattended.
Sherwyn Uy Hatab RN.
 Types of Violence

• Physical abuse includes pushing, shoving,

slapping, kicking, choking, punching and
burning. It may also involve holding, tying
or other methods of restraint.
• The victim may be left in a dangerous
place without resources. The abuser may
refuse to help the victim when sick,
injured or in need.
• Physical abuse may also involve attacking
the victim with household items or with
common weapons.
Sherwyn Uy Hatab RN.
 Types of Violence

• Psychological abuse, , also known as

emotional abuse involves the use of constant
insults or criticism, blaming the victim for
things that are not the victim’s fault, threats
to hurt children or pets, isolation from
supporters, deprivation, humiliation, and
intimidation.
• Psychological abuse, has very great
consequences—some believe even more
than the effects of physical abuse (Strauss &
Sweet, 1992)

Sherwyn Uy Hatab RN.

 Types of Violence
• Economic abuse may be evidenced by
preventing the victim from getting or
from keeping a job, controlling money
and limiting access to funds, and
controlling knowledge of family
finances.
• Economic abuse, is the improper
exploitation of another person’s
personal assets, properties, or funds.

Sherwyn Uy Hatab RN.

Types of Violence

• Sexual abuse involves forcing

the victim to perform sexual
acts against her or his will,
pursuing sexual activity after
victim has said no, using
violence during sex, and using
weapons vaginally, orally, or
anally.

Sherwyn Uy Hatab RN.

 • "Sexual violence" refers to an act which is sexual in
nature, committed against a woman or her child. It
includes, but is not limited to:
REPUBLIC a) Rape, sexual harassment, acts of lasciviousness,
treating a woman or her child as a sex object,
ACT NO. 9262 making demeaning and sexually suggestive
Section 3 remarks, physically attacking the sexual parts of
the victim's body, forcing her/him to watch
Definition of obscene publications and indecent shows or
forcing the woman or her child to do indecent
terms acts and/or make films thereof, forcing the wife
and mistress/lover to live in the conjugal home or
sleep together in the same room with the abuser;

Sherwyn Uy Hatab RN.

 b) Acts causing or attempting to
cause the victim to engage in
any sexual activity by force,
Continuation threat of force, physical or
from sexual other harm or threat of
physical or other harm or
violence coercion;
c) Prostituting the woman or
child.

Sherwyn Uy Hatab RN.

THEORETICAL BACKGROUND

• Biological theory asserts

that violence is an
innate characteristic of
humans, based on
neurophysiological
states.

Sherwyn Uy Hatab RN.

THEORETICAL BACKGROUND

• Psychoanalytical theory states that violence results from the

need to discharge hostility. In addition, frustration is the
stimulus that leads to violence or aggression.
• Social learning theory describes both aggression and
violence as learned responses that may be considered
positive or as negative response depending on the situation.
These behaviors are learned from not only the family, but
also from the community and society.
• Some experts purport that cultural attitudes influence
violence Sherwyn Uy Hatab RN.
Assessing Victims of Violence

• Screening for a history of current and past abuse is essential

at the initial and annual visits regardless of the presence or
absence of abuse indicators, and helps to identify mothers
affected by IPV (Barclay, 2007).
• Screen all pregnant women at least once per trimester and
once postpartum (Washington State Department of Health,
April 2004).
• Screen mothers and child during well child visits to the
pediatrician.
Sherwyn Uy Hatab RN.
 Assessing Victims of Violence
• When sexual abuse is suspected, a complete physical examination is
required.
• Often sexual abuse, such as fondling, oral sex, or activity without
penetration, does not involve physical injury.
• If sexual abuse is suspected, a trained interviewer should conduct a forensic
interview.
• Both the interview and physical examination are part of the actual nursing
interventions that assist the client to recover from the sexual abuse.

Sherwyn Uy Hatab RN.

PREPARING YOURSELF FOR THE
EXAMINATION
• Before the nurse can begin to effectively assess for the presence of
family violence, the nurse must first examine own feelings, beliefs,
and biases regarding violence.
• Violence is a prevalent family and community health problem that
needs to be confronted by society today.
• No one under any circumstances should be physically, sexually, or
emotionally abused.
• As a nurse, it is imperative that you become active in interrupting or
ending cycles of violence.

Sherwyn Uy Hatab RN.

INTERVIEW TECHNIQUES

• Creating a safe and confidential environment is essential to obtain

concise and valid subjective data from the clients who have
experienced domestic violence.
• For any client over the age of 3 years, ask any screening questions in a
secure, private setting with no one else present in the room.
• Prior to screening, discuss any legal, mandatory reporting
requirements or other limits to confidentiality.
• Screening may be done orally and in a written format or through
computer generated questions.

Sherwyn Uy Hatab RN.

INTERVIEW TECHNIQUES

• Remember to ask questions and allow the client to answer

completely. Do not interrupt the client. Convey a concerned
and nonjudgmental attitude. Show appropriate empathy

Sherwyn Uy Hatab RN.

ASSESSMENT PROCEDURE
Family Violence Normal Findings Abnormal Findings
Assessment (Indicators of Violence or
Potential Violence)
Review the client’s past No indicators of abuse are Records include
health history and physical present. documentation of
examination records if past assaults; unexplained
available. injuries.
Unexplained symptoms of
pain, nausea and vomiting
or choking feeling.
Repeated visits to
emergency department or
clinic for injuries

Sherwyn Uy Hatab RN.

 ASSESSMENT PROCEDURE
Assessment Procedure
If partner or parent or
caregiver is present at
the visit, observe client’s
interactions with
partner.
Normal Findings
Client does not seem
afraid of partner and
answers questions
independently. partner
appears supportive.
Sherwyn Uy Hatab RN.
Abnormal Findings
(Indicators of Violence or Potential
Violence
Partner attempts to speak for and
answer questions for client.
Partner criticizes client about
appearance, feelings, and/or actions.
Client appears anxious and afraid of
partner; is submissive or passive to
negative comments from partner.
Partner refuses to leave client’s
presence.
 Interview
• A history is obtained only if the
patient has not already talked to a
police officer.
• The patient should not be asked to
repeat the history. Any history of the
event that is obtained should be
recorded in the patient’s own words.

Sherwyn Uy Hatab RN.

ASSESSMENT PROCEDURE: Interview
• Perform the rest of the
examination without the
partner, parent, or caregiver
present.
Sherwyn Uy Hatab RN.
• Ask clients:
Has anyone in your home ever hurt you?
Do you feel safe in your home?
Are you afraid of anyone in your home?
Has anyone made you do anything you
didn’t want to do?
Has anyone ever touched you without
you telling them it was OK for them to do
so?
Has anyone ever threatened you?
ASSESSMENT PROCEDURE
• For intimate partner violence, begin the screening by telling the client
that it is important to routinely screen all clients for intimate partner
violence because it affects so many women and men in our society.
Ask the client to fill out or help the client fill out the Abuse
assessment screen form.

Sherwyn Uy Hatab RN.

Sherwyn Uy Hatab RN.
ASSESSMENT PROCEDURE

If your situation ever

changes, please call me to
If the client replies “no” talk about it. I am happy
Make statements that
to screening questions to hear that you are not
build trust such as:
and is not being abused. being abused. If that
should ever change, this is
a safe place to talk.

Sherwyn Uy Hatab RN.

ASSESSMENT PROCEDURE
• “Yes” to any of the questions strongly indicates initial
disclosure of abuse. The nurse should do the following:
Acknowledge the abuse and her courage.
Use supportive statements such as
“I’m sorry this is happening to you. This is not your fault. You
are not responsible for his behavior. You are not alone. You
don’t deserve to be treated this way. Help is available to
you.”
Reiterate confidentiality of disclosure
Sherwyn Uy Hatab RN.
ASSESSMENT PROCEDURE

• If screening for IPV is positive, ask the client if she has a

safety plan and where she would like to go when she leaves
your agency.
• If the client says she prefers to return home, ask her if it is
safe for her to do.
• Provide the client with contact information for shelters and
groups.
• Encourage her to call with any concerns.
Sherwyn Uy Hatab RN.
ASSESSMENT PROCEDURE
• For elder mistreatment, start out by asking the elder to tell you about
a typical day in their life.
• Be alert for indicators placing the elder at a high risk for abuse or
neglect. Then ask:
Has anyone ever made you sign papers that you did not understand?
Are you alone often?
Has anyone refused to help you when you needed help?
Has anyone ever refused to give you or let you take your
medications?

Sherwyn Uy Hatab RN.

Physical Examination: Clinical Manifestation
• The most common physical injuries seen are:
• Unexplained bruises
• Lacerations
• Abrasions
• head injuries
• fractures.
• The most common clinical manifestations of neglect are: malnutrition
and dehydration

Sherwyn Uy Hatab RN.

Physical Examination
General Survey Normal Findings Abnormal Findings

Observe general Client appears Abused children may

appearance and body stated age and well appear younger than
build. developed. stated age due to
developmental delays or
malnourishment.
Older clients may appear
thin and frail due to
malnourishment.

Sherwyn Uy Hatab RN.

Physical Examination
General Survey Normal Findings Abnormal Findings

Note dress and hygiene Client is well-groomed and Poor hygiene and soiled
dressed appropriately for clothing may indicate
season and occasion neglect.
Long sleeves and pants in
warm weather may be an
attempt to cover bruising
or other injuries.
Victims of sexual abuse
may dress provocatively.

Sherwyn Uy Hatab RN.

Physical Examination
Assessment Normal Findings Abnormal Findings

Assess mental status. Client is coherent and Client is anxious,

relaxed depressed, suicidal, or
has difficulty
concentrating.
Client has poor eye
contact or soft passive
speech

Sherwyn Uy Hatab RN.

Physical Examination
Assessment Normal Findings Abnormal
Findings
Evaluate vital Vital signs are Hypertension,
signs within normal tachycardia and
limits. tachypnia may be
seen in victims of
abuse.

Sherwyn Uy Hatab RN.

Physical Examination
Assessment Normal Findings Abnormal Findings
Inspect skin Skin is clean, dry, Client has scars,
and free of lesions bruises, burns, or
or bruises. swelling on face,
. breasts, arms,
chest, abdomen, or
genitalia.

Sherwyn Uy Hatab RN.

Skin bruising
Sherwyn Uy Hatab RN.
Physical Examination
Assessment Normal Findings Abnormal Findings
Inspect the head Head and neck are Client has hair
and neck. free of injuries missing in clumps,
subdural
hematomas, or
rope marks or
finger/hand
strangulation marks
on neck.

Sherwyn Uy Hatab RN.

Subdural hematoma and Strangulation marks

Sherwyn Uy Hatab RN.

Physical Examination
Assessment Normal Findings Abnormal Findings
Inspect the eyes Eyes are free of injury. Client has bruising or
swelling around eyes,
or a subconjunctival
hemorrhage.
Assess the ears Ears are clean and free Client has external or
of injuries. internal ear injuries.

Sherwyn Uy Hatab RN.

Subconjunctiva hemorrhage
Sherwyn Uy Hatab RN.
Physical Examination
Assessment Normal Findings Abnormal Findings
Assess the Abdomen is free of Client has bruising
abdomen bruises and other in various stages
injuries and is of healing.
nontender. Assessment reveals
intraabdominal
injuries.

Sherwyn Uy Hatab RN.

Physical Examination
Assessment Normal Findings Abnormal Findings
Assess genitalia Client is free of Client has irritation, tenderness,
and rectal area. injury. bruising, bleeding, or swelling of
genitals or rectal area.
Discharge, redness, or lacerations
may indicate abuse in young children.
Hemorrhoids are unusual in
children and may be caused by sexual
abuse.
Extreme apprehension during
examination may indicate physical or
sexual Abuse

Sherwyn Uy Hatab RN.

• Dried semen stains (appearing as crusted, flaking
areas) on the patient’s body or clothes

Sherwyn Uy Hatab RN.

Physical Examination
Assessment Normal Findings Abnormal Findings
Assess the Client shows full Dislocation of
musculoskeletal range of motion shoulder; old or
system. and has no new fractures of
evidence of injuries face, arms, or ribs;
and poor ROM of
joints are indicators
of abuse

Sherwyn Uy Hatab RN.

Sample Subjective Data Documentation

• Client reports injuries to head, neck, and breasts. States, “I

am having difficulty talking.” Shares that she was beaten with
a plastic ball bat on her head; denies any loss of
consciousness. Reports pain and soreness of her neck and
pain when speaking after being choked with a cord. Also
reports multiple bites and bruising on both breasts. States,
“This has happened on a number of occasions for the past 3
years.” Denies any witnesses for any of the events.

Sherwyn Uy Hatab RN.

Sample Objective Data

• Ears: right tympanic membrane scar noted at 3 o’clock

position; Eyes: conjunctival hemorrhage bilaterally;
Neck: circular pattern of bruising and abrasions noted
around the neck. Chest: respiration regular, 20 per
minute; Breasts: right nipple, red, swollen with
multiple abrasions noted around the areola;
Abdomen: multiple bruises noted at various stages of
healing
Sherwyn Uy Hatab RN.
Presidential Decree
No. 169, s. 1973
• THE ATTENDING PHYSICIAN OF
ANY HOSPITAL WHO HAS
TREATED ANY PERSON OR
PERSONS OF SERIOUS PHYSICAL
INJURIES AS DEFINED IN ARTICLES
262, 263, 264 AND 265 OF THE
REVISED PENAL CODE SHALL
REPORT SUCH TREATMENT TO
THE PHILIPPINE CONSTABULARY
(PNP).
Sherwyn Uy Hatab RN.