Substance abuse as a community health problem.

Violence and nursing response.

Read chapters 26 and 27 of the class textbook and review the attached PowerPoint presentations. Once done answer the following questions.

Discuss the historical trends and current conceptions of the cause and treatment of substance abuse.
Identify and discuss the issues related to substance abuse in various populations encountered in community health nursing practice.
Describe and discuss the concepts of interpersonal and community violence.
Describe and discuss the role of the nurse in primary, secondary and tertiary prevention of violence.

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 6 discussion questions” and the SafeAssign exercise in the assignment tab of the blackboard. If you don’t post your assignment in any of the required forums you will not get the points. A minimum of 2 evidence-based references besides the class textbook no older than 5 years must be used (excluding the class textbook). You must post two replies to any of your peers on a different dates sustained with the proper references no older than 5 years as well and make sure the references are properly quoted in your assignment. A minimum of 800 words is required. Please make sure to follow the instructions as given and use either spell-check or Grammarly before you post your assignment.

Please check your assignment after the week is due because I either made comments or ask for clarification in some statements.

Chapter 27

Violence

Overview of Violence

Violence is a national public health problem.

WHO (2013) defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”

Injuries from violence are referred to as intentional injuries.

2

Factors That Contribute to Violence

Poverty, unemployment, economic dependency

Substance abuse

Dysfunctional family and/or social environment and lack of emotional support

Mental Illness

Media influence (e.g., violent video games, television shows, and movies)

Access to firearms

Political and/or religious ideology

Intolerance and ignorance

3

History of Violence

Long history of human violence.

In the Bible, Cain killed his brother Abel out of jealousy and anger

Audience pleasure (e.g., gladiators in Rome)

Infanticide—if child was female, a twin, sickly, or deformed

Children, especially firstborn, sacrificed for religious reasons

4

History of Violence (Cont.)

Corporal punishment used to control children

“Spare the rod and spoil the child” (Proverbs, 13:24)

“Beating some sense into him”

First legal protection in the United States in 1874

Spousal abuse/marital rape

“Rule of thumb”

“Wives be subject to your husband” (Ephesians, 5:22)

Assault against women not explored until 1960s

Elder abuse

Often undetected because of lack of awareness of HCP

Lack of mandatory reporting

5

Interpersonal Violence

Crosses all ethnic, racial, socioeconomic, and educational lines

Interpersonal Violence (IPV) is about control, not anger.

Includes:

Homicide and suicide

Intimate partner violence

Child maltreatment

6

Interpersonal Violence: Homicide

Homicide

One of the leading causes of death in the United States.

For black males aged 15 to 34, homicide is the leading cause of death.

Young people, women, and African American and Hispanic males at higher risk than the general population.

African Americans were more likely to commit homicide than whites and were more likely to be victims of homicide than whites (2010 data)

7

Interpersonal Violence: Suicide

Suicide is 10th leading cause of death for all Americans in all age groups (2010)

More people die from suicide than homicide.

Men often use firearms.

Women use poisoning.

In Native Americans and Alaska Natives, suicide is the second leading cause of death in persons 15 to 34 years of age.

8

Interpersonal Violence: Suicide (Cont.)

Risk factors for suicide

Psychiatric disorders such as major depression, bipolar disorder, and/or schizophrenia

Substance abuse

Posttraumatic stress disorder (PTSD)

Bulimia or anorexia nervosa

Past history of attempted suicide

Genetic disposition to suicide

Age, such as elderly, and white males (highest rate)

9

Interpersonal Violence: Partner

Intimate partner violence (IPV)

A pattern of coercive behaviors perpetrated by someone who is or was in an intimate relationship with the victim

May include battering, resulting in physical injury, psychological abuse, and sexual assault to progressive social isolation and intimidation of the victim

Typically repetitive and often escalates in frequency and severity

10

Interpersonal Violence: Partner (Cont.)

Risk factors for IPV

Low self-esteem

Poverty

Risky sexual behavior

Eating disorders and/or depression

Substance abuse

Trust and relationship issues

Victims often suffer in silence and accept abuse as a transgenerational pattern of normal behavior

11

Interpersonal Violence: Partner (Cont.)

Pregnancy

May increase stress within the family

All pregnant women should be routinely screened for abuse for commons sign of IPV

Delay in seeking prenatal care

Unexplained bruising or damage to breasts or abdomen

Use of harmful substances (cigarettes, alcohol, drugs)

Recurring psychosomatic illnesses

Lack of participation in prenatal education

12

Interpersonal Violence: Dating

Abusive, controlling, or aggressive behavior in an intimate relationship that takes the form of emotional, verbal, physical, or sexual abuse

May involve the use of date rape drugs

Studies have linked alcohol with dating violence

Stalking—a pattern of repeated and unwanted attention, contact, harassment, or any type of conduct directed at a person that instills fear

Bullying—a repeated oppression, psychological or physical, of a less powerful person by a more powerful person or group of persons

13

Wheel of Power and Control

14

Figure 27-1

Developed by the Domestic Abuse Intervention Project. 206 West Fourth Street, Duluth, MN 55806. Used with permission.

Impact of Interpersonal Violence

Victims often experience…

Chronic fatigue and tension

Disturbed sleeping and eating patterns

Vague gastrointestinal and genitourinary complaints

Misdiagnosis often occurs because of the obscurity of symptoms and/or failure to adequately assess

Victims stay in abusive relationships because of cultural, religious, and economic factors

15

Impact of Interpersonal Violence (Cont.)

Victims who are most likely to leave a battering situation:

Have resources and power

No children

No personal history of abuse (themselves or their mother)

Most dangerous time for victim is when he or she leaves or attempts to leave the relationship

More likely to be killed at this time than any other time in the relationship

16

Interpersonal Violence: Child

Child maltreatment

Most child maltreatment occurs within the family.

More often abused by parents than other relatives or caregivers.

More commonly seen in families in poverty, families in disorganization, or with parents who are younger and who are substance abusers.

17

Interpersonal Violence: Child (Cont.)

Child maltreatment

Risk factors include but are not limited to

Special needs children

Children less than 4 years of age

Family history of violence

Substance abuse

Poverty

Social isolation

18

Interpersonal Violence: Child (Cont.)

Child maltreatment

Four types of child abuse:

Neglect

Physical abuse

Includes beating, burning, biting, and bruising

Abusive head trauma/shaken baby syndrome is leading cause of death in the United States from abuse

Emotional abuse

Sexual abuse

19

Interpersonal Violence: Elderly

Elder abuse

Society fails to recognize the cruelty many older adults experience.

Elders are an “invisible” segment of the population.

Reasons for underreporting of elder abuse

Shame on part of victim

Social and physical isolation from resources

Failure of health care provider to routinely assess during points of contact

No uniform reporting system

20

Interpersonal Violence: Elderly (Cont.)

Elder abuse

Types of abuse and neglect

Physical abuse

Psychological-emotional abuse

Sexual abuse

Neglect

Financial exploitation

Health care fraud and abuse

21

Community Violence

Community violence usually occurs suddenly and without warning and can potentially destroy entire segments of the population

Community violence includes

Workplace violence

Youth violence

Gang-related violence

Hate crimes

Terrorism

22

Community Violence: Workplace

Risk factors include:

Increasing number of acute and chronically mentally ill patients

Working alone

Availability of drugs at worksite

Low staffing levels

Poorly lit parking areas and corridors

Long waits for service

Inadequate security

Increasing number of substance abusers

Access to firearms

23

Workplace violence includes physical assaults, muggings, and verbal and written threats

Community Violence: Youth

Youth-Related Violence

Concentrated in minority communities and inner cities, causing a disproportionate burden on these communities

Adolescents and youth increasingly use violence to settle disputes.

Even when taught peaceful ways of resolving differences, learn by what they observe at home, on television, and in movies.

Schools have become common sites for violence.

24

Risk Factors for Youth Violence (from Textbook, Table 27-3)

25

Individual Risk Factors	Community Risk Factors
Involvement with drugs, alcohol, or tobacco	Diminished economic opportunities
Antisocial beliefs and attitudes	High concentration of poor residents
Low IQ	High level of family disruption
History of violent victimization	Low levels of community participation
History of early aggressive behavior	Socially disorganized neighborhoods

Risk Factors for Youth Violence (from Textbook, Table 27-3—Cont.)

26

Individual Risk Factors	Community Risk Factors
Attention deficits, hyperactivity, or learning disorders	High level of transiency
Poor behavioral control
Deficits in social, cognitive or information-processing abilities
Exposure to violence and conflict in the family
High emotional distress
History of treatment of emotional problems

Risk Factors for Youth Violence (from Textbook, Table 27-3—Cont.)

27

Family Risk Factors	Peer/Social Risk Factors
Poor family functioning	Association with delinquent peers
Low emotional attachment to parents of caregivers	Involvement in gangs
Low parental education and income	Social rejection by peers
Parental substance abuse or criminality	Lack of involvement in conventional activities
Poor monitoring and supervision of children	Poor academic performance
Harsh, lax, or inconsistent disciplinary practices	Low commitment to school and school failure
Authoritarian childrearing practices

Community Violence: Gangs

Reasons that young people join gangs:

Believe that gangs will protect them

Peer pressure

The need for respect

A sense of belonging

Increasingly responsible for crimes and violence throughout the United States

Crimes include illegal alien smuggling, armed robbery, assault, auto theft, drug and weapon trafficking, identity theft, and murder.

28

Community Violence: Prison

Prison violence

The United States has one of the world’s highest rates of incarceration

Inmates are both victims and perpetrators of violence.

Includes allegations of physical abuse and reports of rape by corrections officers and inmates

Little sympathy for this population for a variety of reasons, including indifference, disbelief, and denial

29

Community Violence: Trafficking

Human trafficking is a global problem and a public health issue.

Involves:

Prostitution

Sexual exploitation

Forced labor

Slavery

Removal of organs

30

Community Violence: Hate Crimes

Crimes in which offender is motivated by

An individual’s race*1

Sexual orientation*3

Religious beliefs*2

Ethnic background

National origin

*Rank—most commonly reported

Hate crimes may include

Murder

Rape

Sexual or physical assault

Harassment

Attacks on homes or on places of worship

Vandalism

31

Community Violence: Terrorism

“The calculated use of unlawful violence or threat of unlawful violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological.”

(Department of Defense)

All terrorist acts include at least three key elements—violence, fear, and intimidation.

32

Factors Influencing Violence

Firearms

A gun in the home…

…triples the risk for homicide in the home

…increases the risk for suicide 3 to 5 times

…increases risk for accidental deaths by 4

Firearms are the number one weapon of choice in homicides in the United States.

Direct and indirect costs are staggering.

“Right to bear arms” arguments persist.

33

Factors Influencing Violence (Cont.)

Media violence includes exposure to and participation in …

…violent video games

…music and music videos that depict date rape or violence

…virtual violence that allows subscribers to harm or kill victims

Repeated exposure to media violence leads to emotional desensitization to real-life violence

34

Factors Influencing Violence (Cont.)

Mental illness is considered by many to be a major factor in violence.

Studies are inconclusive that all violence is committed by mentally unstable persons.

Increasing push for legislation to fund public health strategies that identify and treat mental illness across the country

Funding issues have forced states to eliminate or reduce availability of mental health services

35

Violence Is a Public Health Epidemic

The public health system is challenged to go beyond its traditional programs to include prevention and management of violence.

Efforts being made with

Public health strategies

Community approaches

Local, state, and federal governments

Addressed by Healthy People 2020

36

Prevention of Violence: Primary Prevention

Goal: to stop violence, abuse, or neglect before it occurs

Education may include life skills training:

Parenting and family wellness

Anger management

Conflict resolution

Nurses should:

Increase awareness of violence

Identify cases

Work with the community

37

Prevention of Violence: Primary Prevention (Cont.)

Must begin at community level to change attitudes

Focuses on stopping transgenerational aspect of abuse

Start with young children

Continue across the lifespan

Mentoring and peer programs to promote healthy relationships and decrease conflict

Work with high-risk individuals

38

Prevention of Violence: Secondary Prevention

Goal: assess, diagnose, and treat victims and perpetrators of violence.

Consideration of safety of potential victim is critical

Begins with assessment

Once identified, victims must be offered…

Resources to increase their safety

Legal options and how to access them

39

Prevention of Violence: Secondary Prevention (Cont.)

Nurses must screen for abuse. Ask questions

Within the last year, have you been hit, slapped, kicked, or otherwise physically hurt by someone?

Since you’ve been pregnant, have you been hit, slapped, kicked, or otherwise physically hurt by someone?

Within the last year, has anyone forced you to have sexual activities?

Intervene when essential

Interdisciplinary approach leads to optimal outcomes.

40

Prevention of Violence: Tertiary Prevention

Goal: Aimed at rehabilitation of individuals, families, groups, or communities and includes both victims and perpetrators of violence

May take months or even years

Nurses must work in conjunction with a variety of mental health professionals and social service agencies to provide coordinated care

Self-care and recognition of own limitations and needs

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Substance abuse as a community health problem.

Substance abuse as a community health problem.

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