Chapter 55: Family Crisis, Maltreatment & Violence

Family Crisis, Maltreatment & Violence nursing chapter explores the profound impact of child maltreatment and intimate partner violence on the family unit, providing foundational knowledge for intervention and prevention in maternal and child health settings. Child maltreatment, which refers to willful injury by one person toward another, is categorized broadly into physical abuse, psychological or emotional mistreatment, neglect (the most frequently reported type), and sexual abuse. Specific clinical manifestations of maltreatment addressed include Abusive Head Trauma (previously known as shaken baby syndrome), which causes whiplash injury and distinct retinal hemorrhages in infants, and Medical Child Abuse (MCA), where a caregiver invents or induces symptoms in a child, often presenting only when the perpetrator is present. The text also examines nonorganic Failure to Thrive (FTT), a serious form of neglect often linked to disturbances in the parent-child relationship resulting in nutritional deficits and potential cognitive impairment. The underlying cause of maltreatment is often explained by a triad of circumstances: a parent with the potential for abuse ("special parent"), a child viewed as somehow "different" ("special child"), and a stressful event or situation ("special circumstance"). Nurses are mandated reporters in most states, obligated by law to report suspected maltreatment, even if the information was shared confidentially. Key nursing responsibilities, guided by the Healthy People 2030 goals and the QSEN competencies, include detailed family assessment, ensuring the victim's immediate safety, identifying nursing diagnoses related to trauma and coping, and implementing interventions like providing support groups (e.g., Parents Anonymous) and educating parents on appropriate growth and development milestones. The chapter further differentiates forms of sexual maltreatment, such as molestation—committed by pedophiles (seeking prepubescent children) or hebephiles (seeking pubescent adolescents)—incest, and rape. Victims of rape frequently experience Rape Trauma Syndrome, characterized by immediate disorganization followed by a long reorganization phase. Additionally, Intimate Partner Violence (IPV) is discussed, noting its high prevalence, especially during pregnancy, and the predictable cycle of violence (tension-building, acute violence, tranquil loving phases), which may lead victims to develop learned helplessness. Prevention through education, early identification of at-risk families, and role modeling healthy coping mechanisms are vital components of the maternal and child health nurse’s role.