Chapter 28: Child, Older Adult & Partner Violence

The complex public health crisis of family violence, or domestic violence, is explored in depth, identifying that nurses are uniquely positioned to recognize, evaluate, and treat both those who abuse (perpetrators) and those who are abused (vulnerable persons or survivors). The chapter outlines various forms of mistreatment, including physical, sexual, emotional, economic, and neglect (an act of omission). Perpetrators are often characterized by poor social skills, self-centeredness, and a need for control, while acute violence may be triggered by external crises or substance misuse. Specific populations are examined: in child abuse, neglect is the most common form of maltreatment, and the youngest children are the most vulnerable. Intimate partner violence (IPV) frequently follows a predictable cycle encompassing tension-building, acute battering, and a temporary "honeymoon" period, and victims are at greatest risk when threatening to leave. Older adult abuse, which includes significant financial exploitation, is often difficult to uncover due to the victim’s dependency and fear of retaliation. The nursing process emphasizes mandatory screening of all patients in private, using non-threatening, open-ended questions to gather data on types of abuse, anxiety levels, coping mechanisms, and potential for suicide or homicide. Interventions focus critically on safety planning, which includes helping survivors recognize escalation signs, identify escape routes, and compile essential documents for leaving. Prevention efforts are categorized into primary measures (reducing risk factors and stress), secondary measures (early intervention and screening), and tertiary measures (healing and rehabilitation through support and legal advocacy). Therapeutic modalities for survivors aim at empowerment and healing from trauma symptoms like PTSD and depression, while therapy for perpetrators is most effective when court-mandated and focused on changing destructive behavioral patterns.