Understanding Interpersonal Violence and Its Impact on Health

8.1 Overview

rview | 8.2 Objectives | 8.3 Preparing | 8.4 Practicing | 8.5 Reflecting | 8.6 References 8.1 Overview From schoolyard bullying to electronic stalking to domestic homicide, interpersonal violence is significant issue. Interpersonal violence has a significant impact on the health of individuals, families, and communities. The World Health Organization (WHO) considers violence to be a major and growing health problem and has made recommendations for violence prevention aimed at local, national, and international levels (Krug et al., 2002). As a nurse, it is critical for you to understand this universal issue. It is important for you to be able to move from recognizing what interpersonal violence "looks like" day-to-day, in your nursing practice to an understanding of the impact of interpersonal violence on the health of people around the world. The ability to achieve this understanding is based in your ability to articulate and analyze this complex, global issue. 8.2 Outcomes After completing this unit, you should be able to describe the types of interpersonal violence; give an example of each type; describe the context of interpersonal violence in your province; identify the position of your provincial nurses association on interpersonal violence; understand the importance of the issue of interpersonal violence in the context of your nursing practice; and use a framework to analyze this issue. 8.3 Preparing Think of a time in your nursing practice when you felt unsafe. In your nursing practice, in hospital, have you ever entered a patient's room and felt unsafe? In your nursing practice, in the community, have you ever entered a client's home and felt unsafe? What did you see and what did you hear that may have contributed to you feeling unsafe? What else did you notice that may have contributed to you feeling unsafe? In your Learning Journal (Word .doc file), write about this experience. Nurses often become interested in a particular topic or issue as the result of a critical incident in their nursing practice. Read the following story about a public health nurse and her nursing practice with a vulnerable family. As you read the story consider the following questions: What might be some signs that interpersonal violence could be occurring between David and Joanna? What might be some of the factors placing Joanna at risk for interpersonal violence? If you were the RN in this scenario, what might you have done differently? If you were the RN in this scenario, what might you have done the same? It was a busy day in an inner city community health clinic. As I scanned the waiting room between appointments, I could see a family that was very clearly struggling. Both parents looked extremely tired, their clothing was soiled and tattered. The baby seemed to be sick; her nose was running. On the bright side, the pre-school aged boy was active and seemed to be enjoying the toys in the clinic but, he was quite rambunctious knocking over other children as played. The parents stood off to the side, away from the other parents who were visiting with one another and chatting about their babies. I called this family to the clinic room; the intent for the visit was to vaccinate the four year old son and the eight month old daughter. As I attempted to obtain a vaccination history for the children, I was struck by some unusual patterns in our communication. The father answered all of my questions; he alone responded to me. Even though I felt I was skilled at engaging families in conversations, I was unable to engage the mother into this conversation. When I directed my questions towards the mother, the father answered. I was taken aback by his tone of voice, it seemed to be just a little more than assertive. The mother looked down, at her toes, for almost the entire clinic visit. Despite a lengthy visit, I was unable to vaccinate the children. I was unable to obtain a suitable vaccination history and in consult with my supervisor, it was decided that I would follow up with this family with the goal of vaccinating these children, at a later date. I was also relieved about this because I sensed this family was struggling; I hoped I could develop a rapport with them. They were new to the city having just moved from out of province two months ago. I was hoping to assist them to access services they might need. I wondered if they needed help with access to early intervention for the pre-schooler, or to the milk fund or the food bank or other services I knew were available in the community. I attempted to contact the family by phone shortly after the clinic visit. The phone was disconnected. I decided I would drop by for a home visit. I tried this several times as I was out nursing in the community; the family was never at their apartment. Each time, I left my card with my name and number in the mailbox. Once or twice, Joanna, the mother, initiated contact and called me back while I was in the office. We had short, "clipped" conversations and although I tried to steer the conversation towards how the children were doing and the possibility of vaccination, the conversations always ended abruptly and if the issue was broached, we never quite arrived at a clear "plan" involving another clinic visit. During one short phone conversation, Joanna confided to me that she was four months pregnant. Our conversation ended prior to my being able to assess how she was doing and what assistance she might need. I wondered to myself, "What exactly does she need? Why does she call and then abruptly hang up? How can I help this family?" After several weeks and in consultation with my supervisor, it was decided that I would try one final drop-in visit. If the family was not at home, I was to close the file and label it "lost to follow up." I dropped by the apartment. The father, David answered the door. I asked if Joanna was at home and he said "No" and that she had "gone away for awhile." He stated that the children had been "taken away" [by Children's Services] and he was hoping that I might help him "get them back." In my assessment, David appeared to be under the influence of drugs and/or alcohol. I felt unsafe to ask any probing questions about Joanna's whereabouts; I quickly ended the visit by giving my card to David. I asked him to call me if he needed any assistance when Joanna and the children returned. In consultation with my supervisor, it was decided that I would no longer drop by and visit this family; they were labeled "lost to follow-up." Weeks later on the front page of the newspaper there was a headline about a man murdering his partner in their apartment. These allegations involved Joanna and David. Joanna was the victim of a violent and deadly assault and David was the sole suspect. As a community health nurse involved with this family, I was profoundly shaken by this event. I was plagued with self-doubt regarding my nursing practice, I wondered "What did I miss? What might I have done to prevent this tragedy?" The "newsreel" in my head went around and around replaying the few contacts I'd had with this vulnerable family. The "fallout" from my involvement with this family went on for years. I was interviewed by homicide detectives; I was a witness in a child custody court case for the children. As a result of my involvement with this family, I have become more educated on the topic of violence. I have shared my knowledge with many RNs and student nurses through in-services and classroom sessions. I have a strong belief that it is important to assess for violence across nursing practice settings. If all RNs in all practice settings are aware of the risk factors, are willing to assess for these risk factors, and are willing to refer people to services for violence prevention this will add to efforts towards the prevention of tragedies with families, such as the one described here, and over time, on a more global level. Required Reading From your textbook, read the following chapter: Interpersonal violence and abuse: Ending the silence. When addressing the issue of interpersonal violence it is critical to be aware of your feelings about and previous experiences with violence and abuse. By understanding your personal context for violence and abuse you will be better able to assist patients and clients in your nursing practice. AU counseling services is a resource for students who may need assistance on a variety of concerns, including interpersonal violence. They can be contacted at 8.4 Practicing The following is a link to the Public Health Agency of Canada on Family Violence website:p Navigate around this website and read further scholarly articles about topics that interest you, such as: Abuse of Older Adults Child Abuse and Neglect Child Sexual Abuse Intimate partner Abuse Against Women Intimate partner Abuse Against Men Family Violence Questions: What aspect of family violence did you spend some time reading about? What is it about that aspect of family violence that you find interesting? What are the links between this aspect of violence and your nursing practice? How does this aspect of violence impact the health of individuals, families, communities? What gaps did you notice regarding the topics presented ? I what topics do you think are important to engage an audience with ? How does the answer to this question reflect your values and beliefs about interpersonal violence? In your Learning Journal (Word .doc file), write about the responses to these questions. 8.5 Reflecting Access and read the following document: University of Western Ontario. (2019). Centre for research and education on violence against women and children. Retrieved from : http://www.learningtoendabuse.ca/index.html Access the following document: Krug, E.G. et al., eds. (2002) World report on violence and health (ISBN 9 2 4 154561 5). Geneva, Switzerland: World Health Organization at: http://www.who.int/violence_injury_prevention/violence/world_report/en/full_en.pdf Read any two chapters that are of interest to you. Questions: Based on your nursing experience and what you have read in these documents, why is it crucial for nurses to be aware of the health effects of interpersonal violence? In your opinion, what two contexts (historical, ethical/legal, social/cultural, political, critical feminist, and economic) are important in the analysis of the issue of interpersonal violence? (Refer to chapter one in the textbook to refresh your memory, if needed). What is your rationale for choosing these two contexts? How do these particular contexts provide nurses with a clear understanding of this issue? In your Learning Journal (Word .doc file), write about any new thoughts, feelings, and ideas you might have regarding interpersonal violence and the health of individuals, families, and communities. Access the website of your provincial nurses association through the Canadian Nurses Association (CNA) web site by searching: "Canadian Nurses Association Provincial and Territorial Members". Locate and read any documents related to violence. (This might include but is not limited to discussion papers, position statements, bulletins, newsletter articles, etc.). Questions: What types of documents were you able to access? Does your provincial association take a certain position on interpersonal violence? If so, what is it? How is this position communicated to the members? If not, in your opinion, what position should your professional association take regarding interpersonal violence? What strategies might you undertake to communicate your opinion to your professional association? What barriers might exist to engaging in these strategies? If you choose to, share your thoughts and ideas in the Unit 8 Forum. 8.6 References Canadian Nurses Association. About CNA. Our Members. Provincial and Territorial Members. Retrieved April 22, 2013 from http://www.cna-aiic.ca/en/about-cna/our-members/provincial-and-territorial-members/ Krug, E.G. et al., eds. (2002) World report on violence and health (ISBN 9 2 4 154561 5). Geneva, Switzerland: World Health Organization. Retrieved April 22, 2013 from: http://www.who.int/violence_injury_prevention/violence/world_report/en/full_en.pdf McDonald, C. & McIntyre, M. (2019). Realities of Canadian nursing: Professional, practice and power issues (5th ed.). Philadelphia, PA: Wolters Kluwer. McIntyre, M. & McDonald, C. (2014). Realities of Canadian nursing: Professional, practice, and power issues (4th ed.). Philadelphia, PA: Wolters Kluwer; Lippincott, Williams, & Wilkins. Public Health Agency of Canada. (2019). Family violence. Ottawa, ON: Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/stop-family-violence.html University of Western Ontario. (2019). Centre for research and education on violence against women and children. Retrieved from http://www.learningtoendabuse.ca/index.html should write in APA7th edition. Purpose It is becoming increasingly important for registered nurses to assume a leadership role in a changing health care system. Hence, registered nurses must be able to assess and act to fulfill their own learning needs in order to work to their full scope of practice. To complete this assignment, consider an issue or trend in nursing or health care and choose one of the options position paper, discussion paper, issue paper, literature review, etc. to present a discussion on your chosen trend or issue. Your papers must be scholarly in presentation, reflective of course content, and although they may be related to one another, they must not be duplications. Your paper here is about child abuse, although this is an urgent and tragic issue, it is not one that is relevant to the objective and learning goals in this course. Unless you have rationale, I have to consider to convince me otherwise that this topic fits with the objectives of this particular course you need to: -choose a relevant and current trend or issue in nursing preferably and discuss this in a scholarly manner for assignment three.Purpose It is becoming increasingly important for registered nurses to assume a leadership role in a changing health care system. Hence, registered nurses must be able to assess and act to fulfill their own learning needs in order to work to their full scope of practice. To complete this assignment, consider an issue or trend in nursing or health care and choose one of the options position paper, discussion paper, issue paper, literature review, etc. to present a discussion on your chosen trend or issue. Your papers must be scholarly in presentation, reflective of course content, and although they may be related to one another, they must not be duplications. Your paper here is about child abuse, although this is an urgent and tragic issue, it is not one that is relevant to the objective and learning goals in this course. Unless you have rationale, I have to consider to convince me otherwise that this topic fits with the objectives of this particular course you need to: -choose a relevant and current trend or issue in nursing preferably and discuss this in a scholarly manner for assignment three. Purpose It is becoming increasingly important for registered nurses to assume a leadership role in a changing health care system. Hence, registered nurses must be able to assess and act to fulfill their own learning needs in order to work to their full scope of practice. To complete this assignment, consider an issue or trend in nursing or health care and choose one of the options position paper, discussion paper, issue paper, literature review, etc. to present a discussion on your chosen trend or issue. Your papers must be scholarly in presentation, reflective of course content, and although they may be related to one another, they must not be duplications. Your paper here is about child abuse, although this is an urgent and tragic issue, it is not one that is relevant to the objective and learning goals in this course. Unless you have rationale, I have to consider to convince me otherwise that this topic fits with the objectives of this particular course you need to: -choose a relevant and current trend or issue in nursing preferably and discuss this in a scholarly manner for assignment three.