Violence Issue In Healthcare

What is Violence

    Violence
is a public health problem in the United States that impacts individuals,
families, and communities. The US has experienced a downward trend in violence
to 23 million violent and property crimes during 2002, but it remains one of
the most violent countries in the industrialized world (US Department of
Justice, Office of Justice Programs, 2003). 

    The violent crime rate de creased
from 25 per 100,000 persons aged 12 years and older in 2001 to 23 per 100,000
persons aged 12 years and older in 2002. The rate of every major violent and
property crime declined from 1993 to 2002. 

    Rape/sexual assault decreased 56%,
robbery 63%, aggravated assault 64%, simple assault 47%, household burglary
52%, motor vehicle theft 53%, and property theft 49% (US Department of Justice,
Office of Justice Programs).

Victims of Violence 

    Victims
of violence are violated physically, emotionally, psychologically, spiritually,
and socially. Nurses are engaged in providing care to victims and perpetrators
of violence in a variety of health care settings. 

    Nursing scholarship related
to violence recognizes the complex interaction of community factors (in
equality, marginalization, disparity, residential mobility, poverty, lack of
education, lack of career opportunities, housing, social and cultural norms, stigmatization
and bias, and population density) in addition to individual and familial risk
factors that require evidence and research based preventive measures.

Women Violence

    Violence
and abuse against women (VAAW) have been recognized globally as a public health
problem affecting women regardless of age, culture, or socioeconomic status.
Types of VAAW consist of physical, psychological, and sexual; various
controlling behaviors by perpetrators; stalking; and workplace violence.

Violence and Nursing Research 

    Nursing
research has grown out of concern for the victim of abuse and has been focused
on risk factors, battering syndrome, intimate partner violence, children of
battered women, consequences of abuse, relationships of HIV infections and
violence, and abuse during pregnancy. 

    A published review of violence research
by Campbell, Harris, and Lee (1995) highlighted significant findings in the
area of VAAW. ManfrinLeder and Porche (2003) published a metaanalysis of the
state of the science in the intersections of violence and HIV infection.

Ethical and Safety Issues

    Ethical
conduct and safety issues in VAAW research are critical. Future research should
focus on interventions for preventing and combating VAAW, lifetime health
consequences of violence, and long-term effects of VAAW programs using various
methodologies in different cultural settings.

Nursing Contributions

    Contributions
by nurse researchers related to the study of child abuse have focused on shaken
baby syndrome, the battered child, health and sociological consequences of
child abuse, risk factors, child sexual assault, and neglect. 

    Clements and
Burgess (2002) conducted research to understand children’s re sponges to family
member homicide and associations with complicated bereavement, including
childhood posttraumatic stress disorder. 

    Future research in the area of child
abuse must take into account standards and expectations in differing cultures
for parenting behavior, the inclusion of cultural issues, and the long term
effects of child abuse, interventions for prevention and treatment, and
empowerment strategies for victims of abuse .

Elderly Violence

    Elder
abuse and neglect are significantly underdiagnosed and underreported. The
National Center on Elder Abuse ( nd ) defines seven different types of elder
abuse: physical, sexual, and emotional abuse; financial exploitation; neglect
abandonment and self-neglect. 

    Elder abuse is largely hidden under a shroud of
family secrecy, in addition to the problem of not being recognized by health
care providers

Instruments to Identify Elder at Risk for Violence

    Researchers
have developed valid and reliable instruments to identify elders at risk of
abuse. Instruments include screening tools for elder abuse or tools whose
purpose is to assess existing cases of elder abuse for future risk. 

    Two elder
abuse screening tools are the HwalekSeng stock Elder Abuse Screening Test
(HS/EAST) and the Indicators of Abuse Screen. Risk assessment tools for future
abuse generally contain a list of indicators or conditions which are rated with
regard to the elder’s risk for future victimization. 

    Typical indicators include
client characteristics, environmental risk factors, support services,
historical abuse factors and patterns, and abuse factors (Wolf, 2003). Nursing
scholarship by Fulmer and Gurland (1996) has addressed elder mistreatment and
elder abuse assessment. 

    Phillips and Rem Pusheski (1985) studied diagnostic and
intervention decisions in elder abuse and neglect.

Epidemics of Adolescent Violence

    The
epidemic of adolescent violence forces millions, including youth, families, and
communities, to cope with injury, disability, and fatality. Homicide is a
leading cause of death for adolescents. Two general trajectories have been
proposed to explain the development of adolescent violence. 

    One is the
development of violence before puberty and another is violence beginning in
adolescence. Earlier development, before age 13 years, is generally associated
with more violence and more serious crimes over a longer period of time,
continuing into adulthood (US Department of Health and Human Services, 2001a).

 Risk Factors for Adolescent Violence

    Risk
factors for adolescent violence include involvement in serious criminal
activities, substance use before age 13 years, male gender, hostility, low
socioeconomic status, antisocial parents, drug selling, weak social bonds to
traditional peers, ties to delinquent peers, and gang membership ( US
Department of Health and Human Services, 2001a).

    Adolescent
violence is preventable behavior that needs to be understood and treated.
However, nursing research related to adolescents cent violence has been rather
limited. 

    Vesey, Duffy, O’Sullivan, and Swanson (2003) have studied teasing, a
precursor to bullying, and developed the Physical Appearance Related Teasing
Scale Revised (PARTSR) instrument to assess teasing in school age children. 

    Future research in nursing should take into account risk and protective factors
among the biological, psychological, and social contextual aspects of
adolescent violence.

Nursing Practices and Violence 

    Nursing
research, practice, health policy, and political activism have all been
instrumental in addressing violence as a health phenomenon. Nursing research on
violence has advanced the science of violence prevention and treatment. 

    However, more research remains that build on the body of scholarship available.
A variety of methodological approaches, including quantitative and qualitative
designs, is called for in future violence research in nursing. 

    Research data on
human responses to violence should provide direction for
improved health care, nursing care outcomes, and policy.