Prepared by:
M.Vijayarani.Bsc.(N).R.N.R.M.
Evidence based websites:
1.Cochrane Database Of Systemic reviews: http://www.cochrane.org/.
2.Academic Center for Evidence-Based Nursing (ACE):http://www.acestar.uthscsa.edu/
3.Evidence-Based Nursing and Health Care Resources—University of Buffalo:http://ublib.buffalo.edu/hsl/resources/guides/EBHC.html
4.Evidence Based Nursing—University of Minnesota:http://evidence.ahc.umn.edu/ebn.htm
5. Evidence Based Nursing—University of North Carolina, Chapel Hill: http://www.hsl.unc.edu/Services/Tutorials/EBN/index.htm
6. Hardin Library Evidence-Based Nursing filters for CINAHL (Ovid):http://www.lib.uiowa.edu/hardin/ebmfilt_nursing.html
7. Joanna Briggs Institute in Australia: http://www.joanabriggs.edu.au/services/search/php
8.Medscape Nursing: http://www.medscape.com/nurseshome
9. National Guideline Clearinghouse - Guideline.gov:http://www.guideline.gov/
10. Resources for Evidence Based Nursing—McMaster Universityhttp://hsl.mcmaster.ca/ebn/index.html
11. Syllabi for Practicing EBN—University of Toronto:http://www.cebm.utoronto.ca/syllabi/nur/
12.Arizona Health sciences library:http://www.ahsl.arizona.edu
13.cumulative index of nursing and allied health (CINAHL):
14. Pub Med: http://pubmed.gov/http://pubmed.govl, http://www.ncbi.nlm.nih.gov/pubmed/
15. TRIP: Turning Evidence Into Practice: http://www.tripdatabase.com
16. Bandolier: http://www.jr2.ox.ac.uk/Bandolier/index.html
17.The Agency of health care Quality and research (AHRQ): http://www/ahcpr.gov
18.Center For Evidence Based Nursing: www.york.ac.uk/inst/che.
19.The University Of Sheffield: http://www.shef.ac.uk/
20.Ovid: http://www.ovid.com/
21.The university of lowa health care: www.nursing.uiowa.edu/ebp/index.htm
22.The Evidence Based Nursing Journal: http://www.evidence based nursing.com
23.Sigma Theta Taut International: http://www.nursingsociety.org
24.The Task Force On Community Preventive Services: http://www.the community
25.Electronic Textbooks Up To Date: http://www.uptodate.com/
26.Scientific American medicine: http://sammed.com/
27.Webmd: http://webmd.com/
28.Aries Knowledge Finder (KF): http://www.kfinder.com/
30.SUM search: http://sumsearch.uthscsa.edu/
31.Google: http: www.google.com32.The Clinical Information Access Program (CIAP): http://www.ciap.health.nsw.gov.au
Friday, October 19, 2007
Thursday, October 18, 2007
Health and illness continum
Prepared by
Kalyani Moharana .Bsc(N).R.N.R.M
Health and illness continum
Introduction:
Health is a common theme in most culture. In fact all communities have their concepts of health as a part of their culture. Health and illness are defined according to the values of society to which a person belongs. When a person is able to adjust and adapt to his environment he is said to be healthy. A person with good mental health functions comfortably with society. He is satisfied with himself and achievements.
Definition of health:
According to WHO,’ Health is a state of complete physical, mental and social well-being and not merely absence of disease or infirmity.’
Meaning of health:
The WHO definition of health has been criticized as being too broad. Some argue that health can’t be defined, as a’state’at all but must be seen as a process of continuous adjustment to the changing demand of living and of the changing meanings we give to life. It is a dynamic concept. It helps people live well, work well and enjoy themselves.
The WHO definition of health is therefore considered by many as an idealistic goal than a realistic proposition. Some consider it irrelevant to everyday demands, as nobody qualifies as healthy that is perfect biological, psychological and social functioning. That is if we accept the WHO definition, we are all sick.
In spite of the above limitations, the concept of health as defined by WHO is broad and positive in its implications; it sets out the standard, the standard of ‘positive’ health. The state of positive health implies the notion of ‘perfect functioning’ of the body and mind. It conceptualizes health biologically, as a state in which every cell and every organ is functioning at optimum capacity and in perfect harmony with the rest of the body. Psychologically as a state in which the individual feels a sense of perfect well being and of mastery over his environment. Socially as a state in which the individual’s capacities for participation in the social system are optimal.
Recently, a broader concept of health has been emerging-that of improving the quality of life which heath is an essential component. This at once brings to focus that positive health depends not only on medical action, but also on all the other economic, cultural and social factors operating in the community.
Meaning of mental health:
Mental health in a narrow sense, it is describe as a health mind. But it can’t be described without physical, social and spiritual health. Therefore mental is a part of general health. It requires a balance between the body, mind, spirit and environment in which a person lives.
Definition of illness:
According to Susser [83], ‘ Illness is a subjective state of the person who feels aware of not being well.’
Meaning of illness:
As definition of health definition of illness are also individualized to each person, who experience an alternation in health. So illness is the responses, the person has, to a disease; it is an abnormal process in which the person’s level of functioning is changed compared with a previous level. The response is different for each preson, and is influenced by self-perceptions; other perceptions, the effects of changes and body, structure and functions, the effects of those changes on roles and relationships and cultural and spiritual values and beliefs.
Meaning of mental illness:
Mental illness occurs when a state of physical, mental, social and spiritual well-being is disturbed. Personality of a person and use of various defense mechanism, help the individual to adjust to various stressful situation of life. When the capacity to adjustment of the individual is not able to adjust to the situation, he may develop maladaptive behaviour and become mental ill.
Concept of health and illness continum:
Health and disease lie along a continuum and there is no single cut-off point. The lowest point on the health and disease spectrum is death and highest point corresponds to the WHO definition of positive health .It is thus obvious that health fluctuates within a range of optimum well being to various levels of dysfunction, namely the death. The transition from optimum health to ill health is often gradual, and where state ends and the other begin is a matter of judgment.
So the spectral concept of health of an individual is not static. It is a dynamic phenomenon and a process of continuous change, subject to frequent stable variations. What is considering maximum health today may be minimum tomorrow?
That is a person may function at maximum level of health today and diminished level of health tomorrow. It implies that health is a state not to be attained once and for all, but ever to be renewed. There are degrees or ‘levels of health ‘as there are degrees or severity of illness. As long as we are alive there is some degree of health in us.
According to R.Dubois views health as adaptation, a function of adjustment. He believes a utopian state of health can never be so perfectly adapted to the environment that life will not involve struggle, failure and suffering. Human can adapt to environment but each new adaptation procedures new problems that demand new solutions.
Illness is more then signs and symptoms. It is a process and an experience. It is failure of the person’s adaptive power to maintain physical and emotional balance and to utilize the usual health promoting resources in the face of internal and external stressors.
It is a disturbance or adaptation of the person, with observable or felt changes, discomforts and social behavior expectations appropriate to customary role and status.
H.S.Sullivan defines mental or emotional illness as inappropriate interpersonal behavior or behavior that is inadequate for the social context. Sullivan believes that each person has some small degree of illness. Physical or emotional even when he or she feels and looks well. The illness may be minor aches, temper flares, inappropriate forgetfulness, or over use of certain defense mechanisms such as rationalization or forgetfulness. Similarly the emotionally ill person manifests some degree of health. Some appropriate thinking and behavior.
Health illness continuum model:
Health always involves a continuum a range of degree from optimal health at one end to death or total disability at the other. The health of an individual moves back and forth along this continuum throughout life according to health and illness continuum model.
Health is a dynamic state fluctuates as a person adapts to change in the internal and external environment. To maintain a state of total well-being.
High level of wellness and severe illness are at opposite ends of the continuum. According the Neumann’s 1990 health on a continuum is the degree of clients wellness that exist at any point in time running from an optimal wellness condition, with available energy at its maximum to death. Which represents total energy depletion. Risk factors are important in identifying level of health. They include genetic and physiological variables such as age, lifestyle, and environment.
Nursing approach:
It is important for a psychiatric nurse to know her own behavior first, though it is difficult in the beginning. She may not be able to identify her strength and weakness as psychiatric nurse. Her strength may be that she is good at developing rapport with the patient weakness could not be that she lacks good knowledge of the psychiatric nursing subject. This would be able to acquired gradually.
The basic approach or step of caring process is as follows:
- Assessment and identification of needs
- Plan of action.
- Implementation.
- Evaluation.
The basic principles of nursing are to provide a sense of individuality, safety and comport to the patient. He or she should economies his or her time and energy judiciously while nursing the patient. Maximum therapeutic effectiveness should be the goal of nursing care.
However some of the other principles technique of nursing a mentally ill patient are as follows:
Accepts the patient as a human being
Focus on the strength of the patient.
Skill in developing professional relationship with the patient.
Be non-judgmental and non-punitive.
Be an active lisner.
Show professional interest.
Talk with specific objectives.
Be consistent in behavior.
Use self-awareness as therapeutic tool.
Avoid physical and verbal restrains.
Conclusion:
The health and illness continuum and nursing approach to mentally ill provides a framework of some of the common reaction of a nurse to the patient’s behaviors.
Through caring process nurse able to provide optimum care to the patient. The principles of in caring for the psychiatric patient, accepting him as a holistic human being and using his strength are important in helping the patient towards the role road to recovery.
References:
1.K.Park. “Text book of preventive and social medicine”. 17th ed.2002. Banarasidas bharath.Jabalpur.Pp 16-32, and 582- 581.
2.Potter.A.Patricia and Perry Anne Griffinn “ fundamentals of nursing” 6thy ed.2005.Mosby.St.louis miesouri. Pp 91 – 103.
3.Niraj ahuja. “A short textbook of Psychiatry “. 1st edition.1995.Jaypee brothers.Newdelhi.Pp – 1 –2.
4.Stuart.Gail.W.Laria.Michele.T.Principles and practice of psychiatric nursing.8th edition.2007.Mosby: St .Louis.Pp 445 – 472.
Role of nurse,family and patient in adult patient care
Prepared by:
M.Vijayarani.Bsc.(N).R.N.R.M
ROLE OF NURSE FAMILY AND PATIENT IN ADULT PATIENT CARE
INTRODUCTION:
The word “NURSE “originated from the Latin word “NUTRIX” meaning “TO NOURISH”. Nurse assumes a number of roles when they provide care to client. The roles required at a specific time depend on the needs of the client and aspects of the particular environment.
DEFINITION:
1) According to Virgiena Handerson (one of the first modern nurse) " The unique function of the nurse is to assist the individual, sick, or well, in the performance of those activities contributing to health or its recovery (or to peaceful deatyh0that he would perform unaided if he had the necessary strength, will or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible".
2) The International council of nurses published a full definition in 1987,followed by shorter, more succinct version in 2002,"Nursing encompasses autonomous and collaborative care of individual of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.”
DEFINITION OF ADULT HEALTH NURSE:
“A Nurse who has received additional education and training in the primary health care of adults.”
MEANING OF ADULT NURSING:
Adult nursing involves caring for adults, both sick and well, not only ion the hospital environment but also in the community setting. An inherent part of the role of an adult nurse is the promotion of health through education, the prevention of disease, and the care, substance and rehabilitation of adults undergoing diagnostic and therapeutic regimens. Clearly the role of the nurse helping and caring for adults is both challenging and diverse.
GOALS OF ADULT HEALTH NURSING:
Determines responses to health problems, level of wellness, and needs for assistance.
Provides physical care, emotional care, teaching, guidance and counseling.
Interventions aimed at assisting the client to meet own needs.
AIMS OF NURSING IN ADULT PATIENT CARE:
M.Vijayarani.Bsc.(N).R.N.R.M
ROLE OF NURSE FAMILY AND PATIENT IN ADULT PATIENT CARE
INTRODUCTION:
The word “NURSE “originated from the Latin word “NUTRIX” meaning “TO NOURISH”. Nurse assumes a number of roles when they provide care to client. The roles required at a specific time depend on the needs of the client and aspects of the particular environment.
DEFINITION:
1) According to Virgiena Handerson (one of the first modern nurse) " The unique function of the nurse is to assist the individual, sick, or well, in the performance of those activities contributing to health or its recovery (or to peaceful deatyh0that he would perform unaided if he had the necessary strength, will or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible".
2) The International council of nurses published a full definition in 1987,followed by shorter, more succinct version in 2002,"Nursing encompasses autonomous and collaborative care of individual of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.”
DEFINITION OF ADULT HEALTH NURSE:
“A Nurse who has received additional education and training in the primary health care of adults.”
MEANING OF ADULT NURSING:
Adult nursing involves caring for adults, both sick and well, not only ion the hospital environment but also in the community setting. An inherent part of the role of an adult nurse is the promotion of health through education, the prevention of disease, and the care, substance and rehabilitation of adults undergoing diagnostic and therapeutic regimens. Clearly the role of the nurse helping and caring for adults is both challenging and diverse.
GOALS OF ADULT HEALTH NURSING:
Determines responses to health problems, level of wellness, and needs for assistance.
Provides physical care, emotional care, teaching, guidance and counseling.
Interventions aimed at assisting the client to meet own needs.
AIMS OF NURSING IN ADULT PATIENT CARE:
- To promote health
- To prevent illness
- To restore health
- To facilitate coping with disability or death.
To meet these aims the nurse uses knowledge, skills and critical thinking to give care in a variety of the traditional and expanding nursing roles. To provide knowledgeable care the nurse uses cognitive, technical, inter personal, and ethical, legal competencies essential to nurse in practice.
GENERAL DISCRIPTION OF ADULT HEALTH NURSE:
Adult nurses provide medical care to and support the recovery of patients suffering from acute and long-term illness, diseases such as diabetes or arthritis or those requiring surgery.
They focus on the needs of the patient rather than the illness or condition.
They promote good health and well being through the education.
Adult nurses plan and carryout case within a multidisciplinary team but are curing a specific disease, although treatment skills that promote physical healing are important to care givers.
The adult nurse addresses the holistic health care needs of the client including measures to restore emotional, spiritual, and social well being.
The nurse helps the client and family to set goals and meet those goals a minimal cost of time and energy.
The role as a caregiver is the role of nurse.
Gaining the trust and confidence of each patient is an important role of nurses.
In all the cases nurses needs to establish a good relationship with the patient and their relatives.
- Duties of nurses include the following
- Preparing care plans
- Implementing plans through tasks such as preparing patients for surgeries,
- wound treatment and monitoring pulse, blood pressure and temperature.
- Observing and recording the conditions of patient.
- Checking and recording the conditions of patients.
- Setting up drips and blood transfusion.
- Assisting with tests and evaluating.
- Carrying out routine investigations.
- Responding quickly to emergencies.
- Organizing staff and workloads.
- Teaching skills to student and junior nurses.
- Maintaining patient records.
- Making ethical decisions related to current and confidentiality.
ROLE OF NURSE IN ADULT PATIENT CARE:
ROLE:
A role is a set of expected behaviors associated with an individual status or position, which includes behaviors, rights and responsibilities.
Nurses often carry out several roles concurrently, not exclusively of one another. The contemporary nurse functions in the interrelated roles of caregiver, clinical and ethical decision maker, protector and client advocate, rehabilitator, comforter, communicator, and teacher.
1) CARE GIVER:
· As a caregiver, the nurse helps the client regain health through the healing process. Healing is more than just the main point of contact for patients.
· Adult nurses who work mainly in the hospitals have traditionally included those activities that assist the client’s dignity.
· The required nursing actions may involve full care for the completely dependent client, partial care for the partially dependent client, and supportive educative care to assist clients in their highest possible level of health and wellness.
· Caregiver encompasses the physical, psychosocial, developmental, and cultural and spiritual levels.
· The nursing process provides nurses with a framework for providing care.
· A nurse may provide care directly or delegate it to other caregivers.
2) CLINICAL DECISION MAKER:
· To provide effective care, the nurse uses critical thinking skills throughout the nursing process.
· Before understanding any nursing action, wheather it is assessing the clients condition, giving care, or evaluating the results of the care, the nurse plans the action by deciding the best approach for each client. The nurse makes these decisions alone or in collaboration with the client and family.
3) ADVOCATE:
· Adult nurse also assist clients in exercising their rights and help them speak up for themselves. The promotion of human or legal rights and serving of care of all patients based on the belief that patients have the rights to make informed decisions about their own health and lives.
· A client advocate acts to protect the client.
· The nurse may also defend client’s rights in a general way by speaking out against policies or actions that might endanger client’s well being or conflict with their rights.
4) PROTECTOR:
· As a protector the nurse helps to maintain a safe environment for the client from possible adverse effects of diagnostic or treatment measures. Confirming that a client doesn’t have an allergy to a medicine and providing immunization against disease in a community based practice are examples of the nurses protective.
5) COMMUNICATOR:
· The role of communicator is central to all other nursing roles.
· Nursing involves communication with clients and families, other nurses and health care professionals, resourse persons, and the community.
· Without clear communication it is impossible to give care effectively, make decisions with clients and families, protect with clients from threats to well being, coordinate and manage client care, assist client in rehabilitation, offer comfort or teach.
· In the role of communicator nurses identify clients problems and then communicate these verbally or in writing to other members of the health team.
· The nurse must be able to communicate clearly and accurately in order for a clients health care needs to be met.
6) COMFORTER:
· The role of comforter, caring for the client as a person, is a traditional and historical one in nursing and has continued to be important, as nurses have assumed new roles.
· Because nursing care must be directed to the whole person rather than simply the body, comfort and emotional support often help give the client strength to recover.
· While carrying out nursing activities, nurses can provide comfort by demonstrating care for the client as an individual with unique feelings and needs.
· As comforter, nurses should help the client reach therapeutic goals rather than encourage emotional or physical independence.
7) TEACHER:
· As a teacher nurse must helps clients learn about their health and the health care procedures they need to perform to restore or maintain their health.
· The nurse assess the clients learning needs and readiness to learn, sets specific learning goals in conjunction with the client, enacts teaching strategies and measures learning.
· As teacher, the client, the nurse explains to client’s concepts and facts about health, demonstrates procedures such as self-care activities, determines that the client fully understands reinforces learning or client behaviour, and evaluates progress in learning.
· It involves providing emotional, intellectual and psychological support.
· The nurse counsels primarily healthy individuals with normal adjustment difficulties and focus on helping the person develops new attitudes, feelings and behaviour by encouraging the client to look at alternative behaviour, recognize the choices, and develop a sense of control.
9) CHANGE AGENT:
· Nurses who function in the role of change agent recognize the change is a complex process.
· The change agent is proactive (take the initiative to make things happen) rather than reactive (responding to after they have happened).
· The nurse acts as a change agent when assisting others, that is a client, to make modifications in their own behaviour.
· Nurses also often act to changes in a system, such as clinical care, if it is not helping a client return to health.
10) LEADER:
· The assertive, self-confident practice of nursing when providing care, effective change, and functioning with groups.
· A leader influences others to work together to accomplish a specific goal.
· The leader role can be employed at different levels: individual, client, family, and groups of clients, colleagues or community.
· The nurse criticizes the leadership process in a variety of circumstances: when assisting a single patient and or family to make changes in their health related behaviour.
· When assisting groups or communities to alter their health practices, and when assisting groups of nurses or other health care professionals to affect the actions of patients, groups of patients, communities with regard to the achievement of desirable health behaviors.
11) REHABILITATION:
· Rehabilitation is the process by which individuals return to maximum levels of functioning after illness, accidents, or other disabling events, frequently clients experience physical or emotional impairments that change their lives and the nurse help-s them adapt as fully possible.
· Rehabilitation and restorative care activities range from teaching clients to walk with crutches to helping clients cope with lifestyles often associated with chronic illness.
12) MANAGER:
- The term manager in this discussion means the person who co-ordinates human and material resources in providing care to clients,.human resources include
Ø Client
Ø The nurse
Ø The family or significant others
Ø Professional colleagues
Ø Support groups
Ø Research groups
Material resources include equipment and supplies. - The nurse manages the nursing care of individuals, families and communities.
- Managing requires knowledge about organizational structure and dynamics, authority and accountability, leadership, change theory, advocacy, delegation, and supervision and evaluation.
13) CASE MANAGER:
- As a care manager, the nurse coordinates the activities of other members of the health care team, such as nutritionist and physical therapists, when managing a group of clients care.
- In addition, nurse must also manage their own time and the resource of the practice settings.
- As managers, nurses coordinate and delegate care responsibilities and supervise other health care workers.
14) TEAM MEMBER:
- A vital role of the nurse is that of the nurse is that of team members. The nurse doesn’t function in isolation but rather work with other members of the health care team.
- Collaboration requires the nurse to use effective interpersonal skills and promotes continuity of care.
15) RESOURSE PERSON:
- The nurse function as a recourse person by providing skilled intervention and information.
- Identifying recourses and making referrals as needed also fall under the auspices of this role.
- Nurses must consider the client strength as well as availability of resources, including physical, intellectual, economic, social, and environmental factors.
16) RESEARCH CONSIDERATION:
Nurses often use research to improve client care .In a clinical area, nurse’s needs to
- Have some awareness of the process and language of research.
- Be sensitive to issues related to protecting the rights of human subjects.
- Participate in the identification of significant researchable consumer of research findings.
- Be a discriminating consumer of research findings.
17) EXPANDED CAREIER ROLE:
Nurses are fulfilling expanded career roles, such as those of nurse practioners, clinical nurse specialist. Nurse midwife, nurse educator, nurse researcher, and anesthetist, all of which wallow greater independence and autonomy.
18) ROLE IN DIFFERENT HEALTH CARE SETTINGS:
Although many nurses are direct care providers, others role include manager of other members of the health care team providing patient care , administrator ,nurse practitioner ,clinical nurse specialist, patient educator ,in – service and researcher .Nurses play different roles in different centers like.
- Primary care centers
- Ambulatory care centers and clinics
- Home health care
- Long term care facilities specialized care centers and settings
- Day care centers
- Mental health canters rural health centers
- Industry
- Homeless shelters
- Rehabilitation centers
- Healthcare services for care givers and end of life care.
- Respice care
- Hospice care
- Health care agencies (voluntary agencies)
- Eg, alcoholic Anonymous
- Cancer and support groups
- Parish nursing
- Government agencies.
ROLE OF FAMILY IN ADULT PATIENT CARE:
A person illness affects not only the person who is ill but also the family or significant others.
Acute illness may place sudden demands on family. The family should be able to cope with the changes that occur in the family include the following:
- Role changes
- Task reassignment and increased demands on time.
- Increased stress due to anxiety about the illness
- Financial problems
- Loneliness as result of separation and pending loss.
- Changes in social custom.
The family should have a basic understanding of the disease, its treatment and personal care.
Families should be able to cope using the known and behaviors to help them to manage and adapt to the problem.
The family plays an important role in both the development and management of disease condition.
Doubts and issues or misconceptions related to the disease should be clarified with the health care professionals.
Family should know the importance of affection and love etc during illness.
The families if offers remedies and advice, it will take over those roles that the
person is no longer capable of and it will provide the care necessary until recovery or for long term support.
Emotional support from family and friends are essential.
Family members are expected to assist patient in difficulties.
A willing member of the family can be allowed to assist with aspects of nursing care is comforting to the patient as well as to the relatives.
The family is expected to provide a supporting environment for the patient.
The family should understand the need for the assistance and help the patient.
The family should try to fix in support of the ill member, meal preparation and chauffeuring the children around varied work schedules.
Family influences the lives of one another.
The family structure, functioning, and relative position in the society significantly influence the health and ability to respond to health problems.
The family structure, functioning, and relative position in the society significantly influence the health and ability to respond to health problems.
In some cases, the terminally ill may be taken home and the family becomes responsible for his care until death occurs.
Family members are important to chronically ill clients. They may help the management of the chronic illness. This collaboration should be initiated under the direction of the health care team at diagnosis to prevent difficulties later.
Families are an important factor in the client’s response to health problem and in the ability to cope.
Families are not only being kept abreast of the therapeutic plan, but also actively participate in the planning and implementation of the care.
Family experiences a crisis or a crisis-producing event, they attempt to gather their recourses to deal with the demands created by the situation.
Too many visitors may tire the patients and the relatives and families should understand it.
The family should actively participate in the health education.
Also family has an important role in prevention of high-risk diseases in the patient.
Patient family plays a vital role in carrying about restrictions and plans in the patients.eg.diabetes patients should follow strict sugar free diet.
Discharge plans must include both the patient and family and should be taught clearly to the item before discharge or transfer.
ROLE OF PATIENT IN ADULT PATIENT CARE:
1. Patient is the good source of information about illness.
2. Patient is not a passive recipient of care he is an active participant.
3. Patient should be cooperative with the treatment.
4. Patient must be given information about his care to make choices or manage their conditions.
5. Patients are the key player in the decision making in the patient care. Patient plays a decision maker role with skill in tools of the function.
6. Chronically ill individuals must learn to live with the course of chronic illness.
7. Part of the task also involves developing a personal identity that includes the chronic illness and life style changes in necessities.
8. Maintaining interpersonal relationships with the health team members.
9. Patients can clarify the misbelieves and doubts regarding the treatment and procedures with the adult health nurse.
10. Patient’s cooperation is very important in assessment, planning, implementation, and evaluation.
11. Patient also participates actively in the patient and family teaching programmes.
12. Giving consent for surgeries and diagnostic procedures is also an important role.
13. Patient is expected to move the health team members towards the goals of potential well-being.
14. With the level of knowledge, skill and confidence patient can develop the self-management capacity so that he could be targeted towards the quality improvement care.
15. More effective care processes and interventions are to be planned to make the patients function in expanded role.
SUMMARY:
Thus the comprehensive care of adult patient not only involves the care of nurse towards the patient but also the participation of patient and family is important for improvement of the patient towards his potential well being.
REFERENCES:
- Potter.P.A.Perry.A.G.Fundamentals of nursing- concepts of process and practice .4th ed. Saint Louis: Mosby.1997. 223 – 225,484 – 487.
- Kozier.B.Erb.G.Berman.A.Burke.k.Fundamentals of nursing concepts, process and practice.7th ed. Delhi: Pearson 2004.47 – 50,221 – 222,229 – 231,484 – 485,502 503.
- Black.J.M.Hawks.J.H.Medical Surgical Nursing - Clinical Treatment for positive outcomes.7th ed. Phildelphia.:Saunders.2005.vol.1.150 – 152.
- Bauer.F.L.The process of planning care. A theoretical Model.1st ed.St.Louis: Mosby.1972.103 – 110.
- Delaune.S.C.Landner.P.K.fundamentals of nursing Standards and practice.3rd ed. Australia: Thomson-Delmer.2006.266 – 268.
- Smeltzer.S.C.Bare Brenda. Textbook of medical surgical nursing .10th ed. Philadelphia: Lippincott.2004.14 – 16.
- Craven.R.F.hirnle.C.J.Fundamentals of nursing human health and function.5th ed. Philadelphia: Lippincott.2007.1292 – 1293.
- Atkinson.L.D.Murray.M.E.fundamentals of nursing – nursing process approach.296 – 300.
- Stanhope.Larancarter.J.Foundations of nursing in community oriented practice.2nd ed. St Lewis: Mosby.346 – 349.
- Bond.J.Bond.S.Sociosiology and health care an introduction for nurses and others health care professional .2nd ed. Churchil livingstone.112.
- Furest.E.v.Wolff.L.Fundamentals of nursing 3rd. ed. Philadelphia.1964.628 – 629.
- Walsh.M.Tindall.BcLINICAL nursing and related services .6th ed. London: Watson.2002.4 – 9.
- http://content.healthaffairs.org/cgi/content/full/hlthaff.var.133/DC2
child sexual abuse
PREPARED BY:
M.VIJAYARANI.BSC(N).R.N.R.M
CHILD SEXUAL ABUSE
DEFINITION:
ABUSE:
Abuse refers to harmful or injurious treatment of another human being that may include physical, sexual, verbal, psychological/emotional, intellectual, or spiritual maltreatment. Abuse may coexist.
SEXUAL ABUSE:
Sexual abuse refers to inappropriate sexual contact between a child or an adult and someone who has some kind of family or professional authority over them. Sexual abuse may include verbal remarks, fondling or kissing, or attempted or completed intercourse. Sexual contact between a child and a biological relative is known as incest, although some therapists extend the term to cover sexual contact between a child and any trusted caregiver, including relatives by marriage. Girls are more likely than boys to be abused sexually; according to a conservative estimate, 38% of girls and 16% of boys are sexually abused before their eighteenth birthday.
CHILD SEXUAL ABUSE:
Is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification
NEGLECT:
Which is defined as failure to meet a dependent person's basic physical and medical needs, emotional deprivation, and/or desertion. Neglect is sometimes described as passive abuse.
TYPES OF SEXUAL ABUSE:
This term includes a variety of sexual offenses, including:
· Sexual assault – a term defining offenses in which an adult touches a minor for the purpose of sexual gratification; for example, rape (including sodomy), and sexual penetration with an object.
· Sexual molestation – a term defining offenses in which an adult engages in non-penetrative activity with a minor for the purpose of sexual gratification; for example, exposing a minor to pornography or to the sexual acts of others.
· Sexual exploitation – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child, and creating or trafficking in child pornography.
· Sexual grooming - defines the social conduct of a potential child sex offender who seeks to make a minor more accepting of their advances, for example in an online
CHILD SEXUAL OFFENDER:
Refers to a person who has been convicted for one or more child sexual abuse offenses.
INCIDENCE:
Over 20.83% of the populations suffer some forum of sexual abuse before the age of 18 years old. They come from all walks of life; about 25% of children who are abused or neglected are younger than two years of age. It is estimated that before the age of 18 at least 1 in 4 females and 1 in 6 males will have suffered from some form of sexual abuse. That is over 20.83% of the population!!With over 50,000,000 people in the UK, that means that there are more than 10,400,000 people in the UK alone who are, or will become, survivors of sexual abuse. Assuming that people live 70 years that’s over148, 571 NEW victims of childhood sexual abuse per year! And this does NOT include adults who have been raped. Children who suffer from birth defects, developmental delays, or chronic illnesses have a higher risk of being abused by parents or other caregivers.
POPULATION:
They come from all walks of life, all backgrounds, and happens to both females and males, rich and poor, white, black, or pink. Child sexual abuse can take place within the family, by a parent, stepparent, sibling or other relative; or outside the home, for example, by a friend, neighbor, child care person, teacher, or stranger.
COPING MECHANISM IN CHILDREN TO ABUSE:
When sexual abuse has occurred, a child can develop a variety of distressing feelings, thoughts and behaviors.No child is psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old, who cannot know the sexual activity is wrong, will develop problems resulting from the inability to cope with the overstimulation. When sexual abuse occurs within the family, the child may fear the anger, jealousy or shame of other family members, or be afraid the family will break up if the secret is told. A child who is the victim of prolonged sexual abuse usually develops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of marriage and sex. The child may become withdrawn and mistrustful of adults, and can become suicidal. Some sexually abused children become child abusers or prostitutes, or have other serious problems when they reach adulthood. Child sexual abusers can make the child extremely fearful of telling, and only when a special effort has helped the child to feel safe, can the child talk freely. If a child says that he or she has been molested, parents should try to remain calm and reassure the child that what happened was not their fault. Parents should seek a medical examination and psychiatric consultation.
CHILD SEXUAL OFFENDER CAN BE:
Many victims of childhood sexual abuse will have been abused by someone in the family or a close family friend, and the abuser can be either male or female, rich or poor, teacher, step dad, mother, babysitter, vicar, brother or anyone. Some will have been abused by a stranger, and although that is what becomes reported in the news far more often, abuse happens far more often by someone known to the child that they should have been able to trust to protect them.
CAUSES OF ABUSE:
· Early learning experiences
· Ignorance of developmental timetables
· Economic stress
· Lack of social support or social resources.
· Substance abuse: (Alcohol and mood-altering drugs)
· Mental disorders.
· Belief systems
AFTER EFFECTS:
Abuse affects all dimensions of human development and existence.Abused children often display
1. Retarded physical growth and poor coordination
2. In both children and adults, repeated trauma produces changes in the neurochemistry of the brain that affect memory formation.
3.Instead of memories being formed in the normal way, which allows them to be modified by later experiences and integrated into the person's ongoing life, traumatic memories are stored as chaotic fragments of emotion and sensation that are sealed off from ordinary consciousness.
4.These traumatic memories may then erupt from time to time in the form of flashbacks.
5.Abused children develop stress
6.They often misinterpret other people's behavior and refuse to trust them.
7.Emotional distortions include such patterns as being unable to handle strong feelings, or being unusually tolerant of behavior from others that most people would protest.
8.Children who are abused are often in physical and emotional pain at school.
9.cannot concentrate on schoolwork, and consequently fall behind in their grades
10.They often find it hard to make or keep friends, and may be victimized by bullies or become bullies themselves
11.Even though a survivor may consciously want to avoid re-abuse, the individual is often unconsciously attracted to people who remind him or her of the family of origin.
12.Abused adults are also likely to fail to complete their education, or they accept employment that is significantly below their actual level of ability.
COMMON SYMPTOMS OF ADULT SURVIVORS OF CHILDHOOD SEXUAL ABUSE
· Low self-esteem, feeling worthless.
· Fear of abandonment and other abandonment issues.
· Acting out behavior. Not knowing how to identify, process and or express intense feelings in more productive ways.
· Unexplained fears of being alone at night, nightmares and/or night terrors . . .passing urine in bed during night after elder years like after 12 years
· Feeling overly grateful/appreciative from small favors by others.
· Boundary issues: lack of, needing to be in control, power issues, fear of losing control...
· Eating disorders including: anorexia, bulimia, compulsive over-eating etc.. .
· Headaches, arthritis and/or joint pain, gynecological disorders, stomachaches and other somatic symptom logy.
· Unexplained anxiety/panic, when with individuals from childhood.
· Extreme guilt/shame.
· Obsessive/compulsive behaviors (not necessarily Obsessive/Compulsive Disorder).
· History of being involved in emotionally, psychological and/or physically violent relationships (emotionally, physically).
· Memories of domestic violence in childhood.
· Sexual acting out, "sexaholism", history of prostitution, performing in porn films . . .
· Distorted body image/poor body image.
· Hyper vigilance. (Too much sensitivity)
· History of ambivalent (both loves and hurts the same person) or intensely conflictive relationships.
· Depersonalization. Feeling one to be unreal and everyone else to be real (or vice versa).
· Blocking out periods of one's life (usually ages 1-12) or a specific person or place.
· History of multi-victimizations in other forms.
· Extremely high or low risk taking.
· Obsession with suicide at various times of the year or after triggering events.
· Wearing layers of clothing, even in the summer - caused by body image issues.
· Intense anxiety and/or avoidance of gynecological exams.
· Unexplained fears of suffocation.
· Unusual interest in or avoidance of all things of a sexual nature
· Depression or withdrawal from friends or family
· Seductiveness
· Statements that their bodies are dirty or damaged, or fear that there is something wrong with them in the genital area
· Refusal to go to school
· Delinquency/conduct problems
· Secretiveness
· Aspects of sexual molestation in drawings, games, fantasies
· Unusual aggressiveness, or suicidal behavior
LONG TERM EFFECTS OF CHILD SEXUAL ABUSE:
There are many possible long-term effects that childhood sexual abuse can have on a person, and among any group of abuse survivors there are always people who will react in totally different ways, that, at first can seem to contradict each other. I cannot list all of the effects due to there being so many possibilities.
#Intense nightmares
#Flashbacks
#Guilt
#Depression and Bad Days
#Shame
#Self hate
#Feeling a failure
#Fear of fear
#Seeing no way forward
#Fear of men
#Fear of women
#Low self-esteem
#Fear of authority
#Often feeling "used"
#Need to feel in control
#Jealousy
#Fear of other people's motives
#Anger (or fear of your own)
#Agoraphobia
#Fear of the dark
#Unable to say "no"
#Sleep problems
#Self harm & cutting
#Eating disorders
#Unreasonable self blame
#Feeling suicidal
#Drug abuse
#Drink problems
#Lack of emotions
#Isolation
#Fear of sex
#Prostitution
#Masturbation problems
#Feeling lost
#Sexual identity problems
#Relationship problems
#Trust problems
#Feeling different
#Unable to cry
#Always crying
#Inability to plan ahead
#Financial problems
#Panic attacks
#Sexual dysfunction
#Unable to take compliments
#Fear of hurting other people
#Always asking WHY ME?
#Need to be perfect
#The need to please other people, for fear of losing their friendship.
#Need to find some way to push away those that become too close, or mean something, to you before they get a chance to reject you.
#Feeling "if people really knew me, they would reject me".
Additional Behavioral Signs in Pre-teens and Adolescents
· Self-mutilation (the child may repeatedly pick at scabs, cut him/herself with a razor blade, bite his/her finger or arm, burn him/herself with a cigarette)
· Threatening or attempting suicide
· Using drugs or alcohol
· Becoming promiscuous (a child is sexually active without discrimination, or just has that reputation)
· Being prudish (the child avoids any sexuality, does not see him/herself as a sexual being in any way)
· Prostitution
· Fire-setting
· Lying, stealing
· Running away
· Isolating self or dropping friends
· Pre-occupation with death (the child may write poems about death, may ask a lot of questions about death, such as "What does it feel like and where do people go?")
MEDICAL AND PSYCHIATRIC:
In addition to requiring immediate treatment for physical injuries, abused children and adults often need long-term psychotherapy in order to recover from specific mental disorders and to learn new ways of dealing with distorted thoughts and feelings. This approach to therapy is known as cognitive restructuring. Specific mental disorders that have been linked to childhood abuse include
Major depression, (always sad)
Bulimia nervosa, (eating more)
Social phobia,(unable to socialize with others)
Generalized anxiety disorder, (fear of every thing)
Post-traumatic stress disorder, (after a stress developing symptoms)
Borderline personality disorder(acting out in situations badly with out thinking of the consequences)
Dissociative amnesia, (forgetting) and
Dissociative identity disorder. (Forgetting about own identity like whom am I)
Abused adults may develop post-traumatic stress disorder, major depression, or substance (Alcohol and drug) abuse disorders. Sexually abused children and their families need immediate professional evaluation and treatment. Child and adolescent psychiatrists can help abused children regain a sense of self-esteem, cope with feelings of guilt about the abuse, and begin the process of overcoming the trauma. Such treatment can help reduce the risk that the child will develop serious problems as an adult.
WHEN MANY OF US GO INTO THERAPY:
we do so in the hope of getting some quick release from the distress that we are experiencing at the time. We are very aware that therapy is costing us a lot in terms of time, money, and energy, and understandably we want to see some immediate results, especially when we are in emotional pain. No therapist, however, has a magic wand to instantly take away our pain, nor do they have a crystal ball and are able to know our exact needs without us saying. Therapy is not like a doctor that can set a broken leg; therapy takes time to heal the mind.It is important that you talk with your therapist about what your expectations are, and about what your needs are from therapy. Just like any other relationship, the more you know and can communicate what you want and need from that relationship, the better chance you will have of receiving that. For some people, it may be easier, at first, for you to write down your needs than to say them aloud. It may well be that you are entering therapy for the first time and not have any sense of what needs to happen other than you want to feel better than you currently do feel. It is very important that you express this also. Therapy should be a two way process of communication.
RESPONDING TO CHILD SEXUAL ABUSE:
When a child tells an adult that he or she has been sexually abused, the adult may feel uncomfortable and may not know what to say or do. The following guidelines should be used when responding to children who say they have been sexually abused:
What to SayIf a child even hints in a vague way that sexual abuse has occurred, encourage him or her to talk freely. Don't make judgmental comments.
· Show that you understand and take seriously what the child is saying. Child and adolescent psychiatrists have found that children who are listened to and understood do much better than those who are not. The response to the disclosure of sexual abuse is critical to the child's ability to resolve and heal the trauma of sexual abuse.
· Assure the child that they did the right thing in telling. A child who is close to the abuser may feel guilty about revealing the secret. The child may feel frightened if the abuser has threatened to harm the child or other family members as punishment for telling the secret.
· Tell the child that he or she is not to blame for the sexual abuse. Most children in attempting to make sense out of the abuse will believe that somehow they caused it or may even view it as a form of punishment for imagined or real wrongdoings.
· Finally, offer the child protection, and promise that you will promptly take steps to see that the abuse stops.
What to DoReport any suspicion of child abuse. If the abuse is within the family, report it to the local Child Protection Agency. If the abuse is outside of the family, report it to the police or district attorney's office. Individuals reporting in good faith are immune from prosecution. The agency receiving the report will conduct an evaluation and will take action to protect the child.
Parents should consult with their pediatrician or family physician, who may refer them to a physician who specializes in evaluating and treating sexual abuse. The examining doctor will evaluate the child's condition and treat any physical problem related to the abuse, gather evidence to help protect the child, and reassure the child that he or she is all right.
Children who have been sexually abused should have an evaluation by a child and adolescent psychiatrist or other qualified mental health professional to find out how the sexual abuse has affected them, and to determine whether ongoing professional help is necessary for the child to deal with the trauma of the abuse. The child and adolescent psychiatrist can also provide support to other family members who may be upset by the abuse.
While most allegations of sexual abuse made by children are true, some false accusations may arise in custody disputes and in other situations. Occasionally, the court will ask a child and adolescent psychiatrist to help determine whether the child is telling the truth, or whether it will hurt the child to speak in court about the abuse.
When a child is asked as to testify, special considerations--such as videotaping, frequent breaks, exclusion of spectators, and the option not to look at the accused--make the experience much less stressful.
Adults, because of their maturity and knowledge, are always the ones to blame when they abuse children. The abused children should never be blamed.
When a child tells someone about sexual abuse, a supportive, caring response is the first step in getting help for the child and reestablishing their trust in adults.
CHILD ABUSE - THE HIDDEN BRUISES:
The statistics on physical child abuse are alarming. It is estimated hundreds of thousands of children are physically abused each year by a parent or close relative. Thousands die. For those who survive, the emotional trauma remains long after the external bruises have healed. Communities and the courts recognize that these emotional “hidden bruises” can be treated. Early recognition and treatment is important to minimize the long term effect of physical abuse. Whenever a child says he or she has been abused, it must be taken seriously and immediately evaluated.
Children who have been abused may display:
· A poor self image
· Sexual acting out
· Inability to trust or love others
· Aggressive, disruptive, and sometimes illegal behavior
· Anger and rage
· Self destructive or self abusive behavior, suicidal thoughts
· Passive, withdrawn or clingy behavior
· Fear of entering into new relationships or activities
· Anxiety and fears
· School problems or failure
· Feelings of sadness or other symptoms of depression
· Flashbacks, nightmares
· Drug and alcohol abuse
· Sleep problems
Often the severe emotional damage to abused children does not surface until adolescence or later, when many abused children become abusing parents. An adult who was abused as a child often has trouble establishing intimate personal relationships. These men and women may have trouble with physical closeness, touching, intimacy, and trust as adults. They are also at higher risk for anxiety, depression, substance abuse, medical illness, and problems at school or work. Without proper treatment, physically abused children can be damaged for life. Early identification and treatment is important to minimize the long-term consequences of abuse. Qualified mental health professionals should conduct a comprehensive evaluation and provide treatment for children who have been abused. Through treatment, the abused child begins to regain a sense of self-confidence and trust. The family can also be helped to learn new ways of support and communicating with one another. Parents may also benefit from support, parent training and anger management. Physical abuse is not the only kind of child abuse. Many children are also victims of neglect, or sexual abuse, or emotional abuse. In all kinds of child abuse, the child and the family can benefit from evaluation and treatment from a qualified mental health professional
GUIDE LINES TO COPE UP:
1. Relaxation exercises can help to reduce the stress levels.
2. Do something Physical. If you are sitting and feeling agitated, try to do some physical exercise, such as walking about, hovering, go out jogging or for a brisk walk.
3. Engage in a simple repetitive activity. If you are in a supermarket and feeling anxious you could count the number of people in a queue, count the money in your purse or repeat a statement over and over again.
4. A lot of people find that keeping some cards with coping statements on them in a bag or coat pocket helpful. Bring them out when panic symptom start to come on and repeat the statements over to yourself.
5. Express anger by pounding a pillow or cushion. Throw soft thing around, or dig the garden and pound the soil with a spade.
6. Practice muscle relaxation.
7. Do something that requires your concentration to be focused such as playing cards, crosswords or knitting.
8. Practice deep abdominal breathing
REFERENCS:
1. http://www.healthline.com/galecontent/abuse-1/4
2. http://www.theawarenesscenter.org/symptoms.html
3. http://www.aest.org.uk/survivors
4. http://www.aacap.org/page.ww?name=Child+Sexual+Abuse§ion=Facts+for+Families
5. http://www.aacap.org/cs/root/facts_for_families/responding_to_child_sexual_abuse
prepared by vijayarani.M
M.VIJAYARANI.BSC(N).R.N.R.M
CHILD SEXUAL ABUSE
DEFINITION:
ABUSE:
Abuse refers to harmful or injurious treatment of another human being that may include physical, sexual, verbal, psychological/emotional, intellectual, or spiritual maltreatment. Abuse may coexist.
SEXUAL ABUSE:
Sexual abuse refers to inappropriate sexual contact between a child or an adult and someone who has some kind of family or professional authority over them. Sexual abuse may include verbal remarks, fondling or kissing, or attempted or completed intercourse. Sexual contact between a child and a biological relative is known as incest, although some therapists extend the term to cover sexual contact between a child and any trusted caregiver, including relatives by marriage. Girls are more likely than boys to be abused sexually; according to a conservative estimate, 38% of girls and 16% of boys are sexually abused before their eighteenth birthday.
CHILD SEXUAL ABUSE:
Is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification
NEGLECT:
Which is defined as failure to meet a dependent person's basic physical and medical needs, emotional deprivation, and/or desertion. Neglect is sometimes described as passive abuse.
TYPES OF SEXUAL ABUSE:
This term includes a variety of sexual offenses, including:
· Sexual assault – a term defining offenses in which an adult touches a minor for the purpose of sexual gratification; for example, rape (including sodomy), and sexual penetration with an object.
· Sexual molestation – a term defining offenses in which an adult engages in non-penetrative activity with a minor for the purpose of sexual gratification; for example, exposing a minor to pornography or to the sexual acts of others.
· Sexual exploitation – a term defining offenses in which an adult victimizes a minor for advancement, sexual gratification, or profit; for example, prostituting a child, and creating or trafficking in child pornography.
· Sexual grooming - defines the social conduct of a potential child sex offender who seeks to make a minor more accepting of their advances, for example in an online
CHILD SEXUAL OFFENDER:
Refers to a person who has been convicted for one or more child sexual abuse offenses.
INCIDENCE:
Over 20.83% of the populations suffer some forum of sexual abuse before the age of 18 years old. They come from all walks of life; about 25% of children who are abused or neglected are younger than two years of age. It is estimated that before the age of 18 at least 1 in 4 females and 1 in 6 males will have suffered from some form of sexual abuse. That is over 20.83% of the population!!With over 50,000,000 people in the UK, that means that there are more than 10,400,000 people in the UK alone who are, or will become, survivors of sexual abuse. Assuming that people live 70 years that’s over148, 571 NEW victims of childhood sexual abuse per year! And this does NOT include adults who have been raped. Children who suffer from birth defects, developmental delays, or chronic illnesses have a higher risk of being abused by parents or other caregivers.
POPULATION:
They come from all walks of life, all backgrounds, and happens to both females and males, rich and poor, white, black, or pink. Child sexual abuse can take place within the family, by a parent, stepparent, sibling or other relative; or outside the home, for example, by a friend, neighbor, child care person, teacher, or stranger.
COPING MECHANISM IN CHILDREN TO ABUSE:
When sexual abuse has occurred, a child can develop a variety of distressing feelings, thoughts and behaviors.No child is psychologically prepared to cope with repeated sexual stimulation. Even a two or three year old, who cannot know the sexual activity is wrong, will develop problems resulting from the inability to cope with the overstimulation. When sexual abuse occurs within the family, the child may fear the anger, jealousy or shame of other family members, or be afraid the family will break up if the secret is told. A child who is the victim of prolonged sexual abuse usually develops low self-esteem, a feeling of worthlessness and an abnormal or distorted view of marriage and sex. The child may become withdrawn and mistrustful of adults, and can become suicidal. Some sexually abused children become child abusers or prostitutes, or have other serious problems when they reach adulthood. Child sexual abusers can make the child extremely fearful of telling, and only when a special effort has helped the child to feel safe, can the child talk freely. If a child says that he or she has been molested, parents should try to remain calm and reassure the child that what happened was not their fault. Parents should seek a medical examination and psychiatric consultation.
CHILD SEXUAL OFFENDER CAN BE:
Many victims of childhood sexual abuse will have been abused by someone in the family or a close family friend, and the abuser can be either male or female, rich or poor, teacher, step dad, mother, babysitter, vicar, brother or anyone. Some will have been abused by a stranger, and although that is what becomes reported in the news far more often, abuse happens far more often by someone known to the child that they should have been able to trust to protect them.
CAUSES OF ABUSE:
· Early learning experiences
· Ignorance of developmental timetables
· Economic stress
· Lack of social support or social resources.
· Substance abuse: (Alcohol and mood-altering drugs)
· Mental disorders.
· Belief systems
AFTER EFFECTS:
Abuse affects all dimensions of human development and existence.Abused children often display
1. Retarded physical growth and poor coordination
2. In both children and adults, repeated trauma produces changes in the neurochemistry of the brain that affect memory formation.
3.Instead of memories being formed in the normal way, which allows them to be modified by later experiences and integrated into the person's ongoing life, traumatic memories are stored as chaotic fragments of emotion and sensation that are sealed off from ordinary consciousness.
4.These traumatic memories may then erupt from time to time in the form of flashbacks.
5.Abused children develop stress
6.They often misinterpret other people's behavior and refuse to trust them.
7.Emotional distortions include such patterns as being unable to handle strong feelings, or being unusually tolerant of behavior from others that most people would protest.
8.Children who are abused are often in physical and emotional pain at school.
9.cannot concentrate on schoolwork, and consequently fall behind in their grades
10.They often find it hard to make or keep friends, and may be victimized by bullies or become bullies themselves
11.Even though a survivor may consciously want to avoid re-abuse, the individual is often unconsciously attracted to people who remind him or her of the family of origin.
12.Abused adults are also likely to fail to complete their education, or they accept employment that is significantly below their actual level of ability.
COMMON SYMPTOMS OF ADULT SURVIVORS OF CHILDHOOD SEXUAL ABUSE
· Low self-esteem, feeling worthless.
· Fear of abandonment and other abandonment issues.
· Acting out behavior. Not knowing how to identify, process and or express intense feelings in more productive ways.
· Unexplained fears of being alone at night, nightmares and/or night terrors . . .passing urine in bed during night after elder years like after 12 years
· Feeling overly grateful/appreciative from small favors by others.
· Boundary issues: lack of, needing to be in control, power issues, fear of losing control...
· Eating disorders including: anorexia, bulimia, compulsive over-eating etc.. .
· Headaches, arthritis and/or joint pain, gynecological disorders, stomachaches and other somatic symptom logy.
· Unexplained anxiety/panic, when with individuals from childhood.
· Extreme guilt/shame.
· Obsessive/compulsive behaviors (not necessarily Obsessive/Compulsive Disorder).
· History of being involved in emotionally, psychological and/or physically violent relationships (emotionally, physically).
· Memories of domestic violence in childhood.
· Sexual acting out, "sexaholism", history of prostitution, performing in porn films . . .
· Distorted body image/poor body image.
· Hyper vigilance. (Too much sensitivity)
· History of ambivalent (both loves and hurts the same person) or intensely conflictive relationships.
· Depersonalization. Feeling one to be unreal and everyone else to be real (or vice versa).
· Blocking out periods of one's life (usually ages 1-12) or a specific person or place.
· History of multi-victimizations in other forms.
· Extremely high or low risk taking.
· Obsession with suicide at various times of the year or after triggering events.
· Wearing layers of clothing, even in the summer - caused by body image issues.
· Intense anxiety and/or avoidance of gynecological exams.
· Unexplained fears of suffocation.
· Unusual interest in or avoidance of all things of a sexual nature
· Depression or withdrawal from friends or family
· Seductiveness
· Statements that their bodies are dirty or damaged, or fear that there is something wrong with them in the genital area
· Refusal to go to school
· Delinquency/conduct problems
· Secretiveness
· Aspects of sexual molestation in drawings, games, fantasies
· Unusual aggressiveness, or suicidal behavior
LONG TERM EFFECTS OF CHILD SEXUAL ABUSE:
There are many possible long-term effects that childhood sexual abuse can have on a person, and among any group of abuse survivors there are always people who will react in totally different ways, that, at first can seem to contradict each other. I cannot list all of the effects due to there being so many possibilities.
#Intense nightmares
#Flashbacks
#Guilt
#Depression and Bad Days
#Shame
#Self hate
#Feeling a failure
#Fear of fear
#Seeing no way forward
#Fear of men
#Fear of women
#Low self-esteem
#Fear of authority
#Often feeling "used"
#Need to feel in control
#Jealousy
#Fear of other people's motives
#Anger (or fear of your own)
#Agoraphobia
#Fear of the dark
#Unable to say "no"
#Sleep problems
#Self harm & cutting
#Eating disorders
#Unreasonable self blame
#Feeling suicidal
#Drug abuse
#Drink problems
#Lack of emotions
#Isolation
#Fear of sex
#Prostitution
#Masturbation problems
#Feeling lost
#Sexual identity problems
#Relationship problems
#Trust problems
#Feeling different
#Unable to cry
#Always crying
#Inability to plan ahead
#Financial problems
#Panic attacks
#Sexual dysfunction
#Unable to take compliments
#Fear of hurting other people
#Always asking WHY ME?
#Need to be perfect
#The need to please other people, for fear of losing their friendship.
#Need to find some way to push away those that become too close, or mean something, to you before they get a chance to reject you.
#Feeling "if people really knew me, they would reject me".
Additional Behavioral Signs in Pre-teens and Adolescents
· Self-mutilation (the child may repeatedly pick at scabs, cut him/herself with a razor blade, bite his/her finger or arm, burn him/herself with a cigarette)
· Threatening or attempting suicide
· Using drugs or alcohol
· Becoming promiscuous (a child is sexually active without discrimination, or just has that reputation)
· Being prudish (the child avoids any sexuality, does not see him/herself as a sexual being in any way)
· Prostitution
· Fire-setting
· Lying, stealing
· Running away
· Isolating self or dropping friends
· Pre-occupation with death (the child may write poems about death, may ask a lot of questions about death, such as "What does it feel like and where do people go?")
MEDICAL AND PSYCHIATRIC:
In addition to requiring immediate treatment for physical injuries, abused children and adults often need long-term psychotherapy in order to recover from specific mental disorders and to learn new ways of dealing with distorted thoughts and feelings. This approach to therapy is known as cognitive restructuring. Specific mental disorders that have been linked to childhood abuse include
Major depression, (always sad)
Bulimia nervosa, (eating more)
Social phobia,(unable to socialize with others)
Generalized anxiety disorder, (fear of every thing)
Post-traumatic stress disorder, (after a stress developing symptoms)
Borderline personality disorder(acting out in situations badly with out thinking of the consequences)
Dissociative amnesia, (forgetting) and
Dissociative identity disorder. (Forgetting about own identity like whom am I)
Abused adults may develop post-traumatic stress disorder, major depression, or substance (Alcohol and drug) abuse disorders. Sexually abused children and their families need immediate professional evaluation and treatment. Child and adolescent psychiatrists can help abused children regain a sense of self-esteem, cope with feelings of guilt about the abuse, and begin the process of overcoming the trauma. Such treatment can help reduce the risk that the child will develop serious problems as an adult.
WHEN MANY OF US GO INTO THERAPY:
we do so in the hope of getting some quick release from the distress that we are experiencing at the time. We are very aware that therapy is costing us a lot in terms of time, money, and energy, and understandably we want to see some immediate results, especially when we are in emotional pain. No therapist, however, has a magic wand to instantly take away our pain, nor do they have a crystal ball and are able to know our exact needs without us saying. Therapy is not like a doctor that can set a broken leg; therapy takes time to heal the mind.It is important that you talk with your therapist about what your expectations are, and about what your needs are from therapy. Just like any other relationship, the more you know and can communicate what you want and need from that relationship, the better chance you will have of receiving that. For some people, it may be easier, at first, for you to write down your needs than to say them aloud. It may well be that you are entering therapy for the first time and not have any sense of what needs to happen other than you want to feel better than you currently do feel. It is very important that you express this also. Therapy should be a two way process of communication.
RESPONDING TO CHILD SEXUAL ABUSE:
When a child tells an adult that he or she has been sexually abused, the adult may feel uncomfortable and may not know what to say or do. The following guidelines should be used when responding to children who say they have been sexually abused:
What to SayIf a child even hints in a vague way that sexual abuse has occurred, encourage him or her to talk freely. Don't make judgmental comments.
· Show that you understand and take seriously what the child is saying. Child and adolescent psychiatrists have found that children who are listened to and understood do much better than those who are not. The response to the disclosure of sexual abuse is critical to the child's ability to resolve and heal the trauma of sexual abuse.
· Assure the child that they did the right thing in telling. A child who is close to the abuser may feel guilty about revealing the secret. The child may feel frightened if the abuser has threatened to harm the child or other family members as punishment for telling the secret.
· Tell the child that he or she is not to blame for the sexual abuse. Most children in attempting to make sense out of the abuse will believe that somehow they caused it or may even view it as a form of punishment for imagined or real wrongdoings.
· Finally, offer the child protection, and promise that you will promptly take steps to see that the abuse stops.
What to DoReport any suspicion of child abuse. If the abuse is within the family, report it to the local Child Protection Agency. If the abuse is outside of the family, report it to the police or district attorney's office. Individuals reporting in good faith are immune from prosecution. The agency receiving the report will conduct an evaluation and will take action to protect the child.
Parents should consult with their pediatrician or family physician, who may refer them to a physician who specializes in evaluating and treating sexual abuse. The examining doctor will evaluate the child's condition and treat any physical problem related to the abuse, gather evidence to help protect the child, and reassure the child that he or she is all right.
Children who have been sexually abused should have an evaluation by a child and adolescent psychiatrist or other qualified mental health professional to find out how the sexual abuse has affected them, and to determine whether ongoing professional help is necessary for the child to deal with the trauma of the abuse. The child and adolescent psychiatrist can also provide support to other family members who may be upset by the abuse.
While most allegations of sexual abuse made by children are true, some false accusations may arise in custody disputes and in other situations. Occasionally, the court will ask a child and adolescent psychiatrist to help determine whether the child is telling the truth, or whether it will hurt the child to speak in court about the abuse.
When a child is asked as to testify, special considerations--such as videotaping, frequent breaks, exclusion of spectators, and the option not to look at the accused--make the experience much less stressful.
Adults, because of their maturity and knowledge, are always the ones to blame when they abuse children. The abused children should never be blamed.
When a child tells someone about sexual abuse, a supportive, caring response is the first step in getting help for the child and reestablishing their trust in adults.
CHILD ABUSE - THE HIDDEN BRUISES:
The statistics on physical child abuse are alarming. It is estimated hundreds of thousands of children are physically abused each year by a parent or close relative. Thousands die. For those who survive, the emotional trauma remains long after the external bruises have healed. Communities and the courts recognize that these emotional “hidden bruises” can be treated. Early recognition and treatment is important to minimize the long term effect of physical abuse. Whenever a child says he or she has been abused, it must be taken seriously and immediately evaluated.
Children who have been abused may display:
· A poor self image
· Sexual acting out
· Inability to trust or love others
· Aggressive, disruptive, and sometimes illegal behavior
· Anger and rage
· Self destructive or self abusive behavior, suicidal thoughts
· Passive, withdrawn or clingy behavior
· Fear of entering into new relationships or activities
· Anxiety and fears
· School problems or failure
· Feelings of sadness or other symptoms of depression
· Flashbacks, nightmares
· Drug and alcohol abuse
· Sleep problems
Often the severe emotional damage to abused children does not surface until adolescence or later, when many abused children become abusing parents. An adult who was abused as a child often has trouble establishing intimate personal relationships. These men and women may have trouble with physical closeness, touching, intimacy, and trust as adults. They are also at higher risk for anxiety, depression, substance abuse, medical illness, and problems at school or work. Without proper treatment, physically abused children can be damaged for life. Early identification and treatment is important to minimize the long-term consequences of abuse. Qualified mental health professionals should conduct a comprehensive evaluation and provide treatment for children who have been abused. Through treatment, the abused child begins to regain a sense of self-confidence and trust. The family can also be helped to learn new ways of support and communicating with one another. Parents may also benefit from support, parent training and anger management. Physical abuse is not the only kind of child abuse. Many children are also victims of neglect, or sexual abuse, or emotional abuse. In all kinds of child abuse, the child and the family can benefit from evaluation and treatment from a qualified mental health professional
GUIDE LINES TO COPE UP:
1. Relaxation exercises can help to reduce the stress levels.
2. Do something Physical. If you are sitting and feeling agitated, try to do some physical exercise, such as walking about, hovering, go out jogging or for a brisk walk.
3. Engage in a simple repetitive activity. If you are in a supermarket and feeling anxious you could count the number of people in a queue, count the money in your purse or repeat a statement over and over again.
4. A lot of people find that keeping some cards with coping statements on them in a bag or coat pocket helpful. Bring them out when panic symptom start to come on and repeat the statements over to yourself.
5. Express anger by pounding a pillow or cushion. Throw soft thing around, or dig the garden and pound the soil with a spade.
6. Practice muscle relaxation.
7. Do something that requires your concentration to be focused such as playing cards, crosswords or knitting.
8. Practice deep abdominal breathing
REFERENCS:
1. http://www.healthline.com/galecontent/abuse-1/4
2. http://www.theawarenesscenter.org/symptoms.html
3. http://www.aest.org.uk/survivors
4. http://www.aacap.org/page.ww?name=Child+Sexual+Abuse§ion=Facts+for+Families
5. http://www.aacap.org/cs/root/facts_for_families/responding_to_child_sexual_abuse
prepared by vijayarani.M
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