Risk Factors for Violence

This report explores the origin of human violence by discussing the risk factors of the perpetrator and the victims, investigating the ecological framework of the individual’s characteristics, relationship connections, community impact, societal and cultural aspects. This paper will draw the connection from these key risk factors and link its effects on the well-being of a child up to their adulthood from being a victim and becoming a violent offender. The objective of this article is to obtain a deeper understanding of violence and how it’s deeply intertwined with our society. As nurses, we uphold a good reputation in our society as we have direct contact with patients who have been a victim or a perpetrator of violence. Our influence is pivotal to empower every individual to care for the oppressed, develop their resilience, conflict resolution, and problem-solving skills, which are essential in preventing violence. The data collected in this report is from the World Health Organization (WHO) under the World report on violence and health.

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According to WHO (2002), violence is the deliberate use of power and force that can result in harm, injury, and death against oneself, a person, a group of people, towards the community or a country. Despite the negative outcome resulting in harm or death to a person, regardless if it was intentional or unintentional, the act of deliberately applying force or power is considered violent. Violence has three categories, such as self-directed, interpersonal, and collective violence (Friborg et al., 2015). Self-directed is a direct to harm self by head banging, intentional overdose, deliberate self-harm, depriving self with food and medication. It can also be an attempt to end a life by hanging, suicide by carbon monoxide poisoning, jumping off a high building or a moving train (Australian Bureau of Statistics, 2013). Unfortunately, these self-directed methods of violence are a general presentation in the Australian emergency department. In the socio-ecological determinants of violence, an individual’s risk factors are linked with trauma, poor problem-solving skills, mental illness, alcohol, and substance abuse potentially leading to unemployment, homelessness and mental illness (Decker et al., 2018). Violence and mental health are intertwined together, as patients with mental illness are a higher risk of committing suicide (Leyton, 2018). Individuals with previous childhood trauma are a high risk of self-directed violence and mental illness from the abuse and neglect from their parents and guardians, whether, it was by physical, psychological, sexual and verbal assault (Chatzittofis et al., 2017). The outcomes of child maltreatment carry a footprint in their wellbeing to adulthood. The feeling of depression and hopelessness pushes the individual to suicidal behavior as they deemed they have no purpose in life. Furthermore, exposure to childhood violence increases the likelihood of drug and alcohol abuse, risky sexual behaviors, criminal activity, and violence in adulthood (Ravi and Ahluwalia, 2017). In Australia, domestic homicide by an intimate partner leads the highest rate of death in comparison to an acquaintance and stranger homicide. The nature of domestic homicide is by stab wounds, beatings, gunshot, strangulation, or suffocation. The victim’s gender is regularly female in domestic violence, whereas male rated the highest victim in acquaintance homicide and lower in intimate partner homicide in contrary to female (Bryant and Cussen, 2015). Generally, the amount of victims from violence is not one but a vast quantity involving children, indigenous people, the elderly, migrants, refugees, and strangers.

(Bryant and Cussen, 2015)

(Bryant and Cussen, 2015)

 
(Bryant and Cussen, 2015)

Interpersonal violence is used to gain power, control, and dominance over another person through fear, intimidation, threats, or violence. It is divided into two categories:

•    Family and intimate partner violence – violence between members of the family including intimate partner maltreatment and extramarital relationships

•    Community violence – violence by acquaintances and strangers

It occurs in various forms such as child abuse, bullying, sexual assault, maltreatment to the elderly, and health care workers such as nurses, doctors, and paramedics (The Royal Australian College of General Practitioners, 2019). According to Mejia et al (2018), good parenting and family skills showed the most effective prevention to interpersonal violence by promoting effective communication, problem-solving, conflict resolution, and negotiation skills. Children who are not able to form a healthy relationship and attachments with their parents or caregivers may experience limited empathy and remorse when hurting or killing someone (World Health Organization, 2006). Studies have proven child maltreatment and toxic stress negatively affect the brain structure and its activities by reducing the size of the hippocampus that controls emotion, memories, and learning. In severely neglected children, magnetic resonance imaging (MRI) revealed a decreased volume and size of the cerebellum that helps coordinate motor behavior and functioning (Child Welfare Information Gateway, 2015).

In the socio-ecological framework of the individual, a child with previous experience of child abuse, low education, impulsivity, and substance abused increases the risk of being victim or a perpetuator of violence (World Health Organization, 2002). In the developmental stage of adolescent, a young person significantly experiences a psychological, biological, and social transformation. This step includes experimental and exploration of various prosocial and antisocial behaviors. This phase engages in reckless behaviors as having peers increases the adolescent’s willingness to belong to a group and to partake in violent activities such as vandalism, theft, graffiti, fights and drug use (Boyas et al., 2016). In adolescent, engagement with gangs is the quickest pathway to gain peer popularity and respect, as gang affiliations provide a source of social status, safety, belonging and support (Edelstein, 2018). In the community level of the ecological framework, neighborhood violence and criminal activities weaken prosocial activities such as school projects, recreational parks, and job opportunities to beat poverty. High residential turnover and neighborhood disorder such as vandalism, abandoned buildings, broken windows, prostitution, drug selling, and alcohol use imparts a message that no one is in command of safety. These increase fear towards residents and invite other criminal activities, hence an offender of violence does not feel accountable for their crimes (Johnson et al., 2015). Moreover, research has found that adolescents who witnessed violence have a high probability of perpetration in their adulthood, as they may use violence to solve problems and perceive it as normal, acceptable and expected. In addition, exposure to violence reduces their motivation to pursue education aspirations as they lack hope and self-esteem resulting in poor academic performance (Stoddard et al., 2015).

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In a societal perspective, collective violence is a group of people that employs brutality, cruelty, and torture against an individual, group or society to achieve a political, economic or social advantage. It’s a cruel method of a means to an end, which may cost an innocent life to end or to endure a life-long suffering if the victim survives. Collective violence contains wars, terrorism, disappearances, state-sponsored violence such as genocide and torture, armed conflict, and gang warfare. The by-product of collective violence causes severe morbidity and mortality, damages to infrastructures such as hospitals, electricity, depletion of food and water, poor access to roads, and disrupted communication networks. The cost to re-build infrastructures severely prohibits the economy’s growth (Levy and Sidel, 2014).

(Violence Prevention Alliance, 2019)

As a health professional, our role is to be an ambassador to pioneer good mental health, promote healthy family connections, and to build up our community with resilience, develop conflict resolution, and problem-solving skills. Violence is an epidemic public health issue requiring a holistic approach to break the stronghold of violence to liberate the victims and offenders of violence. As registered nurses, our role in preventing violence is significant and diverse as we can deliver effective primary, secondary, and tertiary preventions. Primary prevention designs strategies to stop violence before it happens, such as school and community programs. The goal is to equip children, adolescents, and adults to develop good behavior and morals, cultivate harmonious relationships, take responsibilities, and to care for the abused campaigning anti-violence behaviors (Australian Institute of Family Studies, 2014). In secondary prevention, this level involves immediate action to the consequences of violence such as mandatory reporting of an elderly abuse and child abuse. Nurses can collect specimen evidence, and clothing to submit to the law enforcements, administer medications for pain relief and antibiotics for sexually transmitted infections (STI). We also collaborate with social workers and refer individuals to legal services. Tertiary prevention entails long-term care to victims and offenders to prevent death and disability, it’s the continuous treatment to prevent violence such as rehabilitation for drug, and alcohol abuse, mental health treatment, and safe housing (Kirk et al., 2017).

In conclusion, the impact of violence has a multi-factorial influence to an individual such as illicit drug use, alcohol addiction, poor mental health, unemployment, poverty, and poor education. In relationship aspect, previous exposure to violence and poor relationship with parents or guardians impairs empathy and remorse when hurting a human being or individual. In a community scale, the presence of poverty encourages criminal activities such as drug trafficking, prostitution, child trafficking, and theft as a means of financial resource (Johnson et al., 2015). Violent behavior is a series of negative feelings that utilizes force and power to gain control over a situation, a person, a group of people, or a nation. It requires a holistic approach of every individual to dismantle violence including politicians, law enforcement, teachers, doctors, and nurses. As registered nurses, we must pioneer resilience, good conduct and educate every individual how to develop a coping mechanism, problem-solving and conflict resolution skills which are essential in preventing violent behaviors (Mejia et al., 2018).

References:

• Australian Bureau of Statistics (2013). 3303.0 – Causes of Death, Australia, 2010.
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