6.1 Introduction

Maladaptive coping refers to several types of counterproductive or ineffective behaviors used to manage stressful or unpleasant situations, such as aggressive behaviors and substance misuse. This chapter will discuss abuse and neglect of children and vulnerable adults, intimate partner violence, and workplace violence. It will also discuss substance use disorders, including withdrawal and overdose. Be aware that the content in this chapter may trigger powerful emotions for survivors of similar experiences. Self-awareness and self-care practices should guide your engagement with this chapter.

Nurses encounter clients in all health care settings who are experiencing, or have previously experienced, neglect, abuse, or intimate partner violence. Approximately one in four people experience child abuse or neglect in their lifetime. Of maltreated children, 78 percent are neglected, 18 percent are abused physically, and 9 percent are abused sexually. The fatality rate for child maltreatment is 2.2 per 1,000 children annually, making homicide the second leading cause of death in children younger than age one.^[1]

Nurses also encounter clients in all health care settings who are experiencing, or have previously experienced, effects resulting from substance use disorder. Sixteen percent of the U.S. population aged 12 or older have a substance use disorder, resulting in effects for the individual, as well as for their significant others and family.^[2]

Experiencing child abuse, neglect, or growing up in a household with violence or substance misuse are classified as adverse childhood events that can result in lifelong health consequences, including chronic physical, emotional, and mental health conditions. When nurses recognize signs of these maladaptive behaviors, they can  initiate appropriate actions to promote safety of those affected, as well as to help prevent long-term consequences.^[3]