Domestic Violence - 3 Nursing CEs

Author: Kristi Hudson RN MSN CCRN

Written: 1/21/05

Updated: October 14, 2009

Course Description:

This course is designed to give an overview of the care and management of the victim of domestic violence. Focus will be placed on what is considered to be domestic violence as well as “who” are the victims of domestic violence. Statistic regarding the occurrence of domestic violence as well as identifying victims will be presented. Are you a victim of domestic violence? This course will provide early signs and symptoms of domestic abuse as well as clinical presentation to the Emergency Department. Steps to take if a victim confirms abuse and reporting requirements of domestic violence will be the final focus of this course.

Course Objectives:

Upon completion of this course the student will be able to:

• Define domestic abuse
• Discuss the different types of domestic violence
• Describe “who” are the victims of domestic violence
• State 2 statistics surrounding the instance of domestic violence
• List 3 presenting signs of symptoms of victims of domestic violence
• Explain the early symptoms of domestic violence
• Describe the clinical presentation of the domestic violence victim
• List the interventions to take when a person confirms domestic violence
• Discuss the requirements for reporting suspected domestic violence
• Recognize which states have mandatory reporting laws for domestic violence

What is domestic violence?

Domestic violence (which is also known as partner abuse, spouse abuse, or battering) occurs when one person uses any type of force to inflict injury (either emotional or physical) upon another person they have, or had, a relationship with. It occurs between spouses and partners, parents and children, children and grandparents (also known as elder abuse), and brothers and sisters. Victims can any age, race, or gender.

Who are the victims of domestic violence?

Unfortunately there is no “one” specific victim or personality type. As mentioned above, domestic violence occurs among all ages, races, sexes and socioeconomic classes (it is not a poor mans syndrome). It occurs in families of all educational backgrounds. Individuals may be living together or separated, divorced or prohibited from contact by temporary or permanent restraining orders.

Statistics surrounding domestic violence:

The following are statistics regarding the prevalence of domestic violence in the United States:

• Domestic violence is the single largest cause of injury to women between the ages of 15 and 44 in the United States.
• In the United States, domestic violence occurs in greater numbers the all muggings, car accidents and rapes combined.
• 2 million and 4 million women are battered per year and 2,000 of these battered women will die of their injuries every year.
• Nearly 18 percent of women surveyed, or 17.7 million American women, have been raped or been a victim of attempted rape during their lifetime, according to a collaborative study on violence jointly funded by the Department of Health and Human Services and the Department of Justice.
• Nearly 1 in 3 adult women experience at least one physical assault by a partner during adulthood.
• 28% of all annual violence against women is perpetrated by intimates.
• 5% of all annual violence against men is perpetrated by intimates.
• Research shows that approximately 900,000 parents are beaten or abused by their children each year.

Are you a victim?

Abusers use many tactics to isolate, intimidate and control their victims. The following are early signs of domestic abuse:

• Quick whirlwind romances
• Wanting to be with you all of the time
• Wanting to know where you are at all times
• Being Jealous
• Attempting to isolate you from your friends and family
• Hypersensitive to being slighted
• Pressuring you to do things you are not comfortable with
• Blaming others or situations for acts of abuse

A screening tool to determine if domestic violence exists:

Because domestic violence is not confined to any specific group of people, the following questions can be asked in private to patients, friends and or family members to help the victim open up and determine if a person is a victim of domestic violence:

• When you argue or fight at home, what happens?
• Do you ever change your behavior because you are afraid of the consequences of a fight?
• Do you feel that your partner or spouse treats you well?
• Is there anything that goes on at home that makes you feel afraid?
• Has your partner or spouse ever hurt or threatened you or your children?
• Has your partner or spouse ever put their hands on you against your will?
• Has your partner or spouse ever forced you to do something you did not want to do?
• Does your partner or spouse criticize you or your children a lot?
• Has your partner or spouse ever tried to keep you from taking medication you needed or from seeking medical help?
• Does your partner refuse to let you sleep at night?
• Has your partner or spouse ever hurt your pets or destroyed your clothing, objects in your home, or something which you especially cared about?
• Does your partner or spouse throw or break objects in the home during arguments?
• Does your partner or spouse act jealously, for example, always calling you at work or home to check up on you?
• Is it hard for you to maintain relationships with your friends, relatives, neighbors, or co-workers because your partner or spouse disapproves of, argues with, or criticizes them?
• Does your partner or spouse accuse you unjustly of flirting with others or having affairs?
• Has your partner or spouse ever tried to keep you from leaving the house?
• Does your spouse or partner make it hard for you to find or keep a job or to go to school?
• Every family has their own way of handling finances. Does your partner or spouse withhold money from you when you need it?
• Do you know what your family's assets are?
• Do you know where important documents like bank books, check books, financial statements, birth certificates, and passports for you and members of your family are kept?
• If you wanted to see or use any of them, would your partner or spouse make it difficult for you to do so?
• Does your spouse or partner sometimes spend large sums of money and refuse to tell you why or what the money was spent on?
• Has your spouse or partner ever forced you to have sex or made you do things during sex that make you feel uncomfortable?
• Does your partner demand sex when you are sick, tired, or sleeping?
• Has your spouse or partner ever used or threatened to use a weapon against you? Are there guns in your home?
• Does your spouse or partner abuse drugs or alcohol? What happens?

Clinical presentation (signs and symptoms) of the domestic violence:

The following complaints/signs and symptoms are often present when a victim of domestic violence comes into the Emergency Department:

• Types or extent of injury that is inconsistent with the patient's explanation.
• Substantial delay between when the injury occurred and when the patient seeks treatment.
• Previous assault.
• Repeated visits for minor trauma.
• Injuries during pregnancy.
• Patients who are evasive or embarrassed.
• Patients who come in with care takers who do all of the talking (Very commonly seen with elder abuse).
• Pattern of repeated visits to the emergency department.
• Evidence of alcohol or drug abuse.
• Arriving in the emergency department as a result of a suicide attempt or rape.

Any of the following physical findings:

• Central pattern of injuries.
• Contusions or injuries in the head, neck or chest.
• Injuries that suggest a defensive posture.
• Bone fractures.
• Burns or bruises in unusual locations
• Central injuries (e.g., chest, breasts, abdomen, pelvis, perineum)
• Facial injuries (e.g., teeth, jaw, ruptured eardrum)
• Human bites
• Injuries at various stages of healing
• Injuries from weapons (old scars or new signs)

The best approach when domestic violence is suspected:

First understand that it may be very difficult for the victim to open up about abuse and healthcare workers may find that victims are in denial or refuse to admit that they are being abused. The following approach will help open communication lines when domestic violence is suspected:

• Remain calm.
• Remain non-judgmental and supportive.
• Be clear and concise about your suspicions of abuse (for example; “the shape of the bruise on your face is consistent with the size and shape of a fist”).
• Be accepting of a response of denial
• Be certain to inform the patient that this information is confidential.
• Mention under state law that no one has the right to abuse another.
• Mention that battery is a crime.
• Be patient and continue to ask questions (it often takes time for victims to open up).

What should be done when patient confirms domestic violence?

If a patient confirms suspicion of domestic violence, the following interventions should be immediately put into place:

• Assure that all physical needs are met and care is given for injuries.
• Validate the persons feelings (fear and shame are common emotions).
• Support the person’s right to no longer be abused.
• Acknowledge the potential for future harm.
• Discuss immediate safety concerns (should the person return home, does the abuser have a weapon, is the abuser under the influence of drugs or alcohol).
• Review resources and written material with victim.
• Offer a domestic violence advocate (these advocates are trained and available 24 hours a day).
• Supply the victim with crisis numbers, shelter numbers and victim assistance numbers.

Reporting actual or suspected domestic violence:

The laws governing the reporting of suspected or actual domestic violence differ from state to state. There are currently only 6 states that have mandatory reporting of actual or suspected domestic violence. This is a requirement whether the healthcare official believes that reporting will be beneficial to the victim or not. Regardless of whether reporting is required; it is imperative that healthcare workers are familiar with the laws in their state. The following table lists the states that are required to report domestic violence and under which circumstances.

Note: Whether reporting or not, proper documentation is critical in the event that the victim chooses to take legal action at the time of the visit or sometime in the future.

References

American Bar Association Commission on Domestic Violence. (2003). Multidisciplinary response to domestic violence. Retrieved on January 20, 2006 at:

http://www.abanet.org/domviol/mrdv/identify.html

American College of Emergency Physicians. (2003). Domestic violence. Retrieved on January 20, 2006 at:

http://www.nlm.nih.gov/medlineplus/domesticviolence.html

American Psychiatric Association. (2003). Lets talk facts about domestic violence. Retrieved on January 20, 2006 at:

http://www.nlm.nih.gov/medlineplus/domesticviolence.html

Iavicoli, L., MD. (2003). Mandatory reporting of domestic violence: The law friend or foe? Retrieved on January 21, 2006 at:

http://mssm.edu/msjournal/72/72_4_pages_228_231.pdf

Institute for Clinical Systems Improvement (ICSI). Domestic violence. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2004 Nov. 51 p. [111 references].