Approaches to Domestic Violence Screening for Nurses by Tiffany J. Toerpe

Introduction  The prevalence of domestic violence in Wisconsin is outstanding.  In 2005, domestic violence claimed the lives of 46 women in Wisconsin. 14 of the 46 deaths occurred in the city of Milwaukee. The average rate of domestic violence homicide in Wisconsin in 2005 was 3.3 murders per month. (Wisconsin Domestic Violence Homicide Report 2005, 2007).

Significance to Nursing  This research is significant to nursing because often, the nurse is the first of many to see and screen the patient. It is vitally important to the abused woman that her first contact is with a nurse who is knowledgeable about the screening tool and implements it effectively.  Nurses are advocates. Screening for domestic violence provides a critical opportunity for disclosure of domestic violence and provides a victim and nurse the chance to develop a plan to protect her safety and improve her health.

Research Question In a hospital facility that has implemented a house-wide Domestic Violence screening protocol, what is the frequency of reported abuse by patients?”

Design  This is an exploratory, descriptive, quantitative measurement of the frequency of reported abuse through an objective, systematic chart review.

Sample The sample population is all women seeking medical attention, who consent to a chart review for research, and affirm domestic abuse after being screened. The basis for inclusion in this research study is 1.) Age--18 and older, 2.) Type of abuse--the reported violence must be within a domestic relationship, 3.) Language— English and Spanish speaking, 4.) Status— must be mentally competent, and 5.) Sex— must be female to participate.

Methods  The Domestic Violence screening tool will be utilized upon admission to the hospital. The sample population in this research is all women seeking medical attention, who consent to a chart review for research, fit eligibility criteria, and positively affirm domestic abuse.

Screening Tool DOMESTIC VIOLENCE AND SEXUAL ABUSE GUIDE Domestic Violence is a pattern of assault and coercive behaviors, including physical, sexual, and psychological attacks, that adults or adolescents use against their intimate partners. Without intervention, the abuse usually escalates in both frequency and severity resulting in repeat visits to the health care system. Sexual Abuse is unwanted or forced sexual contact between adults or any sexual contact between an adult and a child. People affected by abuse can be of any age, gender, race, socioeconomic status or sexual orientation. A disproportionate amount of abuse is directed toward women, children and vulnerable people by male abusers. Screen all patients for abuse:  Talk with patient alone in a safe and private environment  Ask simple, direct question such as:  Because abuse is so common in many people’s lives, I’ve begun to ask it routinely…  Have you ever been hit, threatened, or made afraid by anyone close to you?  I’m concerned that your injuries were caused by violence. Has someone hurt you?  What happens when you and your partner have a disagreement?  Are you ever forced into sexual activities that you don’t want to be part of?  Does your partner control what you do, who you see or talk to, or where you go? Other Indicators of possible abuse are: History of traumatic injuries or sexual assault, AODA, depression, anxiety, suicide attempts, problems or injuries during pregnancy, delays in seeking care or repeat visits Behavior Clues: evasive, reluctant to speak in front of partner, overly protective or controlling partner Physical Clues: any injuries with inconsistent history or explanation, various stages of healing, bilateral injuries, marks on neck, sexual trauma, bite marks on genitals/breasts, dental trauma. Send Important Message to Patient Do not blame or shame the Abused person  I’m sorry to hear this, I would like to help in any way I can…  You are not alone  You are not to blame  There is help available  You do not deserve to be treated this way Assess Safety  Are you afraid to go home, work or school?  Is there escalating violence, AODA, mental illness?  Have there been threats of homicide/suicide?  Are there weapons present?  What resources have you used in the past?  Would you like to talk with the police?  Can you stay with family/friends?  Do you need shelter? Make Referrals  Sexual Assault Treatment Center (24hr crisis line)  Aurora Abuse Services-Domestic Violence  The Healing Center (ongoing sexual abuse services) Community Agencies  Sojourner Truth House………………  Milwaukee Women’s Center…………  Task Force on Family Violence………  Latina Resource Center………………  Elder Abuse—Dept of Aging………… Document  Use patient’s own words: “He began to choke me…”  Avoids the term “alleges”—use “states”  Include excited utterances: “I thought I was going to die.”  Take instant photographs of injuries  Safety plan developed with patient  Resources offered Aurora Health Care, 2002

Limitations Domestic violence is an extremely personal issue. Many women may fear that allowing their data to be used in research may somehow be made known to the abuser.

Frameworks  Domestic Violence Power and Control Wheel  Medical Power and Control Wheel

References  Aurora Health Care. (2002). Domestic Violence and Sexual Abuse Guide.  Centers for Disease Control and Prevention. (2007). Injury Department: Intimate Partner Violence. Retrieved on September 27th, 2007 from  Domestic Abuse Intervention Project. (n.d.). The Power and Control Wheel. Duluth, MN.  Domestic Violence Project. (n.d). The Medical Power and Control Wheel: Adapted from the original wheel by the Domestic Abuse Intervention project, Duluth, MN. Kenosha, WI.  Wisconsin Department of Health and Family Services. (2007). Wisconsin Domestic Violence Homicide Report Retrieved on October 1st, 2007 from eport.pdf- eport.pdf- eport.pdf-