1. Intimate Partner Violence (IPV) Chapter 18

2. Intimate Partner Violence (IPV) Current or former emotional, psychological, physical, or sexual abuse between partners in an intimate relationship Domestic violence is number one cause of ED visits by women – Up to 37% of women are battered

3. Characteristics of IPV Battered partner – Lives in terror of next abusive event – Feelings of powerlessness, low self-esteem – Becomes afraid not only for self but also children – Common for social isolation to occur Batterer – Violence is a learned behavior – Low self-esteem, poor impulse control, and limited tolerance for frustration as well as lack of control – Lack of guilt and unconcern about behavior – Extremely possessive, pathologically jealous, believe in male supremacy

4. Cycle of Violence Tension-building phase – Abuser becomes edgy, verbally abusive – Victim feels tense, afraid, like “walking on eggs” Serious battering phase – Abuser becomes unbearable; violence occurs – Victim may try to cover up the injury or may look for help Honeymoon phase – Abuser displays loving behavior, makes promises to change – Victim becomes trusting, hoping for change

5. Nursing Process: Assessment Guidelines Signs of abuse: burns, bruises, scars, wounds in various stages of healing – Victim may present with high anxiety and stress, complain of somatic symptoms Questions to ask – Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, who? – Do you feel safe in your current relationship? – Is there a partner from a previous relationship who is making you feel unsafe now? Always ask if children are also being hurt

6. Nursing Process: Diagnosis and Outcomes Identification Common nursing diagnoses – Risk for violence, Risk for injury, Acute/Chronic pain, Risk for trauma, Risk for self- or other-directed violence, Social isolation, Powerlessness, Disabled family coping Outcomes identification – Most important outcome is to see the woman opt for safe environment for self and children – Realistically, leaving the abuser is not usually the decision made by the woman; therefore, referrals for safe houses, hotlines, and support groups are important

7. Nursing Process: Planning and Implementation Planning – Ensure that victim has a basic safety plan, including how to get out of the house, movement to safe location, bags packed with necessities, code word to use for help Implementation – Ensure patient receives medical treatment, is interviewed in private, and understands legal rights

8. Guidelines for Intervention in IPV for the Emergency Department Ensure medical attention provided Interview patient in private Assess in nonthreatening manner information about: sexual abuse, chemical abuse, thoughts of suicide or homicide Encourage patient to talk about incident, and carefully listen Assess if patient has safe place to go Identify if patient wishes to press charges and facilitate this process If patient not ready to take action, refer to community resources