Mentioning public health problems might bring to mind tobacco use, heart disease and prescription drug overdoses. Just as serious, intimate partner violence (IPV) is a public health problem that affects millions of Americans. Show As the healthcare professionals who are most involved with patients, nurses are uniquely positioned to lead violence prevention and intervention efforts. Understandably, RNs may lack confidence when it comes to addressing this complex issue. Achieving higher levels of education can prepare RNs to care for patients who are affected by IPV. The RN to BS in Nursing online program at Fitchburg State University, for example, puts an emphasis on caring for forensic populations. To understand an RN’s role in violence detection, prevention and intervention, it is helpful to get a sense of the scope of the problem. According to the Centers for Disease Control and Prevention (CDC), IPV was a recognized social problem in the 1960s and 1970s. In 1979, the Surgeon General’s Report identified 15 priority areas for public health. Violence prevention was one of them. Forty years later, intimate partner violence is recognized by the CDC as a “serious, preventable public health problem.” The CDC defines IPV as “physical, sexual, or psychological harm by a current or former partner or spouse.” The CDC stresses that IPV can occur among heterosexual or same-sex couples and does not require sexual intimacy. IPV is more common than many people think:
RNs are known for being trustworthy. This positions them to advocate for patients experiencing IPV. As Futures Without Violence advises, “Being there for a patient unconditionally is the goal.” Patients experiencing IPV are often treated in emergency departments. However, they may not report IPV for many reasons, including:
Therefore, it is essential that RNs recognize the signs. Abrasions, bruising in the chest or abdomen, and broken teeth are common examples. But not all signs of IPV are this obvious. The Emergency Nurses Association (ENA) points out that signs of strangulation can easily be missed. Yet, non-fatal strangulation in IPV is the “most predictive factor for subsequent severe violence.” According to the ENA, victims of one episode are eight times more likely to become a homicide victim of that current or former partner. A joint statement by the ENA and the International Association of Forensic Nurses (IAFN) cites research indicating low screening rates for IPV. Contributing factors may include provider discomfort with “screening questions, positive disclosures, and safety planning.” Compassion and respect for patients’ dignity and worth go hand in hand with nursing. This helps RNs build rapport with patients. In turn, patients may feel safer discussing IPV with their nurse. Pursuing education on IPV can prepare RNs to provide the appropriate prevention and intervention. It is said that knowledge builds power. For RNs, enhancing knowledge and skills related to IPV can make the difference between helping a patient and being one more person who avoids the issue altogether. The course NURS 4520: Caring for Forensic Populations in Fitchburg State’s online RN to BS in Nursing program provides nurses with a foundation for preventing and reducing the consequences of domestic violence. Topics include:
Other courses that provide RNs with additional preparation to serve as advocates for vulnerable populations include NURS 3600: Health and Physical Assessment and NURS 4020: Social Justice and Advocacy. In the foreword for a World Health Organization report on violence and health, Nelson Mandela wrote, “We owe our children — the most vulnerable citizens in any society — a life free from violence and fear. In order to ensure this, we must be tireless in our efforts not only to attain peace, justice and prosperity for countries, but also for communities and members of the same family.” RNs comprise the largest healthcare occupation, and they provide the majority of patient care. Because of the high incidence of IPV, RNs will likely care for patients who experience IPV. By becoming informed about IPV, RNs can take a leading role in substantially improving health outcomes for their patients. Learn more about Fitchburg State University’s online RN to BS in Nursing program. Sources: CDC: The History of Violence As a Public Health Issue CDC: Violence Prevention – Intimate Partner Violence The National Domestic Violence Hotline: Get the Facts & Figures Home > Health and Safety > Additional Reading > Domestic Violence The intentional violent or controlling behavior by a person who is currently, or was previously, in an intimate relationship with the survivor. It encompasses physical injury as well as intimidation, humiliation, fear, financial, emotional or sexual injury (MNA Domestic Violence Task Force, 1993). MNA Domestic Violence Task Force IntroductionSafety in the home and workplace is being increasingly recognized as a public health concern. Health care workers are frequently involved with patients who have been or are experiencing domestic violence (DV). Domestic violence is likely to increase in frequency and severity over time, and the risk is greatest with a decision to leave the abusive situation. Health care workers may also be affected by DV's existence among family members and friends, or by witnesses to violent episodes which spill over into the workplace with colleagues or patients. In addition, as a mostly female workforce, they themselves may be victimized by the problem. Thirty-eight% of women murdered by partners in 1998 were health care workers. Who Are the Abused?Domestic violence occurs in:
RecognitionIndicators of DV include but are not limited to:
Abuser behaviors may include:
InterventionsScreening questions for DV include:
Keys to Reducing Domestic Violence
Legal InterventionsMandated Reporting However, reporting is mandated under Massachusetts law when the victim is a minor, an elder, or disabled, or when there are stab wounds or gunshots, or burn injuries over 5% of the body. Other states laws may differ. Contacts:
Felony Charges Restraining Orders Community InterventionsCounseling Shelters Societal InterventionsHealth care workers also have a responsibility to influence societal attitudes toward domestic violence. As PTA members, church congregants, community participants or leaders, social club members and voters, they can be proactive in supporting social, economic or political changes to assist DV survivors in moving beyond their present situation. MNA's Domestic Violence Task Force has a Speakers' Bureau available for professional or community presentations on DV. WorkplaceEmployee Assistance Programs (EAPs) are the most common source of workplace assistance for counseling and referral to resources. Occupational health nurses may also be of assistance. Some employers have been proactive in direct provision for worker safety such as security pagers, compliance with restraining orders, confidentiality efforts, camera surveillance, and staggered working hours. Employers Against Domestic Violence (617.348.4970) is a Massachusetts group which educates employers, helps by critiquing workplace DV policies and identifies best practices. Employees might suggest that their employer ask them for assistance. Many health care agencies have domestic violence committees who have developed policies about DV for both patients and employees. Information & Referral SourcesFederal, State and Local Agencies
Shelters/Other ServicesGreater Boston:
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What is the priority nursing intervention when caring for a patient who is a victim of interpersonal violence?
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