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Domestic
Violence Recognition & Intervention: for nurses & other health care
workers
Definition
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 Introduction
Safety 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:
• up to
30% of all women at least once in their lifetime
• 30% of women seen in emergency rooms
• 25% of pregnant women
• 15% of women seen for general health care
• possibly 90% of disabled women
• 5-10% of victims are males
• 4% are same-sex relationships
• a high percentage of homeless women
• all racial groups at comparable rates
• every socioeconomic class
No One Is Immune
Recognition
Indicators of
DV include but are not limited to:
• Physical
injury
• Vague chronic complaints, fatigue
• Pelvic pain or GYN disorders
• Depression or substance abuse
• Eating or sleeping disorders
• Suicidal ideation
Abuser behaviors
may include:
• Threats
of injury or use of weapons
• Restriction on movement or activities
• Exposure to risks (reckless driving)
• Forced sexual activity or pregnancies
• Constant criticism or devaluing
• Extreme jealousy or possessiveness
• Over protectiveness
• Destruction of possessions
• Excessive financial control
• Limits on social and family contacts
• Harassment while at work
Interventions
Screening questions
for DV include:
• Have
you ever been emotionally abused, threatened, or controlled by your partner
or someone important to you?
• Have you ever been in a relationship where you have been
hit, slapped, kicked or otherwise physically hurt?
• Has anyone ever forced you to have sexual activities against
your will?
• Does your partner ever make you feel afraid or scared?
• Do you feel safe at home?
Helpful behaviors include:
• Assessing
own feelings about DV
• Preparing to
respond to a disclosure
• Listening actively
and objectively
• Believing the
story
• Validating
feelings and fears
• Making statements
such as “Because DV is so common, I ask all my patients about it.”
• Avoiding “why”
questions such as “Why don’t you leave?” “Why haven’t you called the
police?”
• Documenting
history, symptoms, findings, evidence and photographs
• Assessing safety
and lethality
- Are
threats verbal/physical?
- Are
weapons used or available?
- Is
the violence becoming greater/more frequent?
- What
is the worst thing ever done to you so far?
- Are
your children threatened also?
- Is
your partner jealous (scale: 1-10)?
• Mutually developing
a safety plan
• Respecting
a decision to stay or leave
• Accepting that
lack of immediate “compliance” is not proof of provider failure
• Providing referrals
to local resources: police, hotlines, shelters, counseling
• Educating everyone
about DV
Keys to Reducing Domestic Violence
• Education
• Training health care workers
• Institutional policies and procedures
• Societal awareness
• Adequate community resources
Legal Interventions
Mandated Reporting
In Massachusetts, no law mandates reporting domestic violence. A victim has
the right to decline to report an incident. A health care worker can assist
the DV victim to report.
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:
•
Minor: DSS: 800.792.5200
• Disabled: 800.426.9009
• Elder: 800.922.2275
• Weapon Use: Local police
Felony Charges
Health care workers can be of great assistance to the DV survivor through verbatim
recording of statements regarding threats or fear (assault) and photographic or
body-map documentation of injuries (battery) that can be introduced in court to
support allegations of DV. Felony charges can be sought by the police or
by the survivor.
Restraining
Orders
Survivors of DV may seek emergency, temporary or permanent restraining orders
against the abuser through Superior, Probate, Family, District or Municipal
Courts. These range from orders to refrain from further abuse, to avoid
any contact with the survivor, to provide financial support or funding for losses
suffered, or to give up custody of children. DV survivors need to be aware
that restraining orders can be ignored, and have led to escalation
of violence and even death.
Community Interventions
Counseling
“No one deserves to be abused.” Many survivors of DV need help in regaining
their sense of self-worth. Mental health providers in community health
centers and medical facilities can be helpful in promoting self-esteem and in
assisting the victim to assess risk and develop a long-term safety plan.
Shelters
There are two types of shelters for survivors of domestic violence: homeless
residences for those who do not wish to return to their homes but lack the resources
to obtain another residence, and battered women’s shelters which are anonymous
residences for those fearing reprisal. Often it is safer to use a geographically
distant residence. Child care when leaving the home complicates shelter
issues. Shelters differ on accepting children (particularly male teenage
children) or pets.
Societal Interventions
Health 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.
They may be contacted at 781.821.4625.
Workplace
Employee 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 Sources
Federal, State
and Local Agencies
| National 24-hr
hotline |
800.799.SAFE
TTY#: 800.787.3224 |
| MA State-wide
24-hr hotline |
800.992.2600 |
| MA Battered
Women‘s Coalition |
617.661.7203 |
| Network for
Battered Lesbians & Bisexual Women |
617.423.7233 |
| Gay Men Against
Domestic Violence |
800.832.1901 |
| Brockton Family
and Community Resources |
508.583.5200 |
| New England
Learning Center for Women in Transition (Athol) |
888.249.0806 |
Shelters/Other
Services
Greater Boston:
| Boston |
Asian
Task Force Against Domestic Violence |
617.338.2355 |
| Boston |
Casa
Myrna Vasquez |
800.992.2600 |
| Cambridge |
Transition
House |
617.661.7203 |
| Chelsea |
Harbor
Cove |
617.884.9909 |
| Jamaica
Plain |
Elizabeth
Stone House |
617.522.3417 |
| Jamaica
Plain |
F.I.N.E.X.
House |
617.288.1054 |
| Lawrence |
Women’s
Resource Center |
800.400.4700 |
| Lowell |
Alternative
House |
978.454.1436 |
| Malden |
Services
Against Family Violence |
781.324.2221 |
| Roxbury |
Renewal
House |
617.566.6881 |
| Somerville |
Respond |
617.623.5900 |
| Quincy |
DOVE
Shelter |
617.471.1234 |
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| Northern
MA: |
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| Newburyport |
Women's
Crisis Center |
978.465.2155 |
| Salem |
Help
for Abused Women and Children |
508.744.6841 |
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| Central
MA: |
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| Framingham |
Women’s
Protective Service |
508.626.8686 |
| Newton |
Second
Step Inc. |
617.965.3999 |
| Waltham |
Support
for Battered Women |
800.899.4000 |
| Worcester |
Abby’s
House |
508.756.5486 |
| Worcester |
YWCA
Daybreak |
508.755.9030 |
| Southern
Worcester County |
New
Hope |
800.323.4673 |
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| Western
MA: |
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| Amherst |
Everywomen’s
Center |
888.837.0800 |
| Greenfield |
NELCWIT |
978.772.0806 |
| Holyoke |
Women’s
Shelter/Companeras |
413.536.1628 |
| Leominster |
Battered
Women’s Resources |
877.342.9355 |
| Northampton |
Necessities/Necesidades |
413.586.5066 |
| Pittsfield |
Elizabeth
Freeman Center |
413.443.0089 |
| Westfield |
New
Beginnings/YWCA |
800.479.6245 |
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| Southeastern
MA: |
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| Attleboro |
New
Hope |
800.323.4673 |
| Brockton |
Woman’s
Place Crisis Center |
508.588.2041 |
| Fall
River |
S
STAR |
508.675.0087 |
| Fall
River |
Our
Sisters’ Place |
508.677.0224 |
| New
Bedford |
The
New Bedford Women’s Center |
888.839.6634 |
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| Cape
Cod & Islands: |
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| Plymouth |
South
Shore Women's Center |
508.746.2664 |
| Hyannis |
Independence
House |
800.439.66507 |
| North
Falmouth |
The
Cape Cod Center for Women |
508.564.7233 |
| Nantucket |
A
Safe Place |
508.228.2111 |
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