Martha C. Masington
Domestic violence is a significant problem in the United States, and may contribute to serious injuries. This article explains types and categories of abuse, as well as common signs and symptoms. Guidelines for interviewing a client who has been abused are provided. How to complete a danger assessment and deal with clients in denial of their abuse is also explained. The article concludes with a discussion of how nurses may evaluate successful intervention.
In the United States an act of domestic violence happens every 15 seconds (Cassidy, 1999). Although abuse can happen to either men or women, 95% of the victims of domestic violence are women (Fulton, 2000). It is the leading cause of injuries in women, greater than all other causes, which include mugging, stranger rape, and car accidents combined. Injuries caused by domestic violence account for 22%- 35% of all women’s visits to the emergency department (Shea, Mahoney & Lacey, 1997). Sadly, very few women get the information or help they needed to leave an abusive relationship. Less than 15% of women who are abused report ever being asked about abuse by health care professionals (Rodriguez, Bauer, McLoughlin & Grumbach, 1999). These women may not be treated properly when they enter a hospital or clinical because the healthcare workers may not know how to assess their status or talk to them about their abuse.
Interviewing, examining and talking with a woman who is experiencing abuse may be a challenge for nurses. This article will discuss techniques for nurses to use when interviewing abused clients, including body language, tone of voice, how to listen, and how to question. How nurses present themselves to patients is just as important as what they say. By being supportive and empathetic, nurses can gain the trust and confidence of a patient in need.
What is Domestic Violence
Domestic violence is defined as physical abuse or contact that harms a person physically, mentally and/or emotionally (Valente & Jensen, 2000). It is based on the abuser’s desire to establish power and control over the victim (Berlinger, 2001). Cassidy (1999) describes five types of domestic abuse: physical, sexual, psychological, emotional, and economic (Cassidy, 1999). Physical and sexual abuse includes any acts of physical violence that inflict injury, and are not consensual. Psychological, emotional, and economic abuse deal with the abuser’s desire to be in control. The abuser isolates the victim from other relationships and attempts to keep the victim dependent. These forms of abuse can happen one at a time or in extreme cases all at once. The degree of abuse that victims receive can also affect their ability to communicate. Abusers have been categorized in a range from one to three with three being the most dangerous (Cassidy, 1999). Category one abusers are usually remorseful and have no previous experiences with abuse. Category two and three abusers both have a history of abuse in relationships with little remorse and a significant reoccurrence of violence.
Women who suffer abuse for years oftenfind it difficultto leave because their abuser has made them believe that they are unable to survive without them. Berlinger (2001) states, “Victims of domestic violence are ‘beaten down’ long before they’re ‘beaten up’”(pg. 60). The average victim leaves the abuser seven times before a permanent separation, and 70% of victims are killed by their abusers during the escape.
Understanding abuse is the first step in learning how to interview and examine the abused client. Some signs of domestic violence include: unexplained injuries, depression, anxiety and having an overprotective partner (Berlinger, 2001). Not all victims of domestic violence have obvious signs of abuse. Gerard (2000) suggests that screening for abuse in all patients over the age of fourteen allows for intervention even when the prospect of abuse is not apparent. If domestic violence is suspected, it is important to be in private before asking any questions about abuse (Valente & Jensen, 2000). Nurses should never make an exception to a private interview when screening for domestic violence, as even the most affectionate partner can be an abuser (Berlinger, 2001). When extremely overprotective partners refuse to leave the room, another healthcare professional can arrange to talk with them about an issue such as insurance while the client is interviewed. If the interviewer is unable to talk to the woman privately, a time should be arranged to call her at home when she is alone.
During private interviews sitting down gives the client the impression that the nurse has adequate time to talk. The interview should begin with screening questions instead of those focused on violence. This gives the clienttime to become at ease. Open-ended questions should be posed in a caring and empathetic tone (Berlinger, 2001). It is important for the interviewer to be nonjudgmental and a good listener.
Fulton (2000) suggests an opening statement when domestic violence is suspected: “We frequently see people with injuries such as yours. An intimate partner is the cause of many of those injuries. Could you have received these injuries in the same way?” (p. 31). When the client confides in the nurse, terms such as “why”, “like”, and “only” should be avoided. It is also helpful to stay away from questions such as “Is that all?” and “Why don’t you just leave him?” They can make the client feel as if they are at fault for their abuse (Berlinger, 2001). The client should be assured that there is help available and should be given information on how to get help for their abusive situation. Clients should not be forcedinto anything they do not want to do, but should be givenplenty of options, and congratulated for their strength and courage to have made it this far in an abusive relationship. This helps the client realize that they are capable of escaping the abusive situation. The nurse should take their time and record direct quotes from the client, which can be used later along withtheir physical assessment, if charges are made against the partner.
An important part of the interview and examination is to implement a danger assessment (Langford, 1996). A danger assessment evaluates the amount of violence and the potential for homicide when the woman returns home. It contains questions about potential domestic violence characteristics that the patient may experience when she goes home, such as “Are there any weapons or firearms in your home?” This allows the woman to assess her own safety and make plans to deal with it when she returns home. She may fear that her partner will know that she has talked about the abuse, and she may be in danger.
It is important to maintain the patient’s confidentiality. A patient’s chart should never be left lying open, and if using a computer, care should be taken when leaving the area tomake sure that the monitor is turned off.
Client in Denial