Domestic violence, also referred to as intimate partner violence (IPV), is a cause of serious injury and even death in women and men in the United States every year. Unfortunately, IPV often goes undetected, even though over 10 million men and women in the U.S. experience IPV each year, according to the National Coalition Against Domestic Violence (NCDV).
Nurses have often been reluctant to see IPV as a health issue, according to Domestic Violence: What Can Nurses Do? on the Crisis Prevention Institute (CPI) website, even though women and their children can experience significant health consequences as a result.
“Imagine what could be achieved if all nurses were as informed about domestic violence as they are about wound care, or diabetes management, for example?” the article asks.
Students who pursue MSN nursing careers to become primary care providers, such as FNPs or other advanced-level nurses, will be well positioned to identify and help prevent domestic violence.
Prevalence of Domestic Violence
Domestic violence affects women, men and families all over the world. IPV includes but is not limited to physical or sexual violence and stalking, as well as psychological aggression, such as coercive tactics by a current or former intimate partner.
Pregnant women who are subjected to IPV often experience serious complications during the pregnancy and also while giving birth. The CDC states that more than 1in 4 women and 1 in 9 men in the United States have experienced severe physical violence, sexual assault, or stalking by an intimate partner in their lifetimes.
How Can Domestic Violence Be Detected?
Domestic violence is not always easy to detect, so FNPs first have to understand the nature and characteristics of IPV so they can be on alert for any potential signs in their patients. According to the CDC, IPV includes four types of behavior, which can occur in various degrees and simultaneously:
- Physical violence is when a person hurts or tries to hurt a partner by hitting, kicking, or using another type of physical force.
- Sexual violence is forcing or attempting to force a partner to take part in a sex act, sexual touching, or a non-physical sexual event (e.g., sexting) when the partner does not or cannot consent.
- Stalking is a pattern of repeated, unwanted attention and contact by a partner that causes fear or concern for one’s own safety or the safety of someone close to the victim.
- Psychological aggression is the use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally and/or exert control over another person.
Because a patient will rarely go right up to a nurse and confess to being a victim of domestic violence, FNPs should look for signs of physical injuries and psychological symptoms that are often a result of domestic violence. An article on the Crisis Prevention website lists some signs to watch for:
- Bruising in the chest and abdomen
- Multiple injuries
- Minor lacerations
- Ruptured eardrums
- Delay in seeking medical attention
- Patterns of repeated injury
- A stress-related illness
- Anxiety, panic attacks, stress and/or depression
- Drug abuse including tranquilizers and alcohol
- Chronic headaches, asthma, vague aches and pains
- Abdominal pain, chronic diarrhea
- Sexual dysfunction, vaginal discharge
- Joint pain, muscle pain
- Sleeping and eating disorders
- Suicide attempts, psychiatric illness
- Gynecological problems, miscarriages, chronic pelvic pain
Aside from spotting tell-tale signs, there are also various tools that serve as nursing interventions for domestic violence in its various forms. One of them, developed by the Nursing Research Consortium on Violence, is the cost-free Abuse Assessment Screen (AAS).
The AAS is carried out face-to-face with pregnant women and consists of 3 questions about abuse, including sexual abuse. If the woman answers yes to at least one question, the results are considered positive for abuse. Other tools include the Women Abuse Screen Tool (WAST) and Humiliation, Afraid, Rape and Kick (HARK), which can be used depending on the patient’s profile and situation.
The Role of FNPs in Screening and Reporting Domestic Violence
What can FNPs do to help those who are enduring abuse at home? Researchers maintain that the simplest technique consists of just asking the patient about it.
CPI offers a list of questions that nurses can start with, including:
- You seem very anxious and nervous. Is everything all right at home?
- When I see injuries like this, I wonder if someone could have hurt you?
- Is there anything else that we haven’t talked about that might be contributing to this condition?
Futures Without Violence points out that a compassionate inquiry from an FNP:
- Relays to the domestic abuse survivor that nurses really and are also knowledgeable about domestic violence.
- Validates domestic violence as a central and legitimate health care issue.
- Can be the catalyst for people experiencing abuse to seek the services and opportunities they need, even if they do it at a later time and with a different nurse or other healthcare professional.
The FNP doesn’t have to have a complete, perfect solution for the patient.
“Domestic violence survivors are incredibly resourceful and know their own situation and possibilities better than anyone else,” the article notes. “Being there for a patient unconditionally is the goal. Recognizing the detrimental effects on the patient’s health and the health of her or his children (if the patient is a parent) are areas where the nurse can provide some education. Mostly the intervention is well within any nurses’ expertise and comfort zone.”
Ohio University’s Online Master of Science in Nursing (MSN) Program
The online MSN program at Ohio University is designed for practicing RNs who want to advance their expertise in the nursing field, including learning about detecting and preventing domestic violence. Students in the Family Nurse Practitioner concentration take courses such as primary care of adults and primary care practice.
For more information about the university’s online MSN program and MSN degree benefits, visit Ohio University’s website.
National Statistics: NCADV
Domestic Violence: What Can Nurses Do?: Crisis Prevention
Preventing Intimate Partner Violence: CDC
A Call to Action: The Nursing Role in Routine Assessment for IPV: Futures Without Violence