Domestic violence: the turning point.

A this Canadian study examined the factors impacting on a woman’s disclosure of domestic violence (or intimate partner violence IPV) when presenting to urban emergency departments.

Women experiencing domestic violence were found to most likely disclose this to staff following a significant ‘turning-point’ event (examples of such an event included: fear of being killed by the perpetrator, fearing harm to an unborn baby or other children, needing emergency care for injuries related to violence, and feeling pressured to disclose). This might occur after a series of smaller events resulting in multiple presentations to the ED over a period of time.

Such presentations may or may not be recognized by the treating nurses.

While abused women may seek care in the emergency department, many travel through the system without being recognized as exposed to violence. This is problematic in that nurses, who may be the first point of contact for abused women, may miss an important opportunity for assessment. This is compounded by the fact that emergency department nurses, like other health care providers, continue to face challenges in the detection and documentation of IPV. Common barriers to discussing IPV cited by nurses and other health care providers included a lack of knowledge about IPV, a lack of time to respond to IPV-related issues and disclosures, a fear of offending patients, and a perception that violence is not a priority for their practice area.

Women were found to be far more likely to disclose their problems when interacting with a nurse who was non-judgmental and supportive.

“If a health-care provider encounters a woman experiencing domestic violence, it is important that the health-care provider carries out an empathic and respectful assessment of the client. Health-care providers may misunderstand certain client behaviours, such as denial of abuse when asked, or some health-care providers can become frustrated when women seek acute care for abuse over multiple occasions. In these situations, it is crucial that the health-care provider offer a non-judgmental response. Women experiencing violence have to have power to make their own decisions – even if that means returning to an abusive partner.”

I would add as a afterword that as nurses working in any clinical environment, we may also be presented with a window of opportunity to respond and intervene in cases where males are the recipients of domestic violence and where elder abuse is occurring. It is important to remain sensitive and vigilant to this potential.

Explore deeper: Identifying the Turning Point: Using the Transtheoretical Model of Chang to Map Intimate Partner Violence Disclosure in Emergency Department Settings (PDF).