Posts Tagged ‘intimate partner violence’

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“One Day He Breaks Your Arm, and Then . . .”: How Nurses Can Help Rural Survivors of Intimate Partner Violence

May 7, 2014
Photo by Damien Gadal, via Flickr.

Photo by Damien Gadal, via Flickr.

 By Sylvia Foley, AJN senior editor

“Imagine for a moment that your husband or boyfriend is regularly assaulting you, and often tells you that ‘nobody cares.’ Now imagine that you live in an isolated rural community. The nearest health care services are 75 miles away—and you can’t get there because he removes the car battery to keep you from driving . . . One day he breaks your arm, and then he drives you to that distant hospital. Will the nurses recognize what is happening? Will there be a chance for you to tell them?”

In this month’s CE feature, “Intimate Partner Violence in Rural U.S. Areas: What Every Nurse Should Know,” Amanda Dudgeon and Tracy Evanson explain why it’s important for nurses in all practice settings to understand the particular issues that rural survivors face and how to address them. (Most, though not all, victims of intimate partner violence are women; this article focuses primarily on female survivors.) Here’s a brief overview.

Intimate partner violence is a major health care issue, affecting nearly 6% of U.S. women annually. Multiple mental and physical health problems are associated with intimate partner violence, and billions of health care dollars are spent in trying to address the consequences. Although prevalence rates of intimate partner violence are roughly the same in rural and nonrural areas, rural survivors face distinct barriers in obtaining help and services. Because rural women routinely access health care services in nonrural as well as rural settings, it’s essential that all providers understand the issues specific to rural survivors. Routine screening for intimate partner violence would create opportunities for women to disclose abuse and for providers to help victims obtain assistance and support that may keep them safer. This in turn would likely decrease serious health sequelae and lower health care costs. This article describes the unique aspects of intimate partner violence in rural populations. It also describes a simple screening tool that can be used in all settings, discusses ways to approach the topic and facilitate disclosure, and addresses interventions; relevant resources are also provided.

That simple screening tool is the Abuse Assessment Screen, which consists of just five questions and can be performed in minutes. To learn more, read the article, which is free online, and listen to our podcast with one of the authors. As always, we invite you to share your thoughts and experiences in the comments.

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AJN’s May Issue: Intimate Partner Violence, What Clinical Nursing Instructors Do, Containing Cholera, Noise in the ICU, More

April 25, 2014

AJN0514.Cover.OnlineAJN’s May issue is now available on our Web site. And in honor of Nurses Week, we are offering free access to the entire issue for the whole week (May 6-12). Here’s a selection of what not to miss.

Intimate partner violence. A major health care issue, intimate partner violence (IPV) affects almost 6% of U.S. women annually. And while prevalence rates of IPV are similar in rural and nonrural areas, rural survivors face distinct barriers in accessing care. “Intimate Partner Violence in Rural Areas: What Every Nurse Should Know” describes the unique aspects of IPV in rural populations and provides nurses with tools and information crucial to effective intervention. This CE feature offers 2.5 CE credits to those who take the test that follows the article. And don’t miss a podcast interview with one of the authors (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

Containing cholera. While still recovering from a magnitude-7 earthquake, Haiti confronted a second disaster: a rapidly growing cholera epidemic. The authors of “Responding to the Cholera Epidemic in Haiti,” part of a nongovernmental relief organization team sent to Haiti, describe how they managed more than 23,000 cases of cholera and prevented many more. Listen to a podcast interview with one of the authors and earn 2.5 CE credits by taking the test that follows the article.

New installment on systematic reviews. Last month, our new series from the Joanna Briggs Institute on writing a systematic review provided an overview of the first steps to take when conducting such a review. Now, the third installment of the series, “Constructing a Search Strategy and Searching for Evidence,” details how to develop a comprehensive search strategy.

Unwanted noise. Despite an increased emphasis on the need for noise reduction in intensive care, studies have found that noise levels in the ICU continue to exceed recommendations. “Noise in the ICU,” an article in our Critical Analysis, Critical Care column, provides evidence-based strategies nurses can implement to protect patients from noise. Read the rest of this entry ?

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International Women’s Day: Remembering Lives Shadowed by Violence

March 8, 2013
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Photo by Karen Roush

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

She lived in a trailer with her boyfriend and her three children, all under the age of five. He beat her up regularly.

Every few weeks she came in to see me at the health center where I worked as an NP in urgent care. Sometimes she would come in with bruises, but most of the time it was for the less obvious sequelae of violence—unexplained chest pain, palpitations, anxiety attacks, back pain, relentless headaches. There was a policy in urgent care that you couldn’t ask for a particular provider. So she would call to speak to me directly and when the operator put her through she’d know I was on and would come in.

I’m not sure why she came to trust me over the other providers. Maybe she could sense that I understood and didn’t judge her, though I had never told her about my own history of domestic violence. But it was probably because I listened. There was not much else I could do. She had gone to a counselor when I encouraged her to, but that didn’t last long—it was hard for her to find transportation for the 30-minute trip into town. I prescribed SSRIs, and after trying some different ones we found one that worked well for her. I helped her slowly cut back on the anti-anxiety medication she had relied on too heavily for so long.

It was all complicated by chronic neck and back pain. I got her in to see a neurologist, which eventually led to two surgeries that left her in more pain than before and with terrible sciatica. Still she came to me at each step for advice on what to do. The neurologist wants to do another MRI—should she do it? Now he wanted to do another surgical procedure—what did I think? And there was pain management thrown in on top of everything else.

Of course I knew that she wasn’t going to get better as long as she was with her boyfriend. We talked about that a lot. Read the rest of this entry ?

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Domestic Violence Screening: Why the Rush to Dismiss It?

August 24, 2012

Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

All rights reserved. Photos by author.

A recent study reported in JAMA, “The Effect of Screening for Partner Violence on Women’s Quality of Life” (abstract only), is being touted in overly simplistic headlines across the Web (the word “debunks” has been getting a lot of use) as further evidence that domestic violence screening doesn’t improve outcomes for women.

Don’t believe it.

The problem doesn’t lie with the researchers or with JAMA; they accurately reported just what they found. The problem lies with how it is being interpreted by others as further proof of the overall ineffectiveness of screening for intimate partner violence (IPV).

What the study actually found was that there was no difference in health outcomes between women who received computerized screening and a resource list and women who just received the resource list or women who received neither.

This is how it worked:

Women in primary care settings who agreed to participate and who were randomized to the screening group were seated in front of a computer and responded to the three questions in the partner violence screening (for example, “have you ever been hit, kicked, punched or otherwise hurt by someone within the past year?”) on the monitor. If they checked yes for any question, the computer played a short video of an IPV advocate who “provided support and information about the hospital-based IPV advocacy program and encouraged [them] to attend.”

All rights reserved.

So what’s wrong with this? True, this particular “screening” and “intervention” didn’t make a difference in the participants’ quality of life. The problem lies in the claims being made that this study proves that IPV screening doesn’t work. The reason this is a problem is not with the screening component. Research supports computer screening to improve disclosure rates—it’s one way to address the time burden that is often cited as a major barrier to screening, as well as the stigma attached to disclosure. So yes, further testing of this possible approach to screening is warranted.

The problem, as I see it, is with the approach taken with women who disclosed abuse. We know that women will disclose abuse and accept help if there is trust, the belief that you actually care about them, a nonjudgmental attitude and consideration for their safety. None of these things are present in this approach. In fact, it is the antithesis. What this approach tells women is that we cannot be bothered to actually talk to you in person—that would take more time, money, and actual empathy than we care to spend on you.

We also have evidence that a well-planned advocacy program with follow-up can work. This “intervention” doesn’t take into consideration the complexity of IPV. There are social, cultural, psychologic, economic, and physical factors involved. I don’t know what this computer-presented advocate says to the women watching. But even if it’s all the right things, she or he is still just an image on the screen.

And expecting women to take on all the emotional and practical challenges that disclosure and seeking help can entail, merely in response to a disembodied image on a screen, is a disservice to the women. Beyond the significant risk of increased violence and even death, there are so many other variables, such as fear of losing their children to protective services, or the difficulties involved in accessing resources when you are without transportation or funds. Read the rest of this entry ?

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