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

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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2016-11-21T13:04:49+00:00 May 7th, 2014|nursing perspective|4 Comments

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  1. sfoleyajn May 19, 2014 at 8:38 am

    Thanks so much for your comments!

    NPs Save Lives – it’s undoubtedly frustrating to screen and not be answered truthfully. Fear is very powerful. It’s great that you were able to convey to this young woman that you understood what a difficult decision it was to walk away. I’m sure that helped her down the road, when she finally did so.

  2. NPs Save Lives May 17, 2014 at 9:37 pm

    I agree that we don’t screen enough, but even when we do it’s often not answered truthfully. I had a young woman come to the office and lie to me after I asked her if there were any issues. But I expected it and made it known that I knew that it would be a difficult decision to make the effort to walk away. Later, after her arm was broken, she did.

  3. Laura K Kerr, PhD May 7, 2014 at 4:19 pm

    Reblogged this on Women. Healing. Violence..

  4. Racheal May 7, 2014 at 1:10 pm

    Not every hospital has social workers. Many For Profit hospitals don’t. This can cause a distinct disconnect for victims of abuse. The nurse has the assessment tools and yes, we can even bar the abuser from the hospital, but there are too many times when the only opportunity for a patient to answer those questions occurs when their abuser is present in the room. It’s imperative that our facilities do a better job of isolating our patients at these initial contacts, especially in the ED so our patients can actually give us the true answers. There should also be more education on the med/surg level. The abuser may hover through that ED encounter, only to finally feel comfortable enough to leave once an inpatient admission occurs. We, as nurses, get an amazing amount of training on Elder abuse and Child abuse, but each facility needs a clear protocol for what to do when a patient, who has been a victim of domestic abuse, speaks up and asks for help at the inpatient level.

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