“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 […]

2016-11-21T13:04:49-05:00May 7th, 2014|nursing perspective|4 Comments
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Domestic Abuse Patient

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

All rights reserved. Photos by author. All rights reserved. Photos by author.

It’s the end of October—Domestic Violence Awareness Month. I want to tell you a story about a patient I had in the Adirondacks in upstate New York.

The young woman was back for the third time that month. The previous week, complaints of vague abdominal symptoms had brought her in; this time, it was frequent headaches. Even as I performed a neurologic exam, I suspected I wouldn’t find  anything.

“So, how’s everything at home?”  I asked, after assuring her there was no sign of a neurologic issue.

“Same,” she told me. “Yesterday I forgot to get his cigarettes and [expletive]! you’d a thought I killed someone.”

“Did he hurt you?”

“No. Just twisted my arm a little. I’m fine.”

But she wasn’t fine. She suffered from anxiety, headaches, chronic back pain, and irritable bowel syndrome. She had been through numerous diagnostic evaluations, including invasive procedures, and had tried multiple medications.

She was 25 and had three children. I’d brought up the subject of intimate partner violence after her second visit, but it wasn’t until she’d been seeing me for a few months that she felt safe enough to talk about it. Her […]

2016-11-21T13:06:11-05:00October 29th, 2013|nursing perspective|2 Comments
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International Women’s Day: Remembering Lives Shadowed by Violence

DSC_0028 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. […]

2016-11-21T13:08:10-05:00March 8th, 2013|nursing perspective|3 Comments
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Kasandra Perkins, Domestic Violence, and the Senseless Search for a Reasonable Explanation

photo via Facebook photo via Facebook

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

Let’s call it what it was. Kasandra Perkins was murdered in a domestic violence attack. This was not about a football player who took one too many hits to the head. This was not about a good, loving family man who was driven to take this terrible action. This was not about someone who snapped from stress (would he get enough playing time? would he make enough money to pay for his expensive new car?).

This was about what domestic violence is always about: control, rage, and power. There is no mystery here—we don’t need to search for reasons why a good, loving family man would shoot someone he loved. Because they don’t. Violent men commit acts of violence.

This searching for a reasonable explanation distracts us from the truth. It bolsters myths and misconceptions. It creates the illusion that each domestic violence attack is a special case, not part of the fabric of our society. One in four women experience domestic violence. Over a thousand die every year. Do the math—Kasandra was one of at least three women we could expect to have been murdered in a domestic violence attack on Saturday. We didn’t read about the other two. We wouldn’t have read about Kasandra either if her murder weren’t at the hands of a professional football player.

Not that the […]

2016-11-21T13:08:47-05:00December 6th, 2012|Nursing|6 Comments
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Domestic Violence Screening: Why the Rush to Dismiss It?

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?”) […]

2016-11-21T13:09:26-05:00August 24th, 2012|Nursing|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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