EDITOR’S MESSAGE

IDENTIFYING DOMESTIC VIOLENCE VICTIMS—IT’S OUR JOB

Anne Manton, PhD, APRN, PMHNP-BC, FAEN, FAAN , Bourne, MA

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mportant information about domestic violence, sometimes referred to as domestic abuse, can be found in several articles in this issue of JEN, along with two articles in the previous issue. These articles address the issue of domestic violence from a number of perspectives. Although the term currently favored is “intimate partner violence” (IPV), I prefer to use the older term domestic violence here, because I would like to think more broadly about the violence that occurs in homes and families, not only in the “intimate partner” relationship. Continued efforts by The Joint Commission and various health care organizations to encourage universal screening for domestic violence in the emergency department date back more than 2 decades. The American Medical Association, the American Nurses Association, and other medical and nursing organizations all recommend universal screening for domestic violence. The ENA joint position statement developed with the International Association of Forensic Nurses states, “…nurses routinely screen patients for IPV.” Yet, as noted in the Triage Decisions column in the November 2014 issue of JEN, 1 it has been shown that we emergency care providers are not identifying patients who have been the subjects of such violence in nearly the numbers that are consistently found in domestic violence studies. This is true even though victims of domestic violence are often frequent visitors to Anne Manton is Interim Editor-in-Chief of Journal of Emergency Nursing. For correspondence, write: Anne Manton, PhD, APRN, PMHNP-BC, FAEN, FAAN; E-mail: [email protected]. J Emerg Nurs 2015;41:3-4. 0099-1767 Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jen.2014.11.004

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emergency departments with minor injuries or illnesses, depression, anxiety, substance use disorder, or suicidal ideation. Why are we not identifying more patients affected by domestic violence? As emergency nurses, we need to have a high index of suspicion. We should not take frequent ED visits at face value. We must ask why! A number of reasons have been suggested for the failure of emergency care providers to identify a large percentage of domestic violence victims. Reasons given include staff discomfort in asking questions about violence in the home, privacy concerns, lack of time/too busy, a “not my job” attitude, and lack of knowledge about what to do if the response is positive for domestic violence. Although all these explanations have some basis in reality, none is acceptable. Identifying victims of domestic violence IS our job! Straightforward and brief assessment guidelines that are available for use in triage or during nursing care prompt nurses to ask questions such as these: • Do you feel safe at home? • Have you felt controlled, unable to do something you wanted to do, or forced to do something you didn’t want to do? • In the past year have you been hit, slapped, kicked, punched, or otherwise hurt by someone close to you? In the November 2014 issue of JEN, Amerson, Whittington, and Duggan 2 note that studies have found that when women who have been subjected to IPV are specifically screened for it, 80% disclose abuse. Asking these questions does not take long, but depending on the patient’s response, it might be lifesaving. Another aspect of domestic violence that cannot be ignored is its effect on children. Children might not be safe when violence occurs in the home. Even witnessing domestic violence has detrimental consequences for children such as posttraumatic stress disorder, depression, anxiety, poor school performance, and sleep disturbances. In addition, the behaviors children witness often are emulated in their own bullying behaviors. Much of the literature addresses male-to-female violence, but it is important to remember that males are often victims of domestic violence as well and that domestic violence occurs in both heterosexual and homosexual relationships. Domestic violence is not limited to gender, age, or any social, ethnic, racial, or socioeconomic class.

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EDITOR’S MESSAGE/Manton

What can be done to improve our collective attention to the issue of domestic violence? • Include domestic violence screening in electronic health records if it is not already in place. • ASK THE QUESTIONS! If we don’t ask, we won’t know. • Develop a protocol for intervention when domestic violence is disclosed. • Have a list of resources available for use by nursing staff or to give to patients (possessing such a list might not be safe for some patients, so always check first). • Encourage patients to develop a safety plan (eg, a place to go, money put aside, or clothing at a friend’s house). • Post information in women’s bathrooms with a list of local and national domestic violence resources such as the Domestic Violence Hotline: 800-799-SAFE (800-799-7233).

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• Some emergency departments have small cards (small enough to fit in a woman’s shoe or some other hiding place) in the women’s bathrooms listing the Domestic Violence Hotline number and local resource numbers. Above all, be nonjudgmental; women have many reasons for not reporting domestic violence and not leaving the abusive situation. Respect that they know what is best for them—but give them information they can use when the time is right. REFERENCES 1. Sullivan T. Triage challenges: recognizing intimate partner violence. J Emerg Nurs. 2014;40(6):632-633. 2. Amerson R, Whittington R, Duggan L. Intimate partner violence affecting Latina women and their children. J Emerg Nurs. 2014;40(6): 531-536.

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