* course numbers may vary by facility
Every October, Domestic Violence Awareness Month (DVAM) raises awareness on the devastating effects domestic violence has on individuals, families and communities. This provides an opportunity for healthcare organizations to educate staff about ways to identify and respond to victims of abuse.
Domestic violence is defined by the National Coalition Against Domestic Violence (NCADV) as willful intimidation, physical assault, battery, sexual assault or other abusive behavior as part of a systematic pattern of power and control perpetrated by one intimate partner against another. Within the context of domestic violence; partner, child, elder and sibling violence tend to coexist. The World Health Organization (WHO) has recognized domestic violence as a global public health concern affecting individuals in every community, regardless of age, economic status, sexual orientation, gender, race, religion or nationality. In the U.S.:
In addition to the immediate trauma caused by abuse, domestic violence contributes to chronic health problems including depression, alcohol and substance abuse, sexually transmitted diseases such as HIV/AIDS, and may limit the ability to manage other chronic illnesses such as diabetes and hypertension.
For a number of reasons, healthcare visits provide a critical window of opportunity to stop a cycle of violence.
Major medical associations and organizations recommend routine screening for domestic violence, including the Joint Commission, American Medical Association, American College of Obstetrician Gynecologists, American Nurses Association and the U.S. Preventive Services Task Force. Screening questions should be asked in a nonjudgmental manner in a private place, away from family, friends or children. They should open with a supportive statement, such as “Because abuse and violence are so common in women’s lives, we ask all patients about it.”
Some examples of screening questions recommended by the American Medical Association include:
For more information about screening and assessment, The Centers for Disease Control and Prevention, National Center for Injury Prevention and Control has published the Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings.
If a patient discloses that they are being abused:
Mandatory reporting laws vary from state-to-state, but most states have some type of statute that requires physicians to report to law enforcement officials about certain injuries that appear to have resulted from a criminal act. View the Compendium of State Statutes and Policies on Domestic Violence and Health Care provided by The Family Violence Prevention Fund.
When a patient is a victim of domestic violence, it is important for healthcare personnel to respond appropriately. See how well you answer these DO or DON’T questions.
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Answer: DON’T – She already knows she needs to leave but she doesn’t feel she can. Instead, discuss a safety plan.×
Answer: DO – Violent partners often blame the victim for their actions. Reassure him or her that it’s not their fault and that no one deserves to be abused.×
Answer: DON’T - Let the victim known you’re concerned and that the type of signs you’re seeing are sometimes associated with abuse. Provide referral information and encourage a return visit if violence occurs in the future. Ensure him or her that confidentiality is a priority. Document your concern in the medical record.×
Answer: DON’T – An abuser may try to harm a confronter or retaliate against a victim for talking about abuse. Instead, talk to the patient about a safety plan.×
Answer: DO – Photos are valuable evidence should a case be filed against the abuser in the future. Ask the patient for permission and obtain written consent. Let him or her know that photos will become part of the medical record and can only be released to the police or prosecutor with his or her permission or by court order.×