Domestic Violence and Health Care in Nevada: An Overview for Nurses

For purposes of discussion, this article assumes that the victim is female and the abuser is male. We recognize that some women abuse men, and that gay and lesbian couples may also experience domestic violence. The information contained in this article can be useful in these situations as well.

Researchers from across the country, and from around the world, have concluded that "domestic violence is a health care problem of epidemic proportions. In addition to the immediate trauma caused by abuse, domestic violence contributes to a number of chronic health problems, including depression, alcohol and substance abuse, sexually transmitted diseases such as HIV/AIDS, and often limits the ability of women to manage other chronic illnesses such as diabetes and hypertension" ("The Facts on Health Care" 1). Consider the following facts:

* In 2004, Nevada's domestic violence programs received 40,450 first-time contacts for assistance, and 33,148 repeat contacts. Of the 40,450 first-time contacts made to Nevada's domestic violence programs in 2004, 37,265 of those (about 92 percent) were female.1

* Estimates range from 691,710 incidents of violence against a current or former spouse, boyfriend, or girlfriend per year to three million women who are physically abused by their husband or boyfriend per year. In 2001, about 85 percent of victimizations by intimate partners were against women and 15 percent of victimizations were against men.

* The costs of intimate partner violence exceed $5.8 billion each year, $4.1 billion of which is for direct medical and mental health care services.

* Each year, about 324,000 pregnant women in this country are battered by their intimate partners. Homicide is a leading cause of death for pregnant and postpartum women in the United States, accounting for 31 percent of maternal injury deaths.

* Emerging research indicates that hospital-based domestic violence interventions will reduce health care costs by 20 percent. A recent study found that 44 percent of victims of domestic violence talked to someone about the abuse; 37 percent of those women talked to their health care provider. Additionally, in four different studies of survivors of abuse, 70 percent to 81 percent of the patients studied reported that they would like their health care providers to ask them privately about intimate partner violence.ii

Nursing professionals are in a unique position to assist in reducing the epidemic of domestic violence, as they frequently encounter battered women in their work. Working in the health care setting provides an opportunity for nurses to help victims of domestic violence confront the abuse, and to provide these victims with relevant information and appropriate referrals that will help them to begin eliminating the violence in their lives.

There are a variety of ways in which individual practitioners can make a difference-starting by becoming aware of the problem of domestic violence, beginning to actively and routinely screen for abuse, and having the knowledge and skills to assess safety and make appropriate referrals (Warshaw 6).

Becoming Aware of the Problem

Domestic violence (also known as intimate partner violence) is "a pattern of assaultive and coercive behaviors including inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation, and threats. These behaviors are perpetrated by someone who is, was, or wishes to be involved in an intimate relationship with an adult or adolescent, and are aimed at establishing control by one partner over the other" (Campbell 1).

The intimate context of domestic violence is important to understand when developing effective interventions. Abusers have ongoing access to their victims, know their daily routines and vulnerabilities, and will use this information to continually exercise control over all aspects of their victims' lives. Victims of domestic violence seeking medical care not only deal with the trauma of a specific injury, but also deal with the fear of future assaults and the complexities of having an intimate relationship with their abusers. While a health care provider may be attempting to make sense of the incident that resulted in the victim's presenting injury, the victim is responding to that incident in the context of the pattern of subtle and obvious abuses perpetrated against her over a period of time(Warshaw 17-18).

Victim advocates and researchers have created lists of specific signs to watch for when assessing a patient for victimization, including:

* An "accident-prone" history; time delays between injuries and presentation of injuries; a description of an incident which is not consistent with the type of injury presented.

* Multiple injuries in various stages of healing; defensive injuries, such as bruises to the forearms.

* Psychosomatic or recurring physical complaints with no sign of an illness, including headaches, chest pains, heart palpitation, numbness and tingling, pelvic pain, etc.