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Recognizing Signs of Abuse in Patients

Created May 29 2018, 01:28 PM by Lippincott Solutions
  • domestic abuse
  • intimate partner violence

Allegations of physical abuse earlier this month that prompted the swift resignation of then-New York Attorney General Eric Schneiderman stunned onlookers. Given Schneiderman’s vocal support of the #MeToo movement and his legal action against Harvey Weinstein, he was the last person many would have suspected of sexual assault. (Schneiderman denies the allegations.)

Yet the disturbing control, violence, and threats described by accusers Michelle Manning Barish and Tanya Selvaratnam, both of whom were in long-term relationships with Schneiderman, are common to many women. The Centers for Disease Control and Prevention describes intimate partner violence as a “serious, preventable public health problem that affects millions of Americans.”

While men can be victims, too, women are more often the targets of domestic violence, according to Charmaine Power, RN, PhD, of Flinders University in Australia. Women are also more likely to feel physical effects of abuse.

“Evidence shows the effects of abuse/violence have a profound impact on women's and children's health, and that women regularly seek services from healthcare workers, including nurses, for health concerns related to this abuse/violence,” Dr. Power writes in an article that ran on the Crisis Prevention Institute website.

“Imagine what could be achieved if all nurses were as informed about domestic violence as they are about wound care or diabetes management, for example?”

Suffering in Silence

First, know this: no cultural or socioeconomic group is immune to intimate partner violence. Don’t be tempted to dismiss a suspicion of abuse because of nice clothes, devoted religious practice, or family reputation in the community.

Second, please understand this: victims of intimate partner violence are not likely to ask for help on their own. They are used to keeping this aspect of their relationship secret.

“In a recent women's safety survey, 79% of women who had experienced physical assault and 81.25% who had experienced sexual assault had not sought any professional help,” Dr. Power writes.

Why suffer in silence? Fear for their safety or their children’s safety can play a role, as can disbelief, shame, and even emotional attachment to the perpetrator.

“Significantly, many women do not want the relationship to end,” explains Dr. Power, “but they do, however, want the violence to stop.”

Signs of Abuse

The health of women who experience domestic violence is typically worse than that of other women. These women may present with:

  • stress-related sickness;
  • sleep disorders;
  • chronic headaches;
  • stomach, joint, or muscle pain;
  • sexual dysfunction; and
  • mental health issues such as anxiety, panic attacks, depression, suicide attempt, and substance abuse, according to the article.

Injuries that may signal intimate partner violence include bruising, cuts, and ruptured eardrums. Multiple injuries, delays in seeking treatment, and repeated injuries can sometimes be linked to abuse, too.

Women who experience violence may seem nervous and provide unconvincing explanations for their injuries, Dr. Power explains. They may describe their partner as “controlling” or “angry,” and they may neglect to follow healthcare advice.

How to Respond

Dr. Power recommends nurses who suspect intimate partner violence to initiate a conversation using open, broad-based questions, such as “How are things at home?” More specific, follow-up questions can include “When I see these kinds of injuries, I wonder if someone could have hurt you?” or even “I think there may be a link between your injuries and the way your partner treat you. What do you think?”

“The response of nurses to women in these circumstances can have a profound effect on their willingness to open up or to seek help,” notes Dr. Power, who emphasized the importance of listening, and then communicating belief in her story, validating her decision to share it, and emphasizing the unacceptability of abuse.  

Find out if she feels safe returning home and whether she needs an immediate safety plan. Also emphasize the importance of having an emergency safety plan for the future: a place to go, a mode of transportation, telephone numbers of people to contact for support.

Dr. Power advises to document the safety plan for future reference, should the woman require it.

“There is a growing awareness and commitment at health department level to address the personal, social, and economic costs of abuse/violence,” she writes, “so the time is ripe for nurses to act and ensure serious inroads are made in improving the health of all communities.”

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