Domestic Violence: The Role of Nurses

Nurses have, for a long time, taken a back seat when it comes to getting involved with domestic violence cases. It has traditionally been viewed as a social work issue. However, nurses can play a crucial role in recognizing the signs of domestic violence, allowing victims to feel comfortable discussing their situations, and aiding those in violent relationships in attaining a life of safety. But perhaps the mind shift does not rely solely on the bedside nurse. Hospital administrators must be equally invested in allowing nurses the opportunity to properly care for victims of abuse.

Oftentimes, a victim needs to establish a trusting relationship before exposing the truth about the abuse she is experiencing. Most often, it is the bedside nurse who spends the most time with a patient whether they are in the emergency room or admitted to a unit within the hospital. But nurses are often redirected to issues that are considered…. a higher priority, more medically important. As a unit, nurses are a unique group of caregivers who are constantly advocating for patients, working through lunch breaks to ensure patients are properly cared for. They spend their careers supporting people, feeding people, saving lives, and consoling those in despair. So, think for a moment about how different an experience a battered woman could have if domestic violence was considered as pertinent an issue for a bedside nurse as diabetes management, wound care, or pneumonia.

The Impact of Violence on Health

There are a significant number of health-related problems that a victim of abuse may experience. Generally, women in abusive relationships are in poorer health than those that do not experience violence at home. This can be for several reasons: denied access to healthcare by the abusive partner, no access to finances or health insurance cards, and having no means of transportation are just a few. Victims of domestic violence do not only show up with obvious signs of abuse such as broken bones and unexplained bruises. Many abused women experience chronic headaches, dramatic changes in weight, problems with digestion and bladder function. They also have poorer pregnancy outcomes and may give birth to under-nourished babies.

What Should a Nurse Look for?

When performing assessments on women, nurses should understand that the following injuries could be possible signs of domestic abuse:

Ruptured eardrums
Bruising on the chest and abdomen
Multiple injuries
Delay in seeking medical care.
Patterns of repeated injury

Women who do not present with an obvious physical injury may come in complaining of any of the following:

Anxiety, panic attacks, stress, or depression
Gynecological problems such as multiple miscarriages, and chronic pelvic pain
Sleeping and eating disorders
Abdominal pain, chronic digestive issues

Other Warning Signs May Include:

Appearing nervous, ashamed, or evasive
Apprehensiveness when partner is present.
The partner doing most of the talking.
Giving an unconvincing explanation of injuries

What is the Nurse’s Role if There is a Suspicion of Abuse?

If abuse is suspected, the nurse will need to engage the victim in conversation with specific lines of questioning leading to the disclosure of the abuse. The questions will depend heavily on the relationship that has been built with the victim, the injuries observed, and the willingness of the victim to speak about it. Broad questions are usually a good starting point if abuse is suspected:

“How are things at home?”

“Is there anything else going on that could be affecting your health?”

“How are you and your partner getting along?”

“You seem anxious, is everything alright at home?”

Depending on the injuries sustained, more direct questioning may be indicated.

“Are you concerned about your safety at home?”

“Are there ever times where you are afraid of your partner or anyone else in the home?”

“Does the way your partner treats you ever make you feel bad about yourself?”

The responses by the nurse can have a very profound effect on the victim’s willingness to share information. Remember, victims of domestic violence live in a world where their feelings, needs, and wants are of no consequence. Just the act of listening to a victim talk can make her feel like she is important, which is empowering. Listen intently. And encourage her to share her experiences. Validate how difficult it must be for her to discuss something so personal. And remind her that she does not deserve the abuse she is enduring and there are people willing to help her out of her situation.

If nurses, managers, and hospital administrators prioritize domestic violence recognition, it can have a profound impact on a victim and her children. Working closely with counselors, social workers, and law enforcement offices is the gateway to living in a community of health and safety, which is what every one of us deserves.