An IPV survivor provides information and encouragement.
“I just wanted [the police] to take pictures of my face, and I just wanted it on record … and they said that they had to go arrest him. Well, I knew that was gonna piss my husband off. And it did. I had a restraining order, but that night he was in my bedroom standing over me naked with a knife.”
The above statement was made by a participant in a qualitative study I did on women who experience intimate partner violence. She is describing what happened when she went to the police station after her husband “took [her] head and bashed it through the kitchen wall.” A key finding of the study relates to system-wide abuse of women involved in intimate relationships that involve violence: Discrimination from the legal system and community attitudes that shame and stigmatize women compound the trauma of living with violence and hamper efforts to escape abuse and create a new life.
Victims need understanding and support
Often, nurses are part of that system. Evidence suggests that, when caring for victims of intimate partner violence (IPV), casting judgment is often more common than offering understanding and support. Research has found that nurses, as well as other health care providers, often have negative attitudes toward these victims that reflect their frustration and helplessness, even anger.
Many health care providers look down on IPV victims as weak and believe that attempts to help them are futile. This is a major flaw in our delivery of health care, because research also tells us that health care providers play an influential role in the lives of women who experience IPV. Appropriate nurse interactions with these sufferers can have a positive impact on women’s perceptions of themselves, their situations, and decisions they make about leaving abusive relationships.
One in three
Intimate partner violence is a major health care problem that all nurses will encounter, regardless of setting. One in three women you care for has a history of IPV. As a result of that violence, they may suffer from a multitude of physical and mental-health consequences: depression and anxiety, post-traumatic stress disorder, chronic pain, and gynecological problems, among others. If currently in an abusive relationship, they live with constant stress that wears on their health and constricts their quality of life, and they are always at risk of physical injury and even death.
We need to get better at identifying and treating victims of IPV. Women repeatedly report that they will disclose abuse if they are asked about it in a nonjudgmental manner, feel the nurse really cares about them (rather than routinely checking off a requirement on an admission form), and believe that efforts will be made to keep them safe.
Studies have also found they will accept help and use appropriate resources when offered, which often result in positive outcomes. Yet, despite recommendations by the U.S. Preventive Services Task Force, Institute of Medicine, and major professional organizations—including the Council of International Neonatal Nurses, Emergency Nurses Association, and Association of Women’s Health, Obstetric, and Neonatal Nurses—screening rates for intimate partner violence remain abysmally low, with studies reporting rates that range from 7 to 39 percent.
Why do we continue to find it so difficult to provide compassionate and effective care and services to this population? One of the biggest frustrations I hear from nurses, and one also reported in research findings, is that helping victims is a waste of time. After all, they’re not going to do anything about it, or
they’re just going to go back to the abuser, anyway! I understand this frustration, but it’s based on misconceptions.
Breaking free takes courage!
There are a couple of things to consider here. First, fear is one of the primary reasons a woman is hesitant to act, and that fear is valid. Violence escalates when a woman tries to end an abusive relationship, thus placing her in much greater danger. After a woman leaves an abusive relationship, the chances of her being murdered are three to five times greater. And, unfortunately, according to research and anecdotal evidence, women can’t rely on the justice system for protection. The legal response to IPV is often ineffective and even discriminatory. Think about what this means for a woman you encourage to take action. It takes great courage for her to face these very real dangers!
Second, breaking free of abuse is a process, not a one-time action, and the process can vary. Some women make escape plans and prepare over time, while others reach a breaking point and leave abruptly. Regardless of when or how it happens, most women make multiple attempts to leave before staying away for good. So don’t judge the effectiveness of your interaction with a victim based on whether or not she leaves and stays away from her abuser for good. The real measure should be, where in that process is she after her interaction with you?
If you are judgmental and condescending, you reinforce the messages of the abuser and validate the stigma she faces in the community. But if you treat her with dignity, show concern and empathy, she will leave feeling that she matters and that what happens to her matters. That can move her closer to leaving.
A place to start
October is Domestic Violence Awareness Month. Let’s take this time to change the way we approach our care of IPV victims. Creating therapeutic relationships built on trust and respect, and listening to and working with women to identify appropriate resources and support, are critical to providing effective care while minimizing risk. Intimate partner violence is a very complex phenomenon, and there are many things to consider, but this is a good place to start.
The next time you feel yourself getting frustrated or feeling helpless, keep these two things in mind: what women face in the process of leaving and what we can do in supporting them during that process. When you discharge an IPV victim, and she walks out that door, you won’t know if this will be the time she finally breaks free for good. But you can be sure of one thing: Your interaction with her will have had an impact. Either you’ve nudged her closer to leaving or pushed her farther into silence. RNL
Karen Roush, PhD, APN, assistant professor of nursing at Lehman College in the Bronx, New York, USA, and an IPV survivor, is the author of A Nurse’s Step-by-Step Guide to Writing Your Dissertation or Capstone
. Roush served for many years as editorial director and clinical managing editor for the
American Journal of Nursing (
AJN) and continues her affiliation with the journal as an editorial consultant. The founder of The Scholar’s Voice, established to help professionals and scholars in the health sciences, particularly nurses, become skilled, confident writers, she blogs regularly for
AJN’s “Off the Charts” and advocates against gender-based violence by writing and speaking on the topic.