1. Acknowledge and Support the Person.
When a woman affirms abuse, acknowledge that you've heard
what your patient has said and you believe what you were told. Send an
underlying message of concern and empathy, i.e., "No
one deserves to be abused."
If time allows:
- Let your patient tell you the story.
- Describe the cycle of violence.
- Reinforce the criminal nature of DV.
2. Assess Safety.
"Is it safe for you to return home?"
The decision to go home, or not to go home, must ultimately be made by
the patient and respected by the physician. The patient knows the batterer;
may be afraid for the safety of others, such as children, parents, or
siblings. The patient may know, from prior attempts to leave, that the
criminal justice system cannot really ensure safety from this individual.
If the answer is "It is not safe to return home,"
help by providing the number for the DV hotline from your office. (See
3. Assess Lethality.
The following question are targeted at identifying risk factors for
Counsel the patient who answers "Yes"
to the above questions about the added danger to the patient and children.
- "Are there weapons in the house?"
- "Does your partner abuse alcohol or drugs?"
- "Has your partner ever hit you while you were pregnant?" "Is your
partner violent outside the home?"
- "Does your partner assault or mutilate the family pets?"
- "Is your partner obsessive or jealous about you and the relationship
with you? Does your partner try and control your daily activities?"
- "Has the violence increased in frequency and severity over the past
- "Have you ever been afraid you might die while the batterer was attacking
4. Provide resource information and develop a safety plan.
"Do you have a plan if it happens again?" Help her to think
about a personal safety plan:
Link to The National Center for Victims
Domestic Violence Safety Plan Guidelines http://www.ncvc.org/infolink/INFO15.htm
Provide Number for the National Domestic
In Washington State
It may be necessary for your patient to hide this number in a
Documentation will be important in the future for criminal, divorce
or child custody hearings.
Include in the chart:
- Date, time, place of incident.
- Identity of the assailant.
- Mechanism of injury.
- Describe all injuries, new and older using a body map.
- Photograph injuries if patient permits.
- Document that resource material was provided.
Arrange a follow-up visit to address the DV issue again
It is often difficult to accept that some battered women will return
to an abusive situation. On average the victim will try six or seven times
before leaving permanently. You must respect the patient's right to find
a solution to a difficult and painful problem. Your job is to provide
information, emotional support and resources.
Useful Web Sites for Clinical Practice
- "Domestic Violence: A Practical Approach for Clinicians"
provided by the San Francisco Medical Society developed with Family
Violence Prevention Fund, 1996, and American Medical Association, 1992.
- Domestic violence resources available on the American College of
Emergency Physician's web site, ACEP Online. The ACEP is a national
medical society representing over 19,000 specialists in emergency medicine.
- The National Women's Health Information Center search page--search
under "domestic violence."
Useful Web Sites for Working with a Multicultural Population
- CDC's American Indian/Alaska Natives and Intimate Partner Violence
Aileen MacLaren, CNM, Ph.D.
Director, Nurse Midwifery Program
Family and Child Nursing
School of Nursing
University of Washington