Intimate partner violence occurs in a shocking number of relationships. Unfortunately, 1 in 4 women and 1 in 9 men will experience severe intimate partner violence in their lifetime. Healthcare workers, especially nurses, can help patients who are suffering from intimate partner violence, but they must understand the subtle signs to look for, and know how to offer support.
Recommended course bundle: Forensic Healthcare Bundle: Responding to Patients Impacted by Violence
Understanding intimate partner violence
Many misconceptions surround those who might be at risk of this kind of violence. Because of this, many people who do not fit the typical stereotype of an abused partner do not receive the help and care they so desperately need. Partner abuse can happen to anyone, regardless of age, race, religion, socioeconomic status, career choice, and gender. It is important to recognize bias when looking for signs of intimate partner violence.
When most people think of intimate partner violence, they think of physical violence like choking, punching, or slapping. However, the dynamic of intimate partner violence is about control, not just physical intimidation. In an abusive relationship, the abuser typically feels that they have a right to control their partner.
Abusers may control all finances, forbid their partner to see friends and family, dictate the way their partner dresses, make unreasonable demands regarding household responsibilities, or force physical touch and sexual acts.
Financial, emotional, social, and sexual abuse are all common forms of intimate partner violence. All of these types of abuse are serious and should not be discounted because there are no broken bones or bruises.
Recommended course: Domestic and Sexual Violence Awareness for Healthcare Professionals
Signs of intimate partner violence
Because intimate partner violence includes more than just physical aggression, healthcare providers need to be aware of some of the more subtle signs of partner abuse. These may include:
- Unexplained injuries
- Frequent healthcare visits for injuries
- Withdrawal
- Sudden weight loss or gain
- New onset depression and anxiety
- Limited access to resources
- Cutting off contact with friends and family members
- Not making any decisions without consulting partner
- Asking permission from a partner to fulfill basic needs
- New or increased drug and alcohol use
- Chronic pain
- Gastrointestinal issues caused by stress
- Self-harm or suicidal thoughts and behaviors
Patients who may be victims of violence can be assessed using tools like the HARK or HITS screening questionnaires.
The role of the nurse in addressing intimate partner violence
If a nurse is suspicious that a patient may be suffering from intimate partner violence, one of the most important things to do is to interview the patient without the other partner present. Some abusive partners make it difficult to speak to the patient alone. Asking the suspected abuser to leave the room is best done with two healthcare providers present.
A patient who is alone may be more willing to speak freely about their relationship. However, intimate partner violence is a complex issue, where the victim may feel compelled to protect their abuser. The nurse should remain compassionate and provide support and resources, without forcing the patient to make any decisions regarding reporting the abuser or leaving the relationship.
Healthcare providers should remember the four Rs when caring for patients who experience intimate partner or domestic violence.
- Realizing the widespread impact of trauma
- Recognizing the signs and symptoms of trauma
- Responding by fully integrating knowledge about trauma into policies, procedures, and practices
- Resisting re-traumatization of the patient
Education and resources
Leaving an abusive relationship is more complicated than it may appear. Victims in these situations may have lost all access to resources like money or housing, they may have little to no social support, may share children with their abuser, or may feel helpless about the situation.
In addition, it is important to remember that although there is abuse happening, the victim and the abuser have a relationship that was probably good or even great at one time. Many victims still hold on to hope that their relationship can return to the way it once was if only they put in enough effort.
Because of these complexities, it is futile for the nurse to convince a victim to leave his or her abuser in one appointment. Instead, the nurse should offer resources that the victim can read when they are ready. They should be given information regarding the risks and statistics associated with this kind of intimate violence.
For example:
- Victims of domestic abuse are five times more likely to be killed if their partner owns a firearm
- Victims are at the highest risk of extreme physical violence when they leave their partner.
- 30-60% of households that experience intimate partner violence also have problems with child abuse.
Some of the best educational resources for victims include:
- The National Domestic Violence Hotline
- 1-800-799-7233 (SAFE)
- National Dating Abuse Helpline
- 1-866-331-9474
- www.loveisrespect.org
- National Resource Center on Domestic Violence
- 1-800-537-2238
- www.nrcdv.org and www.vawnet.org
In addition to offering educational information, the nurse can assist the victim in making a safety plan.
Laws and state reporting requirements
While there are many specific laws regarding mandatory reporting of child abuse and sexual assault, the laws are less clear when it comes to violence from an intimate partner. A study published in the Journal of Trauma Violence Abuse states that although most people are in favor of mandatory reporting of all abuse, very few healthcare providers report domestic partner violence.
Any healthcare provider who witnesses or becomes aware of abuse, whether financial, emotional, sexual, or physical, should do what they can to provide support to the victim and inform the appropriate authorities of the concern.
