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How to Navigate Domestic Violence as a Nurse

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Published December 24, 2022

In many states, nurses are mandatory reporters for domestic violence. Learn the dos and don'ts of working with survivors to help them on their path to healing.
How to Navigate Domestic Violence as a Nurse
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  • While domestic violence affects millions, it is rarely mentioned alongside other public health concerns, such as tobacco and alcohol use.
  • Nurses are in a unique position to identify domestic violence and offer patients practical information and emotional support to keep them safe.
  • Chronic domestic violence is associated with several types of chronic illness, like diabetes, depression, digestive diseases, and memory loss.

Everyone deserves a relationship free of violence and abuse. Yet, while domestic violence affects millions living in the U.S., it is rarely mentioned among other public health concerns, such as heart disease, tobacco or alcohol use, drug overdose, or infectious diseases.

Nurses play a unique and crucial role in the identification and care of people who find themselves in a domestic violence situation. Communities can get more safety and security when healthcare professionals and public health workers collectively invest in the well-being of the children and adults they encounter.

Explore how nurses can identify the signs of domestic violence and ways to help navigate it.

How to Identify the Signs of Domestic Violence

When most people think about domestic violence, they think about physical abuse. But abuse can come in several forms, including physical, psychological, mental, emotional, sexual, or financial. They are often inseparable from each other.

Conduct Routine Screenings

Jamie Ferrell is the director of forensic nursing services at Memorial Hermann Health System in Houston. She recognizes that a nurse's role in domestic violence begins when they understand the issue affects all individuals, regardless of their socioeconomic status, education level, race, religion, gender identity, or sexual orientation.

In other words, nurses must look beyond gender stereotypes as they relate to abusers and survivors. She recommends becoming familiar with using a trauma-informed compassionate approach to nursing to routinely screen all patients for domestic violence. This can increase the potential that you will identify someone experiencing abuse and help them in their journey to survivor.

"An effective screening is done by creating a safe space with privacy, seeking to understand — not judge — being intentional with communication, and slowing down to hear," she says.

Ferrell recommends incorporating these screening questions into your routine medical history. This allows the screening to be more conversational and helps the nurse to consistently screen all patients regardless of whether they suspect abuse or not.

Lindsay Nelson, MPA, is a trauma-informed care international activist/coach/trainer. She recommends nurses become educated and familiar with identifying domestic violence in their patients. It is essential that screening is done in a way to help strengthen the trust between you and the patient. It should also ensure that patients remain as safe as possible.

Establish Trust With Patients

In cases where patients are routinely seen by a primary care provider, a checklist of questions can be used that demonstrates empathy and knowledge. You should not force patients to disclose abuse immediately but develop relationships that encourage the patient to reveal their situation.

Nurses and other healthcare providers must not retraumatize the patient through an interrogation. Nurses must also understand that disclosing domestic violence can trigger physical danger for the patient if the abuser continues to have control over and contact with them.

"However, a nurse's interaction," she says, "even a few minutes, can be supportive by doing certain things that will make the survivor feel safe and empowered regardless of if they disclose the abuse they have/are experiencing."

Know the Phases of Abuse

Abusers often follow a five-phase cycle of violence. It begins with a calm phase, followed by tension building, an explosion, and then a makeup or honeymoon phase. The abusers move from building tension as an excuse for a violent outburst to grand gestures of apology and love.

This cycle creates a roller coaster of feelings. This is often why patients act very differently if the nurse meets them directly after a violent episode or a day or so later in the honeymoon phase.

In many cases, the abuser has convinced the survivor that the abuse was genuinely their fault. Many of these patients can present with no obvious signs of domestic violence.

Understand the Relationship Between Illness and Abuse

One survey found women who reported domestic abuse were also more likely to experience several types of chronic illness. While these conditions are associated with domestic violence, just because a patient presents with them, doesn't mean they are survivors of domestic violence.

These chronic conditions include:

  • Back pain
  • Headaches
  • Memory loss
  • Difficulty sleeping
  • Depression
  • Diabetes
  • Asthma
  • Anxiety
  • Digestive diseases

How Is Care for Domestic Abuse Survivors Different From Other Patients?

Patient care for individuals who have experienced domestic violence or intimate partner violence is significantly different from care for the average patient. Safety is always the primary concern for these individuals as care for them can trigger violence in the abuser.

Ferrell advises nurses caring for patients who've experienced domestic violence to use a holistic care approach that includes a comprehensive physical assessment, alongside psychological support and emotional comfort.

"Often the patient having experienced domestic violence is also accompanied by children whose needs must be explored and addressed in collaboration with the patient," she says.

Nelson reminds nurses and other healthcare providers that the patient typically sees the healthcare profession as a position of power. This can be intimidating and make it more difficult for the patient to feel empowered to communicate their needs.

You must be sensitive to that situation. One way to do that is to inform the patient of every step of the healthcare visit process. Also, ask for permission or explain everything that's being done before it's done.

This can help the individual feel more empowered in the process and avoid retraumatizing the patient. It can also help to build trust, ensuring a healthier long-term relationship with the healthcare provider.

You must also be sensitive to any recorded or written communication with the patient that the abuser could access. For example, leaving a voicemail, email, or insurance and billing paperwork. If the abuser learns the patient has sought healthcare, it can trigger a violent outburst and put the patient in immediate physical danger.

Tips for Navigating Patient Care for Domestic Violence Survivors

As mandated reporters, nurses bear a legal responsibility to follow state regulations and an ethical responsibility to care for and protect the rights of their patients.

Nurses must remain cautious in how they navigate potential conflicts between legal responsibilities and consequences, and personal and professional ethics and obligations, even when the situation is emotionally disturbing.

According to the National Association of Mandated Reporters, in many states, intimate partner violence doesn't have the same reporting requirements as other types of domestic abuse or domestic violence.

Nelson advises nurses to inform the survivor they are mandatory reporters before asking questions that may prompt disclosure.

"[Survivors] have had their choice taken away time and again, so it is vital that they understand and get to choose whether to disclose abuse/violence and understand the possible consequences of the disclosure/reporter," she says.

If there is a language barrier, always use a professional interpreter instead of staff or a family member. This reduces the potential risk the patient will misunderstand the conversation or that the conversation will be reported to the abuser.

Nursing staff should also develop strong relationships with community resources and keep printed resources to share with survivors. However, it is essential that printed materials cannot be accessed by the abuser as it places the survivor in significant physical danger.

Nelson cautions nurses not to document the abuse in records that could be requested by the abuser or relatives of the patient, or which may become a part of the public record. She goes on to advise:

  • Don't talk down or belittle based on your judgments of their situation
  • Don't assume: the patient is or isn't a survivor, what they are feeling, what is best for them, or that it is easy for them to leave an abusive situation
  • Help with insurance estimates on costs since the abuser may control the money and insurance
  • Follow through and be reliable; you may be the only trusted person in the patient's life
  • Be patient and even-toned
  • Give the patient information and options for medical treatment
  • Ask permission before touching the patient
  • Remember that abuse victims and survivors can be of any gender; they are not just women
  • Ask about children's health and offer referrals or exams if possible
  • Don't assume the patient isn't worried about their children's health; they often stay in abusive situations because leaving can be more dangerous

When it comes to navigating domestic violence situations, nurses should focus on patient care, safety, and trust.

Meet Our Contributors

Portrait of Jamie Ferrell, MBA, BSN, RN, CA/CP-SANE, SANE-A, SANE-P, DF-IAFN, F-AAFS

Jamie Ferrell, MBA, BSN, RN, CA/CP-SANE, SANE-A, SANE-P, DF-IAFN, F-AAFS

Jamie Ferrell earned her master's in business administration with a healthcare emphasis from the University of Texas and her bachelor of science in nursing from West Texas A&M University. She has 44 years of experience as a registered nurse with extensive practice in emergency/trauma care. For the last 36 years, she has also practiced as a forensic nurse/sexual assault nurse examiner. Ferrell is the clinical director of forensic nursing services for the Memorial Hermann Health System in Houston, Texas. She is responsible for the care of both adult and child survivors of sexual assault.


Portrait of Lindsay J. Nelson, MPA

Lindsay J. Nelson, MPA

Lindsay Nelson is an expert trauma-informed care international activist/coach/trainer with a specialty in sexual and reproductive rights. Nelson took her education in human services and public administration, work experiences in public service, and personal experience of rape, domestic violence, and medical retraumatizations to launch Repro Empowerment Services to change the culture of trauma-informed care in healthcare settings.

Source

Langford A, et al. (2022). Intimate partner violence and chronic health conditions: Are they linked? https://www.center4research.org/partner-violence/


Page last reviewed November 29, 2022

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