Focus

Domestic Care

Domestic violence is a pattern of coercive behaviors that involves physical abuse or the  threat of physical abuse. It may involve repeated psychological abuse, sexual assault, progressive social isolation, depravation, intimidation or economic control.

Domestic violence is a frightening,  traumatic event for the victim. As a care provider, your response to the crisis is of essential importance to the victim’s present and future well being. Providing proper care at this critical time may be  complex and difficult. Those guidelines are designed to guide you to the best and most complete practices to meet the needs of these patients and their families.

It is essential for a clinician to approach  these patients in a non-judgmental, emphatic and reassuring manner, validating the experience while providing safety and privacy. It is critical to understand that patients who have been abused have experienced a  loss of control. By asking for consent and explaining each step of the treatment, decision making is returned to their control. Violent trauma also leads to ambivalence and confusion. Stay with the patient for as  long as your duties permit. Remember that a healthcare provider may be the first person a victim of domestic violence approaches to reveal their problem.

Domestic  violence is a pattern of coercive and violent behavior that may include physical, psychological, and sexual attacks that adults and adolescents inflict upon their intimate partners, of the opposite or same sex. This behavior often produces physical signs on the victim. Occasionally, there are ambiguous or unclear physical signs.

Physical Findings

  1. Injury to head, neck, torso, abdomen, breasts or genitals.
  2. Bilateral or multiple injuries or repeated visits.
  3. Delay between the onset of injury and seeking medical treatment.
  4. Explanation by the patient which is inconsistent with injury.
  5. Any injury during pregnancy, especially breasts or abdomen.
  6. Prior history of trauma.
  7. Chronic pain symptoms without apparent etiology.
  8. Psychiatric distress, depression, anxiety, suicidal ideation, sleep disorder.
  9. A partner who seems overprotective or won’t leave partner’s side during clinical exam or interview.
  10. Suicide attempt/overdose.

Specific, clear and non-judgmental questions can be asked in a confidential setting. The examiner must be alone with the patient in a private room. Opening questions can include:

  1. “Because violence is common in so many people’s lives, I’ve begun to ask about it routinely. At any time has your partner ever hit, kicked or in some other way hurt of frightened you?”
  2. “I know that you said you fell on your left side, but you have injuries on your other side as well. I’m concerned that someone hurt you.”
  3. “Many people come in with injuries like yours and often they are from someone hurting them. Is this what happened to you?”

  1. Patient comes to ER
  2. TRIAGE clinician sees bruised or other indicators and suspects abuse.
  3. Patient taken to exam room.
  4. All persons accompanying the patient are asked to leave.
  5. Clinician conducts screening.
  6. If abuse is revealed or suspected, patient is referred to a social worker.
  7. Social worker
    • Makes referrals to shelters, hotlines, other community resources.
    • Help patient develop a safety plan if needed.
    • Stays with patient throughout her ER visit.
    • Assists the patient in notification of law enforcement if required or requested by patient.