≥ 92% of participants will know how to identify and respond to domestic violence.
CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.
CEUFast, Inc. is an AOTA Provider of professional development, Course approval ID#03649. This distant learning-independent format is offered at 0.3 CEUs Intermediate, Categories: Professional Issues and Foundational Knowledge. AOTA does not endorse specific course content, products, or clinical procedures. AOTA provider number 9575.
≥ 92% of participants will know how to identify and respond to domestic violence.
After completing this course, the learner will be able to:
Domestic violence amongst family members can take many forms. It may include emotional abuse, economic abuse, sexual abuse, threats, using the threat of removing children, isolation, and other behaviors used to maintain fear, intimidation, and power. Acts of domestic violence are categorized into psychological battering, physical battering, or sexual abuse (Centers for Disease Control and Prevention [CDC], 2020a).
While the term “domestic violence” is still widely used, more recently, physical, psychological, or sexual violence in a relationship is called intimate partner violence.
When a person hurts or tries to hurt a partner by hitting, kicking, or using another type of physical force. The harm can range from bruises to death. It often begins more trivial and progressively escalates to more frequent and life-threatening attacks.
It is often broken into three categories:
The use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally, generally exerting control over another person.
There are many theories as to why some people are abusers. However, abusers demonstrate the behavior they do because violence is an effective method for gaining and keeping control over another person. In a domestic situation, the abuser traditionally has not suffered adverse consequences due to violent behavior.
Abusers often display immaturity and are dependent and non-assertive (Sadock et al., 2021).
The psychological dynamics of male abusers include identification with an aggressor (father, boss, brother, etc.), testing behaviors (i.e., "Will she stay with me no matter what I do to her?"), distorted desires to express manhood, and dehumanization of women (Sadock et al., 2021).
Research from both developed and undeveloped countries has consistently identified the following triggers for domestic violence (DeCapua, 2017):
Batterers come from all social classes, races, cultures, religions, backgrounds, and countries (WHO, 2021). The following behaviors may be warning signs (DeCapua, 2017):
Assessment tools have been developed that can help identify someone who has the potential for domestic violence/intimate partner violence.
Although women make up at least 85% of the victims of domestic violence, most often at the hand of male abusers, males are often victims (Kippert, 2021). In fact, according to the Centers for Disease Control and Prevention (2020), approximately 1 in 10 men in the United States have experienced sexual or physical violence and/or stalking by an intimate partner. Male survivors of abuse often experience a stigma to be the "man" who should have the ability to fight back against an abusive partner, especially when that significant other is a female (Kippert, 2021). In the case that the abuser is another male, they are often uncomfortable revealing the abuse because it would mean disclosing a same-sex relationship that they have not shared with others yet. Males also typically experience discrimination from police or domestic violence shelters (Kippert, 2021).
Partner violence within the Lesbian/Gay/Bisexual/Transgender/Queer+ (LGBTQ+) community occurs quite often. Unfortunately, there is much less research available for this community in comparison to those in gender-conforming, heterosexual relationships (Resnick, 2021). The most current statistics from the National Coalition Against Domestic Violence (NCADV) state that 43.8% of lesbian women and 62.2% of bisexual women are raped, the victim of physical violence, and/or stalked by their partner (Resnick, 2021). The members of the LGBTQ+ community at the highest risk for intimate partner violence are African Americans, transgender persons, and bisexual people (Resnick, 2021).
The NCADV also stated that fewer than 5% of LGBTQ+ victims of domestic violence ever seek court-appointed protective orders (Resnick, 2021). Members of this community have their own unique reasons for not seeking help. First is the risk of potential discrimination from law enforcement. As mentioned in the last section, the abuser could threaten their partner if they have not "come out" to their family and friends to disclose a same-sex relationship. This threat can be potentially even more dangerous for any transgender, nonbinary, or those who are gender-nonconforming who have not publicly disclosed their gender identity (Resnick, 2021). In addition, homophobia and transphobia can still make a major impact in the legal proceedings of many states (Resnick, 2021).
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines standards for healthcare organizations and monitors compliance with those standards. JCAHO mandates that hospitals must develop criteria to identify possible victims of abuse.
Staff must be trained to apply these criteria. They should question whether abuse might have occurred if a patient's story for their injury does not match the actual injury. A hospital must maintain a list of private and public community agencies that provide help for abuse victims. Staff also must be able to make appropriate referrals for victims (DeCapua, 2017).
For example, a child's x-rays may show an unexplained broken bone. Staff should observe the behavior of the people who brought the child to the emergency room. Does the child cling to one parent and avoid the other? Staff members should question the child in a non-threatening manner, look for bruises on the body, and listen to explanations to see if there is congruence between the physical evidence and the story.
New York was the first state to require hospitals to establish protocols to identify and treat domestic violence victims and make referrals to community services. California passed the first state law mandating protocols for hospitals and clinics to detect the presence of violence in the lives of patients.
Early identification and intervention with victims of domestic violence can help prevent injuries and save lives (CDC, 2020b; U.S. Department of Health and Human Services, 2010). Many victims of domestic violence seek assistance in healthcare settings, often repeatedly, but are only treated for symptoms and injuries. Unfortunately, healthcare professionals often fail to identify victims. Missed cases of intimate partner violence may be due to the screening method.
Pregnancy may be a risk factor for battering—approximately 1 in 12 women in North America who are pregnant experience some form of intimate partner violence.
Violence during pregnancy increases the incidence of morbidity and mortality.
Healthcare providers can help by screening for domestic violence, documenting abuse in the medical record, safeguarding evidence, providing medical advice, referrals, safety planning, and showing empathy and compassion.
Abuse victims need referrals to legal and social services. They may need help finding temporary shelter, advice on how to keep safe should they return home, and affirmation that the abuse is not their fault (DeCapua, 2017).
It is not the role of the healthcare provider to invoke or foster criminal justice intervention. Calling the police is not always in the best interest of a victim of domestic abuse. Some victims of domestic violence have learned to distrust the police or believe that law enforcement intervention will further endanger them. Immigrant victims may fear that calling the police will lead to deportation. Others are unwilling to use law enforcement intervention until a safety plan is in place.
Each victim should be informed of their legal options and encouraged to make their own choices (Cline et al., 2020).
The first step in treatment is the identification of the victim. Many individuals who are victims of abuse will not voluntarily share this information. However, they will discuss if the provider asks the right question in a compassionate, non-judgmental manner. The healthcare provider might start by asking, "Because violence is common in many people's lives, I ask every patient the same question. At any point, has your partner harmed or threatened you?" These conversations should always take place in a private setting when the patient is alone.
If the patient answers “yes” to this question, the healthcare provider should encourage them to talk about it and listen non-judgmentally. This talk helps begin the healing process and provides information that will help with treatment planning. It is also very important for the healthcare worker to validate the victim's fears because they often think others won't believe them or will downplay their experiences. The healthcare provider might say, "You don't deserve to be treated this way," and "You are not to blame."
The healthcare provider must document the patient's complaints and symptoms. The complaint should be written using the patient's own words and directly placed in quotations in documentation when possible. Also, be sure to detail and describe injuries, including their type, size, location, and number. If possible, take color photographs and include those in the chart as well.
Next, assess the danger to your patient. Determine whether they are safe to leave the healthcare setting. Indicators of escalating danger include an increase in the frequency, duration, or severity of assaults, new threats of homicide or suicide by the partner, threats to children or other loved ones, and the presence or availability of a gun.
Finally, healthcare providers should offer the appropriate referral and support. Start by treating the victims' injuries. If the victim is determined to be in imminent danger, refer them to stay with friends, family, or at a domestic violence shelter. If they are not in imminent danger, provide written information about community shelters and resources. Also, be sure to provide them with a toll-free domestic violence hotline number.
Chelsea is a 43-year-old Caucasian female living with her second husband. She arrives at the clinic, appearing shaky and nervous. During the initial physical assessment, she begins to cry, explaining that her husband is aggressive. She describes his various behaviors, which could be classified as emotional, physical, and financial abuse. She has two children, ages three and six, who are both at the clinic with her.
She denies any current suicidal thoughts and any current drug or alcohol misuse. Assessment of the children does not reveal any evidence of abuse towards them, and Chelsea denies witnessing any aggression towards them in the past. The healthcare worker completes an assessment and explains to Chelsea her legal options. Chelsea agrees to go with her children to a local shelter to begin more specialized treatment and receive adequate community resources.
Hamza, a 28-year-old immigrant from Pakistan living in the Midwest, left his wife and moved into his friend's house after three instances of physical abuse. In addition, his wife was using financial control over him and isolating him from his family and friends. Hamza has obtained a restraining order, but his wife is attempting to retaliate by filing for a modification of custody for their children, citing frivolous allegations and inappropriate parenting. His lawyer represents him, and he has recently begun seeing a therapist for cognitive-behavioral therapy (CBT). This counseling has helped him emotionally process his situation and previous trauma.
Christopher, a 21-year-old college student, broke up with his violent boyfriend about a month ago; however, he continues to stalk him. He continues to show up on campus and will appear outside his classes, the cafeteria, and the library. He calls and sends him text messages daily, saying threatening and hurtful things. Christopher is scared and has been considering dropping out of school. He decides to seek help through a legal aid, who documents his stalking behavior and facilitates a meeting with the college dean. His attorney represents him in a court hearing and he can obtain a protective order to continue his education.
Domestic violence is a crime that causes severe health consequences. Healthcare professionals are mandated and obligated to identify and offer assistance to victims of domestic violence. Legal and societal changes in the United States have reduced the occurrence of domestic violence, but the problem is still an epidemic. Your efforts can make a difference.
National Domestic Violence Hotline
Rape, Abuse & Incest National Network
Alabama Coalition Against Domestic Violence
Alaska Network on Domestic Violence and Sexual Assault
Arizona Coalition Against Domestic Violence
Arkansas Coalition Against Domestic Violence
California Partnership to End Domestic Violence
Coalition to End Family Violence
Colorado Coalition Against Domestic Violence
D.C. Coalition Against Domestic Violence
SOS Program (A part of DC Coalition)
Delaware Coalition Against Domestic Violence
Harbor House of Central Florida
Georgia Advocates for Battered Women and Children
Hawaii State Coalition Against Domestic Violence
24 Hr Hawaii Shelters by Island:
Iowa Coalition Against Domestic Violence
Idaho Coalition Against Sexual and Domestic Violence
Illinois Coalition Against Domestic Violence
Indiana Coalition Against Domestic Violence
Kansas Coalition Against Sexual and Domestic Violence
Kentucky Domestic Violence Association
Louisiana Coalition Against Domestic Violence
Maine Coalition to End Domestic Violence
Maryland Network Against Domestic Violence
Jane Doe Inc./Massachusetts Coalition Against Sexual Assault and Domestic Violence
Minnesota Coalition for Battered Women
Missouri Coalition Against Domestic Violence
Women's Support and Community Services
Mississippi State Coalition Against Domestic Violence
Montana Coalition Against Domestic and Sexual Violence
Nebraska Domestic Violence and Sexual Assault Coalition
Nevada Network Against Domestic Violence
New Hampshire Coalition Against Domestic and Sexual Violence
New Jersey Coalition for Battered Women
New Mexico State Coalition Against Domestic Violence
New York State Coalition Against Domestic Violence
North Carolina Coalition Against Domestic Violence
North Dakota Council on Abused Women's Services
Ohio Domestic Violence Network
Oklahoma Coalition Against Domestic Violence and Sexual Assault
Oregon Coalition Against Domestic Violence and Sexual Assault
Pennsylvania Coalition Against Domestic Violence/National Resource Center on Domestic Violence
Women's Center of Montgomery County
Rhode Island Coalition Against Domestic Violence
South Carolina Coalition Against Domestic Violence & Sexual Assault
South Dakota Coalition Against Domestic Violence and Sexual Assault
Tennessee Task Force Against Domestic Violence
Texas Council on Family Violence
Utah Domestic Violence Coalition
Vermont Network Against Domestic Violence and Sexual Assault
Virginians Family Violence and Sexual Assault Hotline
Washington State Coalition Against Domestic Violence
West Virginia Coalition Against Domestic Violence
Manitowoc County Domestic Violence Center
Wisconsin Coalition Against Domestic Violence
Wyoming Coalition Against Domestic Violence and Sexual Assault
YWCA Battered Women Task Force-Topeka
National Coalition Against Domestic Violence
Public Policy Office
National Battered Women's Law Project
National Resource Center on Domestic Violence
Battered Women's Justice Project
Resource Center on Domestic Violence, Child Protection, and Custody
Battered Women's Justice Project
National Clearinghouse is a national resource and advocacy center providing assistance to women defendants, their defense attorneys, and other members of their defense teams in an effort to ensure justice for battered women charged with crimes.
National Clearinghouse on Marital and Date Rape
National Network to End Domestic Violence
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.