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Domestic Violence, Sexual Violence, Intimate Partner Violence (Kentucky)

3 Contact Hours
Meets the Kentucky State Requirement for 3 hours of Domestic Violence
This peer reviewed course is applicable for the following professions:
Advanced Registered Nurse Practitioner (ARNP), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Occupational Therapist (OT), Occupational Therapist Assistant (OTA), Physical Therapist (PT), Physical Therapist Assistant (PTA), Registered Nurse (RN), Respiratory Therapist (RT)
This course will be updated or discontinued on or before Saturday, November 18, 2023
Outcomes

≥ 92% of participants will know how to identify and respond to domestic violence.

Objectives

After completing this course, the learner will be able to:

  1. Define domestic violence.
  2. Explain the cycle of violence.
  3. Identify characteristics of individuals at risk for domestic violence.
  4. Understand national and state mandates against domestic violence.
  5. Explain the Kentucky state specific reporting process.
  6. Identify how health care workers can help victims of domestic violence.
  7. List the interventions available for victims of domestic violence in the state of Kentucky.
  8. Identify the resources available for victims in the state of Kentucky.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Melissa DeCapua (DNP, PMHNP-BC)

Kentucky State Board of Nursing Requirements

House Bill 309 requires all licensed nurses to complete a one-time, mandatory course addressing domestic violence. The statute mandates that the 3-hour Domestic Violence training course includes (Kentucky Revised Statute, Public Law 403.715 to 403.785):

  • Dynamics of domestic violence
  • Effects of domestic violence on adult and child victims
  • Legal remedies for protection
  • Lethality and risk issues
  • Model protocols for addressing domestic violence
  • Available community services/victim services
  • Reporting requirements

Introduction

Domestic violence remains a persistent problem in the United States. It encompasses a range of abuses, including economic, psychological, sexual, and physical. Victims are primarily women. From primary care offices to urgent centers, victims of domestic violence routinely appear across healthcare settings; therefore, it is essential that healthcare providers, particularly nurses and advanced practice nurses, recognize its symptoms and understand how to establish a plan of care.

Definition

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.

The World Health Organization (WHO) defines intimate partner violence as "any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship" (World Health Organization [WHO], 2021).

“Intimate partner” typically refers to both current or former partners; however, WHO leaves this a bit more open-ended and does not constrain intimate partner violence to any specific type of relationship (WHO, 2021).

In their detailed report, Intimate Partner Violence: Uniform Definitions, the Centers for Disease Control and Prevention (CDC) (2020a) states that intimate partner violence includes the following behaviors:

Physical 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.

Sexual Violence

Forcing or attempting to force a partner to participate in a sex act, sexual touching, or a non-physical sexual event (e.g., sexting) when the partner does not or cannot consent.

It is often broken into three categories:

  1. Sexual activity that is compelled or forced.
  2. Sexual activity with someone who cannot or is incapable of giving consent or understanding the sexual situation.
  3. Sexual activity that is abusive, degrading, or humiliating.

Sexual violence and physical violence commonly occur together.

Stalking

A pattern of repeated, unwanted attention and contact by a partner that causes fear or concern for one's safety or the safety of someone close to the victim.

Psychological Aggression

The use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally, generally exerting control over another person. Typical behaviors include controlling/dominating behavior, deprivation of economic, healthcare, and physical resources, destruction of personal property, embarrassment, excessive possessiveness, harassment, humiliation, and isolation from family and friends.

Intimate partner violence is an escalating process. It often begins with threats, name-calling, and damage to objects or pets. It may start to escalate into restraining, pushing, slapping, pinching, or biting, and then it may evolve into life-threatening behaviors like punching, kicking, choking, breaking bones, and using weapons (CDC, 2020a).

Cycle of Violence

Abuse tends to occur in cycles. It does not just go away and tends to get worse over time. Domestic violence and intimate partner violence typically, but not always, follow a pattern. The more severe the type of domestic violence, the more chronic it is, the more likely it is to worsen over time.

This pattern generally includes periods of tension building, an episode of violence, and a quiet period (Cline et al., 2020).

The Cycle of Violence is as follows (Cline et al., 2020):

Tension Building

  1. Tension mounts in the relationship.
  2. The batterer is irritable, frustrated, and unable to cope with everyday stresses.
  3. The victim attempts to appease the batterer by becoming compliant, nurturing, or staying out of the way.
  4. The victim often assumes responsibility for controlling the abuser's anger.
  5. The victim denies the inevitability of the beating and the terror.
  6. The batterer fears that the victim will leave and their fears are reinforced by the victim's coping strategy of withdrawing and avoiding.

The Battering Incident

  1. The batterer intends to teach a lesson, not to inflict injury. In the process, they lose control of their rage.
  2. Only the batterer can end this phase.
  3. The victim needs a safe place during this phase.
  4. Once over, the victim will deny the incident, injuries, and terror.

The Calm Respite of "the Honeymoon"

  1. The batterer is kind and charming, afraid that the victim will leave.
  2. The victim believes the suffering is over.
  3. Then the cycle continues and returns to stage one.

cycle of violence graphic

Perpetrator

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.

Historically, domestic violence has not been treated as a "real" crime in many cultures and societies. This lack of regard for violence is evident in the lack of severe consequences, like incarceration or financial penalties (WHO, 2021). Some cultures support the man's right and cause to punish their spouse by beating (WHO, 2021).

Abusers often display immaturity and are dependent and non-assertive (Sadock et al., 2021). They tend to suffer from strong feelings of inadequacy and they use their bullying behavior to humiliate their partner to support their low self-esteem. They sometimes displace aggression provoked by others onto their partner.

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).

Risk Factors

Risk factors for violence against their spouse or significant other include (WHO, 2021):

  • Family history of violence
  • Alcohol and drug use
  • Emotional dependency, insecurity, and low self-esteem
  • Lack of impulse control
  • Antisocial, aggressive, and borderline personality disorders
  • Poverty
  • Marital discord or conflict

Triggers

Research from both developed and undeveloped countries has consistently identified the following triggers for domestic violence (DeCapua, 2017):

  • Not obeying
  • Arguing back
  • Not having food ready on time
  • Not caring adequately for the children or home
  • Questioning about money or girlfriends
  • Going somewhere without permission
  • Refusing sex
  • The man suspects the woman of infidelity

Warning Signs

Batterers come from all social classes, races, cultures, religions, backgrounds, and countries (WHO, 2021). The following behaviors may be warning signs (DeCapua, 2017):

  • Extreme jealousy
  • Blames others for their faults and circumstances for their problems
  • Unpredictable behavior
  • Verbally abusive
  • Unable to control their anger
  • Always asking for a second chance, saying they'll change and won't do it again
  • Their family resolves problems with violence
  • It plays on your guilt
  • Their way is the only way
  • Behavior often worsens when using alcohol or drugs
  • Cruelty to animals

Assessment Tool

Assessment tools have been developed that can help identify someone who has the potential for domestic violence/intimate partner violence. The Spousal Abuse Risk Assessment (SARA) is a validated tool that looks for the presence of 20 behaviors such as a history of assault or sexual violence, personality disorder, history of the use of weapons, and emotional denial or minimization of violence (DeCapua, 2017).

Victims

Victims of domestic violence/intimate partner violence are children, men, and women. Why do victims stay? All too often, that question is answered with a victim-blaming attitude. Victims of abuse often hear that they must like or need abusive treatment or otherwise they would leave. Sometimes, victims are told that they "love too much" or have low self-esteem. The truth is that no one likes being beaten, regardless of their emotional state or self-image. The reasons that a victim stays are many and complex (DeCapua, 2017):

Lack of Resources

  • Responsibility for dependent children.
  • Not employed outside of the home.
  • The victim does not solely own any property.
  • Lack of access to cash or bank accounts.
  • Fear of being charged with desertion; therefore, losing children or joint assets.
  • Fear of a decline in living standards for herself and her children.

Institutional Responses

  • Clergy and secular counselors are often trained to see only the goal of saving the marriage at all costs.
  • Police officers treat domestic violence as a dispute instead of a crime.
  • Police may try to dissuade women from filing charges.
  • Prosecutors are reluctant to prosecute cases and judges are lenient with the sentencing.
  • There is little to prevent a released abuser from returning and repeating the assault, even with a restraining order.
  • There are not enough shelters to keep victims safe.

Traditional Ideology

  • The belief is that divorce is not a viable alternative.
  • The belief is that a single-parent family is unacceptable and that even a violent father is better than no father at all.
  • Many women are socialized to believe that they are responsible for making their marriage work.
  • The isolation of a victim contributes to a sense that there is nowhere to turn.
  • Rationalization of their abuser's behavior by blaming stress, alcohol, problems at work, unemployment, or other factors.
  • Many women feel that their identity and worth are contingent upon getting and keeping a man.
  • During the non-violent phases, the abuser may fulfill the woman's dream of romantic love. She believes that he is good overall.

Children

Evidence suggests that domestic violence increases the risk of child morbidity and mortality (WHO, 2021) and it is strongly associated with a high incidence of child neglect and maltreatment. Millions of children witness intimate partner violence at home. The effect of this exposure has been compared to direct physical abuse of the child. These children suffer from a wide range of emotional, physical, and psychological problems, including (DeCapua, 2017):

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Anxiety
  • Behavioral problems, e.g., aggression
  • Depression
  • Eating disorders
  • Poor academic performance
  • Low self-esteem
  • Need for psychotropic medications
  • Nightmares
  • Physical health complaints
  • Self-harming behaviors

Mandates Against Domestic Violence

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. The criteria must focus on observable evidence and not just on allegations. It must address physical assault, rape, other sexual molestation; domestic abuse; and abuse or neglect of elders and children (DeCapua, 2017).

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.

WHO (2021) recommends the following actions:

  • Governments and other donors should be encouraged to invest much more in research on violence by intimate partners over the next decade.
  • Programs should place greater emphasis on enabling families, circles of friends, and community groups, including religious communities, to deal with the problem of partner violence.
  • Programs on partner violence should be integrated with other programs, such as those tackling youth violence, teenage pregnancies, substance abuse, and other forms of family violence.
  • Programs should focus more on the primary prevention of intimate partner violence.

Role of Healthcare Professionals

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.

Barriers to Thorough Screening

Missed cases may also be due to healthcare professionals simply not screening and many nurses are not prepared to provide care to a woman who is a victim of violence from her partner. There are many reasons nurses, physicians, and other healthcare professionals may not screen for intimate partner violence (CDC, 2020b; DeCapua, 2017):

  • Lack of time
  • Lack of training
  • Lack of resources
  • Language barriers
  • Cultural barriers
  • Emotional discomfort
  • Behavior of the victim, e.g., uncooperative, unwilling to accept help

Mental Health

Mental health providers see victims of domestic violence for suicide attempts, anxiety, and depression. Practitioners who specialize in chronic pain, such as headaches or stomach disorders, also treat abuse victims. Pediatricians who see abused children may also see abused women because child abuse and spousal abuse frequently co-exist (CDC, 2020b; DeCapua, 2017).

Pregnancy

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. Specifically, victims of violence are more likely to deliver a pre-term or low-birth-weight infant. It can also affect breastfeeding. These victimized women are more prone to miscarriage, depression, alcohol, and drug abuse, and forgoing prenatal care (DeCapua, 2017).

What We Can Do

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. Victims of domestic violence/intimate partner violence may not discuss the violence unless they are asked directly (DeCapua, 2017). However, many victims of domestic violence/intimate partner violence will talk about the abuse if they are asked in a direct, caring, and non-judgmental manner (DeCapua, 2017).

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).

Screening questions should always be asked in a private room, away from the batterer, and preceded by assurances of strict confidentiality. The spouse or partner should be separated from the patient if they demand to accompany the patient into the examining room (Cline et al., 2020).

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 requirements for reporting incidents of domestic violence/intimate partner violence - what must be reported, how it must be reported and to whom, and who is responsible for the reporting – vary from state to state. It is essential that you become familiar with the rules within your state.

Screening

The U.S. Preventive Services Task Force recommends that healthcare providers, including nurses and advanced practice nurses, screen all women of childbearing age for intimate partner violence, including physical, sexual, psychological, and economic abuse. Importantly, this recommendation applies to all women, not just high-risk groups or women presenting with signs and symptoms of abuse (KBN, 2021).

Implementing this recommendation has been challenging because healthcare workers often forget to screen women without signs of abuse. In addition, healthcare workers often underestimate the prevalence of abuse and lack the appropriate education on the topic. The U.S. Department of Health and Human Services required that screening and treatment for domestic violence be covered by insurance at no cost to address these barriers (KBN, 2021). Furthermore, states like Kentucky have thus enacted legislation that requires specific domestic violence education to be licensed as a healthcare provider (KBN, 2021).

All individuals with evidence of trauma need to be questioned directly about the potential for domestic abuse using a structured non-judgmental, confidential interview conducted in privacy and safety.

Victims of domestic violence often present in healthcare settings with physical injuries such as bruises, cuts, black eyes, concussions, and broken bones. They may also present with damaged joints, partial hearing or vision loss, or scars from knife wounds, bites, or burns. The typical injury pattern includes minor lacerations or bruises to the abdomen, breast, neck, and face. Accidental injuries occur on the periphery of the body, compared with abusive injuries, which occur more centrally (Taft, 2016).

Due to the complex relationship dynamics between the abuser and victim, healthcare workers can feel uncertain about screening. It is important to use a proper screening tool to help the clinician navigate the complex relationship and maintain awareness of the signs and symptoms of abuse. Screening should occur in any healthcare settings where a victim may come in contact with a healthcare profession, including but not limited to pediatric care, obstetric and gynecologic care, psychiatric care, emergency services, or primary care.

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. Victims of domestic violence/intimate partner violence may not discuss the violence unless asked directly (Decapua, 2017). However, many victims of domestic violence/intimate partner violence will talk about the abuse if they are asked in a direct, caring, and non-judgmental manner (Decapua, 2017).

Assessment

Screening questions should always be asked in a private room, away from the batterer, and preceded by assurances of strict confidentiality. The spouse or partner should be separated from the patient if they demand to accompany the patient into the examining room (Cline et al., 2020).

The healthcare worker should gather a detailed history during the initial screening, including the patient's needs, resources, and priorities.

Determining whether the injuries are related to domestic violence is less important than gathering a history. Sometimes, the victim will present with injuries that must be treated immediately; however, after the patient is stabilized, the healthcare worker must perform a detailed assessment.

Overall, healthcare providers should be vigilant at recognizing the signs and symptoms of abuse. The Kentucky State Board of Nursing (KBN) identifies common signs of different forms of abuse (KBN, 2021; Kentucky Revised Statute Protection of Adults, Chapter 209, 2021):

  • Physical abuse: The trauma or injuries are inconsistent with event history, or the patient arrives for medical care long after the initial event.
  • Emotional or sexual abuse: Adults frequently present with complaints associated with long-term stress and chronic anxiety. Children or adolescents may present with behavior problems, and the elderly appear withdrawn or fearful of authority.
  • Patterned injuries: Central injuries to the face, head, neck, breast, abdomen, and genitals are prevalent in contrast to accidental injuries affecting the periphery or extremities. A pattern of multiple, non-life-threatening injuries at varying stages of healing are highly suspicious. Children and the elderly often present with spiral fractures.
  • Pregnancy: Incidence of domestic violence increases in pregnant women.

While the patient may be avoidant when asking about the causes of their injuries, it is important to build rapport and reduce the victim's anxiety. Explain the entire evaluation process before beginning and allow the patient to dictate the pace of the interview. To gather accurate information, give the patient some control over the interview and pay close attention to their nonverbal responses, indicating discomfort. The history and treatment plan should be thoroughly documented in the patient medical record. This documentation helps establish the credibility of the victim's report if/when they seek legal aid.

Finally, a community-based multidisciplinary team should help develop Domestic Violence Protocols that provide appropriate evaluation and intervention during the care of a patient suffering from actual or suspected domestic violence. These protocols should include interviewing strategies, physical assessment guidelines, safety assessment, treatment plan, and referral resources (KBN, 2021).

Table 1: Assessment of Potential Domestic Violence Victims (KBN, 2021)
Initial Assessment
  • Recognize potential victims: question directly about domestic battering.
  • Implement the agency's Domestic Violence Protocol whenever suspicious.
  • Triage for immediate need for treatment.
  • If injuries do not require immediate trauma or surgical care, take a patient's history alone in a private room.
  • If injuries require immediate trauma or surgical care, call security, local police, or both if the partner seems disruptive or dangerous.
  • Contact victim's advocacy representative and offer services to the client as available.
Examination
  • Have the patient undress and put on an examination gown so that all body areas can be seen during the examination.
  • Check the pattern of injuries.
  • Document physical assessment findings in detail; any evidence of injury from the potential battery should be described quantitatively.
  • Record visual evidence of abuse via Polaroid or videotape. If photography is used, including a full-body view (anterior/posterior) and separate photographs for each injury site using a 90° angle. Include an object for scale or size (ruler, coin, etc.).
  • Written consent of the victim may be needed for photography.
  • Conduct mental status examination.
  • Use open-ended, non-judgmental questions; never imply blame or ask why.
  • Recognize potential evidence; collect, preserve and maintain chain of custody.
Safety Assessment
  • Where is the abuser now?
  • Does the abuser know' where the patient is now?
  • Has the abuser threatened to use weapons?
  • Are weapons available to the abuser?
  • Is the abuser intoxicated?
  • Does the abuser have a criminal record?
  • Are there children? Are they safe now?
  • Are they being abused?
  • Is the abuser verbally threatening you?
  • Is the abuser frightening relatives and friends?
Treatment Plan
  • Explain the therapeutic protocol, including evidence collection.
  • Provide a supportive environment and encourage patient's efforts to seek help and get support.
  • Provide appropriate diagnostic and therapeutic interventions in collaboration with other care providers as needed.
  • Provide both verbal and written information about domestic violence and legal options.
  • Provide a listing of community resources.
  • Make appropriate referrals.
  • Initiate mandatory reporting procedures as required.
Kentucky State Board of Nursing

Reporting Requirements

Healthcare providers, including nurses and advanced practice nurses, are legally obligated to report domestic violence to the appropriate authorities. Specifically, the state of Kentucky requires healthcare workers to report cases of actual or suspected spousal abuse or neglect to the Cabinet for Health and Family Services (Kentucky Revised Statute, Chapter 209 and 209a). These laws only apply in situations where the spouse commits the abuse; however, if the healthcare worker is unable to determine who is committing the abuse and the victim is suffering mentally, physically, and unable to carry out their activities of daily living, then reporting the abuse is also mandatory (KBN, 2021).

Of note, reporting is mandatory even without the victim's consent and is a legislative exception to the patient-provider confidentiality rule. If a nurse or advanced practice nurse knowingly and willingly fails to report spousal abuse in the state of Kentucky, she or she can be subject to criminal penalties. In addition, healthcare workers who report suspected abuse in good faith are protected from both criminal and civil liability (Kentucky Revised Statute, Chapter 209 and 209a; KBN, 2021).

Safety Planning

Without proper identification and intervention, the natural course for domestic violence is escalating in nature. It is essential that the healthcare worker who recognizes or suspects a potential domestic violence victim be concerned with the victim's safety and other family members. Presentation for medical health or planned separation from a partner is the greatest potential risk for the victim (KBN, 2021; Kentucky Revised Statute Emergency Protective Order, Public Law 403.740, 2021).

Factors associated with potential lethality include (KBN, 2021):

  1. Children in the home
  2. Threats to kills the partner or children
  3. Availability of a weapon
  4. Alcohol and drug dependency
  5. Escalation of the violence

Homicide is a risk for any victim of domestic violence; therefore, safety planning is of utmost importance. The victim should be given information about safe shelters and legal options. If the abuser is in the vicinity of the treating facility, institutional safety policies must be followed (KBN, 2021).

Additionally, safety plans should include (KBN, 2021):

  • Documenting a plan created in collaboration with the victim about what to do if the violence in the home escalates again.
  • Encouraging the victim to be aware of whether there are weapons in residence.
  • Advising victims to create a code word that signals to children that they should implement an escape plan.
  • Advising victims to create copies of important documents and keep them on hand if needed.
  • Encouraging victims to keep a bag packed and hidden with necessities in case they need to leave immediately.

Legal Protections

If a victim of domestic violence requests or requires legal assistance, local shelters often provide free referrals and support. Kentucky residents have various options, including an emergency protective order (KBN, 2021).

Kentucky Revised Statute 403.740 provides that a judge can create an emergency protective order for domestic violence victims. This emergency protective order is effective for up to 14 days, and a copy of the order is served to the abuser. If the abuser violates any condition of the order, criminal penalties will be levied. Specifically, the emergency protective order:

  • Restrains the batterer from any contact or communication with the abused party, except as directed by the court.
  • Restrains the batterer from committing further acts of domestic violence and abuse.
  • Restrains the batterer from disposing of or damaging any of the property of the parties.
  • Directs the batterer to vacate the residence shared by the abused party.
  • Grants temporary custody of minor children under certain circumstances.
  • Restrains the batterer from coming within a certain distance of specifically described locations or persons.

When the court reviews petitions for protective orders, the abuser is given notice and allowed to attend and present witnesses. If the court determines that a protective order is necessary, a domestic violence order will be created and the abuser will be barred from future contact with the victim. A domestic violence court order is effective for up to three years, at which time a new order can be issued. Abusers who violate a domestic violence order are criminal penalties and incarcerations (KBN, 2021).

If a victim presents to a healthcare setting and their abuser has violated a protective order, the police must be contacted immediately. The victim will be asked to present the police with a copy of the protective order. The police will write a report of the order violation. Then the victim will need to contact the prosecutor's office to request an arrest warrant be issued due to this specific violation (KBN, 2021).

Healthcare workers should warn the victim that abusers are often arrested for a misdemeanor and either given a citation or released from custody within a few hours. Nurses and advanced practice nurses must advise their patients to gather their belongings and find a safe place to stay, such as a shelter or family member's house. An important role of the healthcare worker is to inform victims about the criminal justice system and their role in it (KBN, 2021).

If the prosecuting attorney pursues a criminal complaint, an arraignment occurs. During this time, the court must inform the abuser of the charges and get legal representation. Often, victims must testify at the hearing or trial and even if they don't want to, the court can issue a subpoena and order the victim to give testimony. If the abuser is convicted, the judge sentences them to a combination of a fine, incarceration, victim restitution, mandatory counseling, meditation, substance abuse treatment, or public service (KBN, 2021).

Case Study 1: Chelsea

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.

Case Study 2: Nitya

Nitya, a 28-year-old immigrant from India living in the Midwest, left her husband and moved into her friend's house after three instances of physical abuse. Nitya has obtained a restraining order, but her husband is attempting to retaliate by filing for a modification of custody for their children, citing frivolous allegations and inappropriate parenting. Her lawyer represents her and she has recently begun seeing a therapist for cognitive-behavioral therapy (CBT). This counseling has helped her emotionally process her situation and previous trauma.

Case Study 3: Stephanie

Stephanie, a 21-year-old college student, broke up with her violent boyfriend about a month ago; however, he continues to stalk her. He continues to show up on campus and will appear outside her classes, the cafeteria, and the library. He calls and send her text messages daily, saying threatening and hurtful things. Stephanie is scared and has been considering dropping out of school. She decides to seek help through a legal aid, who documents his stalking behavior and facilitates a meeting with the college dean. Her attorney represents her in a court hearing and she can obtain a protective order to continue her education.

Resources

Once the healthcare worker has identified the victim and their abuser, they should immediately implement a treatment plan to refer to a local domestic violence shelter. More acute or life-threatening scenarios should be referred immediately to local law enforcement officials.

In the state of Kentucky, many domestic violence shelters provide counseling, casework, children's services, 24-hour crisis lines, legal advocacy, and additional referral services. A list of statewide services is provided below. Additionally, Kentucky residents have access to national reporting hotlines, also listed below.

Statewide Services (KBN, 2021)

Adult Protection Branch

  • 275 East Main Street, Frankfort, KY 40621
  • Phone: 502-564-7043
  • Website

Attorney General's Office of Victim Advocacy

  • Capitol Suite 118, 700 Capitol Avenue, Frankfort, KY 40601
  • Phone: 800-372-2551
  • Website

Department for Behavioral Health, Developmental and Intellectual Disabilities

  • 100 Fair Oaks Lane, 4E-B, Frankfort, KY 40621
  • Phone: 502-564-4527
  • Website

Kentucky Coalition Against Domestic Violence

  • 111 Darby Shire Circle, Frankfort, KY 40601
  • Phone: 502-209-5382
  • Website

Local Crisis Centers

Barren River Area Safe Space (BRASS), Inc.

  • P.O. Box 1941, Bowling Green, KY 42102
  • Phone: 270-781-9334
  • Crisis Only: 800-928-1183 or 270-843-1183
  • Areas Served: Allen, Barren, Butler, Edmonson, Hart, Logan, Metcalfe, Monroe, Simpson, Warren
  • Website

Bethany House Abuse Shelter, Inc.

  • P.O. Box 864, Somerset, KY 42502
  • Phone: 606-679-1553
  • Crisis Only: 800-755-2017
  • Areas Served: Adair, Casey, Clinton, Cumberland, Green, McCreary, Pulaski, Russell, Taylor, Wayne
  • Website

Green House 17

  • P.O. Box 55190, Lexington, KY 40555
  • Phone: 859-233-0657
  • Crisis Only: 800-544-2022
  • Areas Served: Anderson, Bourbon, Boyle, Clark, Estill, Fayette, Franklin, Garrard, Harrison, Jessamine, Lincoln, Madison, Mercer, Nicholas, Powell, Scott, Woodford
  • Website

The Center for Women and Families

  • P.O. Box 2048, Louisville, KY 40201
  • Phone: 502-581-7200
  • Crisis Only: 877-803-7577
  • Areas Served: Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, Trimble
  • Website

DOVES of Gateway

  • P.O. Box 1012, Morehead, KY 40351
  • Phone: 606-784-6880
  • Crisis Only: 800-221-4361
  • Areas Served: Bath, Menifee, Montgomery, Morgan, Rowan
  • Website

Family Life Abuse Center

  • P.O. Box 654, Mount Vernon, KY 40456
  • Phone: 606-256-9511
  • Crisis Only: 800-755-5348 or 606-256-2724
  • Areas Served: Bell, Clay, Harlan, Jackson, Knox, Laurel, Rockcastle, Whitley

LKLP Safehouse

  • P.O. Box 1867, Hazard, KY 41702
  • Phone: 606-439-1552
  • Crisis Only: 800-928-3131
  • Areas Served: Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry, Wolfe
  • Website

Merryman House

  • P.O. Box 98, Paducah, KY 42002
  • Phone: 270-443-6282
  • Crisis Only: 800-585-2686 or 270-443-6001
  • Areas Served: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Marshall, McCracken
  • Website

Owensboro Area Shelter and Information Services (OASIS)

  • P.O. Box 315, Owensboro, KY 42302
  • Phone: 270-685-0260
  • Crisis Only: 800-882-2873 or 270-685-0260
  • Areas Served: Daviess, Hancock, Henderson, McLean, Ohio, Union, Webster
  • Website

Safe Harbor/FIVCO

  • P.O. Box 2163, Ashland, KY 41105
  • Phone: 606-329-9304
  • Crisis Only: 800-926-2150
  • Areas Served: Boyd, Carter, Elliott, Greenup, Lawrence
  • Website

Sanctuary, Inc.

  • P.O. Box 1165, Hopkinsville, KY 42240
  • Phone: 270-885-4572
  • Crisis Only: 800-766-0000
  • Areas Served: Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, Trigg
  • Website

Sandy Valley Abuse Center, Inc.

  • P.O. Box 1297, Prestonsburg, KY 41653
  • Phone: 606-285-9079
  • Crisis Only: 800-649-6605
  • 606-886-6025
  • Areas Served: Floyd, Johnson, Magoffin, Martin, Pike

SpringHaven, Inc.

  • P.O. Box 2047, Elizabethtown, KY 42702
  • Phone: 270-765-4057
  • Crisis Only: 800-767-5838 or 270-769-1234
  • Areas Served: Breckinridge, Grayson, Hardin, LaRue, Marion, Meade, Nelson, Washington
  • Website

The ION Center for Violence Prevention

  • 835 Madison Avenue, Covington, KY 41011
  • Phone: 859-372-3570
  • Crisis Only: 800-928-3335 or 859-491-3335
  • Areas Served: Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen, Pendleton
  • Website

Additional Resources

  • Adult & Child Abuse Reporting Hotline
    • 800-752-6200
  • Alcohol & Drug Abuse Information
    • 800-432-9337
  • Kentucky State Police Emergency Hotline
    • 800-222-5555
  • Prevent Child Abuse Kentucky
    • 800-CHILDREN (244-5373)
  • Domestic Violence Hotline
    • 800-799-SAFE (7233)
  • National Center for Missing and Exploited Children
    • 800-843-5678
  • Rape, Abuse, and Incest National Network (RAINN) National Sexual Assault Hotline
    • 800-656-HOPE (4673)
  • Victim Information and Notification Everyday (VINE)
    • 800-511-1670

Conclusion

The Kentucky State Board of Nursing encourages and supports its nurses and advanced practice nurses to remain vigilant to the profound impacts of domestic violence on Kentucky residents. They recommend that nurses remember the acronym AWARENESS (KBN, 2021):

  • Assessment and remaining alert for signs of battery or abuse
  • Witness and document the patient's physical condition
  • Ask directly about domestic and family violence
  • Respect and validate the individual
  • Evaluate the patient's family situation and risk potential
  • Network and refer to community services
  • Empower and educate victims and their care providers
  • Safety of the client is of paramount importance
  • Statutory (legal) mandate to report

Healthcare professionals, including nurses and advanced practice nurses, are uniquely positioned to address domestic and family violence; however, this epidemic public health problem is frequently unrecognized and not treated adequately in healthcare settings. While the battery is considered the leading cause of injury for women, only 4 to 5 percent of domestic violence cases are correctly identified and addressed. Research supports that abused women expect healthcare providers to initiate discussions about abuse. Because nurses work in a variety of settings, they are at the frontlines of these discussions. Improved awareness and appropriate nursing intervention can help interrupt the cycle of domestic and family violence (KBN, 2021).

Select one of the following methods to complete this course.

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References

  • Centers for Disease Control and Prevention. (CDC). (2020a). Intimate partner violence. Centers for Disease Control and Prevention. Retrieved September 25, 2021. Visit Source.
  • Centers for Disease Control and Prevention. (CDC). (2020b). Preventing intimate partner violence. Centers for Disease Control and Prevention. Retrieved September 25, 2021. Visit Source.
  • Cline, D., Ma, O., Meckler, G., Stapczynski, J., Thomas, S., Tintinalli, J.., &; Yealy, D. (2020). Tintinalli's emergency medicine: A comprehensive study guide (9th ed.). McGraw-Hill Education. Visit Source.
  • DeCapua, M. (2017). Domestic Violence, Sexual Violence, Intimate Partner Violence. Visit Source.
  • Kentucky Board of Nursing. (KBN). (2021). Specific content requirements: Domestic violence. Visit Source.
  • Kentucky Revised Statute Definition, Public Law 403.715 to 403.785. (2021). Visit Source.
  • Kentucky Revised Statute Emergency Protective Order, Public Law 403.740. (2021). Visit Source.
  • Kentucky Revised Statute Protection of Adults, Chapter 209. (2021). Visit Source.
  • Kentucky Revised Statute Spousal Abuse or Neglect, Chapter 209A. (2021). Visit Source.
  • Sadock, B., Boland, R., Verduin, M., & Ruiz, P. (2021). Kaplan & Sadock's Synopsis of Psychiatry (12th ed.). Wolters Kluwer. Visit Source.
  • U.S. Department of Health and Human Services. (2010). Compendium of state statutes and policies on domestic violence and healthcare. Family Violence Prevention Fund. Retrieved September 26, 2021, from . Visit Source.
  • World Health Organization. (WHO). (2021). Violence against women. World Health Organization. Retrieved September 25, 2021, from. Visit Source.