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The literature is full of references that
victims are reluctant to disclose IPV/DV to healthcare providers
and that healthcare providers are reluctant to ask patients
about IPV/DV. Most commonly cited reasons that patients do
not disclose is:
- Fear of retaliation by the abuser;
- Shame, humiliation and denial about the seriousness of
the abuse; and
- Concern about confidentiality, especially related to
law enforcement involvement.
In cases when injuries and health problems
are apparent and well documented, healthcare providers often
do not ask about IPV/DV or intervene on behalf of their patients
who experience it. One study found that only 6 percent of
physicians ask their patients about possible IPV/DV, yet 88
percent admitted that they knew they had female patients who
had been abused. Another study indicated that 48 percent of
women supported routine screening of all women, with 86 percent
stating it would make it easier to get help (Kass-Bartlesme,
2004).
Healthcare providers have said that they
do not screen for IPV/DV because (Darrow, et al, 2007; Tjaden,
P. & Thoennes, N., 2002; Borowsky, I.W., Ireland, M., 2002;
Elliott, L., Nerney, M., Jones, T., et al., 2002; Gerbert,
et. al., 1999):
- They lack the necessary training and education, time,
tools, and support resources, and
- Fear of offending the patient;
- Frustration with the lack of change in the patient's situation
or frustrations with the patient's unresponsiveness to advice;
- They do not feel they can make a difference;
- Feelings of powerlessness to "fix" the situation; and
- Their sense of loss of control over the patient's decision
making.
An AHRQ-funded survey found that many primary care clinicians,
nurses, physician assistants, and medical assistants lack
confidence in their ability to manage and care for victims
of IPV/DV (Sugg, et. al., 1999):
- Only 22 percent had attended any educational program
on IPV/DV within the previous year;
- Over 25 percent of physicians and nearly 50 percent of
nurses, physician assistants, and medical assistants stated
that they were not at all confident in asking their patients
about physical abuse;
- Less than 20 percent of clinicians asked about IPV/DV
when treating their patients for high-risk conditions such
as injuries, depression or anxiety, chronic pelvic pain,
headache, and irritable bowel syndrome;
- Only 23 percent of physicians, nurses, physician assistants,
and medical assistants believed they had strategies that
could assist victims of IPV/DV.
A recent study of emergency department nurses (Darrow, et
al., 2007) identified the following barriers to screening
patients for IPV/DV:
- Language difference;
- Lack of training in how to deal with abuse; and
- Time issues affected their ability to adequately screen
patients.
For information regarding the specific studies referred to
above, go to http://www.ahrq.gov/research/domviolria/domviolria.htm#more.
An additional factor for nurses in the identification
of IPV/DV, is that so many nurses are victims of intimate
partner violence. Furniss (1999) reported that 38% of obstetric
nurses are or have been the victims of domestic violence.
She reported on a study by Janssen, et al.,(1998) that:
- 38% of the nurses completing the survey said they had
experienced abuse;
- 27.3% said that their partners try to control them;
- 26.9% said they suffer emotional abuse;
- 22.7% are afraid of their partners;
- 14.6% have been battered;
- 8.1% have experienced sexual abuse.
Darrow, et al., (2007) also identified personal or family
history of abuse as a factor why nurses do not screen for
IPV/DV.
Continue on to Best
Practice Guidelines for Domestic Violence/Intimate Partner
Violence
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