Domestic Abuse Assessment

[opdahlamber]

I was all of 18 when I met my first husband. It was three days after 9/11 and my stepmother had just kicked me out of the house. I had no place to go. I went out with a girlfriend and met this charming, leather-clad man at the bar. I ended up drinking way too much and slept on his couch for three days while he convinced me how truly precious I was and how he just knew I was the one woman who could make him a better man.

He was very honest about how his first wife had had him jailed several times for domestic assault but he would never do something like that to me. She was evil, psychotic; she drove him to extremes of anger. I was a beautiful, sweet young girl and exactly what this 30-year-old man needed to be a true-life prince in shining armor. Of course, I should move in with him; my family was horrible, they did not love me as he could. No one would ever love me as he did. "Don't worry; I will take care of you now."

He was charming and darling for about a year. Until every member of my family had given up on seeing me again, hated me for "abandoning" them, and I had no friends left. Oh, he would yell at me, maybe cuff the back of my head; slap my face occasionally. However, I was young and did not know anything. I was always doing something wrong and he had to teach me. How else was I going to learn?

I married him. Why wouldn't I? I wanted a baby. I was not about to have another child out of wedlock (my first child died at birth when I was 15). I was going to do it right this time. I was going to do right by God so He would let me keep a baby. I wanted dozens of babies, in fact, but was willing to settle for four, maybe six.

He began beating me for no reason. He was mad I knew that John Hancock was the first president of the US, just not voted in as one. He beat me with a cell phone power cord for that. Taught me not to win at Trivial Pursuit. There were days when I could not go to work I was beaten so badly. Leave him, you say? Sure. With what money? He took my paychecks. If I tried hiding some in the tampon box, he would beat me. Where would I go? I had no family left. He had made me move hours away from my family and they all hated me for abandoning them, remember? Stay in a shelter? Sure. Let me go stay in the one safe house in the area; the one he would drive me by every time we went to town and point out to me as being the place "those women go to hide from their husbands when they get tired of being real women." Go to the hospital? I did. Listen up. NOT ONE NURSE OR DOCTOR EVER ASKED ME IF I WAS BEING ABUSED. NOT ONE. Call the police? Oh, please, don't make me laugh at the good ole' boy society you find in rural Iowa.

Eventually, I got pregnant. A little boy. Oh, I cannot explain the absolute joy... I wanted to be a mom more than anything else in the world. At 31 weeks, I was hospitalized for preterm contractions, placed on Mag Sulfate, bed rest for a few days. Got them stopped. I do not know what it is about being pregnant; but he hated me while I had that belly. He beat me almost every day. Guess how may nurses or doctors asked me while I was pregnant if I was being abused; what those marks were from? NOT ONE. At 37 weeks and three days, he hit me so hard my placenta partially abrupted. He was nice enough to take me to the ER right away.

They got the monitor on in time to see the FHR at 52 and dropping. Dropped to nothing. They knocked me out, took my baby by emergency C-section, and got vital signs back. They saved my son.

While I was out, they happened to ask my oh so wonderful husband what were our birth control plans? Did we want a tubal? That was our plans, he said. So they did it. After I woke up and they presented me with my first of at least nine children (I thought) the nurse mentioned how I (at 21, mind you) did not have to worry about hormonal birth control when breast-feeding since the tubal was done, how wonderful for me... Excuse me, what was that? I was brought paperwork from the legal department and signed them promising not to sue. The OB-GYN that had done my C-section and tubal swore to me he would do everything he could to reverse the tubal and make sure I was fertile again. Still no one asked the obvious, "What was going on here?"

I got home with our new baby. That day, my ex-husband hurt me, badly. He ruptured my uterus. The scarring from that... I would never carry another child. I had the most painful menstrual cycles. After a few years, I had a D&C and ablation. No more menses. Even less hope of having my dozen children. I never got that tubal reversed.

No one ever asked, "Do you feel safe at home?" "Has anyone ever punched, kicked, or pushed you?" "Does your partner monitor your time, or constantly accuse you of cheating?" "Are you being isolated from your family or friends?"

Eventually, after another 3 years of abuse, I grew some courage. I went back to school for nursing. I learned I was not stupid. I learned that people, even men, could talk to me and respect me without wanting to sleep with me. I learned that I deserved respect and civility and I was DONE being abused. I kicked that man out of my home. I still have to face him, every other weekend, because that is how the legal system works. He has rights to see his son. I have no rights to feel safe but that is not the focus.

Friends, here is what I want. I want you to ask every single women you see in your career those questions about domestic abuse. I beg you to make a difference. I want you to educate yourselves on the signs of domestic abuse and stand up for the women who have been beaten into submission and cannot stand up for themselves. I cannot explain to you the soul deep belief that I deserved to be treated that way. The nightmares I still have. The crushing guilt I experience for allowing this man to father my baby. My only baby. It was MY FAULT. I own that. However, how much sooner could I have gotten help if even one nurse had made a simple assessment?

Please, contact your local crisis intervention, police stations, etc. Find out the resources you can offer women. You will be shocked at how very little help there is. Statistics show less than 30% of women with traumatic injuries seen in the emergency room are assessed for domestic abuse. Studies are done that conclude it takes at least three times asking a domestic victim, alone with only a nurse asking, to admit to being abused. Domestic abuse victims are 46% more likely than non-abused women to seek medical care for illness, solely in the hope that someone, anyone, will notice them and help them. Please. Ask those few extra questions. Dedicate yourselves to be devoted to service for human welfare. Do you remember that part of the Nightingale Pledge? Hold that in your hearts.

[vamedic4, EMT-P]

I can't imagine the courage it takes to relive those moments in your lives. Thank you, ladies, for sharing your experiences with us. Experiences like yours present a stark reminder that the questions we ask, we ask for a reason. Flashpoint is right, sometimes we get so into the routine that we don't consider that something insidious may be going on.

[BrooklynRN11201]

First of all, I thank the OP and other posters for sharing their experiences and completely agree with most things said in this thread. I get that victims often feel that other methods of help are "pointless" in their particular situation. However, and perhaps I'm just playing devil's advocate here, but if you thought all the other options were pointless and that seeking help on your own would only mean more abuse and you were truly trapped, I'm not sure how any nurse could have convinced you otherwise. I get that the point was that nobody even asked but what would you have done differently had they asked? serious question, and I swear I don't mean any offense by asking this at all, I'm just genuinely curious.

[BrooklynRN11201]

ps - I have my own trauma as well, I was sexually abused by 3 men in my family between the ages of 4 and 10 and showed every "typical" symptom you can imagine. Not ONCE was I asked if things at home were okay by a teacher or a neighbor or even a friend's parents. I totally get it.

[AFhopeful]

I am a brand spankin' new nurse and I just wanted to tell you THANK YOU for giving me a reminder that I need to have confidence to ask family members to please leave the room while I get the patient situated. This provides for a safe environment to assess issues a patient might not want to talk about in front of family members. I was hesitant today but then I thought of your post and said to myself the moment of shyness asking family to step out for a few minutes could negate the pain a patient might have in the future if he/she needs help. Thank you again.

[LadyFree28, BSN, LPN, RN]

First of all I thank the OP and other posters for sharing their experiences and completely agree with most things said in this thread. I get that victims often feel that other methods of help are "pointless" in their particular situation. However, and perhaps I'm just playing devil's advocate here, but if you thought all the other options were pointless and that seeking help on your own would only mean more abuse and you were truly trapped, I'm not sure how any nurse could have convinced you otherwise. I get that the point was that nobody even asked but what would you have done differently had they asked? serious question, and I swear I don't mean any offense by asking this at all, I'm just genuinely curious.[/quote']

I first would like acknowledge your survival.

You bring up a valid point, and the REALITY that many victims face; I find you post not offensive at all.

For me, it was about regaining my sense of empowerment back, knowing that if I took the risk and DIED, that I would be ok with that, because I wanted that back...You are correct, no nurse, no family member, not enough practice on the gun range (I was about to file papers for a gun permit before he shot me-he was a licensed gun owner) would have HELPED me if I wanted MY POWER back. I felt I had to do it myself.

[duskyjewel]

I'm sorry but I think it's an overreach to ask every single woman you see if they are suffering domestic abuse. When there is evidence, fine, but without any, you could be perceived as pretty offensive. I sure as heck would be offended if you assumed my husband is an abuser, and that I must be a victim, which is what you would be doing by asking these questions with no reason to do so.

By the way, men can also be victims of domestic violence. They suffer even more than women sometimes, partly from the sexist assumption that they must be an aggressor and can never be a victim.

This whole post smacks to me of feminist ideology. How about basing your practice on demonstrable clinical facts in front of you, instead of sexist assumptions?

[NicuGal, MSN, RN]

It is part of our admission assessment across the board on all screens. We have found that many women say NO in L/D, clinic or antepartum, but once they get to NICU and see their baby, it becomes a yes. Maternal instinct to protect their offspring. On our med surf floors they find elders will confess to family members abusing them.

It is NOT overkill to ask everyone, it only takes a moment. Our admission assessment is for all inpatients, men, women and children.

[hope3456, ASN, RN]

OK so you do an assessment. They say they are abused. Then what? I tend to agree with the PP who pointed out how few resources there are.

A social worker will come give them some phone numbers to 1) the overfilled DV shelter which they may or may not be able to get into 2) low income housing for which there is a 2 year wait list 3) Local family service office where they might qualify for some food stamps/ medicaid ect - HOPEFULLY she didn't make to much money last month or she is screwed.

[nurseprnRN, BSN, RN]

OK so you do an assessment. They say they are abused. Then what? I tend to agree with the PP who pointed out how few resources there are.

A social worker will come give them some phone numbers to 1) the overfilled DV shelter which they may or may not be able to get into 2) low income housing for which there is a 2 year wait list 3) Local family service office where they might qualify for some food stamps/ medicaid ect - HOPEFULLY she didn't make to much money last month or she is screwed.

@hope 3456 and duskyjewel: I will presume to speak for those with better experience in this matter than you when I say that you and those with your attitude are part of the reason we suffered as long as we did. No one looking at many of us would have seen "clinical evidence," whatever you think that might be or what threshold you think it ought to meet.

As for offending you, a nurse should recognize a basic screening question about any health risk, including this one.

Consider rethinking this callous outlook.

[CodeteamB]

I'm sorry but I think it's an overreach to ask every single woman you see if they are suffering domestic abuse. When there is evidence, fine, but without any, you could be perceived as pretty offensive. I sure as heck would be offended if you assumed my husband is an abuser, and that I must be a victim, which is what you would be doing by asking these questions with no reason to do so.

By the way, men can also be victims of domestic violence. They suffer even more than women sometimes, partly from the sexist assumption that they must be an aggressor and can never be a victim.

This whole post smacks to me of feminist ideology. How about basing your practice on demonstrable clinical facts in front of you, instead of sexist assumptions?

Hoo boy. I will say what I have said many times before. If you like wearing pants, voting and working outside the home whilst married you should probably lay off the feminist as bogeyman theory.

It is policy in my workplace to ask every patient, male or female about domestic violence. I try to get it in there, sometimes I get distracted and forget. The answer is almost universally a little laugh and "no, I'm fine."

The other night I triaged a woman for vague complaints. I was distracted by my phone and did not ask the question. I usually let this go, thinking someone else would ask later, but I guess this thread was on my mind. I called her back into the booth, asked the question and was informed that her symptoms started after her husband assaulted her.

This woman had no injuries, no "evidence" her complaint was made up. The reason she had come to the ER was that she needed help with domestic violence, and she didn't know how to ask.

Thank you OP and all others for sharing your experiences, it really brought the reality home for me.

[hope3456, ASN, RN]

@hope 3456 and duskyjewel: I will presume to speak for those with better experience in this matter than you when I say that you and those with your attitude are part of the reason we suffered as long as we did. No one looking at many of us would have seen "clinical evidence," whatever you think that might be or what threshold you think it ought to meet.

As for offending you, a nurse should recognize a basic screening question about any health risk, including this one.

Consider rethinking this callous outlook.

This issue of DV does concern me and this thread is basically talking about doing inpatient assessments and screening for it. I would be interested to know what the hospital does for the woman after the fact?

The one time I reached out for help all I got was a list of phone numbers. Daycare providers all but laughed at me when I told them my schedule (night shift) and that I had an infant. I live in a rural area where housing is limited and expensive. A PP mentioned " transitional housing" which is great but not available in all areas.

I was able to resolve my issue but It made me wonder how many "survivors" actually get the help they need and how many fall thru the cracks.

I

[Aspirational Beauty, CNA, LPN]

Thank you for sharing your story! This nearly made me cry while my own memories of being an abusive relationship started to resurface. I am so glad you found the courage. It is hard I know when you have a child with that person that treated this way. I am still working on this myself. It is a shame no one even asked what was going on! When I become a nurse I will always make sure I ask. I would have wanted someone to have asked you just as I would have wanted that for myself. You are a very strong woman.