Domestic Abuse/Assault patients in the ED, how do you get through to them?

Faeriewand, ASN, RN · Mar 22, 2008

You don't call the police?

Also, is there a social worker right there on site that comes in and talks to the patient in the ER?

Just asking for a little bit of info that is not personal in nature. I'm not familiar with how most ER's work. I'm still new to mine.

Larry77, RN · Mar 22, 2008

We have a social worker that will help them get into the local Women's Shelter and will help them press charges with the local PD. All of this has to be ok with the victim of course, if the victim refuses to press charges our hands are tied--unless of course we see the abuse. If there are kids in the home we are required to report the situation to CPS as well.

I see these victims similar to drug addicts--they have to WANT change. No matter what you do for them if they don't WANT to leave their abusive s/o they won't. I've had victims get mad at ME for suggesting the police get involved. It's such a sensitive and frustrating matter.

Faeriewand, ASN, RN · Mar 22, 2008

I thought it was required by law to involve law enforcement. Also, the victim doesn't need to cooperate. It's up to law enforcement. The abuser will be prosecuted if the case is strong enough. Or is this just California?

gr8rnpjt, RN · Mar 22, 2008

Having been a victim of domestic violence and abuse for years, I have to tell you that I was the patient who defended my abuser and gave excuses for my injuries. I did not listen to the police when they told me that nothing would change. I listened to the pig who abused me who promised me that things would be a lot worse for me if I told the doctors what had really happened to my back and came to every doctor's appointment and paced in the waiting room until I got out. The knowlege that he was the one with the car keys kept me very compliant and I knew that to make trouble for him would be to "wake the sleeping giant".

Because as bad as things were when times were good, he constantly reminded me of how bad things would be if I were to do something as stupid as tell someone about what was going on. That would be like requesting Armageddon to be unleashed on my head.

And the worst part was if I had to be given pain medication for my injuries, I had to share my pain meds with the monster who caused my pain (Only fair since he DROVE me to the hosptial!!!)

You think that only stupid women become victims of abuse? I am here to say I am not a stupid woman, I got caught up with the wrong man and before I knew it I was trapped in a world I never asked for and saw no way out.

The only way these women will see a good reason to break away is when they see the abuser turn on their children. She will feel that she DESERVES this and take it like a trooper but if she loves those children enough she will break away when the abuse is turned on her children.

The wake up call for me was having my daughter leave my home and tell me that she was not coming back until the abuser was gone. She (at 13) told me that she did not deserve it, and neither did I and neither did her little brother Joey.

I moved him out the next month, but he still insisted on watching our son while I went to work.

I finally had enough when, 2 days before Christmas in 2006, Joey told me that his father had pushed his head into the toilet for getting pee on the seat.

That was my wake up call.

It wasn't easy and I have had ups and downs since I woke the sleeping giant, but I am so glad I did. My life is so much better and my abuser has moved on to his next victim.

Joey still has to have visitation but that may be over very soon. I go before the judge for my divorce hearing next month. He may make a ruling at the same time about visitation, he may not.

Please remember these women are afraid to tell the truth. They don't see that what they are dealing with is not their fault and no one blames them. They think they deserve this life and they may think that the would rather put up with this than be alone. They have no self worth and are being told that they will never get anyone else.

The abusers are masters in getting them to feel that this is the best that they can do, so they stay dependent on their abuser.

You can try to get through and for sure you would be doing them a favor to call social services, the police and child protective services.

But they may still be too afraid to get out.

Faeriewand, ASN, RN · Mar 22, 2008

Thanks for telling your story gr8rnpjt. It gives us some insight into a world we know little about. :flwrhrts:

Jo Dirt · Mar 22, 2008

It stinks but there isn't a thing you can do unless she actually wants the change.

Wants is the key word.

Altra, BSN, RN · Mar 22, 2008

If your hospital has the resources, you can try to make it as "easy" as possible for them to take action: offer the assistance of a social worker while they are in the ER, ask if they want to make a police report while they are in the ER, advise them on the procedure to obtain copies of the medical record, etc. Document injuries thoroughly and include direct quotes: "patient states hit with closed fist 3-4 times to L side of face" etc. Offer to take pictures which become part of the medical record.

You can advise the patient to call 911 when abuse is occurring: I just this week advised a patient that no, she did not have to be actively bleeding or unconscious for the police to make an arrest based on the scene at the house. (that was what her abuser had told her) However, this is highly dependent on the judgement of the individual police officer responding to the call. I also bluntly tell patients that the abuse will continue until they initiate some action.

Be aware of less obvious situations that may indicate signs of abuse. When I have a frequent flyer female patient with vague complaints who seems stressed or fearful, I ask the question, "Is everything going OK at home?" It can open the door to a discussion. It doesn't mean they are being abused, but it's worth exploring.

Ultimately however, as other posters have stated, the abuse victim has to initiate a change in his/her situation. This is the most frustrating part. Over time, you will play a role in some success stories, and some bad outcomes too.

GilaRRT · Mar 22, 2008

It is pretty hard. However, do not look at these people as "normal." Anybody who allows somebody to smack them around time after time has complex phychosocial issues. Many of these people do not think or feel like us, and changing beliefs and behaviors that are so ingrained can be nearly impossibe. Much like attempting to convert a christian to islam or visa versa. Some of these behaviors are as deeply rooted as any religious belief.

santhony44, MSN, RN, NP · Mar 22, 2008

There has been some good advice here.

For your own mental health and sanity, accept that you can only do so much. Sometimes nothing you do or say will make any difference.

It may also help to tell yourself that something you did or said my have planted a seed. You might not see any results right now, but it may come back to that person in time. You'll probably never know!

NursKris82 · Mar 23, 2008

It is pretty hard. However, do not look at these people as "normal." Anybody who allows somebody to smack them around time after time has complex phychosocial issues. Many of these people do not think or feel like us, and changing beliefs and behaviors that are so ingrained can be nearly impossibe. Much like attempting to convert a christian to islam or visa versa. Some of these behaviors are as deeply rooted as any religious belief.

and

"I see these victims similar to drug addicts--they have to WANT change. No matter what you do for them if they don't WANT to leave their abusive s/o they won't. "

I'm sorry, but these generalized statements are ridiculous! I have been in an abusive relationship before and it was awful. I DID want to change, but when you are with an abusive man, alot of times it gets worse when you leave and it's easier to just deal with what you have now. Also, with physical abuse comes emotional.

They usaully don't start out abusive and then when you fall in love with them, they turn on you and are awful to you and you think "why does this person I love not love me, what's wrong with me". So, you may try harder to please them. I knew I was too good for him, but I wanted to prove to him I was (which, of course, would never happen).

Yes, you have to have some issues to be in that kind of relationship and with it brings even more issues, but I was a normal person with an ability to realize it was bad and to want out. I can't even begin to tell you how much WORSE it got when I left him and how long it took for him to leave me alone. That may be what's really weighing on these women's minds.

I am so glad I'm out now and will never allow that to happen to me again, but most of these ladies are not "drug addicts" or "unable to think and feel like us"- they are women just like many of us, but in a terrrible situation that seems hopeless and endless to them.

Let try compassion and not judgement, especially if you don't have any idea of what's really going on!

crb613, BSN, RN · Mar 23, 2008

I would like to ask those of you that have been in these abusive relationships a few questions please...If you had a place to go & financial support would you have left? My daughter is in one of these marriages.....I am furious to say the least....I don't get it.....she was not raised in an abusive home, was never put down, as a matter of fact she was more the princess type.

She has left a couple of times...came to my house in a different state....then goes back & I become the bad guy when all I do is try to help & keep her safe. I really just do not get it....when some one tries to kill you or hurts you.....how in the world can you even think of living with them or trusting them.....and why would you turn on your family & choose the abuser over the people that really love you, & have & would do anything to help you??????

I am so mad & her for staying in this mess & even more for keeping the kids in it......if I did not care for myself (which I don't get) I would definitely put my children first!!!! I am furious.....and since the last time she left & came to my house (Christmas)then went back......I have not heard from her. I am some how trying to run her life and she is mad at me of all people! All I can figure out & I detest to even think it....she evidentially likes the drama or she would leave because she has the means & support to get out. Thanks for letting me vent!