Domestic Abuse Assessment

I was so young when I got married the first time. At 19, I had no idea what I was getting into. Marrying a man 12 year my senior with a history of domestic assault; why would I ever think it wouldn't happen to me? Let me tell you how wrong I was and what I am going to do to help women like me. And how desperately I need your help now. Nurses Announcements Archive Article

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.

Specializes in Pediatrics, Emergency, Trauma.

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.

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The most a clinician can do is ASK, and refer for resources. The process makes it where the survivor has to go through the process. Clinicians can not "guide" through the process, especially when the survivor may go back, especially the ones who do "slip through the cracks"...especially if financial abuse is involved.

It is dangerous and hard to leave a relationship, the survival may mean leaving and going to another state to get help; I got to know one of my cohorts during my pre nursing days that needed to do that...she gave up EVERYTHING to get out. She returned to school and planned to go to law school, which she was able to transfer into. She lived in a car, was homeless, has to hustle brought the system...these programs are generally low in funding in cities or barely existent in rural areas. That is not the hospitals "fault"...as clinicians we can provide the resources and provide emotional support. This last sentence might seem trite, even cliche, but it's the REALITY.

People who are victims and survivors of DV are ultimately adults, and have to do the work; and I am not being trite or flip; again, DV survivor... I had to do the work. I almost lost my property to foreclosure, was on welfare, and ultimately went on SSDI as a result of my "escape". There were times I did not have enough resources, but I made a way, and still have my home till this day by some form of grace from the universe and with funding; I went back to school and got my BSN, and finally was able to my first RN position. It took five years, but I would've kept doing the work as long as it took.

Unfortunately, "social services" do not have a lobby in government; they rely on US-the public to make donations to even keep counselors so they have a safe space to at least have someone LISTEN to them and regain their voice. Many areas do not have the resources that people need; even law enforcement rely on the survivor to press charges, some law enforcement do not ENFORCE the law.

The most this thread did start is to ensure whoever reads this post to be mindful to screen, as well as anyone who needs help to find out where resources are in their area to help with making a safety plan; while successfully surviving, to go seek help as well, especially to heal those invisible wounds.

It also can give one pause to even begin to be involved in this public health crisis and inquire why there are no resources for victims of DV...we have enough public clout to educate and empower. :yes:

Although I have never experienced abuse, I truly do empathize with you. I stand with you and all domestic abuse victims, and I vow, in my future practice, to never neglect to ask these simple questions. You are right. They make a world of a difference, and that could very well be the difference between life and death for potential abuse victims. Right here, on this day August 28, 2013, at 7:37pm, I give you my word to take a stance against this. We must protect each other. I will remember this as I prepare to take the Nightingale pledge in two weeks at my pinning ceremony. Thank you for sharing this story and being so transparent.

Thank you for sharing your story

Specializes in Tele, Med-Surg, MICU.

One of the best things I learned in nursing school is how to pose the question:

"Because domestic violence is so common in our society, we ask everyone... have you been hurt by anyone close to you? Are you afraid at home?"

And this means, they are not alone. We ask everyone.

Getting out of an abusive relationship is a series of steps, it does not happen overnight (usually). It takes a lot of courage and a plan to leave. And the first step can be admitting to a stranger that you are being abused.

I want to let you know that you have made a difference on how I approach my patients. I will ask that question and truly try to find out if my patient is having any domestic issue. Thank you for sharing.

"Because domestic violence is so common in our society, we ask everyone... have you been hurt by anyone close to you? Are you afraid at home?"

Thank you for giving me, us, the words. It seems to simple, but to have you write out the sentence eliminates one more obstacle to creating a safe environment and to ask the question.

I sat on a jury the other day for a case of violating a do-not-contact order of the court. The husband had violated the order. His wife had a number of children by a previous marriage and they had one together. They had been together for about a decade. The woman testified that he was not physically violent but he was a stalker - while they lived together and after they had separated. She had begun with a protection order about 2 months before he was arrested for violating it. She had not filed for divorce at the time of this trial, 9 months after obtaining the first protection order, but she had recently moved to another town to live with another man. It was a criminal case. During her testimony many of us on the jury wondered about her behavior as well as his. There was tremendous co-dependence on both their parts. We found him guilty. After the judge had completed the case, he told us of his experience with these kinds of cases and people.

The judge said that this guy had already been in court previously for violating the protection order and the do-not-contact order. That he was getting close to being locked up for the violations. It seems that it takes many violations to get sent to jail. Again, there was no physical violence in this case, but obviously there was emotional and psychic violation. During the trial and with the judge afterwards, it was argued and explained that the constant phone, text, and email contact (all violations) created a climate where the woman felt a need to reciprocate, even initiate, contact in order to try to keep things "stable."

The judge went on to say that there are a lot of men who violate these protection and do-not-contact orders over and over and end up in court many times. They often admit in court or to the police that, yes, they have violated the orders. This was true in our case, as well. This judge had seen this defendant multiple times already. He kind of said, these guys are crazy because they just won't stop even after being brought to court over and over and admitting that they are violating the orders.

As many people have illustrated, domestic abuse gets really complicated and it takes a lot of time and energy to extract oneself from these relationships or to help someone to get out.

Specializes in Med-Surg, Hospice/Palliative Care.

What a crazy coincidence that I happened to log in to AN today and to see your article. Last night, my sister's live-in BF was arrested for holding her and their 1 year old son at knife-point, in a drunken rage. This is yet another chapter in his book of verbal and physical abuse under the influence of ETOH and various street drugs. My sister has had little contact with any of us, though we have called and texted to remind her that she is loved.

Thank you for sharing your story, your courage, and your healing. I hope my sister can find a similar path of peace for herself and her son.

I will certainly look for opportunities to ask my patients and family members about this important issue, in honor of my sister and the many women (and men) like her and like you, who deserve to live free from abuse. Be blessed!

Specializes in Long term care.

Alot of you have made comments about the next step. Currently, I am fighting my rear end off to be able to answer this. THERE IS VERY LITTLE HELP!!!!! You make the assessment, she (or he) says "yes, I am being abused AND I'm ready to leave. Help me." And right now, you hand them a list of numbers and tell them, "realistically, none of these will help you." My dream is to be able to say, OK, here is the number you can call for someone who will place you in a temporary home with a volunteer OUTSIDE your area that will let you stay there till you find a home. They will help you with daycare. Here is a number of an employer in that area who WILL hire you for maybe not a lot of money but some. Here is a number of a lawyer who will help you pro bono to make sure your kids stay with you. Here is the number for .... fill in the blank with whatever they need. I'm trying to build a network of people to help do this. Meet people. DO what you can to help build this network. Contact lawyers, tell them what you are working for. Ask if they will hep. Contact businesses to help donate money Start a fund at the clinics and hospitals you work at. One thing. DO NOT REFER THESE VICTIMS TO YOUR HUMAN SERVICES DEPARTMENT! They will be prosecuted for allowing their children to be present during these assaults! I had to work for 6 months to appeal a FOUNDED child abuse on MY record off because I "allowed" my ex husband to abuse me in front of my son. These things are realistic and CAN be done. We just have to work for it.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Unfortunately, it is difficult to get help for these victims......for they are adults. They don't make the greatest decisions. I once went to court as a nurse for a woman who was severely beaten by her law enforcement husband on valentines day in front of their 4 year old child......he drug her unconscious to their apartment left her and went down the hall with their child for a few more drinks with his friends. He pulverized her face.

When it got to court, at the bench trial (no jury) she refused to testify...his lawyer badgered me that her facial wounds "Were not that bad" ans that they "both participated" in the argument. I remember the look on that man's face as they gave him back his gun and badge. I was fearful for a while about ramifications.

I always thought...he's going to kill her one day......I never knew what happened nor did I check. I moved.

But if you can help just one. It's worth the question.

Specializes in Geriatrics, Adult Psych.

I remember the day I was asked that question and struggled to say, "Yes, I am safe." I did, after qualifying it with the fact that "he gets angry a lot....once he shoved me, but he wouldn't hurt me". The practitioner paused, looked me in the eye, and said something about making sure I had a safe place to go when things got worse, and he handed me a card of phone numbers to call for help. I hid it in my shoe.

That was the first inkling I had that I was in trouble, and my relationship was unsafe. One part of me tried to get rid of that card ( I threw it in the trash several times then got it out), but another part of me couldn't bear to let it go. Somehow just having that card gave me permission to contemplate safe places. Many months later when I was finally ready to admit I needed a way to get myself out, I turned to that card and found a direction.

Thank you for sharing your story, and reminding us how important those assessments are. Just remember that not every woman is ready to face the truth right away, and that we must respect where they are in the process of escaping. The most important thing we can do is recognize their need and offer them the next step out.

Specializes in Tele, Med-Surg, MICU.

Because of things that happened in my past I donate monthly to a domestic violence organization where I live.

I had the education and family support to get out of a bad situation.

I'm able to support myself.

But not everyone is, and not everyone has family to turn to.

Many of these organization also help rape survivors. There is nothing more infuriating or humiliating than to have to pay for your therapy as a rape survivor.

We have many charitable causes we support - these are mine.

Alot of you have made comments about the next step. Currently, I am fighting my rear end off to be able to answer this. THERE IS VERY LITTLE HELP!!!!! You make the assessment, she (or he) says "yes, I am being abused AND I'm ready to leave. Help me." And right now, you hand them a list of numbers and tell them, "realistically, none of these will help you." My dream is to be able to say, OK, here is the number you can call for someone who will place you in a temporary home with a volunteer OUTSIDE your area that will let you stay there till you find a home. They will help you with daycare. Here is a number of an employer in that area who WILL hire you for maybe not a lot of money but some. Here is a number of a lawyer who will help you pro bono to make sure your kids stay with you. Here is the number for .... fill in the blank with whatever they need. I'm trying to build a network of people to help do this. Meet people. DO what you can to help build this network. Contact lawyers, tell them what you are working for. Ask if they will hep. Contact businesses to help donate money Start a fund at the clinics and hospitals you work at. One thing. DO NOT REFER THESE VICTIMS TO YOUR HUMAN SERVICES DEPARTMENT! They will be prosecuted for allowing their children to be present during these assaults! I had to work for 6 months to appeal a FOUNDED child abuse on MY record off because I "allowed" my ex husband to abuse me in front of my son. These things are realistic and CAN be done. We just have to work for it.

I would love to be in your network of people who help make these changes! Please let me know how to help. I am a fellow survivor and know the true difficulties of actually receiving any help.