5 Questions to Ask if You Think Your Patient is a Victim of Domestic Violence
As a nurse, you never know when you might come face-to-face with a victim of domestic violence. Read one nurse's story about domestic violence in her life and how to help your patients.
I remember the first time I had visible bruises on my arms, neck, and chest. I tried my best to hide them with long sleeves, even in the summer months. I made excuses. I told people I fell or bumped into a doorframe. I came up with any story that would keep people from asking for details.
You might be thinking, "But, she's a nurse, she knows better." Well, even as a nurse, I had the normal "victim" dialogue in my head. I worried that I provoked him or maybe even deserve the abuse. I feared that he would take my kids or convince our families and friends that I was the problem. I would have these conversations with myself late at night and know deep down that it wasn't true, but many times it was just easier to take the abuse than to create a plan to leave.
Today, almost seven years since I've been in that abusive relationship, I'm healthy and happy. This month is Domestic Violence Awareness Month - a time to talk about this challenging subject and remind others that there are countless victims and survivors around each of us in our personal and professional lives.
What is Domestic Violence
According to The National Domestic Violence Hotline, domestic violence (also called domestic abuse, relationship abuse, or intimate partner violence) is a pattern of behaviors used by a partner to maintain power and control over another partner in an intimate relationship. These behaviors may cause fear, physical harm, or force the victim to comply with things they don't want to do.
It isn't only physical. Domestic violence can be sexual, verbal, emotional, or economic. It might also be any combination of these types of abuse.
Why does it happen?
Getting into the mind of an abuser is difficult. But, research has shown that domestic violence typically starts with a desire to control an intimate partner. The abuser often feels that they have the right to control their partner and that they need to be in power. They may make their partner feel that they are not worthy of other relationships, aren't valuable, or deserving of respect.
It's important to know that abuse is a choice. No matter if it is a learned behavior from other relationships or childhood - abuse is not okay. It's a choice made by the abuser. It's never the victim's fault, even though they may tell themselves that it is.
Who Can be a Victim?
Domestic violence doesn't discriminate. It can happen to anyone regardless of age, gender, sexual orientation, economic status, education, or any other factor. It can be a confusing time for the victim. They might question if they are doing something to deserve the abuse. They may feel responsible for angering the abuser. It's important to know that abuse is never acceptable, regardless of what the abuser may be going through.
Common Warning Signs
Nurses have a legal and professional duty to report possible abuse. Here are a few signs that your patient might be a domestic violence victim:
- Black eyes
- Symmetrical bruises on upper arms, neck, or wrists
- Marks, injuries, or bruises that are covered by clothing
- Bruising in various stages of healing
- Fractured jaws
- Ruptured eardrums
- Rib fractures
- Cuts around the eyes or lips
- Unexplained STDs
- Marks consistent with the size and shape of objects like cigarettes or belts
- Poor hygiene, skin ulcers, malnutrition
- Hiding bruises or other injuries with makeup or clothing
Because many of these signs can be related to other, legitimate injuries, it's crucial that you ensure you obtain more information from the possible victim. Be aware that when you begin asking questions, they might become defensive. Remain calm and non-judgemental as you discuss your concerns with your patient.
Questions to Ask
As you begin building a trusting relationship with your patient, it's essential that you start asking questions that can help you gauge what's going on in their personal life. Below are a few questions that you can use. These questions range from broad to direct.
- How are things at home? - This is a broad question that can help establish what's happening in your patient's personal life.
- When I see injuries like this, I wonder if someone could have hurt you? - This question is a bit deeper and lets them know that you have concerns. Inquiries such as this enable the victim to understand that you see things that are concerning. This might help them know they no longer need to hide.
- You seem anxious. Is everything okay at home? - With this question, you are getting more specific and personal into the patient's home life and personal relationships.
- Are you ever afraid of your partner? - This is a direct question that should only be asked once you've established concerning behavior by a partner.
- Are you concerned about your safety or the safety of your children? - Questions like this one are personal and can elicit fear or anger from your patient if they aren't ready to talk about the abuse.
Speaking to possible victims of intimate partner abuse can be uncomfortable. You might not want to offend them. You may worry that you're wrong. But, not asking could leave your patient in an unsafe situation. You can also provide them the hotline number to call at another time when they are safe and away from the abuser - 1-800-799-7233.
Are you a domestic violence survivor? If so, what advice would you give to nurses who might care for someone they feel is in an abusive relationship? Have you ever helped a patient to get out of a bad relationship? Share your experience with domestic violence in the comments below.
About Melissa Mills, BSN
Melissa is a Quality Assurance Nurse, professor, writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word. You can see more of her work at www.melissamills.net or on her blog at www.lifeafterforty.blog.
Joined: Feb '17; Posts: 218; Likes: 718
Freelance Writer, Nurse Case Manager, Professor; from OH , USOct 10Joined: Jul '09; Posts: 304; Likes: 388Ask when not in the presence of family/partner/friends.Oct 10Joined: Jul '09; Posts: 304; Likes: 388I'll also add that you must weigh your decision to report carefully. If your facility is not going to be involved any further than turning it over to LE and sending the patient home, you might be writing a death certificate the next day. Exiting the situation is extremely dangerous.Oct 11Occupation: Graduate Nurse Specialty: Med-Surg ; Joined: Oct '07; Posts: 9; Likes: 1The one time I tried to report DV, the patient ended up back tracking her story once we had someone from security come speak to her. I've often wondered whatever happened to her.Oct 11Joined: Apr '03; Posts: 13,251; Likes: 37,838Why is "unexplained STIs" a sign of DV? Is there a correlation between adultery and domestic violence?Last edit by klone on Oct 11Oct 11Joined: Apr '03; Posts: 13,251; Likes: 37,838Quote from SunnyPupRNIt's not the nurse's decision to report. Unless the injuries are life threatening, you cannot report unless the victim permits you to do so, unless the victim is a minor or "vulnerable" population.I'll also add that you must weigh your decision to report carefully..Oct 11Joined: Jul '09; Posts: 304; Likes: 388I know. I was actually going to say the same thing. But domestic violence reports are not black and white. If there are children in the home, that changes the duty.Oct 11Joined: Jul '09; Posts: 304; Likes: 388Quote from kloneMaybe, maybe not. "Unexplained" could just mean the pt doesn't want to disclose. But it's too far a leap to suspect DV based on STIs that don't have a known source.Why is "unexplained STIs" a sign of DV? Is there a correlation between adultery and domestic violence?Oct 11Joined: Jun '02; Posts: 14,257; Likes: 59,783Quote from kloneAbusers are often cheaters as well.Why is "unexplained STIs" a sign of DV? Is there a correlation between adultery and domestic violence?Oct 11Joined: Jul '09; Posts: 304; Likes: 388Quote from TheLinesterVery, very common. I've seen prosecutors who refuse to charge a DV suspect because they say 90% of the survivors will just recant.The one time I tried to report DV, the patient ended up back tracking her story once we had someone from security come speak to her. I've often wondered whatever happened to her.Oct 11Joined: Apr '03; Posts: 13,251; Likes: 37,838Quote from Ruby VeeRight, but can the opposite be said as true, also? That's what I'm wondering.Abusers are often cheaters as well.Oct 12Occupation: Freelance Writer, Nurse Case Manager, Professor From: OH, US ; Joined: Feb '17; Posts: 218; Likes: 718Quote from kloneHi, klone! I thought this was an odd sign of DV too. I searched several different sources, and it came up on all lists of s/s. One source gave some reasoning behind it - rape is included in the definition of DV. So, if it is an intimate partner known to the victim - they may get an STD if the perpetrator doesn't use a condom and has an STD. Another source stated that some perpetrators might want to give their victims their STDs without their knowledge. (kind sick - but I guess it happens). I think that Ruby Vee also brought up a good point that many abusers are cheaters - which is yet another reason why it's on the list.
I would say it's not one of the most common signs - but it did make the list on several sources.
Thanks for the comments and thoughts.
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