Contact Envision

Envision is a United Way Member Agency.

UW

 Information for Medical Professionals

In this article we will be referring to the abused woman in the emergency setting but all of today’s information would be applicable for intervention in all types of adult abuse.  Child abuse is not addressed as this involves different interventions and a specialized protocol because of mandatory reporting requirements in Saskatchewan.  However, if partner abuse is occurring and there are children present in the home, it is likely that they are witnessing the abuse and are at increased risk of being injured themselves or being abused. 

Many abused women may never call the police, go to court, or flee to a shelter; however, a great number of abused women visit doctors and hospitals for treatment of their injuries and stress-related illnesses. Injuries suffered by abused women range from bruises, cuts and black eyes to fractures and miscarriages caused by violence.  Permanent injuries occur as well, such as damage to joints, partial loss of hearing or vision, scars from burns, organ damage and knife or gunshot wounds.

A hospital’s emergency department is a unique and valuable resource for the abused woman. It is open 24 hours, provides a confidential and safe place for a woman to seek assistance and support both medically and emotionally.

Violence against women is associated with a wide range of health problems.  Emergency staff must be responsible for ensuring that a woman and her children are given quality and compassionate care and are ideally universally screened.  However, staff are not responsible for ensuring that a woman who is abused is not beaten again; only that options of safety, referral, protection and shelter are given.  The most difficult task of the staff will be to respect a woman’s decision to continue or return to live with the individual who has harmed her.

STATISTICS

*Men are abused; however they rarely sustain serious physical injury.

HEALTH RISKS IN GENERAL
Injury frequency is one of the key indicators of domestic violence, as mentioned in the statistics.  A woman who comes to the emergency room three times with injuries has an 80% chance of being an abused woman, whether or not the injuries require sutures.  High frequency of injuries and the presence of multiple injury sites increase the likelihood that a woman is being abused.

Stress of an abusive relationship increases women’s risk of depression, suicide, and substance abuse.  Abused women have an attempted suicide rate approximately five to eight times greater than that of non abused women.

Abused women often experience symptoms of post-traumatic stress disorder not unlike those experienced by soldiers, hostages, and prisoners of war.  Headaches, abdominal pains, and atypical chest pains are not uncommon.  Physical problems associated with depression, such as headaches, gastrointestinal problems, fatigue, restlessness, loss of appetite, and sleep problems are also common.

Sexual S.T.D.’s are frequent.  Many abused women have been infected by abusers who force them into unprotected sex.  Some abusers even deliberately infect their partners to prevent them from having sex with other men.

The abuser’s need for power and control frequently extends to the emergency setting.  The abuser may limit the woman’s access to routine or emergency medical care, remain with her constantly during her stay, or insist that she be released prematurely.  He may also prevent her from taking her medication, hide or destroy her birth control, or prevent her from keeping follow-up appointments, for blood or diagnostic tests or specialists referrals.

ASSESSMENT AND IDENTIFICATION
Identification of the abused woman is very difficult without asking.  Abused women who complain of frequent headaches, stomach disorders, painful intercourse, and muscle pains, but whose X-rays and lab tests are normal, are labeled “neurotic, hysteric, hypochondriac”, or “a well-known patient with multiple vague complaints”.  One non-abused woman in fifty leaves with such a label compared to one in four abused women. Abused women are more likely to leave the emergency room with prescriptions for pain medication or tranquilizers. Only one in ten non-abused accident victims receive such prescriptions, compared to one in four abused women. 

It is vital that the first responders to women in the medical setting have thorough knowledge of the indicators of domestic violence. If they do not have this knowledge, there is a good chance that the violence will go unnoticed and will continue.

PHYSICAL ASSESSMENT
Perform a thorough physical examination without the presence of the partner, friend, children or family member.  Visually examine under the patient’s hospital gown for injuries to the ribs, breast, groin and other body parts covered by clothing.  Note injuries that do not seem consistent with the explanation provided. Note multiple injuries in various stages of healing and document all injuries.

Physical Signs and Symptoms

Emotional Signs and Symptoms

INTERVIEW SUGGESTIONS
In order to survive in abusive relationships, women often deny, minimize, or forget incidents of control and violence, so when interviewing a woman use direct, specific questions about the abuse.  Questions should be direct, nonjudgmental and said in a confidential and safe surrounding.
*Initially ask for descriptions of the relationship - a woman’s answers will be vague, so you will need to become more specific as trust is gained.  At this point, do not use terms such as abused or abusive, as a woman may be very reluctant to answer this. If the abuse is not physical, she may not define herself as being abused.  Words such as controlling, jealous, threatening, and hurtful are usually more appropriate and less threatening.  Move slowly into specific questions of abuse, such as:

Always interview the patient on her own--away from anyone who may have accompanied her, including siblings, children, friends or partner.  If the patient is known to the nurse it is suggested that another nurse assesses her. Avoid an intimidating stance when asking about the abuse, sit at or below the patient’s level when asking about the violence she may have experienced. Ask about the abuse in a direct empathetic, non-judgmental way that shows respect. Focus your attention directly on the person to increase trust and build rapport.  Avoid doing paperwork during the interview. Let her know that you believe her and that violence against women is a crime. Do not make promises but offer support to the best of your ability and knowledge.

IF ABUSE IS DISCLOSED

IF ABUSE IS SUSPECTED BUT DENIED BY THE PATIENT:

For abused women, the hospital can serve as a vital link to other crisis services.  A woman needs to understand and be informed of the many options available to her.  For example, today an abused woman has the option of obtaining an Emergency Intervention Order which allows her and her children to remain in the home, and the abuser to live elsewhere. It is crucial that the nurse and physician support the patient in whatever decision she makes.  Expressing disappointment with the decision only reinforces feelings of low self-esteem and lack of control and may also make her less likely to return for help.  Even if a woman does not immediately leave her abusive partner, the fact that the nurse cared about her suffering validates her feelings and reinforces her capacity to seek help when she decides to do so.

 

Envision Counselling

Envision