Domestic Violence: The Role of the Health Care Professional

Abstract

* Mindy was 17 years old and excited about life. Mindy was shot by her boyfriend and died in the driveway of her home. She had refused to continue dating him because he had been abusive. Though Mindy was stalked by her perpetrator, she felt he was just hurt and would eventually get it.* Jackie, a 32-year-old married woman, was five weeks pregnant and had experienced physical abuse by her husband. When asked about the abuse, Jackie stated that he often pushed her against a wall, yelled in her face, and punched her in the abdomen, several times as hard as he could, until her breath was taken away. Her husband was abusive only when others were not around. Jackie's husband was excited about the pregnancy and felt it would solve all their problems.* Cindy, who is 24 years old, married, and the mother of a five-year-old daughter, came in for her annual exam wearing a cast on her right leg. The fracture had occurred when Cindy fell while being physically abused by her husband, an event that had happened many times in the five years they had been married. This particular beating occurred because the husband's girlfriend had ended their extramarital affair causing him to return home and physically assault Cindy.Domestic violence, a public health menace, is the largest cause of injury to women in the United States. Between two and four million women in this country are battered annually by their partners (Strauss & Gelles, 1990). Domestic violence often begins or escalates during pregnancy (Bohn, 1990).Domestic violence is the result of power, control, and coercive behavior of one individual over another in a relationship. This relationship may include marital, non-marital, dating, and gay/lesbian partnerships. The abuse often involves repetitive battering and injuries, psychological abuse, sexual assault, progressive social isolation, and intimidation (Flitcraft, Hadley, Hendricks-Matthews, McLeer, & Warshaw, 1992). Approximately 90% of the victims of domestic violence are females (Buel, 1995) from all socio-economic, educational, and ethnic backgrounds.Routine screening of women for domestic violence at initial office visits and annual exams has been encouraged (ACOG, 1989). For some health care professionals (HCPs), asking about domestic violence is synonymous with opening Pandora's Box or opening a can of worms (Sugg & Inui, 1992), considering this problem too complicated to address. The American Medical Association (1992) reported that many professionals are falsely influenced by societal misconceptions including: (a) Domestic violence is a rare occurrence; (b) Domestic violence is a private matter; (c) Domestic violence does not occur in normal relationships; and (d) The woman is somehow responsible for her abuse.Lack of knowledge and training in domestic violence may contribute to the inability of providers to recognize and correctly interpret behaviors associated with domestic violence (AMA, 1992). Deficiencies in the education of HCPs listed by Holtz and Safran (1989) included the inability to identify, assess, document, and manage the care of clients experiencing domestic violence. Chambliss, Curtis-Bay, and Jones (1995) found limitations in the education of obstetric/gynecology residents related to domestic violence including: (a) lack of faculty interest; (b) underestimated prevalence; and (c) failure to recognize common presentations. Two unpublished studies confirm that the lack of professional education in both basic and continuing education among nurses and physicians in the state of Michigan continues to exist. In one study of physicians and nurses (n = 109) working with prenatal patients, 72% had not attended a program on domestic violence during the last year (McClure, 1993). In another study of 155 physicians working in ob/gyn, family practice, and internal medicine, 90% (n = 140) had received no education in their basic medical programs and 76% (n = 117) had not attended a program on domestic violence within the last year (McClure & Meierhenry, 1995). …