Florida Domestic Violence Nursing CEU - Nursing CE Central (2022)

Course

Course Highlights

  • In this course you will learn about domestic violence, and why it is important for medical professionals to be aware of signs.
  • You’ll also learn the basics of treatment and reporting, as required by the Florida Board of Nursing.
  • You’ll leave this course with a broader understanding of Florida domestic violence through case studies.

About

Contact Hours Awarded: 2

Course By:
Maureen Sullivan-Tevault
RN, BSN, CEN, CDE

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The following course content

This fulfills the continuing education requirement of Domestic Violence for the state of Florida.

Florida domestic violence is defined as violent or aggressive behavior occurring within the home and usually involves the abuse of a spouse or partner. In the United States alone, it is estimated that more than 10 million adults have been subjected to domestic violence during the course of a year. This statistic translates to an incident of domestic violence occurring every 3 seconds. Due to the increasing prevalence of domestic violence in society, there is a high probability that all healthcare professionals will evaluate and treat a victim (and quite possibly a perpetrator as well) of domestic violence at some time during their healthcare career. The importance of ongoing education and global awareness cannot be understated.

Introduction

Florida domestic violence is defined as violent or aggressive behavior occurring within the home and usually involves the abuse of a spouse or partner. In the United States alone, it is estimated that more than 10 million adults have been subjected to domestic violence during the course of a year. This statistic translates to an incident of domestic violence occurring every 3 seconds. The National Coalition Against Domestic Violence [1] reports some daunting statistics:

  • 1 in 3 women and 1 in 4 men have experienced some form of physical violence by an intimate partner
  • 1 in 4 women and 1 in 7 men have been victims of severe physical violence (such as beating, burning, strangling) by an intimate partner in their lifetime
  • On average, more than 20,000 phone calls placed to domestic violence hotlines nationwide
  • The presence of a gun in a domestic violence situation increases the risk of homicide by 500%; 19% of domestic violence involves a weapon; Most intimate partner homicides are committed with firearms
  • 1 in 15 children are exposed to intimate partner violence each year, and 90% of these children are eyewitnesses to this violence
  • From 2016 through 2018, the number of intimate partner violence victimizations in the United States increased 42%.

Due to the increasing prevalence of domestic violence in society, there is a high probability that all healthcare professionals will evaluate and treat a victim (and quite possibly a perpetrator as well) of domestic violence at some time during their healthcare career. The importance of ongoing education and global awareness cannot be understated.

In 2020, the COVID-19 pandemics stay at home/shelter in place orders resulted in spikes in calls to domestic violence hotlines. From layoffs and loss of income to decreased availability of shelters and backlogged courtrooms, fewer resources were made available to victims of domestic violence. These measures resulted in increases in both the incidence and severity of domestic violence. Sadly, the effects of this pandemic, especially on this issue, continue well in 2021 [2].

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Forms of Domestic Violence

Domestic violence may encompass physical abuse, sexual abuse, emotional and verbal abuse, and spiritual and economic abuse. Defined as a pattern of behavior used to gain power or control over an intimate partner, a domestic violence abuser may use tactics that frighten, intimidate, hurt, blame or injure a person. These behaviors often escalate over time and intensity and have resulted, at times, in lifethreatening injuries or death of a victim [3].

Intimate Partner Violence (IPV) is abuse or aggression that occurs in a romantic relationship. The term intimate partner refers to both current and former spouses and dating partners, including heterosexual and same-sex couples. The Centers for Disease Control and Prevention [4] further delineates IPV into four separate groups: physical violence, sexual violence, stalking, and psychological aggression.

  • Physical violence may include hitting, kicking, and punching someone.
  • Sexual violence may include using force to get a partner to partake in a sexual act.
  • Stalking may include unwanted and threatening phone calls or text messages
  • Psychological aggression may include insults, threats, namecalling, or belittling a partner.

Teen Dating Violence (TDV) [5] is defined as dating violence affecting millions of teenagers annually. In addition to the threats from physical and sexual violence and other forms of aggression, TDV is often done electronically through repeated texting and placing sexual pictures of a person online without permission.

The CDC statistics on teen dating violence report:

  • Nearly 1 in 11 female and about 1 in 15 male high school students report having experienced physical dating violence in the last year
  • About 1 in 9 female and 1 in 36 male high school students report having experienced sexual dating violence in the last year
  • 26% of women and 15% of men who were victims of contact sexual violence, physical violence, and/or stalking by an intimate partner in their lifetime first experienced these or other forms of violence by that partner before age 18.

Domestic violence transects every community and affects all people, regardless of age, socioeconomic status, race, religion, gender, or nationality [6]. Whether the violence results in physical or psychological injury, the effects can last a lifetime and affect multiple generations.

Healthcare professionals are in a pivotal position to impact the lives of those affected by domestic violence positively. Oftentimes, they may be the first person to come in contact with a victim of domestic violence. Their ability to effectively evaluate the situation and provide time-sensitive, patient-centered care (including but not limited to treatment interventions, appropriate referrals, and follow-up care) can enhance immediate victim safety and reduce further injury, and improve the home front circumstances, moving forward.

Healthcare professionals must be able to identify and assess all patients for suspected abuse, and be able to offer treatment, counseling, education, and referrals, as appropriate. These referrals may extend out to shelter options, advocacy groups, child protection services and legal assistance [7].

Profiles of Victims/Abusers of Florida Domestic Violence

Anyone can become a victim of domestic violence. Victims of Florida domestic violence come from all walks of life, all age groups, all socioeconomic groups, all religions, and all nationalities [8]. Violence can occur in any relationship when one person feels they are entitled to control another person through whatever means of abuse possible. This abuse is cyclical and usually increases in frequency and intensity. Victims of such violence report feelings of isolation, helplessness, guilt, anxiety, and embarrassment. They may become suicidal, start abusing drugs and alcohol, and feel that they have no one to turn to for help.

Although there isnt a specific set of factors that result in being a victim,” there are many thoughts as to what might affect a persons active willingness to remain in a violent relationship. The following lists serve only as general guidance to inform the healthcare professional of possible underlying causes. Again, anyone can become a victim of domestic violence.

Victims of Domestic Abuse

There is no single characteristic or risk factor that automatically causes a person to become a victim of Florida domestic violence. Instead, it may be a series of events that cause a person to become more vulnerable and enter into and remain within an abusive relationship [9].

Florida domestic violence victims may have experienced violence during childhood, experienced total financial dependence on another person, or lacked basic social support (family and friends). These factors affect both the physical and psychological make-up of a person. Without intervention, these victims can develop personal esteem and confidence issues, further social isolation, economic dependency, and general feelings of insecurity. These effects may negatively affect the decision to stay in an abusive relationship.

Researchers [10] have found the following factors may place a person at a higher risk of becoming a victim of domestic violence, including (but not limited to):

  • Poor self-image/ low selfesteem
  • Financial dependence on the abuser
  • Feeling powerless to stop the violence or leave the relationship
  • Personal belief that jealousy is an expression of love

Common characteristics of victims of Florida domestic violence include, but are not limited to:

  • A past history of abuse
  • A history of alcohol or substance abuse (for themselves or their partners)
  • Financial and family stressors- low income, limited family/friends contact; poverty status
  • A member of an ethnic minority/ immigrant group; Limited English vocabulary
  • Holds traditional beliefs that they should be submissive in a relationship

Reasons a victim may choose to stay in the relationship:

  • A desire to end the abuse but not necessarily the relationship; They do love their abuser
  • Feelings of isolation and helplessness
  • Fear of judgment if they reveal the abuse by seeking help.
  • Feelings that they may not be able to support themselves if they leave their abuser; Fears for the safety of children involved in the relationship
  • Fear of backlash from community or family and friends/lack of knowledge of services available
  • Strong religious/cultural belief system that reinforces staying in a relationship at all costs
Abusers/Perpetrators of Florida Domestic Violence

As with the domestic violence victim, there is no one set of traits to identify a domestic violence abuser/ perpetrator correctly. There are, however, some signs that may raise the red flag of suspicion when observed in a suspected domestic violence case.

The National Coalition on Domestic Abuse [11] has created a list of red flag indicators, including, but not limited to, the following:

  • Extreme jealousy and possessiveness
  • Verbally abusive
  • Extremely controlling behavior
  • Blaming the victim for anything bad that happens
  • Control over all the finances in the relationship
  • Demeaning the victim publicly or privately
  • Humiliating or embarrassing the victim in front of other people
  • Control over what the victim wears
  • Abuse of other family members, including children (and even pets)

The following is a general list of indicators that help may identify a possible abuser [12].

  • History of abuse within ones family
  • History of personal physical or sexual abuse
  • A lack of appropriate coping skills
  • Low selfesteem
  • Codependent behavior
  • Untreated mental illness
  • Drug or alcohol abuse
  • Socio-economic pressures related to the lowerincome status
  • Prior criminal history

Florida Domestic Violence Nursing CEU - Nursing CE Central (1)

Self Quiz

Ask yourself...

  1. Describe interventions/ resources currently available at your facility to assist a victim of domestic violence.
  2. What resources on Florida domestic violence are currently available for domestic abuse perpetrators?

Initial Interaction and Screening Tools

Screening rates are as low as 1.5% to 13% among emergency and primary care physicians. The Academy of Medicine recommendation suggested that all women should be screened for sexual violence. Research found that healthcare providers working in Emergency Department only screened 20–25% of their encounters. As a result, this decreased opportunities for intervention, increased safety, and prevention of future violence [13].

Domestic violence (including intimate partner violence) is an unfortunate cycle that may not be broken with a single emergency department visit; however, identifying and providing resources is necessary to make a difference, increase confidence and safety, and improve the overall health outcome for patients.

Compassionate, nonjudgmental screening by healthcare professionals affords the best opportunity for Florida domestic violence victims to disclose their abuse. By recognizing possible signs of abuse and inquiring further, the nurse validates that the victim is worthy of care and confirms that the violence is a legitimate concern [14].

The screening for domestic abuse should be done in a private environment. Language interpreters, not family and friends, should be utilized if needed. Universal screening should be used; therefore, preventing any victim from being singled out and also ensuring all potential victims are screened appropriately. All healthcare professionals should remain nonjudgmental and compassionate during the screening process [15].

During the interview process, assure the victim that all patients are screened for domestic violence. Also, DV affects many families, and that services are available to everyone who may be concerned about violence in their home.

An overview of Florida domestic violence screenings follows. Links have been provided to an online copy of each screening tool.

Hurt, Insult, Threaten and Scream (HITS)

5 question screening tool assessing physical and verbal interactions with the partner; scores rank 1 (never) -5 (frequently); a score of 10 is considered positive.

  1. Physically hurt you?
  2. Insult or talk down to you?
  3. Threaten you with harm?
  4. Scream or curse at you?
  5. Force you to do sexual acts that you are not comfortable with?

HITS Screening Tool

Woman Abuse Screening Tool (WAST)

8 question screening tool assessing physical, emotional, and sexual intimate partner violence

Woman Abuse Screening Tool

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Partner Violence Screen (PVS)

3 question screening tool for interpersonal violence:

  1. Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?
  2. Do you feel safe in your current relationship?
  3. Is there a partner from a previous relationship who is making you feel unsafe now?

Partner Violence Screening Tool

Abuse Assessment Screen (AAS)

A multiple section assessment tool for sexual and physical Florida domestic violence, including body maps for documentation of injuries.

Family Health Assessment

The Crisis Prevention Institute (CPI) [16] encourages you to always be aware of physical signs and injuries that could be related to domestic violence, including but not limited to the following:

  • Bruising in the chest and abdomen
  • Multiple injuries
  • Minor lacerations
  • Ruptured eardrums
  • Delay in seeking medical attention
  • Patterns of repeated injury
  • Injuries inconsistent with the presenting complaints

Oftentimes, a Florida domestic violence victim may actually seek medical attention for issues unrelated to a physical injury, such as:

  • A stress-related illness
  • Anxiety, panic attacks, stress, and/or depression
  • Chronic headaches, asthma, vague aches and pains
  • Abdominal pain, chronic pelvic pain
  • Vaginal discharge and other gynecological problems
  • Joint pain, muscle pain
  • Suicide attempts, psychiatric illness

Other observations that may indicate a suspected Florida domestic violence situation include:

  • Appear nervous, ashamed, or evasive
  • Seem uncomfortable or anxious when around their partner
  • Be accompanied by their partner, who controls the conversation
  • Be reluctant to follow advice

As you continue to assess the patient, encourage them to talk and then listen carefully. Only upon listening will you have a better understanding of the patient’s current state and provide the necessary resources and referrals for them to find safety. Above all else, maintain open lines of communication in a safe, accepting environment and assure the victim that they do not deserve the abuse.

Florida Domestic Violence Nursing CEU - Nursing CE Central (2)

Self Quiz

Ask yourself...

  1. What Florida domestic violence screening tools are currently available at your facility to assess for possible domestic abuse? Do you feel that they are effective?
  2. Florida domestic violence and abuse victims may seek medical attention for issues unrelated to abuse (chronic headache, vague aches, and pain, anxiety, or depression). What further assessments can be done to assess for domestic violence?

Legal Issues: Mandatory Reporting Laws for Florida Domestic Violence

The United States Department of Justice [19], defines domestic violence to include felony or misdemeanor crimes of violence committed by:

  • a current of former spouse or intimate partner of the victim,
  • by a person with whom the victim shares a child in common,
  • by a person cohabiting with or has cohabited with the victim as a spouse or intimate partner,
  • by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction receiving grant monies,
  • by any other person against an adult or youth protected from that person’s acts under the jurisdiction’s domestic or family violence laws.

The Florida Department of Children and Families defines domestic violence as patterns of actions or behaviors that adults or adolescents use against their partners or former partners to establish power and control. It can potentially include physical abuse, sexual abuse, emotional abuse, and economic abuse. It may also include threats, isolation, pet abuse, using children, and a variety of other behaviors used to maintain fear, intimidation, and power over one’s partner (19).

Under Florida law [21], Domestic Battery is classified as a first-degree misdemeanor, with penalties including up to one year in jail or twelve months probation and a $1,000 fine. In addition, the accused may face additional penalties of a mandated Batterer Intervention Program.

RAINN (Rape, Abuse, and Incest National Network) [22] is the nations largest anti-sexual violence organization. Under the Laws of your state section, they outline the mandatory reporting laws for Florida.

Florida domestic violence laws require mandatory reporting on Children (defined as any unmarried person under the age of 18 years who has not been emancipated by court order).

Who is Required to Report (From a Healthcare Professional Standpoint)?

  • Physicians
  • Osteopaths
  • Medical examiners
  • Chiropractors
  • Nurses
  • Hospital personnel

When is a Report Required?

  • When any person knows or has cause to suspect that a child is abused, abandoned, or neglected by a parent, legal custodian, caregiver, or another person responsible for the childs welfare,
  • or that a child is in need of supervision and care and has no one to provide supervisional care
  • When any person knows or has cause to suspect that a child is abused by an adult other than a parent, legal custodian, or another person responsible for the childs welfare
  • When any person knows or has cause to suspect that the child is a victim of childhood sexual abuse or the victim of a known or suspected juvenile sexual offender.

Reports can be made to the Department of Children and Family Services abuse hotline at (1-800-962-2873).

Florida Domestic Violence Nursing CEU - Nursing CE Central (3)

Self Quiz

Ask yourself...

  1. What policies and protocols are in place at your facility regarding mandatory reporting?
  2. Who can initiate a report, when there is suspected Florida domestic violence?
  3. What departments are notified, at your facility, if a report is made?

The Effects of COVID-19 on Domestic Violence

As discussed at the beginning of this educational offering, the COVID-19 pandemic has negatively affected domestic violence incidence. Stay at home /shelter in place orders, job losses, and mounting financial concerns, and lack of available shelters in many areas became the norm. Florida domestic violence victims have met with further hurdles to their safety and well-being, as they found themselves sheltering in place with their abuser, along with fewer resources available to them in their time of crisis.

Domestic violence hotlines prepared for an increase in calls; many organizations found the opposite was occurring. Calls to hotlines dropped, in some places greater than 50 percent. Victims were not able to safely connect with necessary services [25].

Due to the restrictions of movement (curfews, travel bans, 14-day quarantine advisories), not only is it more difficult to escape, but injury from abuse may go unnoticed by family and friends as face-to-face interactions have been sidelined. In addition to job losses and financial insecurities, this isolation may force a victim to become even more dependent on their abuser [26].

In March 2020, U.S. police departments reported an increase in domestic violence calls as high as 27% after stay-at-home orders were implemented. The number of Google searches for family violencerelated help during the outbreak has been substantial. This increase in Florida domestic violence has not only affected the United States. In the United Kingdom, calls to the Domestic Violence Helpline increased by 25% in the first week after implementing lockdown measures. Furthermore, In China, domestic violence has reportedly increased three times in Hubei Province during the lockdown [27]. The importance of ongoing domestic education and awareness cannot be overstated.

In review, healthcare settings are often treating victims of Florida domestic violence. Traumainformed care that is patientfocused affords both the staff and patient (victim) the best outcome in terms of successfully navigating the challenges of domestic violence and mandatory reporting laws.

(Video) Intimate Partner Violence and Abuse Reporting

Facilitywide protocols should be in place regarding all aspects of patient care for suspected victims of domestic violence: national hotline numbers, community resources, scene safety protocols, and housewide education. Staff should be regularly in-serviced on interviewing techniques, suspected DV victim indicators, and ongoing community collateral relationships. Improved recognition of these victims and knowledge on how to proceed with specific treatment protocols will lead to a higher level of positive outcomes for Florida domestic violence victims and other forms of abuse.

Time is of the essence when dealing with victims of DV. There may be a small window of opportunity to help these victims when they present to your facility. There may be numerous needs identified quickly (transportation, housing, interpretation services, crisis intervention, case management, safety planning, transitional shelter, and protective orders, to name a few). Staff must feel confident in their abilities to identify possible victims, guide them through the process of seeking help, and advocate for their safety and well-being. Knowledge of their facility protocols and community, state, and national resources will afford them the opportunity to deliver optimal care.

Florida Domestic Violence and National Resources

Community Legal Services of Mid- Florida

CLSMF Website
A full service civil legal aid law firm that promotes equal access to justice, providing professional legal aid on domestic violence to help low-income people protect their health, and their families.

Coast to Coast Legal Aid of South Florida

C2C Legal Aid Website
The Family Law Unit primarily focuses on representing victims of domestic violence in family law matters, such as obtaining an injunction (restraining order), dissolution of marriage cases (divorce), and custody litigation.

Domestic Shelters

Domestic Shelters Website
Overview of 58 Florida based organizations offering domestic violence services in 47 different cities.

Florida Department of Children and Families

Florida Family Policy Council

FL Family Policy Council Website
Resources to assist Florida domestic violence victims (and family members) to find help, safe shelter, legal aid, transitional services and counseling.

Florida Department of Children and Families (Child Protective Services)

FL DCF Website
Phone: 1-800-962-2873
TTY: 1-800-955-8771
The Florida Abuse Hotline accepts reports 24 hours a day and 7 days a week of known or suspected child abuse, neglect, or abandonment and reports of known or suspected abuse, neglect, or exploitation of a vulnerable adult.
Report Abuse at DCF Website

My Florida Families

My FL Families Website
Florida Domestic Violence Hotline
Phone: 1-800-500-1119
Fax: 1-800-914-0004

These services include emergency shelter, counseling, safety planning, case management, child assessments, information, and much more.
These shelters may be viewed on the MyFlFamilies.com website. Healthcare professionals should be familiar with shelters available in their surrounding area.

Harbor House of Central Florida

Harbor House Website
Phone: (407) 886-2856
Offering housing placements service, legal aid, safety planning, support groups, and crisis intervention.

The 15th Judicial Circuit of Florida Batterers Intervention Program (BIP)

15th Circut Website
The Florida BIP is a 6-month intensive program to address root causes of Florida domestic violence; it is at least 26 weeks of group counseling sessions. A list of state wide providers is available on this site.

The Salvation Army

Salvation Army of FL Website
Offering emergency and transitional housing, as well as counseling and rehabilitation services.

National Domestic Violence Resources

Amend, Inc.
Amend Inc. Website
AMEND is a nonprofit organization working to end domestic violence by providing counseling to men who have been abusive, advocacy and support to their partners and children, and education to the community.

Colorado-Based

Emerge
Emerge DV Website
617-547-9879
Emerge is a Massachusetts Certified Batterer Intervention Program & Training Site, offering abuser education groups and batterer intervention.

Massachusetts-Based

National Domestic Violence Hotline
1-800-799-SAFE (7233)

Domestic Violence Prevention, Inc
903-793-HELP (4357)
501C3 nonprofit offering education, counseling, and support services to domestic violence clients in multiple counties in Texas and Arkansas.

National Center on Domestic Violence, Trauma and Mental Health
Offering direct website links to multiple national organizations working with domestic violence cases

National Network to End Domestic Violence
Offering a range of programs and initiatives to address the complex causes and far-reaching consequences of domestic violence.

New York Model for Batterer Programs
845-842-9125
Courtordered program for batterer education, which includes a court-imposed consequence if the offender does not attend.

New York-Based

Womens Law
Providing state-specific legal information and resources for survivors of domestic violence.

Elements of a Safety Plan (Escape Plan)

Abusers may go to extremes to prevent a victim from leaving. This may result in the decision to escape an abusive relationship, one of the most dangerous times for the victim of domestic violence. The creation of a safety plan can assist in enhancing the safety of a victim during all phases of a relationship and during the planning phase of actually leaving the abuser.

Knowledge of the various elements of a safety plan will enable the healthcare professional to initiate dialogue with a victim and guide them in the development of a personalized plan of safety moving forward. Discussion of safety plans/escape plans can be very difficult during the limited interactions of an emergency room or clinic visit; therefore, familiarity with the key elements of a plan will help navigate the victim to the most appropriate resources for their situation.

The following overviews of a safety plan are from Safe Horizon [23] and the National Domestic Violence Hotline [24]. The Safe Horizon is victim assistance nonprofit for victims of violence and abuse in New York City since 1978. The following outline provides a detailed overview of the many aspects to consider when formulating a safety plan. Review the entire plan outlined on their website. Consider creating a template handout for your facility to distribute to domestic violence victims.

A safety plan is an outline that includes ways to remain safe while in a relationship, planning to leave, or after you leave (23). A personalized safety plan assists in coping with emotions, telling friends and family about the abuse, and the steps to be taken in the event of necessary legal action. An effective safety plan should have specific details tailored to your unique situation.

Considerations in creating your safety plan:

  • Do you have a trusted confidant- a friend, family member, or neighbor?
  • Where are some areas in your neighborhood that you could go to in an emergency?
  • Are there phone numbers you need to memorize in the event of an emergency?
  • Do you have children that need to be part of your safety plan? Where would your children go if they witnessed violence?
  • Do you need a safety plan for work school?
  • Where can you safely store your safety plan? Computer? Phone?

Before Leaving

The decision to leave an abusive relationship requires courage and preplanning. Consider these measures before leaving to reduce the risk of violence (23):

  • Record evidence of physical abuse
  • Plan with children and identify a safe place where they can go during moments of crisis. Reassure them that their job is to stay safe, not to protect you.
  • Call ahead to see what the shelters policies are. They can provide information on how they can help and secure a space when its time to leave.
  • Try to set money aside or ask trusted friends or family members to hold money for you

When Leaving

The following list of items serves as a guide for what to take (23):

Identification

  • Drivers license or state I.D. card, social security card
  • Birth certificate and childrens birth certificates
  • Money and/or credit cards
  • Checking and/or savings account books

Legal Papers

  • A protective order, if applicable
  • Health and life insurance papers
  • Legal documents, including divorce and custody papers
  • Marriage license

Emergency Numbers

  • Local Florida domestic violence program or shelter
  • Trusted friends and family members
  • The Hotline

Other Items to Keep in Mind

  • Medications and refills (if possible)
  • Emergency items, like food, bottles of water, and a first aid kit
  • Multiple changes of clothes
  • Emergency money
  • Address book
  • Safe cell phone, if possible

After Leaving

The safety plan should always include ways to ensure your continued safety after leaving an abusive relationship. Here are some precautions to consider (23):

  • Change locks and phone numbers if possible.
  • If possible, change work hours and the typical route
  • Alert school authorities of the situation.
  • If a protection order is present, keep a certified copy present at all times, and inform friends, neighbors, and employers that you have a protection order in effect.
  • Consider renting a post office box or using a trusted friends address for mail (remember that addresses are used for restraining orders and police reports and necessary, use different stores and frequent different social spots.
  • Alert neighbors and work colleagues about how and when to seek help
  • Tell people who take care of children (if you are comfortable doing so) or transport them to/from school and activities.

Again, these suggestions provide an extensive overview of an escape plan. They are meant to assist a victim in the required methodical pre-planning of a safety plan that reduces the threat of violence. Not all sections will apply to every victim, but healthcare professionals should be comfortable in discussing any aspects of a safety plan specific to the individual victim.

Case Study on Domestic Abuse

Mary, 26 years old, presents to the emergency department with complaints of abdominal pain, vague body aches, and a headache. During the triage screening, Mary has minimal eye contact with the nurse and appears inadequately dressed for the cold weather, arriving in only jeans, a t-shirt, gym shoes, and a light sweater. While the nurse helps Mary change into a hospital gown in a private examination room, she notices various bruises on Marys lower back, arms, and legs, all of varying size and color. Mary states she slipped and fell recently at home. You observe that Mary is now avoiding all eye contact, staring down at the ground. She keeps looking at the door, and wall clock, mumbling, “He cant know Im here.”

Exercise

What are your initial thoughts about Marys physical appearance?

What can you do to make Mary feel more relaxed, comfortable, and safe during her emergency room visit?

Mary lives with her boyfriend, Bill. He works parttime; she is currently unemployed. She admits to the occasional use of alcohol and recreational use of marijuana, “…To help me relax; my anxiety is very bad lately.” She mentions that her anxiety has increased because Bill’s hours at work have been cut due to COVID-19, and we’re strapped for money. He is under a lot of pressure.

Upon further examination, and laboratory testing, including a pelvic examination, it is confirmed that Mary is approximately six weeks pregnant and has a suspected STI. Mary bursts into tears and says, “He is going to kill me. We cant afford a baby; what am I going to do?!

Exercise

What are your concerns about this scenario?

How will you address these concerns with your patient, Mary?

Why might healthcare professionals, in general, feel uncomfortable talking with Mary? What are the top priorities of Marys care at this time?

What information would you document in the patient record during this visit?

Mary begins to feel comfortable speaking to you about her situation. She reluctantly tells you that Bill pushed her down the back stairs yesterday after an argument but quickly apologized afterward. On another occasion, Bill beat me up when he ran out of beer before payday. She states he has been really angry lately over his hours being cut at work and is looking for another job. A baby now,Mary confides, would be a terrible thing for Bill, but I want it. Its my first, and I want it. Please help me. Mary gives consent for you to contact your department social worker for additional guidance, but does not want law enforcement notified.

Exercise

What other key staff members need to be part of the care team for Mary?

What local and national resources can you refer Mary to at this time?

How would your plan of care change if Mary did not give consent for the social worker to be notified?

Mary wants to go back home tonight so as not to upset Bill when he returns later this evening. It will be better this way.” She promises to leave him tomorrow and follow-up with the community referrals you gave her. Knowing that these plans may change, you advise Mary to create a safe escape plan just in case.”

Exercise

What items should be part of a safe escape plan?

How safe is it for Mary to return home?

What are your legal obligations to Mary regarding Florida‘s mandatory reporting laws?

As you are getting ready to leave at the end of your shift hours later, you see Mary arrive by ambulance. She is visibly injured with a broken nose and bloody lip. EMS staff state the neighbors called 911 when they heard Mary screaming in her apartment next door. No one else was in the apartment when they entered, and Mary will not tell them who injured her. You escort them to a private examination room. Mary sees you and yells, “Hes coming after me. Help me! He is going to kill me.

Exercise

What are your top priorities for Mary and the staff at this time?

What other hospital departments need to be notified?

Marys boyfriend shows up, intoxicated, at the triage window, demanding to see Mary. He threatens to kick in the door to the main examination room if he cannot see Mary immediately. He is pacing back and forth in the triage area and refuses to sit down.

Exercise

What additional security measures need to be in place upon the boyfriends arrival?

Marys boyfriend is removed from the premises by local law enforcement. Mary is given the national hotline number and is contacting the local shelter at this time. Upon discharge, she is escorted by security personnel to the exit and leaves the facility with a shelter representative.

(Video) Florida Nursing Continuing Education Requirements

References + Disclaimer

  1. National Statistics. (n.d.). National Coalition Against Domestic Violence. Retrieved February 7, 2021, from https://ncadv.org
  2. Sharma, A., & Borha, S. (2020, July 28). Covid-19 and Domestic Violence: An Indirect Path to Social and Economic Crisis. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7386835/
  3. What is domestic abuse? (n.d.). Https://Www.Un.Org/En/Coronavirus/What-Is-Domestic-Abuse. Retrieved February 8, 2021, from https://www.un.org/en/coronavirus/what-is-domestic-abuse
  4. Centers for Disease Control and Prevention. (2020, October 9). Intimate Partner Violence. Centers for Disease Control and Prevention (CDC). https://www.cdc.gov/violenceprevention/intimatepartnerviolence
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  27. Xue, J., Chen, J., Chen, C., Hu, R., & Zhu, T. (2020). The Hidden Pandemic of Family Violence During COVID-19: Unsupervised Learning of Tweets. Journal of Medical Internet Research, 22(11), e24361. https://doi.org/10.2196/24361
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