Domestic Violence

– Nursing Related Essay, Research Paper TABLE OF CONTENTS Description of the Local Population 3 Patterns of Morbidity and Mortality 6 Demographics 7 Environmental Concerns 8

– Nursing Related Essay, Research Paper

TABLE OF CONTENTS

Description of the Local Population 3

Patterns of Morbidity and Mortality 6

Demographics 7

Environmental Concerns 8

Public Services 9

Aesthetics 10

Health-Related Facilities 10

Values and Beliefs of the population 12

Reliance on Local, Regional, and Federal Funding 13

Patterns of Resource Allocation 14

Patterns of Insurance Coverage 15

Expectations of the Public for Care 16

Diagnostic Statements about the Population 16

Interdisciplinary Planning 20

References 22

Description of the Local Population

Domestic abuse in the United States is a large-scale and complex social and health problem. Domestic violence has become a major health threat to this nation, costing America thousands of lives and millions of dollars (Moore, Zaccaro, & Parsons, 1998). Domestic violence is known by many names including spouse abuse, domestic abuse, domestic assault, battering, partner abuse, and so on. McCue (1995) maintains that domestic abuse is commonly accepted by legal professionals as the emotional, physical, psychological, or sexual abuse perpetrated against a person by that person s spouse, former spouse, partner, former partner or by the other parent of a minor child , although several other forms of domestic violence have become increasingly apparent in today s society. This threat has no prejudice, it spans all socioeconomic classes, professions, cultures, religions, ages, and gender; however, research shows that 95 to 98% of victims are women (Ellis, 1999). As many as one in ten women are abused each year in the United States (Attala, McSweeney, Mueller, Bragg, & Hubertz, 1999).

It is inadequate to view domestic violence as an aspect of the normal interpersonal conflict, which takes place in most families. According to McCue (1995), many families experience conflict, but not all male members in families inevitably resort to violence. It is not the fact of family disputes or marital conflict that generate or characterize violence in the home. Violence occurs when one person assumes the right to dominate over the other and decides to use violence or abuse as a means of ensuring that (Currie, 1988). According to McCue (1995), many of the men who present most violently in the household portray themselves quite differently to the rest of society. They are generally not lawbreakers, but rather appear to be charming, often handsome law-abiding citizens outside of their own homes who maintain an image as friendly and devoted family men. In fact, it is likely that many such aggressors are not even aware of the major impact their actions have upon their partners. The abuser assumes control over a woman s activities and prevents or limits interaction with friends, family, and service from health care providers to decrease her access to information and support (Attala et al., 1999). The frequency and severity of abuse increases in frequency and severity and unless stopped will continue to severe acts of violence (Landenburger, 1998). The longer the abuse progresses the more powerful the batter becomes. The batterer perceives a feeling of no accountability if the abuse occurs while under the influence of alcohol. This provides a socially acceptable excuse for the violence. Therefore, a higher risk of domestic violence occurs if the abuser uses drugs or alcohol (Hightower & Gorton, 1998).

Domestic violence remains a hidden problem because it occurs within the privacy of the home and those involved are usually reluctant to speak out (Healey, 1993). However, if one is aware of and screens for the warning signs, successful intervention can be achieved. Commonly, abuse results in multiple health problems. Besides the direct injuries from the physical violence; increased substance abuse, chronic pelvic and abdominal pain, headaches, and gastrointestinal disorders are common (Moore, Zaccaro, & Parsons, 1998). Posttraumatic stress disorder symptoms can develop and finally homicide may result (Landenburger, 1998). In fact, one in five of all murder victims is a woman killed by her partner or ex-partner (Frost, 1999). Of all female homicide victims, 31% were murdered by a boyfriend, spouse, or ex-spouse (Glass & Campbell, 1998). As the frequency and severity of abuse increases, the victim becomes isolated, fearful for their lives or those of her children, and experience increased feelings of desperation and depression (Landenburger, 1998).

Abuse is more likely to start or worsen when the woman becomes pregnant. In fact, 20% of all pregnant women are abused. Moreover, the leading cause of death among pregnant women was due to partner abuse (McFarlane, Parker, Soeken, Silva, and Reel, 1997). Complications such as low weight gain, anemia, infections, 1st and 2nd trimester bleeding, and greater risk for late entry into prenatal care are significantly higher in abused women. The effects on the fetus from abuse include higher incidence of fetal distress and low birth weight. In addition, abuse during pregnancy is associated with significantly higher maternal depression rates, suicide attempts, and substance abuse (McFarlane et al., 1997).

Research indicates approximately 3-10 million children witness their mothers being treated violently each year. These children are at a risk for cognitive, behavioral, and emotional delays (Glass and Campbell, 1998). Not only are they at risk for abuse, but posttraumatic stress disorder, sleep disturbance, separation anxiety, hyperactivity, emotional disorders, and eventually they may imitate such aggressive behavior (Moore, Zaccaro, Parsons, 1998). These children are also at risk for being abused themselves are becoming an abuser. In addition, the cost to society is great, due to the fact that children of battered women use health services 6 to 8 times more than other children (Glass & Campbell, 1998). These children are often neglected and live in a world surrounded by fear. However, the likelihood that a woman gets help is increased if she has children. Children play a major role in notifying others that the abuse occurs. In addition, the scars that form and grow in these children and the fear for their safety influence the woman s decision to leave (Landenburger, 1998).

What has to occur for the woman to break the cycle of abuse and seek help? Research indicates a window phase in the cycle of abuse as the ideal time for adequate and sincere interventions to be successful. The cycle of abuse has three phases: tension-building phase, acute battering incident, and the honeymoon phase. The tension-building phase starts with a moody and hostile batterer who is overly critical of his partner. This phase is followed by the actual assault on the woman. Lastly, the honeymoon phase involves desperate pleas of forgiveness and promises of never again by the batterer. The open window of opportunity for healthcare members to be successful in their interventions is in between the second and third phases (Matar-Curnow, 1997). Research shows multiple barriers in this process, both in the woman s lack of disclosure and healthcare workers failing to ask (Shea, Mahoney, & Lacey, 1997).

Patterns of Morbidity and Mortality

Domestic violence is the mistreatment of one family member by another. Most often perpetrators of an abuse and battering are a spouse, ex-spouse, boyfriend/girlfriend, ex-girlfriend/boyfriend, or lover. Domestic violence occurs in one of five forms: physical, sexual, psychological, emotional, and economic (Chez, 1994). It is more prevalent than most people are aware. Annually, females experience over 10 times as many incidents of violence by an intimate than men. On average each year, 1.8 million women are battered by their husbands. Experts suggest a violent act occurs against a woman every 12 seconds (Straus and Gelles, 1990).

Domestic violence accounts for at least 20% of all medical visits by women and 22-30% of all women seeking emergency treatment. Reported injuries include contusions; abrasions; fractures; injuries to the head, neck, chest, breasts, and abdomen; as well as injuries during pregnancy. Reported medical findings include symptoms related to stress, chronic posttraumatic stress disorder, depression, and other anxiety disorders. However, most women choose not to discuss the abuse with their health-care professional and over half do not discuss the abuse with anyone due to the fear that the revelation will cause the violence to (National Clearinghouse for the Defense of Battered Women [NCDBW], 1991).

According to the latest available FBI statistics, in 1990, 30% of female murder victims were killed by their husbands or boyfriends. This statistic represents approximately three thousand women (Knall, 1992). In a study of females killed by intimate partners between 1980 and 1982, it was found that the majority of women killed were married (57.7%). Girlfriends were the next highest percentage (24.5%), followed by common-law wives (8%), ex-wives (4.8%), and friends (4.6%). Seventeen percent of workplace homicides were committed by a male intimate (Stout, 1993, p. 3). The number one risk factor for actual and attempted suicide in adult women is spouse abuse. She may kill herself or her abuser to escape because she sees no other way out (Radford and Russell, 1992).

In the United States, the average annual medical expense resulting form domestic violence is four billion dollars. In the workplace, domestic violence accounts for 175,000 days of absenteeism and 25% of excessive medical (NCDBW, 1991).

Demographics

Domestic violence knows no boundaries. It persists in every level of society. From 1983 to 1991, the number of domestic violence reports received increased by almost 117% (Domestic Violence Myths, n. d.). Some experts theorize the battered woman syndrome can characterize the effects of battering. “Battered woman syndrome” is defined by a common set of symptoms which include emotional reactions (fear, anger, sadness); changes in beliefs and attitudes about self, others and the world (self-blame, distrust, belief that the world is unsafe); and psychological distress (depression, flashbacks, anxiety, sleep problems, substance abuse) to name a few (Dutton, 1996).

Characteristics of the batterer vary widely. Battering men come from all ages, ethnic, and educational backgrounds. Batterers are traditionalists and have unrealistic expectations of marriage, believing in male supremacy and stereotypical gender roles. Many have high incidence of substance abuse and violence in their backgrounds. Other common characteristics include low self-worth, difficulty trusting people, difficulty forming relationships, and extreme reactions to emotions. Of all the factors that characterize the background of abusers, the most predictably present is previous exposure to some form of violence (Straus and Gelles, 1990). As children, abusers were often beaten themselves or witnessed the beating of siblings or a parent. Children raised in this way may detest violence, but they have had no experience with other models of family relationships (Stanhope and Lancaster, 1996).

Women remain with the abuser because of psychological, economic, and social reasons. Guilt, fear, self-blame, low self-esteem, and feelings of helplessness are all psychological reasons that make it difficult for them to conceive of leaving. Fear of losing their children due to lack of resources and finances is a major determinant for staying. There are half as many shelters for battered women in this country as there are for stray animals, and most do not accept children. For every two women sheltered, five are turned away. For every two children sheltered, eight are turned away. Approximately half of all homeless women and children are on the streets because of violence in the home. Socially, women stay to avoid the stigma of domestic violence (Landenburger, 1989). Violence is the reason stated for divorce in 22% of middle-class marriages. Lastly, another major determinant for staying is fear. The National Coalition Against Domestic Violence reports that women who leave their batterers are at a 75% greater risk of being killed by the batterer than those who stay (Lowery, 2000).

Environmental Concerns

Women of all cultures, races, occupations, income levels, and ages are battered by husbands, boyfriends, lovers, and partners. Just like the victims, there are no typical abusers. Anyone can be an abuser. On the surface, abusers may appear to be good providers, loving partners, and law-abiding citizens. Approximately one-third of the men counseled for battering are professionals who are well respected in their jobs and communities. These men are doctors, psychologists, lawyers, ministers, and business executives ( Domestic Violence Myths, n. d.).

Domestic violence is self-perpetuating because it is a learned behavior. It is used to establish control and fear. The batterer uses violence, intimidation, threats, isolation, and psychological abuse to coerce and control the other person. Even if the violence does not happen often, it remains as a hidden, constant and terrorizing threat. Unfortunately, abuse tends to escalate in frequency and severity over time, and the man’s remorse tends to lessen (Walker, 1984).

Domestic violence has a positive correlation with drug and alcohol abuse. The substance abuse problems must be addressed along with the abusive behavior to reach a successful resolution.

Battering during pregnancy has serious implications for the health of both women and their children. These women are at risk for spontaneous abortion, premature delivery, low birth weight infants, substance abuse during pregnancy, and depression (Bullock and McFarlane, 1989).

Public Services

Public services play an important role in providing services for the battered population. Examples of public services include crisis intervention, counseling services, and abuse intervention (YWCA Crisis Services, 2000).

The private sector is very limited in the services provided to the battered population. An example would be private counseling or counseling within the church. The church would also lend spiritual support, provide positive role models, and reinforcement for peaceful behavior (Stanhope and Lancaster, 1996).

Aesthetics

Domestic violence is not prevalent in any one culture or religion. It is found in all cultures and all religions. However, some faiths uphold the victimization of people with their disapproval of divorce. Family members stay together, although they are at emotional or physical war with one another, because of religious commitments (Lancaster, 1980). Other women give up religion in disillusionment, feeling that a just and merciful God would not let them suffer so (Brown, Finney, Jestis, Johnson, McCorkel, Roach, Schlinke, Smith, Snook, & Warning, 1998).

In our culture, the media has brought attention to the problem of domestic violence. This has lessened the stigma associated with domestic violence and publicized services available to this population. However, the media also brings violence into our homes on a daily basis through television and newspaper reports of violence. This has caused our society to become somewhat desensitized to and the acceptance of violence (Stanhope and Lancaster, 1996).

Domestic violence affects all ages from before birth to the elderly. From the abuse of the pregnant female to the battering of the elderly in the nursing home, violence does not discriminate based on age.

Health-Related Facilities

In the community, there are facilities available to assist and empower battered women. They provide women with safety and security against the abuser. Referrals to these facilities are most often made by the police department or by a social worker in the hospital.

In Oklahoma City, the Domestic Violence Victim Assistance Program (DVVAP) is a cooperative effort through the city and the YWCA, providing support and assistance to victims of domestic violence. The YWCA provides safety by providing emergency shelter and care for battered women who are in immediate danger, and their children (YWCA Crisis Services, 2000).

The YWCA’s program, Passageways, is a nonprofit organization. Passageways is funded by the Department of Justice, Office for Victim’s of Crime, and the United Way. This facility accepts single women and women with children. The maximum stay is sixty days. Women are assisted in obtaining housing, medical care, legal counsel, and transportation. Women staying in the shelter are required to attend classes addressing domestic violence, anger management, and parenting. Education and support help their children avoid further victimization, verbalize feelings, and learn appropriate ways to express emotions. The school they attend is confidential and aids in helping them understand what is occurring in their family. Additionally, the YWCA provides a structured re-education and counseling domestic violence program for men who are violent and/or abusive in interpersonal relationships. (YWCA Crisis Services, 2000)

The DVVAP provides onsite assistance at the Oklahoma City Municipal Court building to aid the victim in filing a Victim Protection Order (V-PO) and/or exploring other options. The DVVAP advocate will accompany the victim to court when appropriate. In addition, referrals are made for Legal Aid of Central Oklahoma, Oklahoma Housing Authority, mental health counseling, and job training. The cost for these services is based on a sliding scale (YWCA Crisis Center, 2000). The YWCA is committed to ending domestic violence through social change and empowering those who have been violated. To this end, the YWCA assist victims through referrals to community outreach programs that provide education and support for individuals who have experienced domestic violence and/or sexual abuse. Referrals to domestic violence groups, sexual assault groups, and individual counseling are also available. Finally, a structured, re-education program called “Third Phase” is available for men who are violent and/or abusive in interpersonal relationships. The YWCA is building brighter futures through support and education (YWCA Crisis Center, 2000).

Values and Beliefs of the population

The definition of battered women according to Walker, as cited in Grant (1995), describes battered women syndrome as a group of psychological symptoms occurring in a recognizable pattern, in women who report physical, sexual, and or psychological abuse by their partner. The results of this abuse are often manifested as post traumatic stress disorder. Most victims of abuse are able to identify their first encounter of violence with their partner, but they describe the escalating occurrences as a blur, one event blending into the next. Many of the women voiced their concerns for their partners needs and describe their efforts to subdue the violence (Grant, 1995). Some of the beliefs of this population include:

1) The violence and abuse is somehow their fault.

2) They have done something to deserve the abuse.

3) There is something they can do to stop the abuse.

4) An intact family is better for the children.

5) Abuse is normal in a relationship (because of previous family learning).

6) If they ask for help, the violence may increase.

7) Help resources are temporary, and they will have no place to turn when services are discontinued.

8) A mistrust for the medical community to supply beneficial and empathetic services.

A possible explanation of the value and belief system of the battered woman is the profile addressed by Linda Poirier (1997). This profile includes social isolation, feeling trapped in the marriage or relationship, low self-esteem, having witnessed abuse as a child, depression and/or suicidal feelings, financial dependence on spouse, abuse of drugs and alcohol, a trusting nature, and a non-aggressive and traditional attitude. These values and beliefs lead to their patterns of seeking health care. Health care professionals must be aware of the need for an increase in screening for domestic abuse. Studies estimate one-fifth to one-third of women are abused during their lifetime (Thurston, Cory, & Scott, 1998). Policies need to be developed concerning uniform screening of all women to ensure their safety (Langford, 1996).

Reliance on Local, Regional, and Federal Funding

It is estimated that domestic violence leads to 28,700 emergency room visits per year, 39,000 physician office visits, $44 million in total annual medical costs, and 175,000 lost days of work (Poirier, 1997). Funding for services is provided through state and federal appropriations, as well as private donations. Our state office is funded through the U.S. Department of Health and Human Services, Violence Against Women Act and the Victims of Crime Act (OCADVSA, n. d.). The Oklahoma Department of Mental Health and Substance Abuse Services (OKDMHSAS) controls funding. The services provided to battered women include safe shelter, crisis hotlines, emergency transportation, legal advocacy, sexual assault advocacy, child advocacy, counseling, educational training, transitional living, and a variety of outreach, prevention, and educational activities (OCADVSA, n. d.).

One of the medical services provided to victims of domestic violence includes coverage of emergency services. In the case of sexual assault, the Oklahoma Sexual Assault Exam Fund can cover most, if not all, of the cost for a physical exam. If this fund is unable to cover the cost completely, the victim may file a claim with the Victim s Compensation Board. One stipulation of these funds is that the victim must file a police report in order for expenses to be covered (OKADVSA, 1993). Another fund that helps with medical expenses is the Oklahoma Crime Victims Compensation Program. This program covers out of pocket expenses for victims or the families of victims. This can cover medical and dental care, prescriptions, counseling and rehabilitation, work loss or loss of financial support, caregiver work loss, homicide crime scene clean-up, and funeral and burial expenses (District Attorneys Council, n. d.). Requirements for eligibility include reporting the crime within 72 hours, filing claim for compensation within one year, full cooperation with investigation and prosecution, compensation cannot benefit the offender, and claimant cannot have contributed to the injury. The total amount of compensation cannot exceed $20,000 (District Attorneys Council, n. d.).

Another service provided for the victims is legal assistance. This is a new program provided through a grant from the Department of Justice. It provides an attorney for protective hearings or other civil cases that assist women in breaking the cycle of domestic violence. Legal Services of Eastern Oklahoma has volunteered to provide services through this grant (OKCADVSA, 1999).

Patterns of Resource Allocation

Funding for domestic violence programs in Oklahoma are channeled through the Oklahoma Department of Mental Health and Substance Abuse Services (OKDMHSAS). The OKDMHSAS is responsible for the nearly 30 statewide resource centers annual budgets. Funding is distributed yearly based on the previous years spending and services provided (Campbell-Fife, 2000). The annual operating budget for the entire state for fiscal year 2000 was $4,502,936.00. This money is divided based on a base pay contract agreed upon individually by each center and the state. Monies allocated above the total of the contracts is divided based on the following formula: 75% based on population served by the center and 25% based on the area (in square miles) covered by the center (Campbell-Fife, personal communication, Feb 1, 2000). The total number of victims served in the fiscal year 1998 was 16,995, while the centers totaled 383,611 volunteer service hours. Each center that provides services has the right to determine their own resource priorities (Campbell-Fife, personal communication, Feb 1, 2000).

Patterns of Insurance Coverage

The battered women population is a very diverse group. Members of this population range from those living in poverty to those who are members of our highest economic class. For the members of the higher economic status accessibility to insurance coverage and health care is not a major factor due to their abundance of financial resources. Resources are not as readily available for those in the middle and lower classes. For those who have insurance, counseling services may not be covered. For those of the lower class who cannot afford insurance coverage, many are not aware of the services available to them. Consequently, they may delay seeking medical care and counseling due to their lack of resources (Rodriguez, Quiroga, & Bauer, 1996). Another barrier in insurance coverage relates to the doctor s reluctance to report abuse. Insurance companies may deny coverage to victims of domestic violence by calling it a preexisting or high-risk condition. Physicians may be reluctant to compromise a vulnerable patient s health care coverage (Gremillon & Kanof, 1996, p.772). A disadvantage of insurance coverage is HMO s require patients to see their primary care provider. This may cause victims to be reluctant to seek health care to prevent discovery of the abuse (Plitsas, 1996). Once the victim is identified by health care providers counseling services are available. Counseling services are provided on a needs basis through the YMCA. These services are available to anyone in need of assistance, regardless of their insurance coverage. The YMCA bills insurance companies for allowable services and the remainder of the cost is funded through grants and legislation (Pierce, personal communication, Feb 8, 2000).

Expectations of the Public for Care

Victims of domestic violence view healthcare providers as an ineffective source of help. Once identified, battered women were, treated insensitively and had their abuse minimized or ignored and (healthcare providers) subtly blamed women for their abuse. (Langford, 1996, p. 39). Due to this treatment, the subject of abuse has become an area of silence between victims and healthcare providers. Some contributors to the silence may be the patient s inability or unwillingness to seek medical help, the patient s withholding of information from the health care provider, and the health care provider s failure to ask the patient about battering. (Rodrigues, Quiroga & Bauer, 1996, p. 155). Other areas of concern for victims are police who are hesitant to get involved, prosecutors who minimize charges, and judges who are effected by the myths and stereotypes of abuse. (Family Violence Prevention Fund, n. d.; Flitcraft, Hadley, Hendricks-Mathews, McLeer & Warshaw, 1992).

Abuse victims desire for these officials to address the issue of abuse and be an advocate for them. Members of this population are entitled to: respect of their confidentiality, our belief and validation of their experiences, our acknowledgement of the injustice, our respect of their autonomy, our help in planning for their future safety, and promoting access to community services (Domestic Violence Project, Inc., n. d.). Cultural issues are also of concern related to language and value barriers (Family Violence Prevention Fund, n. d.).

Diagnostic Statements about the Population

Nursing Diagnoses

1. Actual or potential risk for impaired individual coping among women related to disruption of emotional bonds secondary to abuse, dysfunctional relationships, unsatisfactory support system, and inadequate knowledge of psychological and community resources as manifested by verbalization of the inability to cope or ask for help, difficulty with life stressors, and ineffective coping strategies (Carpenito, 1996).

2. Actual or potential risk for powerlessness (physical and psychological) among battered women related to feelings of loss of control and lifestyle restrictions secondary to abusive relationships (verbal, physical, and sexual) and fear of harm and violence as manifested by expressions of dissatisfaction over the inability to control the situation, depression, inability to leave the abusive relationship, bruises and contusions with varying states of healing, victim of rape assault, and unsatisfactory dependency needs upon the abuser (Carpenito, 1996).

3. Increased risk of a self esteem disturbance among women related to feelings of failure secondary to dysfunctional relationships, history of abusive relationships, and feelings of helplessness secondary to repeated episodes of abuse as manifested by self-negating verbalizations of I deserve to be treated like this and/or I am a terrible person , expressions of shame or guilt in regards to abusive partner or self, possible denial of problems obvious to others, ineffective use of defense mechanisms, and poor body presentation (posture, eye contact, movements) (Carpenito, 1996).

Goals

1. The community will initiate programs within the schools that focus on the exploration of gender roles and expectations, personal safety, legal statutes, and teen dating violence.

2. The community will acknowledge the prevalence and possibility of abuse and will provide resources to women at risk, in terms of community resources, safe shelters, and legal assistance to ensure safety for all involved parties, which is the highest priority.

Primary Interventions

1. The nurse will help initiate and spread awareness of abuse in order to promote healthy and positive lifestyles for victims of abuse (Stanhope & Lancaster, 1996).

2. The nurse will become a resource person and address the knowledge gaps to improve services for victims and perpetrators (Stanhope & Lancaster, 1996).

3. The nurse will initiate home visitations services for adolescent mothers, early adult age women, and women with family incomes below ten thousand dollars per year (Stanhope & Lancaster, 1996).

Rationale

The nurse will need to strengthen battered women and family members so that they can cope more effectively with various life stressors and demands. The nurse will need to help reduce the destructive elements in the community that support and encourage the use of human violence (Stanhope & Lancaster, 1996).

Teenage mothers, young adult women (19-29), and women with family incomes of less then ten thousand dollars per year, carry the highest risk for actual or potential abuse (CDC web page, 1999).

Secondary Interventions

1. The nurse will help to direct women and their abusers towards discussing their problems and seeking alternatives for dealing with the tension that led to the abusive situation (CDC web page, 1999).

2. The nurse will be able to recognize abuse, ask suspected victims about possible abuse, and refer battered women to temporary or permanent safe locations (Stanhope & Lancaster, 1996).

3. The nurse must radiate caring, acceptance, understanding, compassion, and a non-judgmental and non-authoritative attitude in regards to the abuser and the battered woman. The behavior, not the person, must be condemned (Stanhope & Lancaster, 1996, p.746).

Rationale

Nursing interventions are directed towards the early diagnosis of abuse and prompt treatment. The nurse needs to be perceptive to the cues of possible abuse and intervene early to prevent further physical or psychological damage (Stanhope & Lancaster, 1996).

Tertiary Interventions

1. The nurse will care for the battered women and their families experiencing abuse by developing an open and honest relationship with all family members, establishing safety as the number one priority and ensuring measures to promote a safe environment (Stanhope & Lancaster, 1996).

2. The nurse will need to recognize and capitalize on the violent family s strengths, as well as to assess and deal with its problems (Stanhope & Lancaster, 1996, p.747).

3. The nurse needs to give the victim reassurance that their feelings and responses are normal, they are not alone in their dilemma, and they do not deserve to be abused (Stanhope & Lancaster, 1996).

4. The nurse needs to be a resource person and offer continual support for positive individual and family decisions that ensure the safety of the victim (Stanhope & Lancaster, 1996).

Rationale

Nursing interventions need to be geared towards rehabilitation for the abused victim and their families. Ensuring safety is a crucial aspect of this level of intervention. Psychological recovery is an important factor and the nurse needs to teach and to explore with the victims and families, how to deal with their problems in nonviolent ways in order to decrease the incidence of abuse (Stanhope & Lancaster, 1996).

Strengths

Battered women are instinctive in regards to potential abuse or oncoming violence. They are capable of understanding the non-verbal cues and they are very resilient. Battered women are usually devoted to their husbands and children and fear leaving their families. They are determined to stay in the relationship because deep down they love their partners and do not want to be apart from them (CDC web page, 1999).

Weaknesses

Battered women tend to be more passive than their male counterparts and they have a weaker stature. Battered women tend to have low self-esteem and they become stereotyped to society norms that tolerate violence. Female victims of abuse are more likely then men to need medical attention, take time off work, spend more days in bed, and suffer from more stress and depression. Battered women are more likely to have shame and humiliation in regards to abuse and they are more likely to fear that the revelation of the abuse will further jeopardize their safety (CDC web page, 1999).

Interdisciplinary Planning

Responding to domestic violence should involve an, interrelationship between the health, legal, and social sectors so, women are not continually referred to various agencies (Getting help: Support web page, 1999, p. 1). Support is a main component involved in an interdisciplinary care teams plan of care.

Crisis intervention is the first thing that takes place. This involves the following: crisis hot lines, shelters, medical services, transportation networks, and laws that allow victims or perpetrators to be removed from the home (Getting help: Support web page, 1999, p. 1). Emotional support is another critical intervention, which includes self-help groups, assertiveness training, self-esteem, and confidence building sessions, and parenting skill courses. Finally, legal assistance may also be needed for custody of children, property matters, financial support, or restraining orders. Many different people and services come together to form an interdisciplinary team to provide safety, emotional, physical, and psychological treatment for battered women.

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