Nurse Practitioners Empowering Domestic Violence Survivors
Learn how nurse practitioners are ideally suited to screen and address intimate partner violence in the U.S.
If you or someone you know is experiencing domestic violence, you can find help and resources here.
According to the Centers for Disease Control and Prevention (CDC), “About 41% of women and 26% of men experienced contact sexual violence, physical violence or stalking by an intimate partner during their lifetime and reported a related impact.” The National Institutes of Health (NIH) estimates that domestic violence is responsible for more than 1,500 deaths in the United States annually. NIH goes on to add that, “Family and domestic health violence are estimated to affect 10 million people in the United States every year. It is a national public health problem, and virtually all health care professionals will at some point evaluate or treat a patient who is a victim of some form of domestic or family violence.”
Nurse practitioners (NPs) and advanced practice registered nurses (APRNs) play a crucial and valued role in recognizing domestic violence and providing support to survivors of abuse. In order to highlight this important topic, the American Association of Nurse Practitioners® (AANP) interviewed Doncy Eapen, PhD, MSN, RN, FNP-BC — a family nurse practitioner, professor at the University of Texas Health Science Center and researcher on the subjects of domestic violence and homelessness on the latest episode of NP Pulse: The Voice of the Nurse Practitioner®. Speaking with host Sophia Thomas, DNP, FNP-BC, PPCNP-BC, FNAP, FAANP, Eapen describes the different forms of domestic abuse and provides screening recommendations for providers. Read on to learn how NPs can develop a plan of action to support patients confiding in them regarding this delicate issue.
Defining Domestic Violence
There are many phrases and terms used in discussions about domestic violence. The CDC refers to intimate partner violence (IPV) as “abuse or aggression that occurs in a romantic relationship. Intimate partner refers to both current and former spouses and dating partners.” However, IPV does not encompass the entirety of domestic violence. “Sometimes people use IPV and domestic violence interchangeably, but domestic violence also includes non-partner violence,” states Eapen. “For example, if a person lives in a household where they are abused by their parents, siblings and other relatives, that is also domestic violence. A lot of domestic violence is partner violence, but IPV is just a part of domestic violence.”
It's also important to note that domestic violence has many forms — and not all are physical. According to NIH, “Family and domestic violence are abusive behaviors in which one individual gains power over another individual.” Those behaviors may include physical aggression, sexual violence, psychological abuse, stalking, neglect or financial abuse. Regardless of the nature of domestic violence faced, Eapen goes on to explain that these kinds of abuses can occur to everyone. “There are certain risk factors, but it happens everywhere regardless of your race, gender, nationality and socioeconomic status. It all can happen to anyone.”
Empowering Survivors
How can providers address the public health issue of domestic violence? Eapen draws from her own research, explaining, “One of the things that we can do as NPs is screen for domestic violence. Unfortunately, some of the participants that we talked to during our study talk about how they have not been asked that question.” Eapen underscores that victims of domestic violence are likely not visiting providers to discuss harm at home, but other medical issues — which requires NPs to be proactive in identifying red flags. “As practitioners in a busy clinic, your priority is to see the patient for their annual physical or for their chief complaint. They don't come with domestic abuse as a chief complaint. So, something practitioners can do is screen your patients and to look for red flags.”
What are those red flags? To this end, Eapen provides some questions providers can ask themselves when seeing a patient, such as “What are some of the nonverbal signs? During your physical examination, are you seeing any signs of abuse? […] In terms of hygiene and things like that, are they well kept? Are they afraid to speak in front of their partner?” Eapen recommends providers gain familiarity with screening tools like HITS (Hurt, Insulted, Threaten, Scream) and help set the tone for the conversation. “You don't have to bring out the words domestic abuse, perpetrator and victim immediately. You can say something that normalizes the tone of what you're asking,” Eapen explains. “You can say, ‘Sometimes I see a lot of patients and there is a lot of trauma going on, so I want to make sure that you're okay.’ You know, is everything okay at home? Do you have any concerns for your safety?”
Above all, Eapen stresses the importance of aiding survivors through the empowerment process model. In an article published in the Journal for Nurse Practitioners, Eapen and co-author Diane M. Santa Maria, DrPH, MSN, RN, PHNA-BC, FSAHM, FAAN, explain that “Empowerment theory affirms that shared decision making with the individuals and groups affected by violence is more likely to positively affect change.” Through this approach, NPs can provide survivors with meaningful, power-oriented goals — and a wider support system. “You can't do it all alone,” Eapen states on the podcast. “NPs need the support of social workers — you need to be informed of the community resources and shelters that are available out there. Case manager, social worker, those are important people that would be helpful for you at that time. If a patient discloses something, validate their experience. The patient is a decision maker, so you empower them with that choice.”
Continue Your Education in Domestic Violence
Listen to episode 129 of the AANP’s official podcast, NP Pulse: The Voice of the Nurse Practitioner® to hear more from Eapen as she discusses the populations most at-risk for domestic violence and explores how to screen for and best connect with patients who are experiencing harm at home.
Afterwards, enroll in Domestic Violence: APRN Role in Survivor Advocacy Through a Trauma-Informed Approach for the opportunity to continue your learnings and earn 2.25 contact hours of continuing education credit. This discussion will delve into the different types of domestic violence, examine the disparate impacts on men and women and highlight the profound effects on survivors' physical and mental health.