Although domestic violence frequently occurs within the private realm, it’s not a private matter.
Domestic violence can involve physical, sexual, and psychological injuries of intimate partners or family members. It affects people of all ages and socioeconomic statuses, yet disproportionately affects historically marginalized groups, such as women of color. The ramifications of domestic violence aren’t limited to the individuals victimized directly, but also spread across communities and trickle down through generations.
How legal systems respond—or don’t—impacts health outcomes.
Legislative and judicial systems shape the intimate relationships where domestic violence occurs. It takes place within legal constructs, like marriage and divorce, and is deeply related to regulated aspects like reproduction, parenting, and family structure. Much of what constitutes “domestic violence” are criminal acts, such as physical and sexual abuse. And many aspects of seeking safety from domestic violence occur within a legal context. Safety planning also involves asking for help from law enforcement or the courts, such as through civil protective orders or family courts. However, even acts of abuse not categorized as criminal create cascading negative consequences for health. This makes it imperative that we address domestic violence through policy work.
Policy is a public health intervention. We must dismantle barriers to health and safety embedded in existing policies and educate decision-makers across governmental branches, as their judgments directly impact the health of people and communities for generations. Historically, because individuals experiencing domestic violence frequently present to healthcare settings, nurses have been one of their first points of contact. Nurses become crucial partners in responding to the issue.
Thus, a response to domestic violence, including improving safety and increasing opportunities for survivor healing, requires that nurses address domestic violence through policy in addition to caring for the individual survivors at the bedside or in clinics.
Nurse advocacy
One recent example of nurse-led advocacy at the Johns Hopkins School of Nursing are the efforts of Hopkins nurses and researchers in the Supreme Court case, U.S. v. Rahimi, which was decided in June 2024. The court ruled 8 to 1 to uphold the constitutionality of a federal law that prevents people with domestic violence protection orders from possessing firearms. Research shows that the mere presence of firearms in a home where domestic violence has occurred significantly increases the risk of lethality, so this 30-year-old law has and continues to save lives.
In the U.S. v. Rahimi case, students and faculty at the Johns Hopkins School of Nursing contributed to amicus curiae briefs filed with the U.S. Supreme Court. Katie Spearman, a PhD candidate, helped draft an amicus brief focusing on the harms to children from domestic abusers with access to firearms. In addition, faculty members—including Dr. Michelle Patch, Dr. Kamila Alexander, and Dr. Jacquelyn Campbell—contributed to separate amicus briefs. These documents, developed together with other outside experts and national professional organizations, informed the justices on research and clinical practice evidence regarding domestic violence and firearm access (with implications for morbidity and mortality) to aid them in their decision-making process.
This U.S. Supreme Court case is just one of the latest examples of nurses’ critical role in promoting healing policy. It emphasizes the holistic impact nurses make by addressing domestic violence through policy, in addition to their work caring for individual survivors directly. At Johns Hopkins, nurses advocate with support from the Institute for Policy Solutions, which champions the translation of nurse-led research into policy.
Many other avenues for domestic violence advocacy are available to nurses, such as raising awareness through protests, media interviews, testifying in legislative bodies, and petitions. Research is significant as well, and students and faculty regularly lead and contribute to projects that impact policy. For example, Professor Jacquelyn Campbell, PhD, RN, FAAN, created the Danger Assessment, a gold standard instrument that people experiencing domestic violence can use to assess their lethality risk. The tool has driven national policy, been cited in four National Academy of Medicine reports, and used by frontline healthcare and law enforcement professionals in 49 states and internationally.
Assistant Professor Michelle Patch, PhD, APRN-CNS, DF-AFN, FAAN, has focused significant effort on understanding intimate partner strangulation. Her evidence-based testimony before the Maryland General Assembly, including data from her own research, supported the passage of crucial legislation to make strangulation a felony offense. Other strangulation research publications by Drs. Patch and Campbell have been referenced by the U.S. Government Accountability Office’s Report to Congressional Committees (“Domestic Violence: Improved Data Needed to Identify the Prevalence of Brain Injuries among Victims,” 2020, GAO-20-534) and influenced international policy, including citations in the Tasmanian sentencing guideline recommendations and noted as “Key Literature” in Australia’s Domestic and Family Violence Bench Book.
Nursing, both as a profession and as individuals, plays a crucial role in promoting healing policies and stands at the forefront of change. Through our advocacy, research, and collaboration, nurses are both caregivers and catalysts for positive, transformative global change. At the Johns Hopkins School of Nursing, our ongoing efforts underscore our deep and lasting commitment to creating a safer, more equitable, and just world.
Michelle Patch, PhD, APRN-CNS, DF-AFN, FAAN is an assistant professor and Kathryn Spearman, a PhD candidate at Johns Hopkins School of Nursing.
