Implement innovative strategies to help at-risk patients.
The World Health Organization describes intimate partner violence (IPV) as “behavior by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse, and controlling behaviors.” The Centers for Disease Control and Prevention (CDC), which expanded this definition to include stalking, estimates that one in 10 men and one in four women experience sexual or physical violence or stalking during their lifetimes; 43 million women and 38 million men experience emotional abuse. In the mere seconds it’s taken you to read this far, an estimated 20 people in the United States have experienced IPV.
Victims of IPV don’t readily share their abuse with healthcare providers unless they’re specifically asked about it and are ready to accept help. As early as 2004, The Joint Commission required healthcare organizations to use written criteria to identify patients who may be victims of abuse. Joint Commission standards also require providers to report cases of possible abuse and neglect to external agencies according to law and regulation.
However, if a victim of IPV doesn’t freely share their abuse, how can healthcare providers identify them? As a nurse surveyor for The Joint Commission, I’ve observed the unique strategies healthcare organizations use to care for and protect patients in their communities.
For example, one healthcare organization in an affluent community shared its experience of working with a graduate nursing student doing IPV research. The student wanted to understand its prevalence in the community and provide access to resources. The organization thought they wouldn’t find anyone who had experienced IPV.
The student persisted and placed posters with IPV resource contact information “tear-a-ways” in public restrooms, starting in those closest to women’s and children’s services. The healthcare organization was shocked to find that most of the contact information was gone in a matter of days. Organization leaders reevaluated how they assess patients for IPV and subsequently offered resources at discharge.
During another survey, I watched a nurse provide a patient with discharge instructions and materials, including a tube of lipstick, post-delivery. The nurse held up the lipstick and said, “It’s important for your baby that you take care of yourself, too. This is for you when you have a quiet moment by yourself.”
I commented to the nurse later that providing cosmetics was a nice way to remind new mothers to take care of themselves. The nurse then showed me what was really inside the lipstick tube—a list of community resources including an IPV hotline number. The nurse explained that patients might not be ready to talk about or take action against IPV while in the hospital. Because women of childbearing age are at highest risk for IPV, the healthcare organization provides them with this information.
The Joint Commission provides the following additional strategies:
- Partner with local domestic violence providers for on-site training.
- Offer training to all employees who interact with patients, not just licensed healthcare providers.
- Ensure patients receive evidence-based mental healthcare when they disclose IPV.
- Explore various professional organizations’ recommendations.
- Examine whether your screening questions are specific enough and consider how providers ask the questions.
- Rely on interpreters over family members or escorts when evaluating a non-English speaking patient.
- Maintain privacy when discussing IPV.
Conversations about domestic violence, including IPV, can be difficult, but healthcare professionals must act as patient advocates and provide opportunities to seek help.
Lisa DiBlasi Moorehead is field director for the Psychiatric Hospital Accreditation Program and former associate nurse executive at The Joint Commission in Oakbrook Terrace, Illinois.
American Nurse Journal. 2023; 18(8). Doi: 10.51256/ANJ082352
References
Centers for Disease Control and Prevention. Intimate partner violence. October 9, 2021. cdc.gov/violenceprevention/intimatepartnerviolence/index.html
The Joint Commission. New Quick Safety advisory on health care addressing intimate partner violence. January 18, 2022. jointcommission.org/resources/news-and-multimedia/news/2022/01/new-quick-safety-advisory-on-addressing-intimate-partner-violence/#.YnvFc-jMI2w
