ASSESSING FOR

VIOLENCE
Conceptual Foundations

■ Domestic violence is defined by the U.S. Department of Justice Office on Violence

against Women as “a pattern of abusive behavior in any relationship that is used by
one partner to gain or maintain control over another intimate partner.”
■ Family violence is ”violent or threatening behavior, or any other form of behavior
that coerces or controls a family member or causes that family member to be fearful.”
■ Can be physical (e.g. slapping, hitting, kicking, punching, burning)
■ Emotional (e.g. threats of physical harm, financial harm, harm to child or pet, or
suicide; harassment; insults and other verbal abuse; isolation; intimidation; mind games;
throwing objects
■ Sexual (incest or rape)
Theories of Family Violence

■ Violence is “the use of physical force to harm someone, to damage property, etc.”
■ Violence tends to have a negative connotation in the context of murder, torture, or hate,
but has more of a positive connotation if associated with self-defense or acts of war.
■ Aggression is defined as “a forceful action or procedure (unprovoked attack)
especially when intended to dominate or master”
■ Positive – drive for success
■ Negative – associated with the notion of aggressive women, which violates what is
considered appropriate in gender norms in many culture.
LENORE
WALKER’S
CYCLE OF
VIOLENCE
McCue (2008)

■ Presents five theories related to domestic violence for why men batter women:
■ 1. psychopathology theory – (batterers suffer personality disorder)
■ 2. social learning theory (violence learned from childhood)
■ 3. Biologic Theory (physiologic changes from childhood trauma, head injuries, or
thorough heredity cause violent behavior
■ 4. family systems theory (violence grows through family system function)
■ 5. feminist theory (male/female inequity in patriarchal societies leads to violence.)
Types of Family violence

■ physical abuse
■ psychological abuse,
■ economic abuse
■ sexual abuse
■ abandonment
■ physical and emotional neglect
■ parental substance abuse
Physical Abuse
■ Includes pushing, shoving, slapping, kicking,
choking, punching, and burning.
■ It involves holding, tying, or other methods of
restraint.
■ The victim may be left in a dangerous place
without resources.
■ The abuser may refuse to help the victim when
sick, injured, or in need.
Psychological Abuse

• Isolation from others

• Verbal aggression
• Threats
• Intimidation
• Harassment
• Stalking
• Humiliation and defamation
Economic
Abuse
Economic Abuse
■ evidenced by preventing the victim from
getting or keeping a job
■ controlling money and limiting access to
funds, spending the victim’s money
■ controlling knowledge of family finances.
Sexual Abuse
 Sexual Abuse

■ Involves forcing the victim to:

1. perform sexual acts against his or her will,
2. pursuing sexual activity after the victim has said no, using
violence during sex, and using weapons vaginally, orally, or
anally.
■ Sexual abuse is not limited to family members or intimate
partners but can be stranger abuse such as assault and
rape as well.
■ May occur in any type of relationship, but most perpetrators
of sexual assault are known to their victims.
Categories of Family Violence

■ Intimate Partner Violence,

■ Child abuse
■ Elder mistreatment.

■ Family violence affects people of all ages,

sexes, religions, ethnicities, and socioeconomic
levels.
Intimate Partner Violence

■ Physical, sexual, or psychological harm by

a current or former partner or spouse.
■ Forms of the harm may be psychological
abuse, sexual assault, progressive isolation,
stalking, deprivation, intimidation, and
reproductive coercion.
Child Abuse
■ Any recent act or failure to act on the part of a parent
or caretaker which results in death, serious physical or
emotional harm, sexual abuse or exploitation.
■ An act or failure to act that presents an imminent risk
of serious harm.
■ Categories: Neglect. Emotional abuse, sexual abuse,
and physical abuse.
Elder Mistreatment
■ Also known as elderly abuse
■ Includes neglect, physical abuse, sexual
abuse, financial abuse, psychological abuse
(humiliation, intimidation, and threats)
Other types of Violence

■School Violence (bullying and

Punking)
■Human Trafficking
■War crimes
School Violence
■ Bullying can be defined as “unwanted aggressive behavior
among school aged children that involves a real or
perceived power imbalance that is either repeated or a
single event.”
■ Verbal (teasing, name-calling, inappropriate sexual
comments, threatening, or taunting.)
■ Social (spreading rumors, leaving someone out of a group,
discouraging others to not be friends with someone)
■ Physical (hitting, kicking, pinching, tripping, spitting,
taking or breaking others’ things.
■ Using rude hand gestures to someone
■ And/or cyberbullying (bullying via internet, text, or email)
■ The elements of this definition include: unwanted aggressive behavior; observed or
perceived power imbalance; and repetition of behaviors or high likelihood of repetition.
Hate crimes

■ Racial, especially anti-black (48.5%)

■ Sexual orientation, especially anti-gay (20.8%)
■ Religious (17.4%)
■ Ethnicity (11.1%)
■ Disability (1.4%)
■ Gender identity (0.5%)
■ Gender (0.3%)
Human trafficking
Nursing Intervention for Violence
■ A role for nurses
■ Nurses are a large group of service providers who have a
central ethic of caring and an agenda of early intervention and
health promotion in their work to improve the health status of
communities.
■ As a group of health workers, nurses traditionally have been
reluctant to consider domestic violence as a health issue,
preferring instead to consider it to be the domain of social
workers, psychologists and psychiatrists. Nurses have also
been reluctant to embrace this issue in hospital settings.
■ Despite this, nurses have an important role to play
in their work in hospital and community settings,
to assist women (and their children) who are
victims of abuse/violence in a domestic situation.

■ Evidence shows the effects of abuse/violence have

a profound impact on women's and children's
health, and that women regularly seek services
from health care workers, including nurses, for
health concerns related to this abuse/violence.
Health impact of violence
■ A recent review of international literature on
abuse/violence identified a wide range of associated
physical, neurological, psychological and psychogenic
health problems.
■ Women who have been assaulted by their partner
generally have worse heath than other women. Health
issues include chronic problems with digestion,
stomach, kidney and bladder function and headaches,
poorer pregnancy outcomes and lower birthweight
babies.
The range of barriers to disclosing domestic
violence include:
■ Fear for own safety, or safety of children or other family;
■ Denial or disbelief;
■ Emotional attachment to, or love for partner;
■ Commitment to relationship;
■ Hope the behaviour would change;
■ Shame and embarrassment;
■ Staying for the sake of the children;
■ Depression and stress;
■ Isolation;
■ Lack of faith in other people's ability to help; and
■ Belief in the value of self-reliance and independence.
Assessment
■ When assessing women, nurses should be aware that
some of the following physical signs of injuries might be
related to domestic violence:
■ Bruising in the chest and abdomen;
■ Multiple injuries;
■ Minor lacerations;
■ Ruptured eardrums;
■ Delay in seeking medical attention; and
■ Patterns of repeated injury.
■ However it is unlikely women will present with a physical injury. They
will more likely present with issues such as:
■ A stress-related illness;
■ Anxiety, panic attacks, stress and/or depression;
■ Drug abuse including tranquilisers and alcohol;
■ Chronic headaches, asthma, vague aches and pains;
■ Abdominal pain, chronic diarrhoea;
■ Sexual dysfunction, vaginal discharge;
■ Joint pain, muscle pain;
■ Sleeping and eating disorders;
■ Suicide attempts, psychiatric illness; or
■ Gynecological problems, miscarriages, chronic pelvic pain.
The woman may also:
■ Appear nervous, ashamed or evasive;
■ Describe her partner as controlling or prone to anger;
■ Seem uncomfortable or anxious in the presence of her
partner;
■ Be accompanied by her partner, who does most of the
talking;
■ Give an unconvincing explanation of the injuries;
■ Be recently separated or divorced;
■ Be reluctant to follow advice.
■ If nurses think a woman in their care may be
experiencing domestic violence, the detail of
questioning will depend on how well they know the
woman and what indicators they have observed. Nurses
should begin with broad questions, such as:

1. 'How are things at home?'

2. 'How are you and your partner relating?'
3. 'Is there anything else happening that may be
affecting your health?’
Specific questions linked to clinical
observations could include:
■ 'You seem very anxious and nervous. Is
everything all right at home?'
■ 'When I see injuries like this, I wonder if someone
could have hurt you?'
■ 'Is there anything else that we haven't talked about
that might be contributing to this condition?’
More direct questions could include:
■ 'Are there ever times when you are frightened of
your partner?'
■ 'Are you concerned about your safety or the safety
of your children?'
■ 'Does the way your partner treats you ever make you
feel unhappy or depressed?'
■ 'I think there may be a link between your illness and
the way your partner treats you. What do you think?'
How to
respond?
How to respond
■ The response of nurses to women in these circumstances can have a
profound effect on their willingness to open up or to seek help. Some
responses to assist successful communication in these circumstances
could include:
■ Listening: Being listened to can be an empowering experience for a
woman who has been abused.
■ Communicating belief: "That must have been very frightening for
you."
■ Validating the decision to disclose: "It must have been difficult for you
to talk about this." "I'm glad you were able to tell me about this today.'
■ Emphasising the unacceptability of violence: "You do not deserve to
be treated this way."
What not to say
■ Nurses should avoid responses that undermine
the woman's actions, such as:
1. "Why do you stay with a person like that?"
2. "What could you have done to avoid the
situation?"
3. "Why did he hit you?"
Assisting safety

■ It is also imperative to assist the woman by assessing

her safety and the safety of her children. To do so,
speak to the woman alone and ask her:
■ Does she feel safe going home after the appointment?
■ Are her children safe?
■ Does she need an immediate place of safety?
Assisting safety
■ Does she need to consider an alternative exit from your
building?
■ If immediate safety is not an issue, what about her future
safety? Does she have a plan of action if she is at risk?
■ Does she have emergency telephone numbers (i.e. police,
women's refuges)?
■ Help make an emergency plan: Where would she go if she had
to leave? How would she get there? What would she take with
her? Who are the people she could contact for support?
■ Document these plans for future reference.