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Are We Asking or Avoiding Questions about Domestic Violence?

Posted Nov 03 2008 9:02pm

Nurses have an opportunity, or, more accurately, an obligation, to make a difference in curbing domestic violence. Doing so requires only a simple action—just ask. I see two doctors regularly, usually once or twice a year for routine exams. At each visit I am asked a basic set of questions regarding my use of tobacco, seat belts and other lifestyle matters. I’ve never been asked if I am a victim of domestic abuse.

The incidence of domestic violence is such that it’s considered a public health pandemic by experts in medical ethics. It’s more prevalent among women than many medical conditions for which doctors regularly check, yet, a recent nationwide study involving 5,000 women found that only seven percent had ever been asked by a medical professional about domestic abuse.

Ideally a woman should be questioned in private, with no family members present, as part of a routine medical history. Although many women, even when asked, will deny they suffer abuse, they will remember they were questioned and may later—even years later—ask for help. Just asking the question often plants a seed for change.

A major report issued seven years ago by the Institute of Medicine, which advises the federal government, determined that health workers receive little or no training in the area of domestic violence. The report called upon the Department of Health and Human Services to establish centers to educate the medical community regarding the facets, implications and inquiry of such violence. Unfortunately, the recommendations were released on September 11, 2001 when the nation was consumed with the immediate aftermath of the terrorist attacks. The report was understandably pushed aside at that time but no action has been taken since and it’s high time something be done.

Meanwhile, nurses in offices, clinics and emergency rooms need to be more vigilant, attentive and proactive. Don’t dodge an uncomfortable subject. When you see bruising on a child you’re mandated to rule out child abuse. When you see bruising on an adult you also need to ask the tough questions. Even when there is no visible evidence or apparent reason to ask, you should ask. Although we’re not necessarily qualified to solve the problem, should the patient divulge there is one, we can and should be armed with contact information for safe houses for women, the domestic violence unit of the police department and other social agencies that deal with issues of abuse.

What are your opinions on the subject? Are any of you already asking? If so, I’d like to hear from you. If not, why not?

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