Guest Editorial Breaking the silence: What emergency nurses can do about battering Marlene Jezierski, RN, BAN, Blaine, Minnesota
A lively discussion followed a recent panel presen- tation on nurs ing assessment and intervention in
cases of domestic violence. Our panel 's position was that all patients should be assessed for violence in their histories and most women should be asked about abuse. " I 'm up to here with domestic violence this, domest ic violence that," exclaimed a frustrated staff nurse. "What can one nurse possibly do when there's a pat ient with an acute myocardial infarction who needs thrombolytics on the one hand and a trauma pat ient going to surgery on the other? Now we're told we need to ask everyone about battering, and then do something about it. I simply can' t do it all!" This sea- soned, skilled, sensit ive emergency nurse reflected the opinion of several.
Understanding her frustration I reflected for a moment, then asked if she obtains blood pressures on all her pat ients and if so, why. "Sure," she replied, "to screen for hypertension." "Screening for family vio- lence is no different," I responded. "In fact, we are more likely to reach a larger population by assessing for family violence than in most routine screenings." Millions are be ing battered. Battering results in high morbidity and signif icant mortality. One survivor of domestic violence, a nurse, noted we risk negl igence when we fail to recognize signs of an acute myocar- dial infarction. She believes we are equally liable if we fail to note signs and symptoms of domestic violence.
The seriousness and scope of family violence and the need to intervene is indisputable. However, the prescribed sett ing for intervention is not as clear. Some think meaningful intervention is difficult in the chaotic ED environment. Others are not comfortable asking sensitive, probing questions. Regardless of the
Ms. Jezierski is nurse manager, Emergency Department, Unity Hospital, Fridley, Minnesota. Reprints not available from author. J ~.MERG NURS 1996;22:5-6 Copyright 9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00 + 0 18/61/71588
reasons, emergency nurses must challenge them- selves to be proactive in the stressful ED environment in which reactivity is the norm. ED intervention in cases of domestic violence is possible. Please consider my thoughts on three key questions.
What are emergency nurses' responsibilities? Is it reasonable to expect emergency nurses to spend time counsel ing victims and to make numerous phone calls in their behalf? Sometimes, yes. And in busier times, we can at least affirm and support ("You do not deserve to be hurt, you did not cause this to happen and there is help if you want it' '), and provide a phone number and a phone or call an advocate. These actions can take minutes and still give the pat ient hope, support, affirmation, and a possible exit from a violent environment.
What barriers to effective intervention do nurses face? To answer this, ask yourself some questions. Do you as the caregiver think you have to fix the problem? Do you know that you cannot? Are you also in an abusive envi ronment at home or work? Do you understand abuse is not anger or loss of control because of chem- icals, the result of a tough life or a partner who messed up, but rather a conscious decision to mainta in con- trol? Do you feel comfortable asking questions like, "These injuries are often caused when someone hits someone. Is this what happened to you?" These bar- riers can be overcome with counsel ing to deal with personal abuse histories and knowledge and insight, achieved through education.
How do you feel when the victim returns to the abusive environment? Can you support the vict im's right to make that deci- sion even though she or he may be in danger? Do you understand the vict im's fear? Battering can be com- pared with a hostage experience in which the captor rapidly gains control over the hostage. Do you know that when victims leave their battering relationships,
February 1996 S
JOURNAL OF EMERGENCY NURSING/Jezierski
i t is o f ten only after s ix to e ight a t tempts? One surv i -
vor noted that v ic t ims of domest ic v io lence do not leave a re la t ionsh ip , they escape f rom it.
It may not a lways feel l ike it, but te l l ing v ic t ims
the i r abuse mat ters to you and prov id ing encourage-
ment and hope may be the most power fu l th ing you
can do in a workday , It is one way nurses can address
soc ie ta l v io lence. If i t feels hope less , remember that
hope less i ssues have been addressed in the past .
Twenty years ago wou ld anyone be l ieve there wou ld
be smokef ree meet ings and a i rp lane f l ights? Th i r ty
years ago there was no guaranteed pub l i c whee lcha i r access . Group act ion aga ins t v io lence may also make
a d i f ference. Nurses can take the lead in dec la r ing a
morator ium on the s i lence that ex is ts in the area of
fami ly v io lence. It is t ime to act.
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