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JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 421 RESEARCH Domestic Violence: What Do Nurse Practitioners Think? Sharon A. Bryant, PhD Gale A. Spencer, PhD, RN INTRODUCTION Domestic violence has reached epidemic proportions in the United States. Researchers have reported that women are ten times more likely than men to be victims of intimate partner violence, and lifetime prevalence rates of male to female violence varies from 14% to 50% (Gagen, 1998; Kernic, Wolf, & Holt, 2000). It accounts for three times as many emergency room visits as car crashes, rapes, and muggings (Wilt & Olson, 1996). Moreover, most non- trauma visits to primary care settings (e.g., multiple somatic complaints or stress-related illnesses) are also associated with domestic violence (Poirier, 1997; Wolf, Kernic, Holt, Rivara, & Levy, 1999; Rodriguez, Bauer, McLoughlin, & Grumbach, 1999). Therefore, the American Academy of Nursing, and other health care provider professional organizations (e.g., the American Public Health Association and the American Medical Association) have acknowledged that violence against women is epidemic and emphasize that it should be treated like any other public health crisis (Abbott, Johnson, Koziol-McLain, & Lowenstein, 1995). Primary health care settings are one of the first places that victims of domestic violence seek care for a variety of somatic complaints that result from either acute or long-term consequences of domestic violence. Listwin (1992) estimates that domestic violence incidents result in approximately 39,000 health care office visits per year. However, because primary care set- tings have low domestic violence detection rates, this number may be under- estimated. In a study of primary care health providers, the researchers found that 1 in 20 providers correctly diagnosed injuries related to domestic vio- lence (Sassetti, 1993). Universal screening will ensure that women’s needs related to domestic violence will be met. BACKGROUND Despite increased attention to and awareness of domestic violence, health care professionals seldom identify women who are victimized by their part- ners (Quillian, 1996; Sugg, 1999; Wiist & McFarlane, 1999). Even when health care providers are knowledgeable about domestic violence, they asked only 13% of battered women whether their partners assaulted them (Fontanarosa, 1995; Parsons, Zaccaro, Wells, & Stovall, 1995). Therefore, health care providers must incorporate universal domestic violence screening into their practice. Universal domestic violence screening, as used in this study, includes asking, identifying, referring, and reporting patients who are victims of domestic violence. One aspect of universal domestic violence screening is asking screening questions of all patients. Several assessment tools have been developedto deter- mine a patient’s level of domestic violence risk, and one tool that could easily be integrated into an office visit asks only three questions (McFarlane, Parker, Soeken, & Bullock, 1992). Health care providers must ask domestic violence Purpose To examine factors that influence nurse practi- tioners’ (NPs) ability to incorporate universal domestic violence screening practices (e.g., ask- ing, identifying, referring and reporting) into their practices. Data Sources A stratified random survey of certified NPs in New York state was conducted in 1999. There were 118 family, women’s health, OB/GYN, and adult NPs in the survey. Chi-square and ANOVA were used to analyze the data. Conclusions There were significant differences in the domestic violence screening practices among women’s health, OB/GYN, adult, and family NPs. Women’s health and OB/GYN NPs were more likely to ask screening questions and identify vic- tims of domestic violence than their other NP counterparts. Implications for Practice There is a need to identify strategies that encour- age all NPs to incorporate universal domestic vio- lence screening behaviors into their practices. Key Words Domestic violence; universal screening; nurse practitioners. Authors Sharon A. Bryant, PhD, is an Associate Professor at Decker School of Nursing, Binghamton University, Binghamton, NY. Gale A. Spencer, PhD, RN, is a Professor and Director of the Kresge Center for Nursing Research at Decker School of Nursing, Binghamton University, Binghamton, NY. Contact Dr. Bryant by e-mail at [email protected].

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JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 421

RESEARCH

Domestic Violence: What Do Nurse Practitioners Think?

Sharon A. Bryant, PhD

Gale A. Spencer, PhD, RN

INTRODUCTION

Domestic violence has reached epidemic proportions in the United States.Researchers have reported that women are ten times more likely than men tobe victims of intimate partner violence, and lifetime prevalence rates of maleto female violence varies from 14% to 50% (Gagen, 1998; Kernic, Wolf, &Holt, 2000). It accounts for three times as many emergency room visits as carcrashes, rapes, and muggings (Wilt & Olson, 1996). Moreover, most non-trauma visits to primary care settings (e.g., multiple somatic complaints orstress-related illnesses) are also associated with domestic violence (Poirier,1997; Wolf, Kernic, Holt, Rivara, & Levy, 1999; Rodriguez, Bauer,McLoughlin, & Grumbach, 1999). Therefore, the American Academy ofNursing, and other health care provider professional organizations (e.g., theAmerican Public Health Association and the American Medical Association)have acknowledged that violence against women is epidemic and emphasizethat it should be treated like any other public health crisis (Abbott, Johnson,Koziol-McLain, & Lowenstein, 1995).

Primary health care settings are one of the first places that victims ofdomestic violence seek care for a variety of somatic complaints that resultfrom either acute or long-term consequences of domestic violence. Listwin(1992) estimates that domestic violence incidents result in approximately39,000 health care office visits per year. However, because primary care set-tings have low domestic violence detection rates, this number may be under-estimated. In a study of primary care health providers, the researchers foundthat 1 in 20 providers correctly diagnosed injuries related to domestic vio-lence (Sassetti, 1993). Universal screening will ensure that women’s needsrelated to domestic violence will be met.

BACKGROUND

Despite increased attention to and awareness of domestic violence, healthcare professionals seldom identify women who are victimized by their part-ners (Quillian, 1996; Sugg, 1999; Wiist & McFarlane, 1999). Even whenhealth care providers are knowledgeable about domestic violence, they askedonly 13% of battered women whether their partners assaulted them(Fontanarosa, 1995; Parsons, Zaccaro, Wells, & Stovall, 1995). Therefore,health care providers must incorporate universal domestic violence screeninginto their practice. Universal domestic violence screening, as used in thisstudy, includes asking, identifying, referring, and reporting patients who arevictims of domestic violence.

One aspect of universal domestic violence screening is asking screeningquestions of all patients. Several assessment tools have been developedto deter-mine a patient’s level of domestic violence risk, and one tool that could easilybe integrated into an office visit asks only three questions (McFarlane, Parker,Soeken, & Bullock, 1992). Health care providers must ask domestic violence

PurposeTo examine factors that influence nurse practi-tioners’ (NPs) ability to incorporate universaldomestic violence screening practices (e.g., ask-ing, identifying, referring and reporting) intotheir practices.

Data SourcesA stratified random survey of certified NPs inNew York state was conducted in 1999. Therewere 118 family, women’s health, OB/GYN, andadult NPs in the survey. Chi-square and ANOVAwere used to analyze the data.

ConclusionsThere were significant differences in the domesticviolence screening practices among women’shealth, OB/GYN, adult, and family NPs.Women’s health and OB/GYN NPs were morelikely to ask screening questions and identify vic-tims of domestic violence than their other NPcounterparts.

Implications for PracticeThere is a need to identify strategies that encour-age all NPs to incorporate universal domestic vio-lence screening behaviors into their practices.

Key WordsDomestic violence; universal screening; nursepractitioners.

AuthorsSharon A. Bryant, PhD, is an Associate Professorat Decker School of Nursing, BinghamtonUniversity, Binghamton, NY. Gale A. Spencer,PhD, RN, is a Professor and Director of theKresge Center for Nursing Research at DeckerSchool of Nursing, Binghamton University,Binghamton, NY. Contact Dr. Bryant by e-mailat [email protected].

422 VOLUME 14, ISSUE 9, SEPTEMBER 2002

screening questions at every visit regardless of whether it is a rou-tine or an interval appointment. Many providers feel that they willembarrass their patients if they ask them questions about intimatepartner violence (Sugg & Inui, 1992); however, research hasdemonstrated that women patients are not offended when healthcare providers ask them domestic violence screening questions(Rodriguez, Sheldon, Bauer, & Perez-Stable, 2001). Therefore,health care providers must become comfortable asking such ques-tions in order to save women’s lives.

Identification of domestic violence victims is an important rolefor health care providers. When health care providers identify vic-tims of domestic violence, they are communicating that domesticviolence is a problem that can be addressed in health care settings(Gagan, 1998; Neufield, 1996). Some health care providers havethe attitude that their patients are not at risk for domestic violence;they feel the need to establish that violence occurred before sug-gesting the possibility to a patient, and their fear of offendingpatients interferes with their ability to identify victims of domes-tic violence (Rodriguez et al., 2001; Sugg & Inui, 1992).Identifying patients who are experiencing domestic violencemakes clients feel that their health care provider really cares abouttheir health and safety. Misdiagnosing violence against women canlead to the initiation of inappropriate and potentially harmfultreatment that may increase the patient’s sense of entrapment andhelplessness (Fontanarosa, 1995; Poirier, 1997).

McFarlane, Christoffel, Bateman, Miller, and Bullock (1991)found that women had higher abuse disclosure rates during thenurse interview than they did with a self-report tool. Patients aremore likely to self-disclose violence when they feel that theirprovider will respond in positive and nonjudgmental ways(McFarlane et al., 1991; Wiist & McFarlane, 1999). Health careproviders can increase their rates of disclosure by interviewingwomen alone and by reiterating that all information will be keptconfidential (McFarlane et al., 1991; Poirier, 1997).

Health care providers should refer patients who are victims ofintimate partner violence to community agencies that providebattered women with shelter, counseling, and social and legalservices (Gerbert et al., 2000; Rodriguez, Quiroga, & Bauer,1996). It is a good idea for health care providers to have a com-munity resource guide that lists the domestic violence servicesavailable in the community. In prior research, health careproviders have felt reassured when they were able to connect vic-tims of domestic violence with trained domestic violence profes-sionals in the community (Gerbert et al.). After referring thepatient to support services, the health care provider should con-tinue to follow up with the patient; however, the pace of changeshould be the patient’s decision.

Battered women need trained health care providers who willinform them about their rights and refer them to the appropriatecommunity agencies; however, they do not want health careproviders to report their injuries to the police without their per-mission. Police intervention can place women at increased risk ofbeing battered. Many battered women will not seek medical ser-vices from health care professionals who inform the police prema-turely (Rodriguez et al., 1996; Worcester, 1995). Domestic vio-lence interventions should include assisting a woman in identify-

ing a personal support system, discussing the cycle of violence the-ory and providing information about local community domesticviolence resources (Quillian, 1995; Rodriguez et al.). Wiist andMcFarlane (1999) report that when health care providers integrateuniversal domestic violence screening practices with education,referral, ongoing support, and follow-up, the prevalence rate ofdomestic violence can be reduced up to 75%.

Domestic violence reporting laws differ from one state toanother. Thirteen states have enacted domestic violence report-ing laws; these states are California, Colorado, Florida, Kansas,Maine, Minnesota, Missouri, New Hampshire, Rhode Island,Texas, Vermont, and Washington. Most of these states, however,only allow for the reporting of domestic violence cases that resultin life threatening injuries and gunshot wounds (FamilyViolence Prevention Fund, 2001). While New York State has notenacted a domestic violence reporting law, it has enacted domes-tic violence training (NY Exec §575), screening (NY PublicHealth §2137) , and protocols (NY Public Health §2803)(Family Violence Prevention Fund).

The purpose of this study was to examine New York state NPs’practice behaviors regarding asking, identifying, referring, andreporting of patients for domestic violence. Few research studies ondomestic violence have focused on NPs (Gagen, 1998; Greenberg,1996). Most of the literature has focused on nurses’ and physicians’treatment of domestic violence victims in hospital-based settings,such as emergency rooms. When primary care settings are studied,physicians’ practice behaviors are most frequently the focus of thesestudies. This study is different, because it investigates the domesticviolence practice behaviors of NPs in a variety of primary care set-tings (e.g., community based clinics, family practice offices, as wellas obstetrical and gynecological offices) throughout New YorkState. In this study, nurse practitioners’ practice behaviors regardingasking, identifying, referring, and reporting of patients were exam-ined. Several questions guided this study:

How frequently do you ask domestic violence screening ques-tions?

What are some of the barriers to identifying victims ofdomestic violence?

What are some of the barriers to referring victims of domes-tic violence?

How frequently do you report victims of domestic violence? Do demographics (e.g., age, practice location, years of prac-

tice, or history of domestic violence) influence differences in theasking, identifying, referring, and reporting behaviors of NPs?

These questions allowed the researchers to discover reasonswhy NPs fail to ask, identify, refer and report victims of domes-tic violence.

METHODS

SubjectsThis project received approval from the University Human

Subjects Review Committee before the initiation of the project.The researchers used the 1999 list of New York state certifiedNPs to select a randomized sample of 300 NPs. The sample was

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 423

stratified by specialty: adult, family, obstetrics and gynecology(OB/GYN), and women’s health. These specialties were selectedbecause they provide primary care services to women across theage span. Recruitment began in June 1999 when the first ques-tionnaires were mailed, a second follow-up mailing was sent inOctober of 1999.

Of the 300 NPs sampled, 118 (39%) completed the survey.Characteristics of the study population are presented in Table 1.The sample was overwhelmingly female (100%) and White(93%). The participants ranged in age from 25 to 65 years, and49% of the NPs were between the ages 40 and 49.

Forty-nine percent of the NPs specialized in family practice,26% practiced in adult health, 6% practiced in the area ofwomen’s health, another 19% practiced in the area of OB/GYN.The majority of the NPs (39%) had practiced 4 years or less.

ProcedureThe questionnaire used for this project was adapted for NPs

from an instrument developed by the Pacific Center for ViolencePrevention to reflect the needs and concerns of primary carephysicians (Rodriguez, McLoughlin, Bauer, Paredes, &Grumback, 1999). The content of the questionnaire after adap-tation included questions regarding NPs’ attitudes concerningbarriers to asking domestic violence screening questions, identi-fying, referring and reporting victims of domestic violence, anddemographic data. Barriers to asking screening questions aboutdomestic violence were measured using a five-point Likert scale.The response choices included new patient visit, periodic check-up with injury, periodic check-up with psychosomatic com-plaints, first prenatal visit, and periodic prenatal visit. To assessthe level of the barrier for identifying and referring victims ofdomestic violence, the respondents were asked to rate the level ofeach of the barriers for identifying, referring and reportingdomestic violence (see Table 2 for individual questions). For eachstatement, respondents were asked to rate whether the barrierwas major, minor, or not a barrier.

To rate how frequently NPs respond to victims of domesticviolence, statements regarding what the victim was or should betold were identified. For each behavior, the NPs were asked toidentify how often they incorporated this behavior into their

Table 1. Demographic Characteristics of Participants(n=118) and their Experience with IntimatePartner Violence

Characteristic Frequency Percentage

Age of Women18-29 5 4 30-39 29 25 40-49 58 49 50-59 22 19 60-69 4 3

Race/ethnicity White 106 93 Black 7 6 Asian 1 .9

Clinical Specialty Adult 30 26 Family 58 49 OB/GYN 7 19 Women’s Health 22 6

Years In Pract. 1-4 46 395-9 24 2110-14 15 1315-19 13 1120-24 7 625 and over 12 10

Family Abuse Yes 28 24No 89 76

Domestic ViolenceYes 37 31No 81 69

Table 2. Barriers to Identifying and Referring Victims of Domestic Violence

Barriers to IdentifyingThe patient does not raise the issue of battering during history-takingThe patient’s language is not EnglishThe patient’s cultural norms and customs interfere with the discussion of battering The patient is accompanied by partner or children (i.e., lacks privacy)Nurse practitioners do not think they can make a difference in domestic violencePatient’s appointment times are too short for a discussion of topic

Barriers to ReferringI do not have a list of local community agencies for referralThe patient does not follow up on the referral I am hesitant to refer unless patient indicates desire for referral

424 VOLUME 14, ISSUE 9, SEPTEMBER 2002

practice. The frequency choices for each behavior were never,sometimes, often, always, and not applicable. Table 3 provides alist of behaviors.

In order to assess NPs’ reporting behaviors, seven choiceswere given of instances when domestic violence should bereported to the police whether or not there was a legal mandate.For each of the behaviors identified, respondents were asked tochoose whether they felt that a report to the police should bemade by indicating whether they strongly agree, agree, disagree,or strongly disagree with each of the examples. See Table 3 for alist of reporting behaviors.

Survey data were analyzed using SPSS® statistical package forWindows. Frequency data were stratified by practice specialty.For cross tabulations, statistical significance was determined byPearson X2 and defined as p < .05. Analysis of variance(ANOVA) was used to examine differences among specialtygroups; statistical significance was determined by F ratios anddefined as significant at the .05 level.

RESULTS

Domestic Violence Screening: Asking and Identifying Behaviors

This study analyzed relationships between NPs in differentpractice specialties and their practice behaviors related to askingscreening questions and identifying victims of domestic violence.There was a significant relationship between clinical specialtyand asking domestic violence screening questions. Nurse practi-tioners in OB/GYN practices (OB/GYNNP) and those inwomen’s health practices (WHNP) were more likely to askscreening questions than were the NPs in other specialties.Seventy-one percent of OB/GYNNPs often asked prenatalpatients about domestic violence on the first visit, as comparedto 50% of WHNP, 18% of family NPs (FNP), and 0% of adultNPs (ANP). When these groups were compared using one-wayANOVA, a significant mean difference (F=12.812, df=3, 116,p=.000) was found between groups. Results of the Scheffe’ posthoc test, to examine which groups differed, revealed that theOB/GYNNP significantly differed in asking domestic violencescreening questions from ANPs and the WHNPs significantlydiffered from the ANPs and FNPs (Table 4). The WHNPs andOB/GYNNPs were more likely to ask screening questions dur-ing periodic visits than ANPs and FNPs. Because of their prac-

tice settings, these NPs are more likely than other NPs to seewomen during their prenatal visits; they also indicated that theywere more willing to ask patients about domestic violence dur-ing their prenatal visits. Nurse practitioners in both WH and inOB/GYN identified victims of domestic more frequently thanthose in other NP specialties (FNP and ANP).

Domestic Violence: Referring and Reporting BehaviorsNo significant differences were found among or between spe-

cialty groups for referring victims of domestic violence in thisstudy. While all of the specialties agreed that they would reportdomestic violence to the police when a patient complained ofphysical abuse, when a patient’s safety is of concern, when thepatient is pregnant, and when guns are in the home, there weresignificant differences among the different clinical specialtiesregarding when to report domestic violence to the police (Table 5).

When the specialty groups were compared using one-wayANOVA, a significant mean difference (F=3.472, df=3, p=.019)was found between the groups for reporting violence when thepatient was pregnant. When the patient complained of physicalabuse, a significant mean difference was found (F=4.489, df=3,p=.005) among all the specialty groups. When there were chil-dren in the home, a significant mean difference (F=2.749, df=3,p=.046) was found among all the specialty groups. When therewere guns in the home, a significant mean difference (F=3.452,df=3, p=.019) was found among all the specialty groups. TheScheffe post hoc test, to determine which specialty practice cat-egories were significantly different, revealed that theOB/GYNNPs and ANPs significantly differed in their reportingbehaviors. The ANPs agreed at a significantly higher level thatthey would report domestic violence to the police when thepatient is pregnant (m diff=-.9064, p=.039), when the patientcomplains of physical abuse (m diff=-1.062, p=.015), when thereare children in the home (m diff=-.7635, p=.05), and when thereare guns in the home more than OB/GYNNPs (m diff=-.8857,p=.03). In addition, FNPs agreed at a significantly higher levelthan OB/GYNNPs that they would report domestic violence tothe police when there are guns in the home (m diff=-.8719,p=.02). Negative values were found due to reverse scoring.Because of their practice settings, OB/GYNNPs are more likelythan other NPs to see women on a regular basis. Thus, they mayfeel that they can monitor the woman’s risk consistently, whichmay account for their likelihood to identify and address violencebut not to report it to the police.

Prior History of Domestic ViolenceThe only demographic difference found to be of significance

in this study was that of prior history of domestic violence.Twenty-four percent of the respondents experienced violence intheir family of origin and 31% of the sample experienced inti-mate partner violence. Significant differences were foundbetween those NPs that had a prior history of violence and NPswithout a prior history of violence regarding barriers to identify-ing and reporting domestic violence to the police (Table 6).Nurse practitioners with a prior history of violence were morelikely than NPs without a history of violence to report short

Table 3. Nurse Practitioner Reporting Behaviors

Reporting BehaviorsThe patient is pregnantThe domestic violence leads to hospitalizationThe patient has obvious physical abuseThe patient has presented multiple times

with complaints of physical abuseThere are children in the home

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 425

patient appointments as a barrier to identifying victims ofdomestic violence. In addition, NPs with a prior history of vio-lence were more likely to agree to report domestic violence to thepolice when a patient’s safety is of concern than NPs without aprior history of violence.

DiscussionThere were significant differences between and among the

domestic violence practice behaviors (asking, identifying, andreporting) of WHNPs, OB/GYNNPs, ANPs, and FNPs. TheWHNPs and OB/GYNNPs were more likely to ask domesticviolence screening questions and to identify victims of domesticviolence than were FNPs and ANPs. Domestic violence screen-ing questions and identification of domestic violence victimsoccurred most frequently during the first prenatal and subse-quent prenatal visits. This finding suggests that WHNPs andOB/GYNNPs are aware of the pregnant woman’s increased riskof experiencing violence during their pregnancy; they are also theNPs that most frequently care for pregnant women and thushave the most opportunity to incorporate these screening behav-iors into their practice (Krulewitch, Pierre-Louis, de Leon-Gomez, Guy, & Green, 2001).

Reporting domestic violence to the police is a very controver-sial issue, particularly when health care providers report violenceto the police without patients’ knowledge and approval.Women’s health and OB/GYNNPs were more likely to disagreewith reporting violence to the police than ANPs and FNPs.These findings are interesting because ANPs and FNPs were lesslikely to ask domestic violence screening questions and identifyvictims of domestic violence. This suggests a contradiction inreporting behaviors. Although ANPs and FNPs agree to reportdomestic violence to the police, they are less likely to incorporate

screening behaviors (e.g., asking and identifying) into their prac-tice. The OB/GYNNPs indicated that they were more willing toask patients about domestic violence during their prenatal visits,but appear to be conflicted about reporting domestic violence tothe police. This suggests that they recognize that the tenuousrelationship between a health care practitioner and a patient canbe harmed if health care providers report violence prematurely tothe police without the patient’s approval. Furthermore, they mayfeel that they put the patient at greater risk for violence whenthey report prematurely.

Nurse practitioners with a prior history of intimate partner orfamily violence differed in reporting barriers to identifying victimsof domestic violence and reporting violence to the police. Thosewho had a prior experience with violence recognize that it takestime for a patient to feel comfortable disclosing violence to a healthcare provider. Short appointment times only allow the health careprovider to focus their attention on the patient’s complaint and donot provide the time needed to screen (ask, identify, refer andreport) for domestic violence. Moreover, NPs with a prior historyof violence know that reporting violence to the police can place apatient’s life in jeopardy. The police need to be involved when apatient is ready and has a firm safety plan in place.

There are several limitations to this study. First, it cannot begeneralized to all NPs because only New York State NPs were eli-gible to participate in the study. This study had a low responserate which might be due to several reasons: The survey was con-ducted by mail, contained sensitive material which may havetriggered uncomfortable feelings in the NP, and because manypeople do not open unsolicited mail.

In conclusion, this study revealed that additional strategiesneed to be developed to encourage NPs to incorporate asking,identifying, referring, and reporting domestic violence behaviors

Table 4. Clinical Specialty by Asking Screening Questions and Identifying Victim of Domestic Violence

ANP FNP WHNP OB/GYNP p(n=30) (n=58) (n=22) (n=7)

Asking screening questions during first prenatal visit .000Often/Always 0 18 50 71Sometimes 3 11 23 0Never 7 9 0 29N/A 90 62 27 0

Asking screening questions during periodic visits .000Often/Always 3 14 27 14Sometime 0 14 37 72Never 7 9 9 14N/A 90 63 27 0

Identified a domestic violence patient .01Yes 57 83 91 86No 43 17 9 14

* p values were derived by Pearson X2

426 VOLUME 14, ISSUE 9, SEPTEMBER 2002

Table 5. Clinical Specialty by Reporting Domestic Violence to Police

ANP FNP WHNP OB/GYNP p(n=30) (n=58) (n=22) (n=7)

Pregnant patient .01Strongly Agree 62 43 47 29Agree 38 45 24 29Disagree 0 10 29 29Strongly-Disagree 0 2 0 14

When patient complains ofphysical abuse .04Strongly Agree 63 43 57 29Agree 37 38 29 14Disagree 0 16 14 43Strongly Disagree 0 3 0 14

When patient’s safety isof concern .01Strongly Agree 73 60 71 43Agree 23 35 10 14Disagree 4 3 14 29Strongly Disagree 0 2 5 14

When guns are in the home .01Agree 33 26 29 0Disagree 0 2 0 14Strongly Disagree 4 5 9 43

* p values were derived by Pearson X2

Table 6. Prior History of Intimate Partner Violence Barriers to Identification and Reporting Domestic Violence to Police

Domestic Violence Domestic Violence p*Yes No(n=37) (n=81)

Barriers to Identification of DV Victim

Appointment Time Too Short .04Major Barrier 30 20Minor Barrier 32 58No Barrier 38 22

Reporting domestic violence to policeWhen patient’s safety is of concern .03

Strongly Agree 84 56Agree 11 32Disagree 2 9Strongly Disagree 3 3

* p values were derived by Pearson X2

JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS 427

into their practice. While this project suggests that NP specialtygroups need to be targeted differently, all NP educational pro-grams must include domestic violence screening (asking, identi-fying, referring and reporting) into the curriculum.

Women’s health and OB/GYNNPs appear to be more willingto practice domestic violence screening behaviors in their spe-cialty practices; however, this study suggests they are less likely torefer victims of domestic violence to support agencies and reportvictims of domestic violence to the police. While this findingneeds further investigation, these specialty groups may needmore education on referral sources, such as shelters, advocacyoffices and safe houses located in the community. They also mayneed to develop working relationships with police departmentsand with police officers who specialize in domestic violence intheir community. These topics should be presented at NP coali-tion dinners and meetings on an annual basis.

While ANPs and FNPs were more likely to agree to reportdomestic violence to the police, this study found that these providersmay need assistance with strategies to incorporate the domestic vio-lence screening behaviors (e.g., asking, identifying, and referring)into their practice. It appears that ANPs and FNPs are more hesitantto ask and identify victims of domestic violence in their practices.While these practices may see an older patient group than theOB/GYNNP, they must recognize that these patients are also at riskfor domestic violence and require screening on a regular basis. Thecoalition meetings and dinners for these groups would also be anappropriate venue for domestic violence education.

Since the prevalence of domestic violence is increasing, weneed to evaluate the domestic violence educational modulesdeveloped for NPs and to offer more continuing education cred-it for programs that teach health care providers strategies forimproving domestic violence screening. Since all NPs arerequired to take continuing education for recertification, thiswould be an excellent way to increase NPs’ knowledge andexpertise regarding domestic violence.

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