E D I T O R I A L

Violmce: An Epidemic mat’s Right at Home

rime-and the fear of crime-are part of our lives. Security has become a growth industry,

and many urban employers offer crime prevention pro- grams. For women, however, the greatest risk for vio- lent assault is right at home. The threat is not from strangers, but from intimates.

Domestic violence against women is a timeless and worldwide phenomenon. In reviewing the litera- ture, Martins, Holzapfel, and Baker (1992) learned that female Egyptian mummies, 2,000-3,000 years old, had an incidence of fractures 30-50% higher than the males. Nineteenth-century English Common Law permitted husbands to punish their wives by beating them, although the “rule of thumb” restricted men to using a stick no wider than their thumb.

At least 30 of every 1,000 women are physically abused by their male partners each year in the United States (American Academy of Nursing Expert Panel on Violence, 1993). Canadian studies report a 10-12.5% incidence rate for wife abuse-a figure that includes physical, emotional, psychologic, sexual, and eco- nomic abuse; United States studies report rates of 26- 29% (Martins, Holzapfel, & Baker, 1992).

Violence is not just a police and judicial problem, it is a public health problem. Abused women tend to have poor health, suffer chronic pain and depression, attempt suicide, have addictions, and experience problem pregnancies in greater numbers than women who are not abused. Victims of abuse use a dispropor- tionate share of health-care services, including more emergency room, primary care, and mental-health vi- sits than nonvictims (Plichta, 1992).

Although abuse of women is prevalent, and many of the victims seek care for injuries, nurses and physi- cians routinely fail to detect abuse. Plichta (1992) notes that even when clinicians diagnose the abuse, they have difficulty addressing the problem: “Woman abuse is a unique health-care problem in that its etiol- ogy lies outside of the woman (i.e., is caused by a violent male), and its solution involves more nonmed-

ical components (such as the legal and welfare sys- tems) than medical ones” (p. 159).

Battering usually increases both in frequency and severity over time. It may begin with a slap and end with a homicide (Martins, Holzapfel, & Baker, 1992). Therefore, early identification and intervention are crucial to curtail further violence.

Knowledgeable health-care workers can screen women and intervene in abusive situations. Screening for abuse is both effective and feasible. Health-care workers can develop and implement protocols for de- tecting abuse. Techniques that help women disclose abuse include questioning the woman alone in a pri- vate office and asking direct, simple questions. Plichta (1992) suggests a question such as “It is not uncom- mon for a husband to hit a wife: Has this ever hap- pened to you?”

Once abuse is detected, more information is needed. Ask the women whether or not she is in any present danger. Is there a gun in the house? Are there children at risk? Does the woman think that she and her children can leave the violent situation? Always discuss an exit plan for the woman and the children. Identify community agencies that specialize in family violence and make referrals as needed.

Some communities have gone beyond providing intervention for troubled families to providing vio- lence prevention programs (White, 1992). Their goal is to establish a “no violence” standard in the public mind. The effort is modeled on programs, such as Mothers Against Drunk Driving, which have success- fully changed public behavior. Violence prevention strategies in the community can be controversial, how- ever. Some people advocate censoring violence against women in the media; others do not. Some peo- ple want education about sexual victimization offered in the schools; others do not. Everyone, however, agrees on the goal-a cultural norm that violence against women is unacceptable.

Karen B. HaUer, RN, PhD Editor

References

American Academy of Nursing (AAN) Expert Panel on Vio- lence. (1993). Violence as a nursing priority: Policy im- plications. Nursing Outlook, 42, 83-92.

Martins, R., Holzapfel, S., & Baker, P. (1992). Wife abuse: Are we detecting it? Journal of Women’s Health, 2(1),

Plichta, S. (1992). The effects of woman abuse on health- care utilization and health status: A literature review. Women’s Health Issues, 2, 154-163.

White, C. (1992, Fall). When intervention isn’t enough. Opening Doors, pp. 4-5.

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July/August 1993 J O G N N 309