Guest Editorial Breaking the silence: What emergency nurses can do about battering Marlene Jezierski, RN, BAN, Blaine, Minnesota

A lively d i scuss ion followed a recent pane l presen- ta t ion on nu r s ing a s s e s s m e n t and in te rven t ion in

cases of domes t ic violence. Our pane l ' s posi t ion was tha t all pa t ien t s should be assessed for violence in their histories and mos t w o m e n should be asked abou t abuse. " I 'm up to here wi th domest ic violence this, domes t i c violence that ," excla imed a frustrated staff nurse. "What can one nurse possibly do w h e n there ' s a pa t i en t wi th an acu te myocardial infarct ion who needs thrombolyt ics on the one hand and a t r auma pa t i en t go ing to surgery on the other? Now we ' re told we n e e d to ask everyone abou t bat ter ing, and then do some th ing abou t it. I s imply can ' t do it all!" This sea- soned, skilled, sens i t ive e m e r g e n c y nurse reflected the opin ion of several.

U n d e r s t a n d i n g her frustrat ion I reflected for a momen t , t hen asked if she ob ta ins blood pressures on all her pa t i en t s and if so, why. "Sure," she replied, "to sc reen for hyper tens ion ." "Sc reen ing for family vio- l ence is no different," I responded. "In fact, we are more likely to reach a larger populat ion by a s ses s ing for family violence t h a n in mos t rout ine sc reen ings . " Millions are b e i n g bat tered. Bat ter ing results in h igh morbid i ty and s igni f icant mortality. One survivor of domes t ic violence, a nurse, no ted we risk neg l igence w h e n we fail to recognize s igns of an acu te myocar- dial infarction. She bel ieves we are equally liable if we fail to note s igns and symptoms of domest ic violence.

The ser iousness and scope of family violence a nd

the need to in te rvene is indisputable . However, the prescr ibed se t t ing for in te rven t ion is not as clear. Some th ink mean ingfu l in te rven t ion is difficult in the

chaot ic ED envi ronment . Others are not comfortable ask ing sensi t ive, p rob ing quest ions . 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, e me r ge nc y nur ses mus t chal lenge them- selves to be proactive in the stressful ED e nv i r onmen t in which react ivi ty is the norm. ED in te rvent ion in cases of domest ic violence is possible. Please consider my thoughts on three key quest ions.

What are emergency nurses' responsibilities? Is it reasonable to expect e me r ge nc y nurses to spend t ime counse l ing vic t ims a nd to make numerous phone calls in their behalf? Sometimes, yes. A nd in bus ier t imes, we can at least affirm and support ("You do not deserve to be hurt, you did not cause this to h a p p e n and there is help if you w a n t it' '), and provide a phone n u m b e r a nd a phone or call an advocate. These act ions can take m i n u t e s and still give the pa t i en t hope, support, affirmation, and a possible exit from a

violent envi ronment .

What barriers to effective intervention do nurses face? To answer this, ask yourself some quest ions. Do you as the caregiver th ink you have to fix the problem? Do you know that you canno t? Are you also in an abus ive e n v i r o n m e n t at home or work? Do you u n d e r s t a n d abuse is not anger or loss of control because of chem- icals, the result of a tough life or a par tner who m e s s e d up, bu t rather a consc ious decis ion to ma in t a in con- trol? Do you feel comfortable asking ques t ions like, "These injuries are often caused w h e n someone hits someone. Is this wha t h a p p e n e d to you?" These bar- riers can be overcome wi th counse l ing to deal wi th personal abuse histories a nd knowledge and insight, ach ieved through educat ion .

How do you feel when the victim returns to the abusive environment? Can you support the v ic t im ' s right to make that deci- sion even though she or he ma y be in danger? Do you u n d e r s t a n d the v ic t im 's fear? Batter ing can be com- pared wi th a hostage exper ience in which the captor rapidly ga ins control over the hostage. Do you know that w h e n vic t ims leave their ba t te r ing relationships,

February 1996 S

JOURNAL OF EMERGENCY NURSING/Jezierski

i t is o f t e n on ly a f t e r s ix to e i g h t a t t e m p t s ? O n e s u r v i -

vo r n o t e d t h a t v i c t i m s of d o m e s t i c v i o l e n c e d o n o t

l eave a r e l a t i o n s h i p , t h e y e s c a p e f rom it.

I t m a y n o t a l w a y s fee l l ike it, b u t t e l l i ng v i c t i m s

t h e i r a b u s e m a t t e r s to y o u a n d p r o v i d i n g e n c o u r a g e -

m e n t a n d h o p e m a y b e t h e m o s t p o w e r f u l t h i n g y o u

c a n d o in a w o r k d a y , It is o n e w a y n u r s e s c a n a d d r e s s

s o c i e t a l v i o l e n c e . If i t f ee l s h o p e l e s s , r e m e m b e r t h a t

h o p e l e s s i s s u e s h a v e b e e n a d d r e s s e d i n t h e p a s t .

T w e n t y y e a r s a g o w o u l d a n y o n e b e l i e v e t h e r e w o u l d

b e s m o k e f r e e m e e t i n g s a n d a i r p l a n e f l i gh t s ? T h i r t y

y e a r s a g o t h e r e w a s n o g u a r a n t e e d p u b l i c w h e e l c h a i r

a c c e s s . G r o u p a c t i o n a g a i n s t v i o l e n c e m a y a l so m a k e

a d i f f e r e n c e . N u r s e s c a n t a k e t h e l e a d i n d e c l a r i n g a

m o r a t o r i u m o n t h e s i l e n c e t h a t e x i s t s i n t h e a r e a of

f a m i l y v i o l e n c e . It is t i m e to ac t .

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