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Case Study
1. Roseanne
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Roseanne is rushing to get ready for work. She finishes helping 3 year old Matthew get dressed and gives him some breakfast. She grabs the baby from her crib and a shooting pain stabs her in the right shoulder. With the pain comes the memory of last night. Roseanne's husband Jack got home late last night-he had been drinking and he was in a foul mood. He finally went to bed-but not before berating Roseanne, as usual, and slapping and punching her multiple times. She has bruises on her face that her makeup can barely hide. She touches up her makeup one last time before dropping off both Matthew and the baby with her mother.
Her mother knows that it's been difficult for Roseanne, but she doesn't know how bad it's gotten. Since Roseanne was pregnant with 5 month old Tara, she has been punched, kicked and sexually victimized repeatedly by her husband. It has become a routine part of her life. While driving to work, Roseanne starts crying. She tries to reapply some more makeup to cover the bruises as she rushes onto the unit. Roseanne is a neonatal nurse.
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Roseanne is like so many American women; she is the victim of intimate partner violence/domestic violence (IPV/DV). IPV/DV is actual or threatened physical or sexual violence or psychological and emotional abuse directed toward a spouse, ex-spouse, current or significant other, or current or former dating partner. Intimate partners may be heterosexual or of the same sex; sexual intimacy is not a requirement in this definition (CDC, 2013).
IPV/DV is widespread in the US-indeed it is rampant worldwide. According to the National Coalition Against Domestic Violence (NCADV), one in four women report that they have been physically assaulted or raped by an intimate partner (NCADV, 2007).
Estimates, generally considered very conservative, are that 1.3 million women are victims of IPV/DV (NCADV, 2007a). If one compares this estimate of women victims to the total number of females in the US (157 million in 2010), it is clear that the estimated number of 1.2 million women is quite low.
According to the CDC (2011), each year, women experience about 4.8 million intimate partner related physical assaults and rapes. Men are the victims of about 2.9 million intimate partner related physical assaults.
It's important for victims of IPV/DV to know they are not alone (NCADV, 2014; USDHHS, 2011a):
- Nearly 25 percent of U.S. women have been raped or physically assaulted by an intimate partner at some point in their lives;
- Nearly 20 people per minute are victims of physical violence by an intimate partner in the US; in one year this comes to more than 10 million victims;
- Almost 1 in 3 women and 1 in 4 men have experienced some form of physical violence from an intimate partner within their lifetime;
- More than 1 million women are stalked by partners each year;
- 19.3 million women and 5.1 million men in the United States have experienced stalking in their lifetime. 66.2% of these female stalking victims reported stalking by a current or former intimate partner.
- Physical and psychological abuse is connected to chronic health problems such as gastrointestinal disorders, chronic pain syndrome, depression and suicidal behavior;
- Abused women are six to eight times more likely to use healthcare services than non-abused women.
In Florida, in 2010, 113,378 crimes of domestic violence were reported to Florida law enforcement agencies, resulting in 67,810 arrests. During fiscal year 2010-2011, Florida's certified domestic violence centers provided 477,489 nights of emergency shelter to 15,789 survivors of domestic violence and their children. Advocates created 87,474 tailored safety plans, provided a total of 484,950 hours of outreach and counseling services, and answered 130,393 domestic violence hotline calls from individual seeking emergency services, information, and safety planning assistance (FCADV, No Date).
Many more survivors of domestic violence are not reporting their abusers to the police or accessing services at domestic violence services due to reasons such as shame, fear, or being prevented from doing so by their abusers. For this reason, the true extent of abuse nationally and in Florida may never be known (FCADV, No Date).
Unfortunately, when victims seek medical care, healthcare
providers often do not screen for and identify IPV/DV. Some
studies have shown that approximately 70 to 81 percent of
survivors of abuse want their healthcare professionals to
ask them about domestic abuse during their appointments (USDHHS, 2011a). The purpose of this course is to assist healthcare
providers to intervene more effectively in identifying and
treating victims of IPV/DV.
Conceptualizing IPV/DV as a public health issue helps one
to recognize that this issue impacts multiple domains (relational,
financial, education, employment, law enforcement/legal) in
the life of the individual, family, community and social in
general. Healthcare providers have long supported the conceptualization
of IPV/DV as a public health issue through:
- Identifying the problem (definitions, frequency, prevalence,
injuries, death),
- Identifying risk factors and protective factors,
- Developing and testing strategies (such as the use of
best practice and evidence-based guidelines), and
- Assuring widespread adoption of the strategies.
The purpose of this course is to provide healthcare providers
with current information about IPV/DV, in order to support
greater identification and intervention of IPV/DV in the healthcare
setting.
For the purposes of this course the term intimate partner
violence/domestic violence (IPV/DV) will be used. The course
will also use the pronouns "she" and "her" in relation to
victims of IPV/DV and "he" or "him" for perpetrators. The
learner is reminded that although statistically more women
are abused by men, this violence can also occur at the hands
of women towards their male partners, and among same-gender
partners.
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