 |
Gerbert, et. al. (1999) reported that the
literature is full of references that victims are reluctant
to disclose IPV/DV to healthcare providers and that healthcare
providers are reluctant to ask patients about IPV/DV. Most
commonly cited reasons that patients do not disclose is (Gerbert,
et al., 1999): fear of retaliation by the abuser; shame, humiliation
and denial about the seriousness of the abuse; concern about
confidentiality, especially related to law enforcement involvement.
In cases when injuries and health problems
are apparent and well documented, healthcare providers often
do not ask about IPV/DV or intervene on behalf of their patients
who experience it. One study found that only 6 percent of
physicians ask their patients about possible IPV/DV, yet 88
percent admitted that they knew they had female patients who
had been abused. Another study indicated that 48 percent of
women supported routine screening of all women, with 86 percent
stating it would make it easier to get help (Kass-Bartlesme,
2004).
Healthcare providers have said that they
do not screen for IPV/DV because they lack the necessary training
and education, time, tools, and support resources, and fear
of offending the patient; frustration with the lack of change
in the patient's situation or frustrations with the patient's
unresponsiveness to advice; and they do not feel they can
make a difference; feelings of powerlessness to "fix" the
situation; and their sense of loss of control over the patient's
decision making (Gerbert, et. al., 1999; Tjaden, P. & Thoennes,
N., 2002; Borowsky, I.W., Ireland, M., 2002; Elliott, L.,
Nerney, M., Jones, T., et al., 2002). An AHRQ-funded survey
found that many primary care clinicians, nurses, physician
assistants, and medical assistants lack confidence in their
ability to manage and care for victims of IPV/DV (Sugg, et.
al., 1999):
- Only 22 percent had attended any educational program
on IPV/DV within the previous year.
- Over 25 percent of physicians and nearly 50 percent
of nurses, physician assistants, and medical assistants
stated that they were not at all confident in asking
their patients about physical abuse.
- Less than 20 percent of clinicians asked about
IPV/DV when treating their patients for high-risk
conditions such as injuries, depression or anxiety,
chronic pelvic pain, headache, and irritable bowel
syndrome.
- Only 23 percent of physicians, nurses, physician
assistants, and medical assistants believed they had
strategies that could assist victims of IPV/DV.
|
For information regarding the specific studies referred to above,
go to http://www.ahrq.gov/research/domviolria/domviolria.htm#more.
An additional factor for nurses in the identification
of IPV/DV, is that so many nurses are victims of intimate
partner violence. Furniss (1999) reported that 38% of obstetric
nurses are or have been the victims of domestic violence.
She reported on a study by Janssen, et al.,1998 that:
- 38% of the nurses completing the survey said they
had experienced abuse;
- 27.3% said that their partners try to control them;
- 26.9% said they suffer emotional abuse;
- 22.7% are afraid of their partners;
- 14.6% have been battered;
- 8.1% have experienced sexual abuse.
|
Continue on to Barriers
to Identification of Intimate Partner Violence/Domestic Violence,
Con't.
|
|
