Intimate Partner Violence (IPV)

1. Intimate Partner Violence (IPV) Chapter 18

2. Intimate Partner Violence (IPV) • Current or former emotional, psychological, physical, or sexual abuse between partners in an intimate relationship • Domestic violence is number one cause of ED visits by women • Up to 37% of women are battered

3. Characteristics of IPV • Battered partner • Lives in terror of next abusive event • Feelings of powerlessness, low self-esteem • Becomes afraid not only for self but also children • Common for social isolation to occur • Batterer • Violence is a learned behavior • Low self-esteem, poor impulse control, and limited tolerance for frustration as well as lack of control • Lack of guilt and unconcern about behavior • Extremely possessive, pathologically jealous, believe in male supremacy

4. Cycle of Violence • Tension-building phase • Abuser becomes edgy, verbally abusive • Victim feels tense, afraid, like “walking on eggs” • Serious battering phase • Abuser becomes unbearable; violence occurs • Victim may try to cover up the injury or may look for help • Honeymoon phase • Abuser displays loving behavior, makes promises to change • Victim becomes trusting, hoping for change

5. Nursing Process: Assessment Guidelines • Signs of abuse: burns, bruises, scars, wounds in various stages of healing • Victim may present with high anxiety and stress, complain of somatic symptoms • Questions to ask • Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, who? • Do you feel safe in your current relationship? • Is there a partner from a previous relationship who is making you feel unsafe now? • Always ask if children are also being hurt

6. Nursing Process: Diagnosis and Outcomes Identification • Common nursing diagnoses • Risk for violence, Risk for injury, Acute/Chronic pain, Risk for trauma, Risk for self- or other-directed violence, Social isolation, Powerlessness, Disabled family coping • Outcomes identification • Most important outcome is to see the woman opt for safe environment for self and children • Realistically, leaving the abuser is not usually the decision made by the woman; therefore, referrals for safe houses, hotlines, and support groups are important

7. Nursing Process: Planning and Implementation • Planning • Ensure that victim has a basic safety plan, including how to get out of the house, movement to safe location, bags packed with necessities, code word to use for help • Implementation • Ensure patient receives medical treatment, is interviewed in private, and understands legal rights

8. Guidelines for Intervention in IPV for the Emergency Department • Ensure medical attention provided • Interview patient in private • Assess in nonthreatening manner information about: sexual abuse, chemical abuse, thoughts of suicide or homicide • Encourage patient to talk about incident, and carefully listen • Assess if patient has safe place to go • Identify if patient wishes to press charges and facilitate this process • If patient not ready to take action, refer to community resources