Running head: ADULT DOMESTIC VIOLENCE

Policy White Paper on Adult Domestic Violence

Crystal Buck
Dixie State University

ADULT DOMESTIC VIOLENCE

Policy White Paper on Adult Domestic Violence

Domestic violence or intimate partner violence (IPV) as endorsed by the World Health
Organization is behavior within an intimate relationship that causes physical, sexual, or psychological
harm, including acts of physical aggression, sexual coercion, and psychological abuse and controlling
behavior (Modi, Palmer & Armstrong, pp 1). Every year 1.3 to 5.3 million women in the United States
alone experience IPV in one form or another. IPV results in exorbitant physical, emotional, and
economic costs, and death is not an uncommon result (Karakurt, Smith & Whiting, pp 1). In a 2011
census 1,026 women were killed by intimate partners.
IPV affects both men and women however women experience IPV in greater volume and so this
paper will focus on aggression and violence against women. Studies show a greater prevalence of
physical health problems, financial need, substance abuse, and depression/suicide attempts in abused
women compared with women who have never experienced abused. This translates to a significant
economic financial burden in the form of healthcare, housing, advocacy, legal and other support
services. IPV not only effects the victim but also the lives of her children. Studies have shown that
children exposed to abuse are at the highest risk for carrying violent behavior from one generation to
the next. One of the main problems that surround the issue of IPV is the continuity of care after abuse
has been disclosed. This paper will focus on options for resolving the problems of addressing abuse and
continuity of care for those affected.
Policy
Although different areas of health care are not created and set up specifically to deal with
domestic violence issues they are in a great place to discover and begin to address the concern. Within
healthcare systems, the emergency department, family medicine clinic, and pediatrics clinic have
considerable potential to function as violence prevention centers. These settings have skilled clinicians
who can, with appropriate training and support from an integrated system of care, ask all women about

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domestic violence; assess and treat injuries and illnesses related to domestic violence; and provide
support including safety planning, legal advocacy, risk assessment, and documentation. They can
furthermore offer preventive education about healthy relationships, as well as provide professional and
community education (Ambuel et al, pp 834).
Currently pediatric abuse situations are mandatory reportable. Adult abuse situations are not
unless the adult is considered a dependent. This places adults, women specifically, in a tenuous
situation where they have to pursue the reporting them selves in order to get assistance. Women are
generally in one of 3 stages: ready to change, focused on negative symptoms/repercussions, and
focused on feelings of guilt and self-blame. Victims of violence are likely to feel guilt, shame, and
selfblame for being abused. Unfortunately, this can contribute to a vicious cycle as victims who have
negative self-images are less likely to take steps to avoid or exit abusive relationships. Further, selfesteem damage can occur if acquaintances or professionals blame the victim for not preventing her
abuse (Karakurt, Smith & Whiting, pp 694-695). Because of this it is extremely important for
providers and all those in position to provide care need to have additional education and training to
better serve this population. Currently there are policies in place that mainly state specific steps to take
such as contacting police for reporting as well as contacting specially trained personnel to interview
and address the concerns. Having special trained personnel to deal with the situation is great once they
get there and once the person is in that place. The difficulty becomes in making the patient feel safe
enough to disclose the IPV to the initial providers as well as be willing to go forward in investigating
possible resources and assistance. Because many women try to hide or minimize the violence they
experience, staff should create open and safe environments for disclosing (Morris, pp 21)
Wilson and Websdale spoke of the need for policies set in place that provide professionals with
clear referral pathways for those who experience domestic abuse. The initial caretakers need to receive
training on enhancing their knowledge and ability to address domestic violence. Studies have shown

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that there are times potential abuse is disclosed but because of discomfort and lack of knowledge on the
providers part the concern is bypassed and left unaddressed.
With IPV the victim is often concerned about repercussions should their abuser discover them
telling the truth or if the victim should attempt to leave to a safer place. Most cases that end in death at
one point during the abuse the victim was in a position to receive assistance and either did not have
their needs addressed or did not have the resources and support they needed to truly remove themselves
from the situation. There is a need for policies to be able to monitor and supervise treatments for
victims that are further reaching than sending them home with resources and options. Most women sent
home will not pursue the course on their own. A large part of this is lack of knowledge of resources
available and how they can really help as well as victims believing they will be in trouble for reporting.
A whistle blower type of policy for their protection needs to be created so that victims can feel they are
safe to report the abuse without it turning on them. Especially those from lower economic, or
immigrant status. Senator Patty Murray of Washington stated Where a person lives, who they love, or
what their citizenship status may be should not determine whether or not their perpetrators are brought
to justice.(Modi, Palmer & Armstrong, pp 46).
As well as addressing the needs of the patient, clear and through documentation is necessary for
legal and community safety support. Documentation of IPV needs to have defined requirements to
ensure that it is consistent and inclusive of necessary information.
In the community there is a need for violence prevention education. What IPV looks like, those
who are affected and what you can do about it. Youth especially can benefit from additional training in
how to choose and be in a healthy relationship as well as conflict resolution that does not involve
aggression of any form.
My Experience
I myself have been a victim of IPV from my ex-husband. Fortunately I had the support of my

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family to help me escape the situation and also protect my children at the same time. There were many
instances that I felt I was responsible for the treatment I was receiving or I allowed it to continue
because it was better the evil I knew than what might happen if I attempted to change anything. Even
reporting to the police was terrifying because it would inflame the situation and that was more unsafe
than letting it go. It is a scary time and in the situation people do not know what to do even when to
everyone else around them it seems clear. Leaving the situation is not that simple and often is the thing
that leads to death of the victim if they dont have the support and resources to stay safe.
As a nurse it is vital for us to be understanding of the victims concerns and to believe them.
There is already so much doubt in the victims mind that any additional doubt or disbelief from those
they are seeking help from may make them completely withdraw and not seek the help they need.
Many nurses and providers have no idea how to respond when they are informed of some sort of abuse.
Education on how to address and support the victim is vital to moving forward till they are willing to
obtain the specialized help they need from victim, therapist, legal and safety support.
Conclusion
Intimate partner violence is a widespread public health concern. It is not specific to any one
population. It is a widespread disease that has the potential to cause long term devastating results.
Whilst it is important to attend to the here and now in terms of immediacy of responding to omens
health needs, those current approaches of screening and identification do little to ensure ongoing or
appropriate care once disclosure of violence is made (Tower, Rowe & Wallas, pp. 860). As this issue
becomes more prevalent and more recognized there is hope that policies will be created to assist with
recognition and assistance for those experiencing IPV. With better education and confidence in how to
deal with domestic violence concerns, there is a greater potential to halt the cycle and not only give
victims the opportunity for a better life but also may in fact lead to the saving of their life.

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6
References

Wilson, J. S., & Websdale, N. (2006). Domestic violence fatality review teams: An inter-professional
model to reduce deaths. Journal Of Interprofessional Care, 20(5), 535-544.
doi:10.1080/13561820600959253
Modi, M. N., Palmer, S., & Armstrong, A. (2014). The Role of Violence Against Women Act in
Addressing Intimate Partner Violence: A Public Health Issue. Journal Of Women's Health
(15409996), 23(3), 253-259. doi:10.1089/jwh.2013.4387
Ambuel, B., Hamberger, L., Guse, C., Melzer-Lange, M., Phelan, M., & Kistner, A. (2013). Healthcare
Can Change from Within: Sustained Improvement in the Healthcare Response to Intimate
Partner Violence. Journal Of Family Violence,28(8), 833-847. doi:10.1007/s10896-013-9550-9
Tower, M., Rowe, J., & Wallis, M. (2011). Normalizing Policies of Inaction-The Case of Health Care in
Australia for Women Affected by Domestic Violence. Health Care For Women
International, 32(9), 855-868. doi:10.1080/07399332.2011.580406
Morris, P. (2014). HELPING PEOPLE WHO HAVE BEEN SUBJECTED TO ABUSE. Emergency
Nurse, 22(4), 16-22.
Karakurt, G., Smith, D., & Whiting, J. (2014). Impact of Intimate Partner Violence on Women's Mental
Health. Journal Of Family Violence, 29(7), 693-702. doi:10.1007/s10896-014-9633-2