Seen but not heard: Battered women’s perceptions
of the ED experience
Author: Marylou Yam, PhD, RN, CS, Oradell, NJ
Introduction
A plethora of studies describe helping professionals’
responses to and actions directed toward battered
women in the emergency department. However, re-
search that yields data regarding the clients’ percep-
tions about their actual experiences in the ED set-
ting is sorely needed. The aim of this study was to
describe battered women’s perceptions of their ED
experience.
Method
A qualitative design, namely a phenomenologic ap-
proach, was used for this inquiry to enable the
women to express themselves in their own voices.
Informants were recruited from shelters for battered
women. Women who had sought help for abuse-
related injuries at a hospital emergency department
within the past 12 months were asked to participate.
Methods used to collect data were in-depth, individ-
ual, audiotaped interviews and demographic data
sheets. Data analysis was conducted using Colaizzi’s
(1978) procedural steps.
Results
Several categories emerged as being descriptive of
the women’s perceptions of their ED experience.
Themes identified included the women’s feelings
during the visit, such as fear of their partner, concern
for children, and loneliness; the women’s belief that
the ED staff do not understand abuse; satisfaction
with treatment of physical injuries but dissatisfac-
tion with how the issue of abuse is managed; the dif-
ficulty of disclosing the abuse because of fear, em-
barrassment, and a lack of resources; and a request
that health care professionals display compassion,
provide referrals, and offer options.
Discussion
The women’s narratives explicate their feelings dur-
ing the ED visit and sensitize nurses to their experi-
ence. The reports of dissatisfaction with the care
they received in the emergency department add to
the validity of findings from previous studies that
have documented similar results and point to the
Marylou Yam is Chairperson, Department of Nursing, Saint Peter’s
College, Englewood Cliffs, NJ.
Funded by a research award from the New Jersey State Nurses
Association.
For reprints, write: Marylou Yam, PhD, RN, CS, 550 Winne Ave,
Oradell, NJ 07649.
Copyright © 2000 by the Emergency Nurses Association.
0099-1767/2000 $12.00 + 0 18/1/110432
doi:10.1067/men.2000.110432
464 Volume 26, Number 5
need to examine and reshape the delivery of care
to abused women in the emergency department.
(J Emerg Nurs 2000;26:464-70)
D omestic violence is a worldwide health problem
that affects the lives of millions of women each
year. Statistics indicate that a woman is physically
abused every 9 seconds in the United States and that
42% of women who are murdered are killed by their
male partners.1 Battering or violence is the single
major cause of injury to women.2 Abuse is associated
with long-range health problems including perma-
nent disabilities resulting from physical injury, sexu-
ally transmitted diseases, HIV, and perinatal compli-
cations.3 Women who have been subjected to abuse
may experience psychological problems such as de-
pression, suicide, anxiety, posttraumatic stress disor-
der, and alcohol and drug abuse.3 A large number of
abused women present themselves to the health care
establishment for help. A review of previous studies
led researchers to estimate that 31% to 54% of women
who visit the emergency department report a history
of intimate partner violence.4
Although a great many of these women seek help
in the emergency department, data indicate that only
abut 3%5 to less than 10%2 of all battered women are
identified by health care professionals. Although the
nature of the help provided in the emergency depart-
ment is short term, it is crucial to uncovering hidden
violence, reducing the effects of physical and psycho-
logical trauma, interrupting the cycle of violence, and
saving a woman from a potentially life-threatening
situation.6
A plethora of studies from the professional helper’s
perspective or through medical record review docu-
ment the health care management of abused women
in the emergency department.4,7-10 Evidence has
shown that, in many instances, health professionals fail
to identify abuse,4,8 neglect to implement protocols,7,9
derogate victims, and/or are unsympathetic.7,11
Fewer studies examine the ED visit from the bat-
tered women’s perspective. In l982, Drake11 conduct-
ed a descriptive inquiry in which 12 battered women
were interviewed.11 The study revealed that none of
the women expressed positive feelings about the
health care they received. The women relayed in-
stances of impersonal care, lack of support, and dis-
interest in their problems. In another study, the

perceptions of battered women and battered women
advocates were surveyed.12 Findings revealed that
abused women treated in the emergency department
reported feelings of humiliation and blame and be-
lieved that their abuse was minimized, referrals were
insufficient, and they were not identified as battered
women.12
Specific issues related to battered women’s en-
counters in the health care setting have also been ex-
amined. Researchers investigated reasons that influ-
ence the identification and management of abused
women in the health care setting.13 Findings revealed
that reasons for nondisclosure included threats of vio-
lence from the abuser, embarrassment, adherence to
gender roles, concerns about police involvement, and
mistrust in the health care provider.13 Data also
showed that battered women requested that health
care professionals ask about domestic violence, en-
gage in a supportive relationship, and refer them to
resources in the community.13
Given the small number of studies exploring the
ED visit from the battered women’s perspective, more
data are needed to understand their experience. The
purpose of this study was to describe battered
women’s perceptions of the ED experience using a
qualitative approach, namely phenomenology.
Method
Design
The aim of phenomenology is to describe the lived ex-
perience.14 According to Bruyn,15 “Phenomenology
serves as the rationale behind efforts to understand
individuals by entering into their field of perception in
order to see life as these individuals see it.” In other
words, individuals’ perceptions as they experience
them are investigated. In this study, the research
question was the following: What are the perceptions
of the ED experience from the battered woman’s per-
spective?
Informants
The women were recruited from battered women’s
shelters in the New Jersey-New York area. After ob-
taining institutional review board approval, the shel-
ters were sent a cover letter, proposal, and letter re-
questing their participation in the study. A request to
participate was sent to a total of 8 shelters. One shel-
ter refused to participate, stating they had “no women
who would be candidates.” Only two shelters allowed
the researcher to speak to the women directly to re-
quest their participation. At the other shelters, the
staff recruited the women. For this study, a battered
woman was defined as a woman who had been sub-
jected to the use of physical force (battering) by her
Yam/JOURNAL OF EMERGENCY NURSING
male partner. She could be married or unmarried but
had to be involved in an intimate, cohabiting, hetero-
sexual relationship. Purposive sampling was used.
Women who had sought help for abuse-related injuries
at a hospital emergency department at least one time
in the previous 12 months were asked to participate.
Data collection
Women’s perceptions were elicited using semistruc-
tured interviews with probing questions. The inter-
views were audiotaped. All of the interviews were
conducted at the shelters, in private, at a time conve-
nient for the women. Each woman signed a consent
prior to the interview. Interviews lasted from 60 to 90
minutes. Each woman was interviewed by the same
researcher, and the following request was made: “Tell
me about your experience in the emergency depart-
ment.” Other probing questions asked of each partic-
ipant included the following: “What did the nurse
say? Do? What did the doctor say? Do?”
In addition, the researcher collected demograph-
ic data related to age, race, type(s) of injury, number
of visits to the emergency department, number of
years in the relationship, and types of help sought.
In a phenomenologic investigation, data are
gathered until data saturation is achieved. Data satu-
ration occurs when no new themes or essences
emerge from the participants and the data are being
repeated.16 In this inquiry, themes became repetitive
after 5 informants were interviewed.
Data analysis
Interviews were listened to initially by the researcher.
Analysis was begun with the first interview and was
ongoing throughout data collection and presenta-
tions. Data were analyzed using Colaizzi’s method of
phenomenologic analysis.17 Narratives were read and
reread to get a sense of the data. Significant state-
ments—that is, sentences or phrases that directly ad-
dress the phenomena being explored, namely, the ED
experience—were extracted from the descriptions,
meanings of each significant statement were spelled
out, and clusters of themes were organized into cate-
gories from the formulated meanings.
To enhance credibility, audiotapes were tran-
scribed verbatim onto a computer and transcripts
were compared with the audiotapes for accuracy.
One measure of theoretic validity relies on whether
there is agreement among researchers concerned
with the study as to the terms used to depict the phe-
nomenon.18 In this study, to validate the researcher’s
interpretations, significant statements, formulated
meanings, categories, and themes were discussed
with and reviewed by a consultant with expertise in
October 2000 465
JOURNAL OF EMERGENCY NURSING/Yam
the phenomenologic method, and they were deter-
mined to be consistent with the data. Thus, theoreti-
cal validity was established.
Results
The 5 participants ranged in age from 22 to 36 years.
Two of the women were white, 2 women were African
American, and one woman was biracial (white and
Hispanic). None of the women were married; rather,
all of them had been living with their male partners.
The number of years that the women were in the abu-
sive relationship ranged from 4 to 11 years. Collec-
tively, the total number of visits to the emergency de-
partment was approximately 13. The number of visits
to the emergency department per person ranged from
2 to 4 visits. One woman was hospitalized and re-
quired surgery for abuse-related injuries. Injuries in-
cluded concussions, eye injuries, a fractured humerus,
and a complication of abuse during pregnancy (pla-
centa previa). All of the women had use of shelter ser-
vices, and 4 of the women had used hot line numbers
for domestic violence.
Following analysis of significant statements and
theme clusters, 5 categories were identified:
1. Feelings experienced during the ED visit: a mul-
titude of emotional states
2. Beliefs about how staff members perceive women
who have been abused and the problem of abuse
3. Perceptions of the nurse and physician and of the
care received
4. Concerns about disclosure: Should I tell?
5. Suggestions for caregivers
Feelings experienced during the ED visit: a multitude of
emotional states
Themes expressed by respondents included the
following:
• Anger
• Concern for children
• Inability to think clearly
• Loneliness
• Embarrassment
• Frustration
• Fear of partner
Women described multiple and varied emotional
states, which at times were experienced simultane-
ously. Feelings of fearfulness and embarrassment
were common to all the women. In addition, some of
the women expressed anger and frustration regarding
the long waiting period in the emergency depart-
ment. Three of the women described feeling lonely
while waiting to be seen.
I felt frustrated and kind of scared because I got
this man locked up and what is he thinking, what’s he
466 Volume 26, Number 5
gonna do, this is all going through my mind. I’m wor-
ried about him. While I was waiting...somebody could
have been talking with me, they just left me waiting.
You’re gonna sit and you’re gonna wait, till they
get rid of their priorities first.
At this point you are thinking—what did he do to
me and oh my God, here I am with all these people
who are going to know what happened to me.
They were nice, but they wanted me to press
charges, and I was too afraid to do that.
In addition, women who had children were con-
cerned about their well-being. For example, one
woman stated:
You are nervous and you are not thinking straight.
They have to understand I have kids at home, that I
had to let my children know I wasn’t dead. So I didn’t
let them admit me.
Beliefs about how staff perceive women who have been
abused and the problem of abuse
Themes expressed by respondents included the
following:
• Blaming the woman
• Pity
• Misunderstanding abuse
All of the women shared their beliefs about how
they believed staff perceived them and the issue of
abuse. This category included themes of blame, pity,
and abuse not being understood. The women be-
lieved that health care professionals did not really un-
derstand the essence of their abusive existence.
Three of the women believed that the doctors and
nurses had a matter-of-fact attitude toward battered
women and that health care professionals did not
consider their situation to be serious. For example:
They just say oh, okay she’s hurt, another woman
beat up by her man, treat her, send her home, you
know, that’s how they treat you.
They kept trying to get me to press charges, kept
telling me I shouldn’t be going through this. They just
can’t understand why you don’t do that. They don’t
know, they’ve never experienced it.
(Regarding abuse) They have no idea. The people
at the hospital don’t know. They are coming from their
houses with white picket fences and do not know
what I dealt with at home.
Other women articulated instances in which they
believed that staff blamed and pitied them.
They don’t treat you as though you’ve been hurt,
not because it’s your fault, but because someone de-
liberately did this to you, and that they have a prob-
lem and that you need to get away from them.
I feel like a lot of the hospital staff feel, like why
would you stay? It’s your fault, you know?

One nurse hollered at me and said: “Are you
crazy?” “What’s the matter with you?” They can’t do
that. They can’t holler at you. I mean that’s their opin-
ion, but it is not good for the person.
That feeling sorry for you. That was the most un-
comfortable. People just pity you and I shouldn’t be
pitied. That made me feel uncomfortable. They treat
you like they feel bad for you.
Perceptions of the nurse, physician, and care received
Themes described by respondents included the
following:
• Unconcerned
• Controlling
• Lack of humanness and compassion
• Rushed, hurried approach
• Physical injuries treated
• Abuse not addressed: I’m hurting on the inside too
All the informants discussed their perceptions of
the nurse, physician, and care received. Themes that
emerged included the sense that nurses and physi-
cians displayed a lack of concern, appeared to lack
humanness in their work, and were not compassion-
ate. Some comments that reflect these perceptions
include the following:
She (the nurse) was just there to take my vital
signs. I don’t think she was really too much con-
cerned. She was trying to do her job and get me out
of there so she could see the next patient.
One woman believed that the staff’s lack of con-
cern and intervention caused her to delay seeking
help. She stated:
The doctor said nothing to let me know that he
was really concerned about the fact that my boyfriend
hit me with a bottle and I think, had somebody en-
couraged me back then to leave him, I wouldn’t be
here now.
The women perceived staff as not being compas-
sionate and provided numerous accounts of a rushed
and hurried approach on the part of caregivers. One
participant stated:
They have no compassion whatsoever, none. And
that’s the field they chose! They chose this field to help
people, so I would expect them to be understanding.
It seems as if they want to get you out.
One woman saw the nurse as too busy to listen to
her plight. She explained that it would have been help-
ful if the nurse took the time to listen and talk with her:
I don’t think the nurse had the time to, let’s put it
that way, to really sit down and say, okay, listen, this
is not right, if you want to talk to me, if you need my
help or whatever.
In addition to feeling rushed, one woman voiced
a statement that indicated a lack of humanness on
Yam/JOURNAL OF EMERGENCY NURSING
the part of the caregiver. The woman explained that
the nurse recorded her answers but did not respond
to her situation:
They (doctors and nurses) just wanted to get me
out. They ask you questions like a textbook. They
could act like they really care—even if they don’t, pre-
tend. They just want to get you out so they can see
the next person. They act like they are reading a text-
book when they talk to you. They write down the an-
swers, but just say ah, um....
All the women spoke positively about the medical
treatment they received for their physical injuries.
However, with regard to the underlying cause of their
injuries, they conveyed that the abuse was not ad-
dressed and that the physicians and nurses only “saw
the outside.”
The themes “abuse not addressed: I’m hurting on
the inside too” and “physical injuries treated” are re-
flected in the following comment:
As far as medical treatment, they are great, but
as far as knowing how you feel and you are feeling
pretty lousy—they only see the outside—they don’t
see the inside.
In spite of treating the physical problems, the
issue of abuse is not addressed and the cycle of abuse
remains uninterrupted. In essence, the women are
seen, but not heard. One woman stated,
You get to the hospital and there is nobody there.
The doctors treat you, stitch you, give you your dis-
charge papers and send you home, which means you
are going home to the same man.
Other examples of these themes are illustrated in
the following statements:
They asked me nothing. I told the nurse and I told
the doctor. Nothing. Nothing was said, and I didn’t go
to a shelter. I went back home after the hospital, limp-
ing around, and his father called and asked me, “Just
don’t leave, please don’t leave him.”
I told the nurse what happened. I told her my
son’s father beat me up. He had pushed me on the ce-
ment. I sprained my knee. She just wrote down what
was hurting me and my vital signs and that was it.
She didn’t ask any more questions.
The doctor asked: “What happened?” I said, “My
boyfriend hit me with a bottle.” The doctor asked:
“What did you do?” The client stated: What did I do?
What could I do? He sent me for x-rays, removed the
glass, and cleaned my eye. The doctor could have
said, “This is not right. If you want to talk to me I can
sit you down. I can let you know there’s a bit more
that I can help you with if you want to get out of this.”
The women described interactions in which staff
were controlling and told them instead of asked them
what they wanted to do. For example:
October 2000 467
JOURNAL OF EMERGENCY NURSING/Yam
They’ve got to understand that you are with this
guy who is controlling you and telling you all the time
what to do and you don’t need to be told what to do—
you don’t need one more person telling you what to
do. They don’t treat you independently.
Concerns about disclosure—should I tell?
Themes described by respondents included the
following:
• Fear
• Embarrassment
• Lack of resources/support systems
• Opening up: Disclosing the abuse
All of the women spoke about the difficulty of dis-
closing the abuse to staff. At times, they wanted to in-
form the physician or nurse how their injuries oc-
curred but were afraid or embarrassed to speak out.
Two of the women explained that their abuser was
present during the questioning. Statements that re-
flect these themes included:
I was too embarrassed to tell.
I was afraid to tell; my boyfriend was right there.
The doctors believed him when he said he was my
brother and I couldn’t tell them he was lying.
It intimidates you and especially with him stand-
ing right there and him making sure you don’t open
your mouth.
Two of the women who had been interviewed
alone also indicated that fear and a lack of resources
and support systems inhibited them from disclosing
their dilemma:
As much as they kept telling me, I just wouldn’t
say anything. I mean there’s a list of reasons. At that
time—you’re scared, you have nowhere else to go.
They were nice but they wanted me to press
charges and I was too afraid to do that. I never told
anybody that he hurt me because I thought he would
find out.
One woman explained that staff are unaware of
the “risk” involved in revealing abuse. She stated:
They (nurses and physicians) can’t understand
why you won’t go out on a limb and say that he did
this to me.
One woman did reveal her abusive situation to a
nurse. She relayed the following:
One nurse, I did tell. She really seemed concerned
about it so that’s why I told her what really happened.
Because she didn’t flat out ask me—are you a victim
of violence? She didn’t ask me like a textbook. She told
me that a lot of women came in here and they’re
abused by their husbands. She started telling me sto-
ries about other women and then asked me. I felt more
comfortable talking then. She gave me a whole list of
places to call and I started calling them from then on.
468 Volume 26, Number 5
Suggestions for caregivers
Themes reported by respondents included the
following:
• Express compassion
• Have an advocate available
• Make me feel safe
• Explore options
• Listen
• Talk with me
• Interview me privately
All of the women suggested strategies for inter-
ventions. It seemed as though they wanted to protect
other women from having similar experiences. They
talked about the need for compassion on the part of
staff and for the presence of an advocate for battered
women in the emergency department. The women all
requested that they be interviewed privately and that
their options be explored. Many of the suggestions
centered around the need for staff to take the time to
question them about their injuries and listen to their
stories of abuse.
The doctor could have said this is not right. If you
want to talk to me I can sit you down, I can let you
know there’s a bit more I can help you with, if you
want to get out of this.
Give me a chance; you asked (what happened)—
you opened the door. Don’t open the door and shut it.
Ask my boyfriend to leave so I can open up to you.
Two of the women suggested that a “trained
counselor” be available in the emergency department
for battered women.
A trained counselor on call 24 hours a day. If you
need to go to the emergency room they’re there with
the woman to let the doctors know she was physical-
ly abused. The counselor could tell them (doctors and
nurses) she may not be comfortable with some of you.
I’m here to be with her.
The advocate would know what to tell staff to say
or not to say. Like when the nurse was hollering at me.
She would know what to say and she would know
what to tell the staff to say or not to say. You are al-
ready feeling bad and she would try to make you feel
comfortable.
One woman suggested that a follow-up call is
needed; because of the way the woman is feeling at
the time of the visit, she often needs a few days to de-
cide what to do. This woman suggested:
Maybe some way to follow up, like a few days later
call me and ask me how I feel and what I want to do.
Other comments reflected the women’s request
to be cared for with compassion and to talk with them
not at them regarding their options:
I’ve been through a rough ordeal—treat me like a
human being.

I mean medically, they did things like order med-
ication. But they need to have some kind of literature
they can hand you so you can read. Rather than
telling you what to do. You are nervous and you are
not thinking straight at the time.
They can’t be pushy on what you tell somebody
to do—they did that a lot. “You should do this or
somebody telling you what you should do.” I think
they need a different tactic, perhaps like, “We have
some literature if you would like to read this.” Just do
it in a different approach.
The following comments indicate the need for
staff to deal with the woman’s fear and safety con-
cerns first and the importance of informing the women
of the availability of safe places where they can go.
You are upset and you are scared and the more
they push and try to get you to do things—I mean you
know this person that’s doing this stuff to you and you
are not going to do anything because you are scared.
Let me know there is a place I can go to be safe.
Discussion
Thematic analysis revealed commonalities in the bat-
tered women’s descriptions that may be similar to
those of other patients who have sought help in the
emergency department. For example, other clients
may experience similar problems of impersonal care
and feel frustrated with the long waiting period. How-
ever, because of the circumstances of their injuries,
these feelings and emotions may be heightened for
battered women. Also common to the women in this
study and possibly dissimilar to clients with other
health problems are the feelings of fear, shame relat-
ed to their injuries, and the struggle to decide
whether to reveal the cause of their physical trauma.
Unlike other clients, these women will return to the
emergency department unless a significant change
occurs in their lives.
The narratives in this inquiry seem to support
findings of previous research11,12 in that the women
reported instances of feeling blamed and sometimes
believed that the abuse was not taken seriously.
Moreover, consistent with the findings reported by
Rodriguez et al,13 fear was a reason for not disclosing
the nature of their injuries. However, unlike previous
research, the data in this inquiry illuminated the
range of emotions and feelings that the women may
experience during their ED encounters, such as con-
cern for their children, anger, loneliness, and frustra-
tion. Although the data yielded in this study are rich,
the sample size is small, and more research is needed
to confirm these findings.
In this study, the women were all satisfied with
the treatment of their physical injuries; however, they
Yam/JOURNAL OF EMERGENCY NURSING
each reported dissatisfaction with the care received
and offered strategies that would be helpful for nurs-
es and physicians to use. For example, the women re-
quested that nurses and physicians explore options,
deal with safety issues, interview them privately, and
take the time to listen and talk to them. The battered
women in this inquiry expressed the need for com-
passionate care and to be given referrals, which is
similar to what was reported in the investigation by
Campbell et al.12 The data are congruent with inter-
ventions cited in the literature as being effective in
dealing with battered women.10,19,20
The women reported an unconcerned attitude
and rushed and hurried approach on the part of health
care professionals. Even with time constraints, it is
crucial that nurses and physicians provide a quiet
place for the women to be interviewed alone, apolo-
gize for the long wait, and offer a comment of con-
cern. Providing appropriate referrals can be done effi-
caciously. For instance, an information sheet of
community resources could be developed and used
by all the staff. ED staff members need to know that
they can obtain information from local crisis centers
and hot lines. If advocates are not available, staff
should have a good understanding of the resources
that are available in their hospitals. Also, the patient
could be given access to a phone and a local hot line.
The women in this study indicated that disclos-
ing the nature of their injuries is difficult. Techniques
for questioning battered women are well documented
in the literature. However, the realization that these
women may lack knowledge about resources and feel
fearful and embarrassed is requisite to couching
questions, sharing information, and conveying a pro-
fessional demeanor that emulates trust and may en-
able the woman to discuss the nature of her physical
trauma. Because some women, as in this study, may
not disclose that they have been abused, it is impor-
tant that information be available to all women. A
comment such as “Because this happens to many
women, we have information for everyone who might
find it helpful” may encourage a woman to reach out.
A factor that was identified in the data as facilitating
disclosure was when a nurse asked a woman about
the nature of her injuries in a nondirect manner and
shared stories of other women who had been abused.
One woman in this inquiry indicated that attempts by
staff to tell a woman what to do may not be therapeu-
tic. Even if the woman chooses not to disclose that
she has been abused, if we share the availability of
options and create a supportive environment, she
may disclose the abuse on another occasion.
In spite of Joint Commission on Accreditation of
Healthcare Organizations guidelines and literature
October 2000 469
JOURNAL OF EMERGENCY NURSING/Yam
describing therapeutic interventions and staff educa-
tion, abused women in this sample reported dissatis-
faction with the care they received in the emergency
department, as have women in other studies. These
data, as well as findings from previous research, point
to the need for researchers to examine the work cul-
ture of the ED setting. Exploring the goals of institu-
tions and the support and resources that are available
for the staff may yield important information for direct-
ing and reshaping ED care and delivery for abused
women. For instance, on-site battered women’s advo-
cates can be effective in augmenting the services
provided by the ED staff. Also, with regard to staff
training, educational sessions for health care profes-
sionals need to be conducted at frequent intervals to
maintain the knowledge and skill of seasoned staff
and to ensure that new staff are trained. It is impor-
tant that the training sessions include time for the
staff members to examine their beliefs about abuse.
Advocates and/or a survivor can be invited to training
sessions to discuss barriers and issues with staff
members. In-house experts such as psychiatric clini-
cal specialists can also help with this process. It is im-
perative that the leaders in charge of education at the
institution be supportive of these activities.
Conclusion
This inquiry provides insights into the battered
women’s feelings at the time of their visit to the emer-
gency department, such as fearfulness of their part-
ner, loneliness, and concern for their children. The
data from these women, as well from those in previ-
ous studies in which dissatisfaction with care has
been reported, suggest that research should be con-
ducted to investigate the work culture of the emer-
gency department. Such studies may provide addi-
tional information for redesigning the way care is
rendered to abused women in this setting.
Acknowledgments
I thank Dr Pierre Woog, Professor, Adelphi University, for his
consultation and Dr Claire Manfredi, Associate Professor,
Villanova University, for her review of this manuscript.
References
1. Family Violence Prevention Fund. The health care re-
sponse to domestic violence: incidence and prevalence in
an emergency department. JAMA 1996;273:1763-7.
470 Volume 26, Number 5
2. American Nurses Association. Domestic violence: im-
pacting the nation’s health care delivery system. Nurs
Trends Issues 1997;2:1-9.
3. American Association of Colleges of Nursing. AACN po-
sition paper: domestic violence as a public health problem.
Washington: 1999; The Association.
4. Rodriguez MA, Bauer HM, McLaughlin E, Grumbach K.
Screening and intervention for intimate partner abuse.
JAMA 1999;286:468-74.
5. Digirolamo KM. Letter to the editor. New York Times 1991
Nov 6;Sect A:24.
6. Yam M. The relationship between endorsement of the
compensatory model of helping and analytic style among
nurses who care for wife abuse victims in the emergency
room setting [dissertation] (University Microfilms Interna-
tional No. 9416017). Garden City (NY): Adelphi Univ; 1993.
7. Kurz K. Emergency department responses to battered
women: resistance to medicalization. Soc Probl 1987;34:69-
79.
8. Varvaro FF, Wolfinger KH, Jones M. Documentation of
abuse as cause of injury. In: Violence: nursing debates the is-
sues. Washington: American Academy of Nursing; 1993. p.
24.
9. Warshaw C. Limitations of the medical model in the care
of battered women. Gender Soc 1989;3:506-17.
10. Yam M. Wife abuse: strategies for a therapeutic re-
sponse. Sch Inq Nurs Pract 1995;9:147-58.
11. Drake V. Battered women: a health care problem in dis-
guise. Image J Nurs Sch 1982;14:40-7.
12. Campbell JC, Pliska MJ, Taylor W, Sheridan D. Battered
women’s experiences in the emergency department. J
Emerg Nurs 1994;20:280-8.
13. Rodriguez MA, Quiroga S, Skupinki S, Bauer HM. Break-
ing the silence: battered women’s perspectives on medical
care. Arch Fam Med 1996;5:153-8.
14. Van Mannen M. Research on lived experience: human
science for action-sensitive pedagogy. New York: SUNY
Press; 1990.
15. Bruyn SR. The human perspective in sociology. Engle-
wood Cliffs (NJ): Prentice Hall; 1966. p. 90.
16. Streubert HJ, Carpenter DR. Qualitative research in
nursing. Philadelphia: J.B. Lippincott Co; 1999.
17. Colaizzi PF. Psychological research as the phenomenol-
ogist views it. In: Valle R, King M. editors. Existential phe-
nomenological alternative for psychology. New York: Oxford
University Press; 1978.
18. Maxwell JA. Understanding and validity in qualitative
research. Harv Educ Rev 1992;62:279-97.
19. Campbell JC, Sheridan DJ. Emergency nursing inter-
vention with battered women. J Emerg Nurs 1989;15:12-7.
20. Campbell JC, Humphreys J. Nursing care of survivors of
family violence. St. Louis (MO): Mosby; 1993.