Suspect Domestic Violence Discussion 5

What characteristics would lead a provider to suspect domestic violence, child abuse, or elder abuse is taking place within a family? Discuss your facility’s procedure for reporting these types of abuse.

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Domestic violence is a serious public health and human rights concern and an on-going challenge for nursing. This article provides an overview of the three major types of domestic violence: intimate partner abuse, child abuse, elder abuse. The scope, history, and health consequences of each type of violence are addressed. Despite advances in research, public awareness, legislative initiatives, and public policy, these types of interpersonal violence continue to affect millions worldwide.

Key words: domestic violence; intimate partner abuse; child abuse; elder abuse; interpersonal violence; victimization; violence

Introduction
Domestic violence is recognized globally as a critical public health problem and a human rights violation that robs victims of “full and equal participation in all spheres of life” (United Nations, 1995, p. 3). Women and children worldwide are especially vulnerable to aggression, violence, and abuse by family members, caretakers, and intimates. Domestic violence has been defined as:

Physical, sexual, or emotional/psychological violence directed toward

men, women, children, or elders occurring in current or past familia

or intimate relations whether the individuals are cohabiting or not

and including violence directed toward dating partners. (AACN, 2001,

p. 1)

Domestic violence is best understood within a cultural context (Campbell, Moracco, & Saltzman, 2000; Hoff, 2001). For example, The Beijing Declaration and Platform for Action, resulting from the 1995 Fourth World Conference on Women stressed, “Violence against women … derives essentially from cultural patterns, particularly the harmful effects of certain traditional practices and all acts of extremism linked to race, sex, language or religion that perpetuate women’s lower status…” (United Nations, 1995, p. 7). Campbell et al. (2000) argued that violence research demands a cultural competency that extends beyond cultural sensitivity to include an in-depth appreciation of group norms, beliefs, and life ways. Cultural competency is reflected by the acknowledgment that violence occurs in a gendered sociocultural context, an understanding of the relationship between colonial practices and violence and oppression, an awareness of cultural practices and attitudes that support, as well as deter, domestic violence, advocacy for cross-cultural research, and a commitment to oppose oppression experienced by minority groups and those marginalized by their society (e.g., women of color, migrant women, immigrant women, and lesbian women) (Campbell,Campbell, 1996; Campbell et al., 2000, Hoff, 2001). Suspect Domestic Violence Discussion 5

Domestic violence is associated with varied and significant health-related consequences. In addition to immediate physical injuries stemming from an assault and acute psychological distress related to victimization, domestic violence is associated with long-term psychological, physical, social, and economic effects. Nurses and other health care providers play a key role in domestic violence identification and intervention and have been visible advocates for the prevention of domestic violence throughout the world. Many health care professionals have had personal experiences with domestic violence and are forced to confront their own concerns related to violence as they attempt to help others.

This article will provide an overview of the three major types of domestic violence: intimate partner abuse, child abuse, elder abuse. The scope, history, and health consequences of each type of violence will be described.

Spouse/partner abuse
Walker (1999) argued that “the single most powerful risk marker for becoming a victim of violence is to be a woman” (p. 23). While strangers or acquaintances commit the majority of the assaults against men, women are much more likely to be raped, assaulted, or murdered by romantic/intimate partners (Mahoney, Williams, & West, 2001).

Intimate partner abuse includes abuse by current or former spouses or romantic or co- habitating partners. Partner abuse does not typically involve a single violent assault; it is a cyclic, progressive process in which violence is used to control one’s partner. Most violence against women by male partners is best described as battering — that is, “a pattern of behaviors through which one person continually reinforces a power imbalance over another in an intimate/romantic relationship context” (Mahoney et al., 2001, p. 145). Intimate partner abuse includes a variety of abusive and coercive behaviors that may be of a physical, psychological, sexual, or economic nature (Ganley, 1998). It is estimated, for example, that 40 to 45% of battered women also experience forced sex by male partners (Campbell, 1998).

Unlike street violence, domestic partner violence occurs in the context of “shared” lives. In addition to affective ties, the victim and the perpetrator share, or have once shared, a residence, financial obligations and resources, children, and/or friends. The abuse often occurs in the context of an on-going or recently severed relationship; perpetrators may therefore have on-going access to the victim. Because intimate partner violence is considered a “family concern,” it is often taken less seriously than stranger or street violence. Victims often experience social and economic barriers to ending the relationship (Ganley, 1998).

Scope
Findings from the National Violence Against Women Survey, a telephone survey of a national random sample of 8,000 U.S. men and 8,000 U.S. women, indicated that approximately 22.1 % of the surveyed women were physically assaulted by a current or former spouse, co-habitating partner, boyfriend or girlfriend, or date in their lifetime; 1.3 % of the surveyed women reported such violence during the previous year. Based on these findings and U. S. Census data, the researchers estimated that approximately 1.3 million women are physically assaulted annually by an intimate partner or ex-partner. In addition, 7.7 % of the surveyed women were raped by a current or former intimate partner at some time; 0.2 % experienced such violence in the preceding 12 months. It is estimated, therefore, that over 200,000 women are raped each year in the United States by an intimate partner (Tjaden & Thoennes, 2000a).

Many health care professionals have experienced domestic violence in their personal lives. Ellis (1999) surveyed 40 registered nurses employed in a large emergency department and found that 57.5% reported a personal experience with domestic violence. While 35% reported having been hit, kicked, or punched, only 25% of this group identified these experiences as abuse. In a survey of 275 nurses in perinatal practice, 31% reported abuse of themselves or their family members (Moore, Zaccaro, & Parsons, 1998).

Significant controversy exists about the prevalence and the nature of female violence against male partners. Some experts maintain that women are as violent as are men to their partners, whereas others maintain that female to male violence differs significantly in both frequency and severity, and is often used in self-defense (Tjaden & Thoennes, 2000b). Results of the National Violence Against Women Survey support the latter view. Whereas 22.1 % of the women surveyed had been physically assaulted by a current or former partner at some time, only 7.4 % of the men had experienced similar violence. Women were thus more than 2.9 times as likely as men to report abuse by a partner of the opposite sex. Survey results also indicated that the frequency of victimization was greater for women (7.1 incidents vs 4.7 incidents), as was the duration of the violence (3.8 years vs 3.3 years). The female victims also experienced significantly more life threats (33 % vs 26 %) and fear of bodily injury (45 % vs 20 %). The authors concluded that male and female violence in relationships is asymmetrical as women experience male-perpetrated violence more frequently, and the abuse is more repetitious and physically injurious.

History
According to English common law, women were viewed as chattel — first as property of their fathers, and then of their husbands. When a woman married, her legal existence was consolidated into that of her husband; she was considered to be under his protection and influence and could not inherit property (Schornstein, 1997). Physical violence was used frequently by husbands against wives. According to the “rule of thumb” law, a man could beat his wife with a rod no bigger than his thumb (Barnett, Miller-Perrin, & Perrin,1997).

Schornstein (1997) provided several examples of 19th century U. S. court rulings that reflected the principles of English common law and upheld the right of a husband to physically discipline his wife. In 1864, the Supreme Court of North Carolina ruled in State v. Black that a husband could not be convicted of battering his wife unless he inflicted a permanent injury, used excessive violence, or exhibited malignity or vindictiveness. In 1868, the Supreme Court of South Carolina in State v. Rhodes refused to hold a husband criminally responsible for having beaten his wife with a small stick. Suspect Domestic Violence Discussion 5

In the late 1800s, legal reform related to domestic violence began in the United States (Barnett et al., 1997). In the 1870s, Alabama and Massachusetts introduced the first legislation making it illegal to beat one’s wife. Several other states followed with similar legislation. Few arrests were made, however, and district attorneys were unlikely to prosecute. In 1882, the state of Maryland passed legislation that outlawed wife beating and made it a crime punishable by 40 lashes or a year in jail (Schornstein, 1997).

Grassroots feminists brought the problem of violence against women to public attention in the U.S. in the l960s and 1970s and began to establish a number of community-based programs for battered women. Haven House in Pasadena, California, the first shelter for battered women and their children, was opened in 1964. Organizations such as the National Organization of Women and the National Coalition Against Domestic Violence pushed for social services and legislative reform to better protect battered women (Barnett et al., 1997).

In 1979, Lenore Walker published The Battered Woman , an influential book that defined the battered women’s syndrome (BWS). The major components of BWS are the post-traumatic stress symptoms and learned helplessness that develop when the woman’s attempt to end the abuse proves futile. Walker’s work was significant as the symptoms experienced by battered women were identified as responses to on-going abuse, challenging the traditional assumption that a woman’s psychological vulnerability causes or contributes to, rather than results from, her battering. In 1982, the U.S. Commission on Civil Rights published a report entitled Under the Rule of Thumb: Battered Women and the Administration of Justice evaluating the treatment of victims of domestic violence by the criminal justice system and social service agencies. The report concluded that police officers, prosecutors, and judges provided little relief for victims of domestic violence because they considered domestic violence a private matter rather than a crime (Schornstein, 1997).

The former US Surgeon General, Everett Koop, designated the battering of women as a significant health problem and convened The Surgeon General’s Workshop on Violence and Public Health in 1985 (USDHHS, 1986). The 150 attendees were advocates, practitioners, educators, and researchers concerned with violence against women. Mandatory training and examination of health professionals in the essentials of domestic violence intervention was a major recommendation from the workshop (Hoff, 2001). Suspect Domestic Violence Discussion 5

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