Summer Vacation and a Serious Subject

ALOHA Colleagues!

It’s summer vacation time for nursing faculty and some of us are taking time to travel and spend some time with ohana. Even though there are many ways to stay connected, when I’m away from home I somehow find I am less connected to the larger world. Sometimes my phone can’t pick up a signal and sometimes the internet is sooo slow. What did we do when there was no internet and only landlines? I’m not sure if it was better or worse!Despite the disconnect, I still see some research and found an article that I had to share with you. It’s about domestic violence, and I cannot keep quiet about it!

In June, the U.S. Preventive Services Task Force (USPSTF) announced its recommendation that all female patients of reproductive age need to be screened for domestic violence when they seek healthcare. At first glance, this sounds good! I have found that a simple question, “Do you feel safe at home?” Is an excellent screening tool & way to open the conversation: If the patient says, “yes” well, good. If they say, “no” we need to ask what is unsafe? It could be lots of things: bad wiring, bad neighbors, Kilauea. It could also be an abusive person at the home, or who knows where they live. There are many, many screening tools and I am sure your facility uses one. As nurses, it’s our responsibility to elicit the information, carefully document, and pass on referral information to the patient, all in the context of HIPPA and facility guidelines.

“Clinicians can make a real difference for women suffering from intimate partner violence by helping identify them and getting them the support they need,” said task force member and family physician John Epling Jr., M.D., M.S.Ed., in a news release. Sounds good, right?

My complaint with all of this is that the U.S. Preventive Services Task Force (USPSTF) stopped there. They stated that “more research” was needed on domestic violence directed at men and that “more research was needed” to support the need for screening of not only male patients, but vulnerable adults, and old people for domestic violence. Why not recommend doing the screening and gather the data in the process? Of course, as nurses, we will ask if we notice something amiss, but without the recommendation for universal screening, I’m afraid many cases will go undetected and suffering will continue.

I always think of domestic as physical, sexual, or verbal abuse, making threats, or destruction of property, directed at one member of the household by another. A review of the literature reveals I am pretty accurate with that definition. Let’s be clear, though, domestic violence is not just bad behavior: It’s a crime! According to the US Department of Justice, The term “domestic violence” includes felony or misdemeanor crimes of violence committed by a current or former spouse or intimate partner of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner.
against an adult or youth victim.”

And research shows that women are victimized more often than man. But is that really the case? How likely is a man to admit he was beaten by a woman? And, what about abuse in gay and lesbian relationships? The National Commission Against Domestic Violence reports that 1/4 of all women and 1/7 of all men will experience domestic violence in their lifetimes. Notice the word “lifetimes” not “reproductive years”.

Over the years, I have personally treated several male patients (both young and old) who have been seriously physically abused by a domestic partner (male & female) who express shame when making the disclosures. I have also treated many post-menopausal women who have been abused by their partners. Violence is not age-limited or gender-specific. It is a behavior that cannot be tolerated.

If you agree with me and think there is a need to screen people of different genders and ages for domestic violence, I encourage you to let the U.S. Preventive Services Task Force know by submitting a comment.

Mahalo colleagues, for reading this. Domestic Violence is a distressing topic but one we cannot avoid. If you have questions or comments, please contact me.

Best regards! Leslie

For more information, check out the following resources:

Hawaii Say No More

National Domestic Violence Hotline 1-800-799-SAFE

For Domestic Violence Emergency Shelter and Transitional Housing (808) 959-8864

For military services VA Pacific Island Health Care (808) 433-0600