One urban community, the North Philadelphia neighborhood, is represented in the domestic violence focus this issue, but it could be any city in the nation or across the oceans. We live in a world that is beset by violence amidst the goodness of peoples. Each day, as citizens, we share in the stories of pain, hurt, and desperate acts. Even as we began this issue we were overwhelmed by the tragedy of the unconscionable attacks on people in the World Trade Center, in the Pentagon, and on the four hijacked aircraft. As we pull ourselves forward to rebuild selves, dreams, lives, and relationships, we hold hope that our indomitable spirit and dedication to one another might rekindle respect for all humanity. Those tragedies were powerful in their devastation and violent messages, and visible to our world. We are angry and we are saddened.
In contrast, the victims of domestic violence may be painfully hidden from the view of others. We walk among these wounded each day. They are our friends, family members, neighbors, and even our coworkers. The victims may be our own health care professionals who so compassionately give of themselves to others. The awareness is profoundly powerful and disturbing.
As nurses and caregivers, we are called to attend to the needs of vulnerable persons, particularly those who suffer physiologic, psychological, and emotional distress. When we see the visible evidence of illness with symptoms, physical manifestations, and behavioral changes, we direct our energy, skill, and care to heal the whole person. Are we less likely to offer that same care to those who bear the unseen scars of intimate partner violence, spousal abuse, or chronic domestic violence?
The statistics for prevalence of domestic violence are distressing with numbers that range from 20% to 30% of all women in the United States regardless of income level or ethnicity. 1 The dimensions of the violence appear to be linked to power and control issues with actions that slowly and consistently devalue, demoralize, and strip a person of self-esteem and health. The outcome can be death of the woman, the wife, the girlfriend, the mother of the abuser's children. The problem has grown to a public health epidemic across all demographic areas and populations. How do we respond to the crisis?
Universal screening remains a debated issue and the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) identified expectations for health care practitioners as screening, referrals, and documentation of domestic violence in 2000, yet "rates of recognition by health care professionals remain low." 2(p11)
This issue of Holistic Nursing Practice (16:3) addresses several dimensions of domestic violence and collaborative work across the health professions. As nurses we cannot stand alone in the struggle to manage case finding and care management of our patients and clients. We bring a compassionate, caring nursing model to the table with clinical psychologists, emergency medicine physicians, nurse-midwives, social workers, and chaplains. By intent, the content is eclectic yet focused, scholarly yet emotional, enlightening yet challenging. The theme opens with a touching poem from the heart of a public health nurse who has seen and felt the impact of domestic violence on families in the nursing center community. Kinsey shares her insights with all of as we uncover the hurt, the shame, and the guilt felt by the most powerless of family members in the midst of confrontation in the home.
Martin's review of psychological effects on children is chilling in its forthrightness. It allows us to see the aftermath of violence on a child's life. In its overview of the multiple types of exposures, she documents the current state of the science in the clinical psychology arena and presents the key factors in assessment and intervention.
The case study of the young mother by O'Brien reveals the downhill trajectory of the chronically mentally ill person who is caught within the prison of domestic violence. The description of the 2-year treatment period with its intensive home visits and threatening environment demonstrates the failures of the health care system in case management. The safety net is broken and demands attention if our most vulnerable are to be protected and provided with resources for meaningful lives.
The emergency department study by Heinzer and Krimm originated as a prevalence study after considerable discussion with an interdisciplinary team on implementing routine screening for domestic violence during the intake interview of clients. Careful planning and educational preparation for the staff were not sufficient to overcome the difficulties in actually initiating the screening process. Not surprisingly, triage nurses were the sole participants in the data collection, a process that was to be done by any health care professional on any shift to ensure that all adult clients were given the opportunity to answer the questions. Follow-up meetings resulted in a hospitalwide task force, workshops, and seminars for all members of the medical center staff.
With the chaplain's emotional words, we open another concern in holistic care, the spiritual realm. The poetry by Hofstetter shares the feelings of nurses, physicians, and health care workers who confront the effects of domestic violence on the vulnerable who are treated in emergency departments, clinics, and health care facilities across the world. She ends with a universal prayer, one that transcends individual religions and speaks to each of us as caregivers.
Although the future looks bleak to many on the front lines of the struggle against domestic violence, the concerted efforts of health care professionals in collaborative models are beginning to show positive effects. Several task forces in the Philadelphia region are conducting training sessions and workshops for health professionals and educators in the schools. 3 Train-the-trainer programs are increasing in emergency settings and community centers. Case finding and accurate assessment, referral, and treatment are mandatory for a healthy community. However, prevention of domestic violence is the hallmark for the future. 4,5
The literature is replete with information, posters throughout the community boldly print hotline numbers and names of resource groups for the public to access, and emergency contacts are inscribed on small laminated pocket cards. Domestic violence advocates are increasingly available in neighborhoods, chaplains are linking victims and high-risk women to support programs and interventions, and nurses are leading many of the educational programs for coworkers and community members. We, as health care professionals, have heard the call to action to the role of finding and responding with a holistic approach to eradicate the public health problem that challenges all persons. 5-7 We, as nurses, will continue our work with the most vulnerable among us to achieve a healthy, safe, and peaceful world for those who touch our hearts each day.
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