Intimate partner violence (IPV) is perpetrated against both women and men; however, most research indicates that women are more likely than men to be victims.1,2

Screening strategies

All adult female patients should be screened for IPV,3 regardless of how or why they present for care in the clinical setting. (See When to suspect IPV).4 When screening for IPV, it's of utmost importance that the perioperative nurse follows a protocol that ensures patient privacy, safety, and confidentiality. Therefore, IPV screening should only be done in a private setting with no other adults present. Direct and straightforward questioning presented in a nonjudgmental and unbiased manner is recommended. Examples of questions to ask include:

* Are you now or have you ever been in a relationship with someone who physically hurts you or threatens you?

* Have you ever felt afraid of a partner with whom you shared an intimate relationship?

* Because I see so many patients who have experienced personal violence or abuse by their partner, I now ask all my patients about it- is this something that has ever happened in your life?

Nurses who routinely screen for IPV must learn to offer an appropriate response when patients acknowledge a positive history of ongoing or past intimate violence. Continuing education that supports perioperative nurses' competence in the identification and assessment of victims in the clinical setting is important.

Documentation that screening has taken place should be included in the patient record. The content should be objective, unbiased, and include statements made by the patient. Some words to avoid using when charting include those with judgmental overtones, such as identifying a patient as "noncompliant" with a suggested treatment or intervention, or that the patient "refused" to be treated.

Crisis centers that provide support to victims of IPV exist in all 50 states, and offer a variety of confidential services to victims of IPV including a 24-hour toll free crisis/information hotline, support groups, emergency shelter, and advocacy in legal, social service, and healthcare settings. To locate an organi-zation that offers support and services in your area, contact the coalition against domestic violence in your state or visit the Web site of the National Coalition Against Domestic Violence at http://www.ncadv.org. OR

When to suspect IPV4

Suspect abuse in any patient who:

* has unexplained bruises, lacerations, burns, fractures, or multiple injuries in various stages of healing (particularly in areas normally covered by clothing)

* delays seeking treatment for an injury

* appears embarrassed, evasive, anxious, or depressed

* has a partner who's reluctant to leave, uncooperative, domineering, or who insists on answering all questions for the patient. Keep in mind that some abusers are excessively solicitous of the victim.

* says her partner has a psychiatric history or problems with alcohol or drugs

* has injuries that don't reflect the nature of her "accident"

* expresses fear about returning home or fear for her children's safety

* talks about harming herself.

Even when a patient doesn't have these characteristics, trust your instincts if you think she's suffering abuse.

References