Clinical providers routinely use screening tools to inquire about patients’ personal relationships and confirm they’re safe at home. However, in addition to these screening questions, it’s important for providers to be aware of other potential signs of abuse.
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Although screening questions, which often begin with nursing staff, can be a way to broach sensitive topics, it’s also important to have a clinical workforce that’s trained to recognize the warning signs of abuse and know how to respond, explains Michele Reali-Sorrell, DNP, RN, a Cleveland Clinic forensic nurse manager. Because few patients will readily admit to being victimized, she encourages clinicians to remain vigilant when managing suspicious injuries and complaints.
“Victims often feel unsafe or even ashamed to admit they’re being abused; some patients may have even normalized the dynamics of their violent relationship and no longer recognize the abuse for what it is,” says Reali-Sorrell. “That’s why it’s so important for providers to understand the complexity of these situations and be prepared to address any red flags.”
Jennifer Rivchun, APRN, MSN, FNP-C, patient safety program manager for Cleveland Clinic South Pointe Hospital, urges caregivers to remember that domestic violence crosses all boundaries of gender, age, race and socioeconomic status.
Unexplained contusions, lacerations, bite marks and burns are among the most obvious signs of potential abuse, but Rivchun cautions providers to also watch for subtler complaints, including delays in seeking care and repeat visits for chronic or seemingly minor medical issues.
“Repeat visits for emotional issues like anxiety or depression can be signs of an untenable domestic situation, as can chronic GI issues, chest pain, or headaches — problems that can often be physical reactions to trauma,” says Rivchun.
A dominating partner who attempts to control the clinical visit or consistently speaks for the patient is another potential red flag, explains Reali-Sorrell. “In some cases, a cognitive problem like dementia can prevent patients from speaking for themselves. But in the absence of such issues, a patient’s silence may indicate controlling or manipulative behavior by a partner,” she says. “In these situations, it’s crucial to find an opportunity to talk with the patient privately.”
Although it can be difficult for those who have not experienced domestic violence to understand why victims decline help or stay with their abusers, it’s crucial to avoid blaming the victim, says Ashley Withrow, LISW-S, a victim advocate at Cleveland Clinic.
“There are a million reasons why people remain with their abusers, including justifiable fear, practical concerns about food and housing, and worries about the wellbeing of children or pets,” she says. “The goal is to work with the patient to develop a safety plan, regardless of whether those steps include leaving the abuser.”
Withrow urges to caregivers to approach these cases with empathy, understanding that a victim’s attempts to leave or pull away from an abuser often lead to an escalation in violence.
Efforts to persuade a victim to “just leave” the relationship are unwise, she says, unless there is a strong safety plan in place. “It is important to understand that any patient seeking help for domestic abuse is taking a significant risk. Providers must be prepared to really listen to their patients and connect them with resources that can help protect them. Information about local shelters or a referral to a victim advocate or social worker on site can be lifelines for at-risk patients,” says Withrow.
Rivchun urges nurses to intervene when warning signs arise. “You never know when you might save somebody’s life by taking that next step,” she says.
Withrow adds, “When you think about the sheer volume of individuals in our society who experience domestic violence at some point in their lifetimes – violence isn’t a matter of if, but of when.”