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DOMESTIC VIOLENCE

Author: Alene Burke RN, MSN
1 Contact Hour

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DESCRIPTION:

This course fulfills the state of Florida's, and other states', mandatory continuing education requirement for license renewal.

The purpose of this course is to provide the learner with information about domestic violence, the number of people that are victims of domestic violence, the number of people who are perpetrators of domestic violence, the signs and types of abuse and interventions, including screening, assessment, and others, such as counseling, referrals to community domestic violence centers, advocacy groups, legal aid, shelters, follow up victim counseling, batterer counseling, and child protection services.

This course also provides the learner with additional readings and available domestic violence resources.

OBJECTIVES:

1. State statistics relating to domestic violence.
2. Detail some of the characteristics of an abuser and the signs of physical, psychological, financial and sexual abuse, including marital rape.
3. Appropriate screen, assess and intervene in cases of suspected domestic violence.

INTRODUCTION

Domestic violence is not discriminating. It affects all races, all nationalities, and people of all cultures. It cuts across the lines of economics, sexual orientation, physical ability, and religion. It affects all socioeconomic groups and all walks of life.
(National Coalition Against Domestic Violence, 2005; National Domestic Violence Hotline, 2005).

THE MAGNITUDE OF THE PROBLEM

Domestic violence is a very serious problem in our country.

• "The National Domestic Violence Hotline has received more than 1,000,000 calls for assistance since February 1996. - National Domestic Violence Hotline, December 2004
• Nearly one-third of American women (31 percent) report being physically or sexually abused by a husband or boyfriend at some point in their lives. - Commonwealth Fund survey, 1998
• It is estimated that 503,485 women are stalked by an intimate partner each year in the United States. - National Institute of Justice, July 2000
• Estimates range from 960,000 incidents of violence against a current or former spouse, boyfriend, or girlfriend each year to 4 million women who are physically abused by their husbands or live-in partners each year. - Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends, U.S. Department of Justice, March, 1998
• Studies show that child abuse occurs in 30-60% of family violence cases that involve families with children. - "The overlap between child maltreatment and woman battering." J.L. Edleson, Violence Against Women, February, 1999
• While women are less likely than men to be victims of violent crimes overall, women are 5 to 8 times more likely than men to be victimized by an intimate partner. - Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends, U.S. Department of Justice, March, 1998
• In 92% of all domestic violence incidents, crimes are committed by men against women. - Violence Against Women, Bureau of Justice Statistics, U.S. Department of Justice, January, 1994
• 31,260 women were murdered by an intimate from 1976-1996. - Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends, U.S. Department of Justice, March, 1998
• A child's exposure to the father abusing the mother is the strongest risk factor for transmitting violent behavior from one generation to the next. - Report of the American Psychological Association Presidential Task Force on Violence and the Family, APA, 1996
• Husbands and boyfriends commit 13,000 acts of violence against women in the workplace every year. - Violence and Theft in the Workplace, U.S. Department of Justice, July, 1994" (National Domestic Violence Hotline (2005).

WHAT IS DOMESTIC VIOLENCE?

Abuse is defined as 'maltreatment'. Elder abuse affects older adults. Child abuse is the maltreatment of infants and young children. Men, women, adults, children and people of all ages can be abused, but the vast majority of abuse is directed at the most vulnerable populations. For example, children, the elderly and the developmentally disabled are at greater risk for abuse and neglect than other populations.

Domestic violence is defined as acts of violence, abuse and/or battering against a family member of any age. Domestic violence can be directed against a spouse, a child, an elder and a person who cohabitates with another without marriage. Domestic violence, abuse, assault and battering are crimes in all states. This behavior used to be ignored by law enforcement. Today, it is not. It is, instead, diligently pursued and prosecuted in our country.

Healthcare professionals and others, such as school psychologists and teachers, must, by law in Florida and many other states, immediately report all cases of suspected elder abuse and child abuse. You do NOT have to be certain that the abuse is occurring, that is up to an investigative team. You must report all cases of suspected abuse.

Domestic violence is a complex phenomena that is often not fully understood. It is known, however, that domestic violence results from the batterer's need for power and control over the victim. The batterer feels "entitled" to have and maintain control over the victim for one reason or another. Emotional abuse, in the form of intimidation, fear and threats of violence are frequently the precursors of domestic battering and another sad trend is the use of children as pawns to gain power and control over the victim. Often, these children are in need of protective services.

Abuse and neglect can take several forms. Neglect is a failure to do what should be done. It is an act of omission. Neglect can take the form of physical, psychological or financial abuse. Abuse is an active, rather than passive act, it is an act of commission. Neglect can be psychological, physical, and economic or financial. Abuse can be emotional, physical, economic or financial as well as sexual.

Men are the predominant perpetrator of domestic violence and abuse. Women are the most common victims of domestic violence in virtually all cultures and geographic areas of the world. (National Domestic Violence Hotline, 2005) The escalation of abusive and neglectful behavior generally shows a trend. It may start with name-calling and other signs of disrespect and progress to acts of undirected violence, such as punching a fist through a wall, and/or damage to objects or pets. Later it may progress to pushing, slapping and pinching. Without intervention, the abuse can escalate to serious life-threatening acts, such as choking, breaking bones, and/or the use of weapons.

FORMS OF ABUSE

There are four forms of abuse. They are physical abuse, psychological abuse, financial abuse and sexual abuse. All of these forms of abuse can occur in domestic violence cases.

• Physical abuse. Physical abuse is the use of physical force to batter another. It generally has a gradual and insidious path of escalation, often beginning with a rare push or a mild punch and then progressing to increasingly more frequent and aggressive behaviors such as beating, punching and even highly serious crimes like murder. Some of the signs of physical abuse include burns, skin tears, bruises, head injuries, broken bones and other physical injuries or scars which cannot be explained by the individual in terms of how they occurred and/or when they occurred. Physical abuse often leads to sexual abuse and rape.
• Psychological abuse. The abuser's psychological abuse can include such things as threats, yelling, belittling, name-calling harassment, excessive possessiveness, and the isolation of the victim from family and friends. Signs of mental abuse include fearfulness, depression, panic attacks, anxiety, insomnia, feelings of low self-esteem, suicide attempts and suicide gestures. Psychological abuse is often concurrent with and/or the precursor to physical abuse.
• Financial abuse. Financial abuse occurs when the perpetrator withholds the funds necessary for the victim to have basic essentials when the financial means to do so are there. For example, the victim, who is often unemployed, is not given access to the family funds and is, therefore, not able to purchase such basic items as personal hygiene items and groceries for the family. Signs of financial abuse include poor attire, empty kitchen cabinets, and no access to cash, knowing that the family has the financial resources to have much more.
• Sexual abuse. Sexual abuse is best defined as unwanted sexual contact. Although abused women are more often raped by the perpetrator than those that are not abused, this is not always the case. Some are raped without a history of battering and other forms of abuse.

Marital rape, like all other kinds of rape, is defined as nonconsensual sex of any kind, including oral, anal and vaginal sex, which transpires with or after physical force, intimidation and/or threats. Marital rape occurs at the hand of a spouse, ex-spouse, significant other, or intimate partner. All states in our nation have laws against marital rape. (National Domestic Violence Hotline, 2005).

Battering rape is a combination of sexual assault and physical abuse as concurrent events or forcing sexual activity after an assault as a sign that the victim forgives the abuser.

Force only rape occurs when perpetrator uses only as much force as necessary to have control over the victim for the purpose of sexual contact. This is the most common form of marital rape. The perpetrator erroneously thinks that they are simply exercising their right to the spouse on their own terms.

Obsessive rape is the least common form of marital rape but perhaps the most harmful of all. This form of marital rape occurs when the victim is physically forced to carry out perverse and strange sexual activities with the perpetrator. (National Domestic Violence Hotline, 2005)

THE RISK FACTORS ASSOCIATED WITH DOMESTIC VIOLENCE

Why do loved ones abuse those they love? This has been many theories and speculations about why domestic violence occurs. Some speculate that domestic violence is the result of poor communication skills, dysfunctional family dynamics, stress, chemical abuse, provocation, economic problems and the lack of spirituality. The fact remains, however, that the need for power and control is the cause. When all other factors are removed, it is known that domestic violence continues as a result of the abuser's need for power and control over the victim and the fact that it often goes unpunished.

Some of the risk factors associated with the profile of an abuser include the following:

• jealousy and possessiveness;
• low self esteem;
• feelings of powerlessness;
• their belief that the victim is a piece of property that they own;
• lack of respect to the victim's gender as a whole;
• inability to accept responsibility for ones own behavior. The abuser externalizes blame on things other than self, including the provocation of the victim;
• unpredictable temperament;
• quick temper and lack of self control;
• history of cruelty to animals;
• alcohol and drug abuse;
• strongly held beliefs that stereotype women as possessions rather than human beings and that they should follow the man's orders; and
• history of being abused themselves and/or witnessing domestic violence in their own home while they were growing up. This kind of upbringing teaches a child that violence is natural and the way to solve problems. It becomes self-perpetuating. This history is the greatest risk factor associated with domestic violence.
  (National Coalition Against Domestic Violence, 2005)

Domestic violence has no barriers. It affects both genders and people of all ages. Although there is no firm profile of a victim, there are some identified reasons why victims remain in violent relationships. Some of these reasons include:

• economic fears, particularly when the victim is unemployed;
• feelings of guilt and shame;
• rationalization that the violence is the result of stress and other outside factors, rather than the abuser themselves;
• the lack of financial resources belonging solely to the victim;
• concerns about the batterer's increased violence;
• lack of access to support and safety resources outside of the home;
• fears about the children and single parenting, including losing custody and other losses associated with abandonment if they do leave;
• feelings that an intact family is better than a broken home; and
• false or misguided hopes that things will get better.
  (National Coalition Against Domestic Violence, 2005)

THE EFFECTS OF DOMESTIC VIOLENCE

Domestic violence leads to more than bruises and broken bones. About 50% of abused women have significant signs of depression, as compared to the 30% without a history of domestic violence. Over 30% of abused women have experienced problems accessing healthcare and about 20% of abuse women have a disability or illness that impedes their ability to work and/or perform daily activities, as compared to only 15% of women without a history of domestic violence. (National Domestic Violence Hotline, 2005)

The effects of harmful physical, psychological and financial harm experienced by the victim, domestic violence also has far reaching and long terms effects on children. Children in homes with violence may:

• become violent themselves when they grow older;
• do poorly in school;
• act out and bully others;
• exhibit animal cruelty;
• withdraw from others; or
• excessively try to be the model, perfect child. (National Domestic Violence Hotline, 2005)

As stated previously, domestic violence can touch any life, in any occupation. Concerned with domestic violence in the military, Donald Rumsfeld states, "Domestic violence in the military adversely affects unit readiness. We must make every possible effort to establish effective programs to prevent domestic violence, but when it does occur, we have a duty to protect the victims and take appropriate action to hold offenders accountable." (U.S. Department of Defense, 2002).

DOMESTIC VIOLENCE INTERVENTIONS FOR HEATLHCARE PROFESSIONALS

While three-quarters of women exposed to domestic abuse had discussed these incidents with a friend or relative, only 29 percent had discussed them with a physician or health care professional. (National Domestic Violence Hotline, 2005)

Every client contact should include screening and assessment with the purpose of determining if the person is a possible victim or a possible perpetrator. This screening and assessment includes people of all ages. Elders and children must also be screened.

Complete care for the victim includes a through assessment (history, physical examination and psychological evaluation) that is mindful of the signs of abuse; interventions including physical and psychological care, safety planning and referrals to domestic violence safe shelters, legal aid, child protective services, follow up victim counseling and when appropriate battering counseling, and victim advocacy groups and resources. The continuity of care from screening to discharge referrals is necessary to protect the victim.

The victim is often reluctant to leave the abusive home and that is their right to do so if they are competent to make decisions, but nonetheless, safety planning and discharge planning to available community resources are imperative.

CONCLUSION

Domestic violence continues to be a major healthcare problem in our country. It is nondiscriminating. It affects all ages, religions, sexes, colors and socioeconomic classes.

Healthcare professionals are in a unique position, one that can be highly instrumental in decreasing the frequency of this pervasive crime. Thorough and effective assessment and intervention is necessary, while maintaining the right to make decisions about leaving an abusive home in the hands of the victim.

DOMESTIC VIOLENCE RESOURCES

National Domestic Violence Hotline

1-800-799-SAFE (7233) or 1-800-787-3224 (TTY).

Assistance through email at ndvh@ndvh.org

Crisis intervention and referrals to the Deaf through the TTY line and email at deafhelp@ndvh.org); www.ndvh.org

Florida Coalition Against Domestic Violence

(850) 425-2749

TDD: (850) 621-4202

In-state: 800-500-1119

Crisis Prevention Institute, Inc. (CPI). www.crisisprevention.com

Ending Violence Against Women: An Agenda for the Nation www.4woman.gov

Initiatives Related to Domestic Violence www.ilj.org/dv/index.htm

National Center for Victims of Crime www.ncvc.org

National Crisis Prevention Institute, Inc. www.crisisprevention.com

Survivors International www.survivorsintl.org

American Women Overseas www.awoscentral.com

The R.O.S.E. Fund (Regaining One's Self-Esteem) Fund www.rosefund.org

Men Stopping Violence www.menstoppingviolence.org

The White Ribbon Campaign www.whiteribbon.ca/language/default.asp?thisUrl=%2FDefault%2E.asp

The Safer Child www.safechild.org

Children Now www.childrennow.org

Child Trauma Academy www.childtrauma.org

The Corporate Alliance to End Partner Violence www.caepv.org

National Organization for Women www.now.org

NOW Legal Defense and Education Fund www.nowldef.org

Family Violence Prevention Fund www.fvpf.org

National Immigration Forum www.immigrationforum.org

Institute for Women's Policy Research www.iwpr.org

The Urban Institute www.urban.org

U.S. Department of Health and Human Services www.hhs.gov

U.S. Department of Health and Human Services, Office of Civil Rights www.hhs.gov/ocr/

U.S. State Department Information on International Child Abduction www.travel.state.gov

National Alliance for the Mentally Ill www.nami.org

Women and Depression www.nami.org/helpline/women.html

Abused Deaf Women Advocacy Services www.adwas.org

Deaf Abused Women and Children Advocacy Services www.dawcas.org

Institute on Domestic Violence in the African American Community www.dvinstitute.org

The National Tribal Justice Resource Center: www.tribalresourcecenter.org

Women's Justice Center/Centro de Justicia Para Mujeres www.justicewomen.com

Asian Women United of Minnesota www.awum.org

Asian Task Force Against Domestic Violence www.atask.org

Asian Women's Resource Exchange www.aworc.org

The New York Asian Women's Center www.nyawc.org

Korean American Women in Need www.angelfire.com/il/kanwin/

Asian Japan Women's Resource Center (www.ajwrc.org) English - Japanese

Muslim Women's Homepage www.jannah.org/sisters/

Gay Men's Domestic Violence Project www.gmdvp.org/index.html

National Coalition of Anti-Violence Project's Report on Lesbian, Gay, Bisexual, Transgender Domestic Violence www.lambda.org/dv97.htm

Partners & Allies of Sexual Assault Survivors. www.twhj.com/allies.shtml

The Wife Rape Information Page www.wellesley.edu/WCW/projects/mrape.html

Sexual Abuse Treatment Referral, Resource, and Research Page www.angelfire.com/mi/collateral/index.html

The Center for the Prevention of Sexual and Domestic Violence www.cpsdv.org

National Organization on Male Sexual Victimization www.malesurvivor.org

Men Stopping Violence www.menstoppingviolence.org

National Runaway Switchboard www.nrscrisisline.org

National Sexual Violence Resource Center, Teen Dating Violence www.nsvrc.org/teendating.html

Nursing Network on Violence Against Women, International www.nnvawi.org

Physicians for a Violence-Free Society www.pvs.org

Safe At Work Coalition www.safeatworkcoalition.org

REFERENCES

National Coalition Against Domestic Violence. (2005). "Barriers to Leaving a Violent Relationship". www.ncadv.org

National Coalition Against Domestic Violence. (2005). "What is Battering?" www.ncadv.org

National Coalition Against Domestic Violence. (2005). "Why Do Men Batter Women?" www.ncadv.org

National Coalition Against Domestic Violence. (2005). "Why Do Women Stay?". www.ncadv.org

National Domestic Violence Hotline. (2005). "Domestic Violence and Health Care". www.ndvh.org

National Domestic Violence Hotline. (2005). "Domestic Violence and Impact on Children" www.ndvh.org

National Domestic Violence Hotline. (2005). "Domestic Violence and the Military". www.ndvh.org

National Domestic Violence Hotline. (2005). "National Statistics" www.ndvh.org

National Domestic Violence Hotline. (2005). "Sexual Abuse". www.ndvh.org

Contact Hours: 1
Price: $10.00
Course Title: DOMESTIC VIOLENCE
Course Number: 20-53828

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