1. What is the definition of domestic violence? (2 points) According to U.S. Department of Justice definition, domestic violence is a pattern of behavior in a relationship that is used by one partner to exert control over another intimate partner. It includes physical assaults, sexual, emotional, economic or psychological actions that influence another person. 90 percent of cases involve women being abused by men (Eisenstat and Bancroft, 1999). Domestic violence is the leading cause of morbidity and mortality for women of childbearing age and the main consequences are from the mental health aspects of abuse (Hegarty, 2011).
2. Identify complaints/psychological indicators for abuse in this case. (10 points)
- Amy has pain in different parts of her body consistent with physical abuse. She has anxiety, insomnia, and loss of appetite. Amy also has nightmares and stress.
- Amy and her boy-friend have arguments over money and paying the bills indicating relationship tension.
- It is likely that Amy is being physically, emotionally and psychologically abused by her boyfriend. Amy is small built 5’ 2”, weighs 92 pounds and likely cannot defend herself.
3. When questioning patients about suspected domestic violence it is essential for the provider to know that all conversations are private and that the partner should never be informed that the patient is being questioned. Provide two reasons why. (2 points)
- It is very important for Amy’s safety that her partner is not aware that Amy is being questioned. Amy will not be able to speak freely to her healthcare providers in her partner’s presence.
- According to US HIPAA laws health, information is private and to be kept confidential. These health records can only be released to the patient or spouse of the patient with the patient’s permission according to U.S Department of Health and Human Services
4. Framing the questions in a non-threatening way are necessary to illicit responses. However, it is also necessary to ask questions in a direct manner. Provide three examples of direct questioning. (3 points)
- Amy is to be asked if she had ever been hit or physically threatened by her boyfriend.
- It is important to ask Amy if her boyfriend has ever tried to force her into doing anything she did not want.
- Amy is to be asked if she is afraid of her partner or anyone else (Buttaro, Trybulski, Bailey and Sandberg-Cook, 2013).
5. Patients will often deny abuse due to fear and embarrassment. If a provider suspects abuse despite the denial, what are three actions you can do? (3 points)
- Further questioning while trying to make the patient feel safe and secure.
- Providing the patient with resources and allowing them to feel free to choose whatever they want.
- Counsel the patient about unwanted pregnancies and what she can do to prevent it. This could include self-help strategies because domestic violence often occurs at home (Powers and Simpson, 2012).
- Advising the patient to seek psychological counseling and therapy as required (Buttaro et al., 2013).
6. What is the law in your state for reporting abuse of adults? Provide a brief answer. Provide the reference. (5 points) The Illinois Domestic Violence Act is the law governing reporting abuse of adults. However, it does not fall under mandatory statutes to report in Illinois. In fact reporting domestic violence to authorities without the victim’s explicit consent breaches confidentiality and can be dangerous. When domestic violence is reported, orders of protection are usually issued according to Illinois Attorney General.
7. If the victim does not cry or appear upset after admitting to abuse, does this mean she is lying? Yes or no? Provide a rationale. (4 points)
- No, it is not necessary that she is lying since Amy may be emotionally numb from the abuse. After admitting to abuse, crying or being upset does not necessarily indicate that the victim is lying or not (Buttaro et al., 2013).
8. Abusive relationships are based on two issues. What are they, and how does this work? (5 points)
- Control of the victim by the abuser is an important issue. There is a cycle of violence and control.
- Fear of partner, self-worth of victim and dependence is another important issue. The more powerless a victim feels, the less likely she is to leave the relationship.
9. How can providers help themselves care for abuse victims? (5 points)
- Providers can help Amy feel less isolated and care for her psychological well-being.
- They can recommend that she visits certain providers confidentially.
- They can teach her strategies to keep herself safe from her abuser (Buttaro et al., 2013).
10. When managing a patient that has admitted to being a victim of domestic violence, the provider should include four things. What are they? Provide a brief rationale (8 points)
- The provider should consider physical complaints, psychological indicators or a combination of the two.
- When prescribing medication, the provider should take care not to give medication that could impair the victim’s judgment or ability to respond and put her at greater risk for further injury.
- The provider should ask the victim if the follow-up should be by mail or phone and take care to ensure that the victim is not further abused due to the follow-up procedure.
- Building a respectful patient-provider relationship and providing openings for further disclosure are also important (Buttaro et al., 2013).
Buttaro, T.M., Trybulski, J., Bailey, P.P., Sandberg-Cook, J. (2013) Primary Care: A Collaborative Practice., 2013, Chapter 18, Lifestyle Management, pp136-141
Eisenstat S. and Bancroft L., (1999), Domestic Violence, New England Journal of Medicine, Volume 341, No 12, pp886-892
Hegarty K., (2011), Domestic Violence: the hidden epidemic associated with mental illness, British Journal of Psychiatry, Volume 198, pp 169-170
U.S. Department of Justice, Retrieved on Oct 5, 2014, from website http://www.justice.gov/ovw/domestic-violence
U.S Department of Health and Human Services, Retrieved on Oct 5, 2014, from website http://www.hhs.gov/ocr/privacy
Powers R.A., and Simpson S. (2012), Self-protective behaviors and Injury in Domestic Violence Situations: Does it hurt to fight back? Journal of Interpersonal Violence, Volume 27, No 17, pp3345-3365
Illinois Attorney General, Retrieved on Oct 5, 2014 from website http://www.illinoisattorneygeneral.gov/women/idva.html
Helpguide.org, Retrieved on Oct 5, 2014 from website http://www.helpguide.org/articles/abuse/domestic-violence-and-abuse.htm