How Nurses Can Help an Assaulted Woman

Role of Nursing Staff and Physicians with Assaulted Women

• screening/identification
• assessment/examination
• documentation
• safety planning
• referral

For the Emergency Department Nurse

Triage in Abusive Situations

It is difficult to identify abuse.  However, regardless of how minor an abused woman's injuries may seem, there are crucial areas of nursing assessment and intervention that must be addressed in order to avert potential death.  There are often multiple old and new injuries, that may be overlooked, especially if the presenting problem is a facial injury or profuse bleeding.

Assessment

You should approach the patient in an open and sensitive manner in order to determine whether injuries are the result of physical abuse.  Interviewing the woman in private insures a more accurate response. Record the nature and extent of the injuries, using the word "alleged" when referring to the assault.  Also, record whether or not the patient accepted the referral to a counsellor.  Report findings to the physician and discuss an appropriate approach to the patient.

Specific signs to look for when assessing the situation for woman abuse:

Injuries

• Site: head, face, neck, throat, chest, breasts, back, abdomen, genitals
• Type: abrasions, bruises, dislocations, lacerations, bites, fractures, strangulation
• Description of the accident is inconsistent with the type of injury

Behaviours:

• Delay in seeking help is unexplained (12 to 18 hours)
• Partner's behaviour: hangs around, insists on staying while she is being examined, answers for the woman
• Woman's behaviour: says nothing in front of her partner, minimizes the seriousness of the situation, although there is real danger; is anxious about a minor injury
• Repeated visits to the emergency department for injuries.
• Timing of visits: is in the evening or on weekends

Recurring Physical Ailments

• headache, migraine
• chest pain
• backache
• hyperventilation
• difficulty catching her breath
• fatigue
• gastrointestinal disorders
• pelvic pain
• menstrual pain
• vague abdominal pain
• heart palpitations
• numbness
• injuries to arms or fingers

Emotional signs and symptoms

• depression
• nervousness
• anxiety
• suicidal gestures
• substance abuse
• sleep disturbance, insomnia
• withdrawal from touch
• avoidance of eye contact
• low self-esteem
• hostility

Safety Plan

If you believe she is in danger, tell her.  Help her plan an emergency exit.

Although police can be asked to accompany a woman going back home to retrieve personal belongings, encourage her to be prepared for the possibility of leaving home in a hurry.  She should have necessary documents or photocopies ready, as well as important items such as:

• credit cards, cash, bank books
• passport, birth certificates, citizenship papers
• house keys
• medication
• children's favourite toy, clothes, etc.

Never recommend joint family or marital counselling in situations of emotional or physical abuse.  It is dangerous for the woman and will not lead to a resolution that is in her interest.  Encourage separate counselling for the man and woman if they want counselling.

Do not place yourself in danger by confronting the assaultive man.

Referrals

Does she have a safe place to go or does she need an emergency shelter?  Have phone numbers for local shelters handy.

Does she have a lawyer?  She will need good, sympathetic legal representation.  Provide her with the names of some lawyers or legal aid.

What supports does she have?  She will need the support of those who understand the experience of wife assault.  Ask her if she would like you to call some community support groups or give her the numbers to call herself.

It is critical that you establish a system for ongoing contact.  Can she be reached at home?  Perhaps, a signal strategy will be needed such as doctor's secretary calling.  Who can you contact in case of emergency?