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Finding Their Voices

Nurses help victims of domestic violence and sexual abuse get care and find safety.

In one 24-hour period in September 2008, 60,799 victims of domestic violence received support and found safety in programs and shelters across the U.S.1In that same time period, workers in domestic violence programs answered more than 14 hotline calls every minute.

In 2003, the U.S. Department of Justice estimated 6 million women are physically abused by their husbands or boyfriends every year. That's a staggering statistic, but it pales when compared to numbers released by the Human Rights Watch in December 2008.2Those numbers show a 42 percent increase in reported domestic violence, and a 25 percent increase in the reported incidence of rape and sexual assault. Among all violent crimes, domestic violence, rape and sexual assault showed the largest increases, with some states, including Massachusetts, faring worse than others.

"In Massachusetts there has been an uptick in domestic violence and elder abuse, and there has been a 300 percent increase in intimate-partner homicides," said Erin Miller, MPA, MPS, CASAC, coordinator of the Domestic Violence/Sexual Abuse Program at Newton-Wellesley Hospital, Newton, MA. "We are outside of the statistical norm for the country."

No One is Immune

Nationally, three out of four Americans personally know someone who is or has been a victim of domestic violence, according to the Domestic Violence Resource Center. The numbers in Massachusetts may be even higher. Many of these victims of domestic and sexual violence turn up in hospitals, taken there by police, ambulance and, in some cases, their own abuser.

Statistically, that means nurses see these victims more frequently than they realize, according to Annie Lewis O'Connor, PhD, MPH, NP, program manager of nursing practice at the Center for Women & Newborns at Brigham and Women's Hospital in Boston. "Every single nurse in this country has taken care of a victim of violence - every one. There is no way around it."

Newton-Wellesley's Domestic Violence/Sexual Abuse Program relies on nurses to listen and to ask questions. Both tactics help victims feel safe enough to tell their stories.

"When they first disclose, you have to be alert. You have to listen," Miller explained. "At Newton-Wellesley, triage nurses are trained to listen for nuance. They have a gut instinct, and they will ask additional questions."

Miller says asking questions opens the door to disclosure for victims.

"We know now you are likely to get more disclosures if you ask repeatedly, if you ask directly, if you ask multiple questions and in multiple formats - in writing, in private, verbally."

Hands-on Learning

First to discover abuse, a nurse may also be the first and perhaps the last person a victim of domestic violence or sexual assault can tell what happened and turn to for help. But Robin Cunningham, DNP, NP, says nurses may not always be comfortable in that role.

"It's very nerve-wracking," she said. "Nurses worry if they do something wrong, it will affect the outcome of prosecution."

Cunningham, the clinical educator in the emergency department at Newton-Wellesley, thinks apprehension stems from nurses not seeing domestic violence victims frequently. Education can suppress their fears.

"We do BASE - Bi-Annual Standards Exam - and we do a week-long competency," she said. "We have the [sexual assault evidence collection] kit open and the cart. We do role playing and different scenarios.

Cunningham, who has worked in domestic and sexual violence nursing for 28 years, says learning relies on hands-on training. "It is not just on the computer, and I've checked off this box and I am OK. It's making people comfortable with it. That removes some of the barriers."

Cunningham educates the nurses at Newton-Wellesley; Miller supports them 24/7. Together, they have helped build a program which offers a full spectrum of free services like crisis intervention, safety planning, individual counseling, advocacy and referrals to community resources.

Miller said strong ties to community and state-run programs enhance their program. "I have really strong relationships with all of the community-based domestic and sexual violence programs. They are my right arm, really and truly."

Finding Their Voices

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I am a lawyer and R.N. and I own my family law practice with my husband. There is a great need to coordinate Court Rooms with medical people. Protection Orders are not given appropriately and there should be a more medical view when doing custody cases where child go with bad parents.

Caran  Mattis,  Lawyer,  Own my Practice March 25, 2010
Shamokin, PA

I have been an RN for many years and then went to law school and added another career. I am a prosecuting attorney and work with our Domestic Violence Bureau. Since I frequently visit my daughter in Cambridge, MA, I would love to meet with any of the Boston or Newton nurses mentioned in the article to do an exchange of information. My next trip to Cambridge wil be on the March 12th. You can contact me also by phone at 718 250 2457. Hope to hear from someone soon.

Joan Ierardi,  Asst DA ,  Brooklyn DA's OfficeMarch 03, 2010
Brooklyn, NY


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