Photos aid police, can prompt victim to seek help

Careful written documentation can also help nurses avoid subpoenas

Your documentation can be crucial to the outcome of a legal case made against a batterer, says Susan Hohenhaus, RN, an emergency nurse at the University of North Carolina Hospital in Chapel Hill, NC. "In the case of one of our patients, thorough written documentation resulted in a felony charge for her abuser," she reports. Here are some tips for documenting domestic violence:

A picture is worth a thousand words. Photos are powerful evidence in the courtroom.

"Whatever you write on the patient's chart, it will not have the impact of a photo," Hohenhaus explains.

If possible, obtain the patient's permission to photograph any suspicious injuries. "Tell the woman, I'm really concerned about your injuries. I would like to take some photographs and put them in a sealed envelope in case you want to use them at a later time," says Hohenhaus. "Sometimes they refuse, but other times they really want you to."

Record ongoing violence. When a woman repeatedly presents with severe injuries caused by abuse but refuses to press charges, nurses often feel a sense of frustration. Taking photographs of the injuries is key, even if the victim refuses to press charges. "If nothing else, you can document what happened, so if something worse happens down the road, it's on record," says Anna Waller, ScD, research assistant professor for the department of emergency medicine at the University of North Carolina in Chapel Hill. "That allows you to feel you've done something more than patch up her wounds."

Take follow-up photos, if patients are admitted to hospital. When a woman came to University of North Carolina's ED after being shot in the chest by her husband at fairly close range, photos were taken immediately and again on the next day. "The abuser's bail was raised by $50,000 due to the follow-up photos, which showed intense bruising," reports Hohenhaus.

Use photos as a wake-up call. In some instances, photographs can shock a batterer into getting help. When a woman came in with her husband who had caused severe injuries, photos were taken. "When the police showed up after the victim gave us permission to call them, they showed the pictures to the batterer and it hit home," recalls Mary Anne Nolan, RN, CEN, clinical coordinator of emergency services at Deering Hospital in Miami, FL. "He admitted he needed help, and asked to get into a treatment program."

Put everything the victim says in quotes, instead of paraphrasing. "If they use a word you wouldn't normally use, write it down anyway, and put it in quotes," Hohenhaus advises. "Document if this if the fifth time you've seen the patient with the same complaint, who comes with her, how they act, and how they interact with their children."

Document carefully to avoid being subpoenaed. "If you do it right, your documentation speaks for itself, which means you are less likely to be called to testify," says Hohenhaus.

However, if you are summoned to court, it's important that you testify, Hohenhaus stresses. "There is no better person than a nurse to do that," she says. "Nurses have credibility, they have the public trust, and we have been putting physicians' discharge instructions in laypeople's terms for years."

Record suspicions about injuries. If you feel a woman's injuries were not adequately explained, record your opinion. "Do the same thing as you would if a patient was in a car crash and it doesn't look like he or she was wearing their seatbelt, even though [he or she] claims to have been," says Hohenhaus. "If a woman's explanation isn't consistent with her injuries, document that, including her denial."