Safe place to talk is first aid for abused
Safe place to talk is first aid for abused
How you can help with existing resources
Low self-esteem and isolation from the world outside their homes that’s the trap that binds women into violent relationships. If you believe it doesn’t happen to your patients, think again. Whether your center is tucked away in a small, quiet town or ensconced in an affluent suburb, some of your patients live with abuse.
Much attention has been paid to domestic violence. In fact, the Joint Commission on Accreditation of Healthcare Organizations ruled in 1995 that health facilities establish procedures for recognizing and connecting domestic violence victims to services. The problem continues, however.
"One in four women in our country lives in an abusive relationship. And only 25% to 30% of them come to the emergency room with their injuries," says Susan Hadley, MPH, founder and director of WomanKind, a Minneapolis-based program for battered women.
Look for clues
If abuse always presented as black eyes or swollen jaws, it would be easier to confront. In reality, Hadley explains, the indicators are often more subtle, such as recurring vaginal or urinary tract infections. The problems result, she says, from the genital abrasions caused by rough sexual behaviors of abusive partners.
A full-blown counseling and support group program isn’t the only way to aid abuse victims. A lower-cost alternative begins with strong ties to service agencies for abused women. If you don’t know who they are, Hadley says, "Start asking questions."
Your facility probably has a quality assurance manager and perhaps a task force on domestic violence. Through their efforts to implement the Joint Commission’s standards, they probably can give you some leads.
"Use the women’s health grapevine, and you’ll find someone who knows where the services are in your area," Hadley adds.
If you’re fortunate and have a women’s shelter or safe house in your community, be careful how you use it, she warns.
"Abused women don’t like to be labeled, and many don’t think of themselves as abused," especially if they live with verbal humiliation or threats of physical violence, she says. So if you refer them to the shelter, they may think you’re off base.
A better link is to use the shelter staff’s expertise to train your providers in recognizing abuse and helping women explore their options. Those options might include an eventual stay at the shelter as the first step out of the abusive relationship. But that’s a leap most abuse victims don’t make right away, Hadley says.
Women have to feel safe before they’ll talk. Adding to the difficulties are providers’ normal tendencies to avoid touchy subjects when they don’t know the words to use.
Safety first
On that note, understand that assistance to your abuse victims starts with creating an environment where they feel safe revealing their problems. Make a policy of doing intimate exams, clinical breast exams, vaginal exams, and obstetric check-ups without patient’s partners present. Hadley suggests simply telling an accompanying partner or spouse, "I’m going to examine the patient now, please step out to the waiting room."
If you find bruises or other warning signs, Hadley says, one way to open discussion is to say, "When I see injuries like this, the first thing I think of is that someone has hurt you. How did this happen to you?" If the patient talks, of course, it’s an opportune time to explain the help she can find through community resources. Emphasize that everything she tells you is confidential.
It’s usually not that easy, though. (See insert, Asking the Questions, for additional ways to break the silence.) Abused women fear their perpetrators and often have good reason to anticipate more harm to themselves or their children if they tell outsiders what’s going on.
Seeking help can be a frightening prospect. "Many abused women stay in abusive relationships because they cannot afford to support themselves," says Irma Cruz, BA, women’s health associate at the University of Illinois at Chicago. "Women with children find that choosing safety is choosing poverty," she says.
Opening new doors
"It’s a major life decision," Hadley adds. The WomanKind staff views contacts following the initial one as the best indication a woman is building resources to stop the abuse or move out of the abusive relationship. (On the graph, p. 118, note the upward trend in the number of WomanKind’s follow-up contacts. Those repeat contacts represent subsequent calls by women who ask WomanKind about support groups or community programs such as job training services.)
"That’s when the staff and volunteers call women back after their first contact with us," Hadley explains. "It’s where the real progress is made. We’ve found when someone calls an abused woman back to ask how she’s doing, it does more than anything else to raise her self-esteem.
"Breaking the isolation can convince [an abused woman] that she really has a way out" Hadley explains. ß
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