Women's Healthcare Utilization Following Routine Screening for Past-Year Intimate Partner Violence in the Veterans Health Administration.

BACKGROUND: Experience of intimate partner violence (IPV) can have adverse health impacts and has been associated with elevated rates of healthcare service utilization. Healthcare encounters present opportunities to identify IPV-related concerns and connect patients with services. The Veterans Health Administration (VHA) conducts IPV screening within an integrated healthcare system. OBJECTIVE: The objectives of this study were to compare service utilization in the 6 months following IPV screening between those screening positive and negative for past-year IPV (IPV+, IPV-) and to examine the timing and types of healthcare services accessed among women screening IPV+. DESIGN: A retrospective chart review was conducted for 8888 female VHA patients across 13 VHA facilities who were screened for past-year IPV between April 2014 and April 2016. MAIN MEASURES: Demographic characteristics (age, race, ethnicity, marital status, veteran status), IPV screening response, and healthcare encounters (based on visit identification codes). KEY RESULTS: In the 6 months following routine screening for past-year IPV, patients screening IPV+ were more likely to utilize outpatient care (aOR = 1.85 [CI 1.26, 2.70]), including primary care or psychosocial care, and to have an inpatient stay (aOR = 2.09 [CI 1.23, 3.57]), compared with patients screening IPV-. Among those with any utilization, frequency of outpatient encounters within the 6-month period following screening was higher among those screening IPV+ compared with those screening IPV-. The majority of patients screening positive for past-year IPV returned for an outpatient visit within a brief time frame following the screening visit (> 70% within 14 days, >95% within 6 months). More than one in four patients screening IPV+ had an emergency department visit within the 6 months following screening. CONCLUSIONS: Women who screen positive for past-year IPV have high rates of return to outpatient visits following screening, presenting opportunities for follow-up support. Higher rates of emergency department utilization and inpatient stays among women screening IPV+ may indicate adverse health outcomes related to IPV experience.

Immediate and Late Response to Intimate Partner Violence Intervention in the Pediatric Emergency Department: A Case Report.

Childhood exposure to intimate partner violence (IPV) results in numerous, lifelong, negative health outcomes, underscoring the American Academy of Pediatrics' recommendation for IPV screening and intervention in the pediatric health care setting. We report a case in which a mother denied IPV during routine IPV screening in a pediatric emergency department (ED). However, subsequent discussion with health care providers during the ED visit revealed IPV. The mother declined to meet with an IPV advocate because the abuser was texting repeatedly to ask about the duration of the ED visit. However, the onsite social worker met with the mother to provide supportive counseling and complete safety assessment and planning. The mother returned to the abusive home after ED discharge because 3 of her 4 children were with the abuser at that time. Four months later, the mother returned to the ED with her children to see the IPV advocate. After speaking with the advocate, the mother and children went to safe shelter directly from the ED. This case underscores the importance of providing caregivers with multiple opportunities to disclose IPV, the need for health care providers to remain alert to indications that IPV may be occurring, and the role of the entire health care team in addressing IPV. This case also demonstrates that although IPV interventions may not immediately result in leaving an abusive relationship, the unseen benefits of such education and support can ultimately improve safety.

Screening for Intimate Partner Violence.

Intimate partner violence (IPV) is a serious concern for women that is associated with significant adverse health effects. Routine screening for IPV is recommended, but there are many barriers to screening that have been identified by providers, including discomfort, lack of training, and not knowing how to respond to a positive screen. This article reviews IPV screening and appropriate techniques for responding to a positive screen. IPV screening best practices include using a systematic protocol, developing a screening script, using a validated screening tool, and considerations for privacy and mandatory reporting. Responding to a positive screen should include acknowledging the experience, asking if the woman desires help, offering support and referrals, encouraging safety planning, and completing additional assessments to determine level of danger and to identify any comorbidities. Using these techniques along with therapeutic communication may increase IPV identification and create an environment in which women feel empowered to get help.

Support to women who denounce experiences of violence based on her social network / Apoio à mulher que denuncia o vivido da violência a partir de sua rede social / Apoyo a la mujer que denuncia lo vivido de la violencia a partir de su red social

Objective: to analyze the possibilities of help/support through the mapping and acknowledgement of the social network of women who denounce experiences of violence at a Police Precinct for Women.Method: qualitative study based on the theoretical-methodological framework of Lia Sanicola's Social Network, through interviews with 19 women.Results: the analysis of the network maps evidenced that the primary social network was more present than the secondary on and, despite consisting of significant relations, it demonstrates limitations. The women access the secondary network occasionally in the violence problem and/or its repercussions in their life and health. The discrete presence of the health network in the composition of the social network was revealed and, when mentioned, the relation between the health professional and the woman was characterized as fragile.Conclusion: the importance of the social network relates to the creation of spaces of help/support for the women beyond the moment of the aggression, which accompany them throughout their process of emancipation from an experience annulled by violence, considering that each woman acts and makes decisions in the relational context when she is ready for it.

Objetivo: analisar as possibilidades de ajuda/apoio mediante o mapeamento e reconhecimento da rede social de mulheres que denunciam o vivido da violência, em uma Delegacia de Polícia para a Mulher.Método: estudo qualitativo, ancorado no referencial teórico-metodológico de Rede Social de Lia Sanicola, mediante entrevista junto a 19 mulheres.Resultados: a análise dos mapas de rede evidenciou a rede social primária mais presente que a rede secundária, no entanto, mesmo constituída por relações significativas, demonstra limitações. A rede secundária é acessada pelas mulheres em momentos pontuais da problemática da violência e/ou de suas repercussões em sua vida e saúde. Revelou-se a presença discreta dos serviços de saúde na composição da rede social e, quando mencionados, a relação profissional da saúde e da mulher foi caracterizada como frágil.Conclusão: a importância da rede social reside na criação de espaços de ajuda/apoio à mulher que transcenda o momento pontual da agressão, que a acompanhe em seu processo de emancipação de um viver anulado pela violência, compreendendo que cada mulher tem seu tempo para agir e tomar decisões no contexto relacional.

Objetivo: analizar las posibilidades de ayuda/apoyo mediante el mapeo y reconocimiento de la red social de mujeres que denuncian lo vivido de la violencia, en una Estación de Policía para la Mujer.Método: estudio cualitativo, ancorado en el referencial teórico-metodológico de Red Social de Lia Sanicola, mediante entrevista junto a 19 mujeres.Resultados: el análisis de los mapas de red evidenció la red social primaria más presente que la red secundaria. Sin embargo, aunque constituida por relaciones significativas, demuestra limitaciones. La red secundaria es accedida por las mujeres en momentos puntuales de la problemática de la violencia y/o de sus repercusiones en su vida y salud. Se reveló la presencia discreta de los servicios de salud en la composición de la red social y, cuando mencionados, la relación entre profesional de la salud y mujer fue caracterizada como frágil.Conclusión: la importancia de la red social reside en la creación de espacios de ayuda/apoyo a la mujer que va más allá del momento puntual de la agresión, que le acompañe en su proceso de emancipación de un vivir anulado por la violencia, comprendiendo que cada mujer tiene su tiempo para actuar y tomar decisiones en el contexto relacional.

Conjugal violence in the perspective of "Family Health Strategy" professionals: a public health problem and the need to provide care for the women / Violencia conjugal na perspectiva de profissionais da "Estrategia Saude da Familia": problema de saude publica e a necessidade do cuidado a mulher / Violencia conyugal en la perspectiva de profesionales de la "Estrategia Salud de la Familia": un problema de salud publica y la necesidad del cuidado a la mujer

OBJECTIVE: to construct a theoretical matrix based on the meanings of the interactions and actions experienced by the professionals regarding the nursing care practices and the health of women in situations of conjugal violence in the ambit of the Family Health Strategy. METHODS: research based in Grounded Theory. Following approval by the Research Ethics Committee, 52 professionals were interviewed in Santa Catarina, Brazil. The analysis was based on open, axial and selective codifications. RESULTS: the theoretical model was delimited based on the phenomenon "Recognizing conjugal violence as a public health problem, and the need for management of the care for the woman", which reflects the experience of the professionals in relation to care for the woman, as well as the meanings attributed to this care. CONCLUSIONS: the phenomenon allows one to understand the movement of action and interaction regarding the care for the woman in a situation of conjugal violence. .

OBJETIVO: construir uma matriz teórica a partir dos significados das interações e ações experienciadas pelos profissionais sobre as práticas de cuidado de enfermagem e saúde às mulheres em situação de violência conjugal, no âmbito da Estratégia Saúde da Família. MÉTODOS: pesquisa fundamentada na Grounded Theory. Após aprovação pelo Comitê de Ética em Pesquisa, foram entrevistados 52 profissionais em Santa Catarina, Brasil. A análise baseou-se nas codificações aberta, axial e seletiva. RESULTADOS: o modelo teórico foi delimitado a partir do fenômeno "Reconhecendo a violência conjugal como problema de saúde pública e a necessidade de gestão do cuidado à mulher", que reflete a vivência dos profissionais no que tange ao cuidado à mulher, bem como os significados atribuídos a esse cuidado. CONCLUSÕES: o fenômeno permite a compreensão do movimento de ação e interação acerca do cuidado à mulher em situação de violência conjugal. .

OBJETIVO: construir una matriz teórica a partir de los significados de las interacciones y acciones experimentadas por los profesionales sobre las prácticas de cuidado de enfermería y salud prestada a las mujeres en situación de violencia conyugal en el ámbito de la Estrategia de Salud de la Familia. MÉTODOS: se trata de una investigación fundamentada en la Grounded Theory. Después de aprobada por el Comité de Ética en Investigación, fueron entrevistados 52 profesionales en Santa Catarina, Brasil. El análisis se basó en la codificación abierta, axial y selectiva. RESULTADOS: el modelo teórico fue delimitado a partir del fenómeno "Reconociendo la violencia conyugal como un problema de salud pública y la necesidad de administrar el cuidado a la mujer", que refleja la vivencia de los profesionales en lo que se refiere al cuidado de la mujer, así como los significados atribuidos a ese cuidado. CONCLUSIONES: el fenómeno permite la comprensión del movimiento de acción e interacción acerca del cuidado a la mujer en situación de violencia conyugal. .

Violência doméstica contra mulheres e a atuação profissional na atenção primária à saúde: um estudo etnográfico em Matinhos, Paraná, Brasil / Domestic violence against women and professional intervention in primary healthcare: an etnographic study in Matinhos, Paraná State, Brazil / Violencia doméstica contra mujeres y la actuación profesional en la atención primaria a la salud: un estudio etnográfico en Matinhos, Paraná, Brasil

A violência doméstica provoca múltiplas repercussões na saúde das mulheres e gera desafiadora agenda para os profissionais do SUS. Objetivou-se analisar como profissionais de saúde atendem tais mulheres, problematizando a noção de acolhimento em saúde. Adotou-se pesquisa qualitativa e aproximação etnográfica com profissionais de uma unidade básica de saúde (UBS) de Matinhos, Paraná, Brasil. A pesquisa revelou atendimentos centrados em: (1) preceitos biologizantes, com foco em lesões físicas e medicalização; (2) diálogo, escuta ativa, questões psicossociais e estabelecimento de vínculos, destacando-se agentes comunitários de saúde nesta abordagem. A escassez de estrutura local oficial para manejo da violência doméstica enseja atuação inscrita sob a gramática do acolhimento, preconizada pelo SUS, descrita pela literatura, verbalizada na UBS, mas pouco problematizada. Com este artigo buscou-se, portanto, contribuir com tal debate, não no estabelecimento de prescrições, porém no levantamento de indagações e principalmente visibilizando e traduzindo vozes de quem trabalha diuturnamente com esse desafio.

Domestic violence has multiple repercussions on women's health and raises a challenging agenda for health professionals in Brazilian Unified National Health System (SUS). The aim of this study was to analyze how health professionals treat these women, problematizing the notion of acolhimento (receptiveness or openness to patients). A qualitative ethnographic research approach was used with health professionals from a primary care unit (PHU) in Matinhos, Paraná State, Brazil. The study revealed care that was focused on: (1) biologizing principles, with a focus on physical lesions and medicalization and (2) dialogue, active listening, psychosocial questions, and establishment of ties, especially featuring community health agents in this approach. The limited official local structure for handling domestic violence justifies treatment oriented by the grammar of acolhimento, recommended by the SUS, described in the literature, and verbalized in the PHU, but rarely problematized. This article thus proposed to contribute to this debate, not by establishing prescriptions for action, but by raising questions and mainly highlighting and translating the voices of those who deal with this challenge on a daily basis.

La violencia doméstica provoca múltiples repercusiones en la salud de las mujeres y genera una desafiante agenda para profesionales del SUS. El estudio tuvo por objetivo analizar cómo atienden los profesionales de salud a tales mujeres, problematizando la noción de acogida en salud. Se adoptó una investigación cualitativa y una aproximación etnográfica con profesionales de una unidad básica de salud (UBS) de Matinhos, Paraná, Brasil. La investigación reveló atención centrada en: (1) preceptos biologizantes, centrándose en lesiones físicas y medicalización; (2) diálogo, escucha activa, cuestiones psicosociales y establecimiento de vínculos, destacándose los agentes comunitarios de salud en este enfoque. La escasez de estructura local oficial para el manejo de la violencia doméstica da pie a la actuación inscrita bajo las tesis de la acogida, preconizada por el SUS, descrita por la literatura, verbalizada en la UBS, pero poco problematizada. Con este artículo se buscó, por tanto, contribuir con este debate, no en el establecimiento de prescripciones, sino en la realización de indagaciones y, principalmente, visibilizando y traduciendo voces de quien trabaja desde hace mucho tiempo con ese desafío.

Referral patterns and service utilization in a pediatric hospital-wide intimate partner violence program.

OBJECTIVES: To describe the referral patterns and utilization of on-site intimate partner violence (IPV) services in both inpatient and outpatient settings at a large urban children's hospital. METHODS: Retrospective review of case records from IPV victims referred to an on-site IPV counselor between September 2005 and February 2010. Descriptive statistics were used to examine IPV victim demographics, number of referrals per hospital department, referral source (type of staff member), time spent by IPV counselor for initial consultation, and services provided to IPV victims. RESULTS: A total of 453 unique referrals were made to the IPV counselor: 81% were identified by universal screening and 19% by risk-based screening. Thirty-six percent of IPV victims were referred from primary care clinics; 26% from inpatient units; 13% from outpatient subspecialty clinics; 12.5% from the emergency department; 5% from the Child Protection Program; and 4% were employee self-referrals. Social workers generated the most referrals (55%), followed by attending physicians (17%), residents (13%), nurses (7%), and other individuals (self-referrals) (4%). The median initial IPV intervention required 42 minutes. Supportive counseling and safety planning were the services most often utilized by IPV victims. CONCLUSIONS: IPV screening can be successfully integrated in both inpatient and outpatient settings by a multidisciplinary group of hospital staff. Most referrals were generated by universal screening outside of the primary care setting. IPV victims generally desired supportive counseling and safety planning over immediate housing relocation. Many IPV screening opportunities were missed by using verbal screening alone.

Intimate partner violence against women and healthcare in Australia: charting the scene / Violência por parceiro(a) íntimo(a) contra mulheres e cuidado em saúde na Austrália: cartografando o cenário

Intimate partner violence against women is a common problem in all countries and generates a challenging agenda for the health sector. Exchanging experiences between different countries, specifically strategies to respond to this problem, can constitute a tool for stimulating debate and promoting reflection. The scope of this article is to present and reflect on aspects of the Australian health sector response to intimate partner violence, and chart the scenario that surrounds this issue. We draw on a range of methods, combining a literature review and a dialogue with different stakeholders and site visits. We describe historical, contemporary and conceptual aspects of healthcare responses to intimate partner violence in Australia. Further we present some of the strategies, public policies and innovative projects that have been developed in this field in Australia. Some of the strategies include: screening vs. case-finding; primary care approaches for dealing with all family members; respect for diversity; and new randomized trials aiming for sustainable health system change for enhanced health professional care of people experiencing intimate partner violence. Despite the limitations of this approach to such a complex theme, we hope to stimulate thinking and discussion.

A violência por parceiro íntimo contra mulheres é comum em todos os países, gerando desafiadora agenda para o setor saúde. A troca de experiências entre países, referente às estratégias de enfrentamento do problema, pode constituir-se em subsídio para fomentar debates e promover reflexões. Este artigo pretende apresentar e refletir sobre aspectos do contexto australiano no âmbito de respostas do setor saúde à violência por parceiro íntimo, cartografando o cenário que cerca essa questão. A metodologia foi desenhada combinando pesquisa bibliográfica, diálogo com diferentes atores e visitas in loco. Foram descritos aspectos históricos, contemporâneos e conceituais acerca das respostas da saúde a violência por parceiro íntimo na Austrália e apresentadas algumas estratégias, políticas públicas e projetos que vêm sendo desenvolvidos no país. Merecem relevo: rastreamento e busca ativa de casos de violência por parceiro íntimo; abordagem em atenção primária com todos os membros familiares; respeito às diversidades; ensaios randomizados envolvendo mudanças na formação dos profissionais e no sistema de saúde no que tange ao cuidado de mulheres vivenciando violência por parceiro íntimo. Apesar das limitações ao abordar tema tão complexo, espera-se estimular reflexões e discussões.

Violencia en la pareja: ¿es posible la terapia conjunta?: [revisión] / Domestic violence: is it possible conjoint therapy?: [revisión]

La violencia en la pareja se ha entendido predominantemente con una perspectiva víctima - victimario. Coherente con esto, se diseñan y ejecutan políticas y programas destinados a la atención de la víctima y la sanción y rehabilitación del agresor. Desde una mirada relacional y mediante la revisión de la literatura existente, el presente trabajo postula que existen diferentes tipos de violencia que requieren distintos tipos de abordaje clínico y psicosocial. En particular, se sostiene que la terapia de pareja es una indicación posible para un tipo de violencia en particular: la violencia agresión. Finalmente, se describen las condiciones en que esto sería posible así como focos posibles de la terapia conjunta.

The intimate partner violence is predominantly a perspective understood victim - perpetrator. Consistent with this are designed and implemented policies and programs to the attention of the victim and the punishment and rehabilitation of the offender. From a relational view and by reviewing existing literature, this paper posits that there are different types of violence require different kinds of clinical and psychosocial approach. In particular, it argues that couples therapy is a possible indication for a particular type of violence: violence assault. Finally, we describe the conditions under which it would be possible as well as potential sources of joint therapy.

The prevalence of intimate partner violence across orthopaedic fracture clinics in Ontario.

BACKGROUND: from 1999 to 2004, an estimated 653,000 women in Canada were either physically or sexually abused by their current or previous intimate partners. We aimed to determine the proportion of women presenting to orthopaedic fracture clinics for the treatment of musculoskeletal injuries who had experienced intimate partner violence, defined as physical, sexual, or emotional abuse, within the past twelve months. METHODS: we completed a cross-sectional study of 282 injured women attending two Level-I trauma centers in Canada. Female patients presenting to the orthopaedic fracture clinics anonymously completed two previously developed self-reported written questionnaires, the Woman Abuse Screening Tool (WAST) and the Partner Violence Screen (PVS), to determine the prevalence of intimate partner violence. The questionnaire also contained questions that pertain to the participant's demographic characteristics, fracture characteristics, and experiences with health-care utilization. RESULTS: the overall prevalence of intimate partner violence (emotional, physical, and sexual abuse) within the last twelve months was 32% (95% confidence interval, 26.4% to 37.2%). Twenty-four (8.5%) of the injured women disclosed a history of physical abuse in the past year. Seven women indicated that the cause for their current visit was directly related to physical abuse. Ethnicity, socioeconomic status, and injury patterns were not associated with abuse. Of the twenty-four women who reported physical abuse, only four had been asked about intimate partner violence by a physician; none of these physicians were the treating orthopaedic surgeons. CONCLUSIONS: our study suggests a high prevalence of intimate partner violence among female patients with injuries who presented to two orthopaedic fracture clinics in Ontario. Surgeons and health-care personnel in fracture clinics should consider intimate partner violence when interacting with injured women.

Perceived changes in health and safety following participation in a health care-based domestic violence program.

This descriptive study explores perceived changes in health and safety and the potential process by which these changes occur. Forty-nine women experiencing intimate partner abuse participated in a health care-based domestic violence (DV) advocacy program for 6 months or more. An analysis of structured interviews in English and Spanish found that the majority of participants perceived positive changes in their personal safety and emotional health because of their involvement in the program. Some participants also perceived improvements in their physical health, unhealthy coping behaviors (e.g., overeating and smoking), and health care following program involvement. Participants' responses suggest a process of change whereby DV advocacy services first contribute to improved safety and emotional health, which then facilitates behavioral changes. Behavioral changes may subsequently contribute to improvements in physical health, which may also benefit emotional health. Longitudinal evaluations are needed to evaluate the impact of DV advocacy and other interventions for partner abuse on women's health and safety over time.

Atendimento à mulher vítima de violência sexual: protocolo de assistência de Enfermagem / Atención a la Mujer Víctima de Violencia Sexual: Protocolo de Asistencia de Enfermería / Assistance to women victims of sexual violence: a nursing care protocol

O Ministério da Saúde preconiza o atendimento integral e humanizado às mulheres vítimas de violência sexual. Teve-se por objetivo descrever o Protocolo de Enfermagem na Assistência às Mulheres Vítimas de Violência Sexual do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas, recentemente revisado. Para tanto, seguiram-se as etapas do processo de enfermagem e após a identificação dos principais diagnósticos da North American Nursing Diagnosis Association (NANDA) foram determinadas as intervenções, com base em normas técnicas nacionais e internacionais. O protocolo atual engloba o atendimento imediato e tardio, o acompanhamento ambulatorial e as ações relacionadas à interrupção legal da gravidez decorrente do estupro. O protocolo de enfermagem tem proporcionado à cliente um atendimento integral e humanizado e à enfermeira, maior autonomia na sua área de atuação, favorecendo o trabalho colaborativo e interativo com a equipe multidisciplinar.

The Ministry of Health recommends integral and humanized assistance to women victims of sexual violence. This study was aimed at describing the Nursing Protocol in the Attention to Women Victims of Sexual Violence at the Center for Integral Attention to Women's Health of the State University of Campinas (Unicamp), which has recently been revised. To do so, the phases of the nursing process were followed, and after the identification of the main nursing diagnoses of the North American Nursing Diagnosis Association (NANDA) the nursing interventions were determined, based on international and national guidelines care for sexual violence. The current protocol encompasses both immediate and late care, outpatient follow-up and actions regarding legal interruption of pregnancy resulting from rape. The nursing protocol has been providing integral and humanized assistance to women and, for nurses, more autonomy in their area and the possibility of participative and collaborative work with multidisciplinary teams.

El Ministerio de Salud preconiza la atención integral y humanizada a las mujeres víctimas de violencia sexual. Se tuvo como objetivo describir el Protocolo de Enfermería en la Asistencia a las Mujeres Víctimas de Violencia Sexual del Centro de Atención Integral a la Salud de la Mujer de la Universidad Estatal de Campinas, recientemente revisado. Para tal efecto, se siguieron las etapas del proceso de enfermería y después de la identificación de los principales diagnósticos de la North American Nursing Diagnosis Association (NANDA) fueron determinadas las intervenciones, con base en normas técnicas nacionales e internacionales. El protocolo actual engloba la atención inmediata y tardía, el acompañamiento ambulatorio y las acciones relacionadas a la interrupción legal del embarazo derivado de la violación. El protocolo de enfermería ha proporcionado a la cliente una atención integral y humanizada y a la enfermera, mayor autonomía en su área de actuación, favoreciendo el trabajo colaborador e interactivo con el equipo multidisciplinario.

Care for emergency department patients who have experienced domestic violence: a review of the evidence base.

AIMS: A literature review was conducted to identify and evaluate the research base underpinning care for emergency department patients who have experienced domestic violence. BACKGROUND: The extent of domestic violence in the general population has placed it high on health and social policy agendas. The Department of Health has recognized the role of health care professionals to identify and provide interventions for patients who have experienced domestic violence. METHOD: Systematic review. RESULTS: At least 6% of emergency department patients have experienced domestic violence in the previous 12 months although actual prevalence rates are probably higher. Simple direct questioning in a supportive environment is effective in facilitating disclosure and hence detecting cases of abuse. Although routine screening is most effective, index of suspicion screening is the current mode of practice in the UK. Index of suspicion screening is likely to contribute to under-detection and result in inequitable health care. Patients with supportive networks have reduced adverse mental health outcomes. Women will have negative perceptions of emergency care if their abuse is minimalized or not identified. Women want their needs and the needs of their children to be explored and addressed. Access to community resources is increased if patients receive education and information. CONCLUSION: Domestic violence is an indisputable health issue for many emergency department patients. Practitioners face challenges from ambiguity in practice guidelines and the paucity of research to support interventions. Recommendations for practice based on the current evidence base are presented. RELEVANCE TO CLINICAL PRACTICE: The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self-efficacy.

Identifying signs and symptoms of intimate partner violence in an oncology setting.

Domestic violence (DV), or intimate partner violence (IPV), is a prevailing problem in public health. Often, healthcare providers may be the first people that victims of DV will approach to reveal their problem or seek assistance. IPV is a pattern of control using assault and intimidating behaviors that has devastating effects on individuals, their families, and communities. Oncology nurses need to become familiar with common indicators of DV so that signs and symptoms of abuse can be identified when assessing patients in an oncology setting. Standards of oncology nursing practice support that the psychosocial impact of cancer on patients and their families or significant others needs to be considered at all stages of diagnosis and treatment. The psychosocial impact of other personal situations or concerns, such as IPV, can add to the complexity of cancer management. Routine screening for signs and symptoms of psychosocial distress helps identify patients who require additional interventions. Oncology nursing practice is based on a holistic approach to patient care, which supports that identification of physical and psychosocial needs are equally important. Oncology nursing provides many unique opportunities to help patients cope with cancer. Routine nursing assessment for signs and symptoms of abuse will provide an opportunity to assist patients with cancer to manage not only the life-threatening aspects of their diagnosis but also the life-threatening aspects of IPV.

Domestic violence against women with cancer: examples and review of the literature.

Over a recent 3-month period in our oncology practice, we became aware of multiple patients reporting domestic abuse. We present three selected cases, review the literature on domestic violence, and explore issues of diagnosis and management in a cancer population. Domestic violence against cancer patients may be more common than initially appreciated, and further awareness and research are indicated.

Hombres que ejercen violencia en la pareja: reflexiones de una experiencia de atención individual / Men who exert violence on their couples: reflexions about an experience of personal assistance

La violencia masculina hacia la mujer al interior de la pareja se ha transformado en un problema social de gran envergadura. Diversas instituciones han desarrollado programas de atención destinados a la atención de hombres que ejercen violencia contra sus parejas. El presente trabajo revisa brevemente el estado actual de la comprensión de la violencia contra la pareja y la investigación sobre los resultados de los tratamientos. Se expone de manera sistematizada una experiencia de trabajo individual analizando el ciclo de atención. Finalmente, como manera de ejemplificar, se describe el proceso inicial de atención de una persona que consulta por violencia contra su pareja.

Medical management of intimate partner violence considering the stages of change: precontemplation and contemplation.

BACKGROUND: We undertook a study to understand how women who are victims of intimate partner violence (IPV) want physicians to manage these abusive relationships in the primary care office. METHODS: Thirty-two mothers in IPV shelters or support groups in southwestern Ohio were interviewed to explore their abuse experiences and health care encounters retrospectively. The interviews were taped and transcribed. Using thematic analysis techniques, transcripts were read for indications of the stages of change and for participants' desires concerning appropriate physician management. RESULTS: Participants believed that physicians should screen women for IPV both on a routine basis and when symptoms indicating possible abuse are present, even if the victim does not disclose the abuse. Screening is an important tool to capture those women early in the process of victimization. When a victim does not recognize her relationship as abusive, participants recommended that physicians raise the issue by asking, but they also warned that doing more may alienate the victim. Participants also encouraged physicians to explore clues that victims might give about the abuse. In later contemplation, victims are willing to disclose the abuse and are exploring options. Physicians were encouraged to affirm the abuse, know local resources for IPV victims, make appropriate referrals, educate victims about how the abuse affects their health, and document the abuse. Participants identified a variety of internal and external factors that had affected their processes. CONCLUSIONS: In hindsight, IPV victims recommended desired actions from physicians that could help them during early stages of coming to terms with their abusive relationships. Stage-matched interventions may help physicians manage IPV more effectively and avoid overloading the victim with information for which she is not ready.