Reflections on written comments by women on their abuse.

In a study to differentiate injuries of physical abuse from non-physical abuse, 103 women wrote uninvited comments that were analyzed in two ways: Q-sort and phenomenology analyses. Q-sort identified two categories: helplessness and assertiveness. Comparisons with subject responses about current or previous violence indicated that women who wrote assertive comments were less likely to be in a violent relationship than women who wrote helpless comments. Phenomenological analysis indicated that women who were categorized as silent, received or subjective were in abusive relationships; some had been abused on the day of admission. Two women wrote comments considered subjective procedural; both were living with their abuser and stated that the abuse no longer occurred. Health-care professionals must question the appropriate goal to counsel abused women. Whether these two continua reflect a readiness to leave the relationship or result from having left, the comments by two women who say they are no longer being abused are more assertive and appear to show higher levels of knowing.

Battered women: where they go for help.

OBJECTIVE: Assistance must be available to abused women where they seek help. This study identified victims of partner abuse and asked them to indicate where they sought help when battered. The characteristics of acute battering incidents were also investigated. METHODS: Consecutive women, ages 19 to 65, were recruited when they came to 10 emergency departments in two cities. Women were excluded if the following criteria existed: a language barrier, serious illness, or inability to separate subjects from accompanying persons. RESULTS: Of 4448 women who completed the questionnaire, 37% acknowledged physical abuse by a partner at some time; 10% reported a present battering relationship; and 4% said their current visit to the emergency department was for abuse by an intimate partner. In 70% of surveys, the battering person was a boyfriend or ex-boyfriend. Weapons used were items near at hand. The three most common helping resources, in decreasing frequency of use, were family and friends, police, and the emergency department. DISCUSSION: Resources to provide help must be available where women seek care when they are abused. Abuse among women who come to emergency departments is common, and emergency departments are the third highest resource cited by abused women. Emergency nurses should be prepared to identify and assist abused women.

Nonbattering presentations to the ED of women in physically abusive relationships.

To determine which diagnoses in the emergency department (ED), apart from battering injuries, were more common among women who were living in physically abusive relationships than among women who were not, a study was conducted in 10 hospital-based EDs in two cities serving inner city, urban, and suburban populations. A total of 9,057 women between the ages of 19 and 65 years presenting to the EDs were eligible for the study. Medical records were reviewed, and a written questionnaire was used. The questionnaire was completed by 4,501 (73% of those asked, 59% of those eligible, and 50% of those presenting). Two hundred sixty-six (5.9%) were currently in a physically abusive relationship but not in the ED for battering injuries, and 3,969 (88.2%) were not currently in a physically abusive relationship. An additional 266 (5.9%) were positive, probable, or suggestive for battering injuries and excluded from diagnosis comparisons. Women in physically abusive relationships were more likely to be diagnosed with urinary tract infections, neck pain, vaginitis, foot wound, suicide attempt, and finger fracture. However, these represented only 19.8% of diagnoses in this group. The use of this knowledge alone to predict the presence of intimate violence in individual patients in the ED will not identify the majority of women at risk. These results suggest the use of routine inquiry for abuse in all women.

Battered women: injury locations and types.

STUDY OBJECTIVE: To characterize injuries to battered women by comparing their location, type, and severity with those of injuries to women resulting from other mechanisms. METHODS: Cross-sectional study of 9,057 women between the ages of 19 and 65 years who presented for any reason to the emergency departments of 10 hospitals serving inner-city, urban, and suburban populations. RESULTS: A total of 280 injured, battered women were identified during the study period. About 3.1% (95% confidence interval [Cl]. 2.7% to 3.5%) of all women seen in the ED, and 11.2% [95% Cl, 10.0% to 12.4%) of injured women with known mechanisms of injury, were determined to be positive for battering. Battered women were more likely to be injured in the head, face, neck, thorax, and abdomen (P < .001) than were women injured by other mechanisms. Twelve specific injury types were identified that occurred more frequently in battered women. CONCLUSION: Although battered women experience certain injury types more frequently than women injured by other mechanisms, the low positive predictive value of these injuries supports the use of universal screening for domestic violence in all injured women.