Posttraumatic stress in battered women: does the diagnosis fit?

Posttraumatic stress disorder (PTSD) has been recommended as an appropriate psychiatric diagnosis for battered women. The criteria for the diagnosis are reviewed along with research that supports its application in battering situations. Definitional, diagnostic, research, and treatment issues using the diagnosis with abused women also are discussed, including recommendations for future investigations and clinical application.

Battered women: intervention and prevention. A psychosociocultural perspective, Part 2.

Building on the foundation of understanding and comprehensive assessment of battered women, this article addresses service planning and intervention. Strategies are approached within the framework of a Crisis Paradigm developed from field research with battered women and their families. They include mechanisms such as support groups which link crisis service to the long-term needs of battered women, and systematic approaches to removing the obstacles which keep women victimized. An Assessment and Service Planning Guide (ASPG) is proposed for inclusion in routine health care of abused women. The article concludes with strategies for preventing violence at interpersonal and societal levels.

The curriculum revolution in action: nursing and crisis intervention for victims of family violence.

The curriculum revolution might have been born at the University of Detroit in their RN-to-BSN program. Situated in an urban environment where violence is an ever-present problem, the faculty developed an innovative clinical course for senior students, entitled Nursing and Crises Intervention for Victims of Family Violence. The curriculum was designed to respond to a social problem that affects individuals, families, and groups at both physical and psychological levels. It was hoped that creative use of the educational process would promote nursing intervention with a population whose needs have traditionally been unrecognized and unmet by the profession. The response to the course has been very positive and students have applied the content in nontraditional clinical agencies such as shelters for battered women and children, sexual abuse centers, and phone crisis centers. More importantly, these RN students report not only a change in personal attitudes, but an integration and application of their knowledge in their own professional practice. They act as educators to their peers and colleagues while reshaping their own practice in light of their newly acquired sensitivity. By creatively using the nursing curriculum, educators can prepare nurses to deal with many of the social ills affecting individuals, families, and groups. In so doing, they encourage nurses to step into the forefront of health care. They invite nursing practitioners to become proactive rather than reactive. Ultimately, such curriculum creativity will ensure that clients currently ignored or unrecognized by the health care system are identified and treated in a caring fashion by the profession that prides itself on its ability to care.

Nursing interventions for abused women on obstetrical units.

Battering is a public health problem that traditionally has been ignored by nurses, which has conveyed acceptance and approval of violence. Using the Betty Neuman Health Care System Model, nurses on obstetrical units can understand the health effects battering has on the mother and infant. Battering puts the woman at serious risk. By systematically addressing this stressor, nurses can improve the health and quality of life of the mother and newborn.

Exploration of women's identity: clinical approaches with abused women.

This article outlines clinical approaches with women in abusive relationships or those who recently have left such situations. A model, the process of entrapment in and recovering from an abusive relationship, describes the experience of women in abusive relationships with a male partner and the cumulative influence of these experiences on women's views of self. This model has served as the basis for the development of specific interventions designed to assist women at different points in time while they experience abuse in a relationship or are recovering from the experience of being abused.

Abuse of adolescents: what can we learn from pregnant teen-agers?

One of the most perplexing issues for nurses working with abused women is the extent of violence experienced by teen-agers. This article presents research findings from a study of pregnant women and teen-agers in Baltimore and Houston that found 32% of pregnant teen-agers reported having been physically or sexually abused in the prior year. The rate of abuse during pregnancy was 22% for teen-agers. Teen-age violence is discussed in terms of possible reasons for teen-agers to be reluctant to report abuse and nursing considerations in the assessment and intervention of adolescents experiencing abuse.

PIP: To determine the extent of abuse experienced by pregnant women, especially adolescents, 691 pregnant women recruited from public prenatal clinics in Houston and Baltimore received the Abuse Assessment Screen. Overall, 182 women (26%) reported physical or sexual abuse within the past year (stranger rape or assault excluded). Among the 235 teenagers (mean age 17.5 years) in the sample, 32% reported abuse in the past year. The rate of abuse during pregnancy was 22% for teenagers and 16% for adult women. Over half of study projects abused in the previous year were reabused during pregnancy, making prior abuse a significant predictor of violence against pregnant women. Also correlated with abuse was the attitude of the couple toward the pregnancy. 51% of abused women compared with 31% of their nonabused counterparts reported a negative reaction to the pregnancy. Similarly, 29% of the male partners of abused women had a negative response to the pregnancy compared to only 13% of the partners of nonabused women. Assessment for battering should be incorporated into routine nursing care of all pregnant women. Nurses must be aware of state reporting procedures and resources such as battered women's shelters. Work with abused adolescents demands special sensitivity, since many may be reluctant to discuss this issue with an authority figure or may minimize the frequency and severity of the violence. Those whose identities are grounded in their relationship with a man and lack other sources of self-esteem may be resistant to terminating an abusive relationship. Moreover, adolescents are even less willing than their older counterparts to enlist police protection or enter a shelter service. A useful technique is for the nurse and client to prepare a list of options, discuss the positive and negative implications of each option, and select the best alternative. If a woman elects to remain in an abusive relationship, counseling should be provided on signs of imminent danger and methods of self-protection.

Screening for abuse in the clinical setting.

Physical examinations can be positive patient experiences, providing reassurance, education, and case finding. However, examinations also can be extremely anxiety provoking because of feelings of shame and embarrassment about visible injuries from an abuser. They also may provoke flashbacks related to incest, child sexual abuse, and rape. Nurses involved in clinical assessment of any kind need to be aware that a patient's history often affects her response to clinical evaluation. Asking a patient about abuse before evaluation is respectful and empowering and often establishes a valuable opportunity for intervention.

Nursing care of African-American battered women: Afrocentric perspectives.

The focus of this article is on prominent Eurocentric beliefs, attitudes, and behaviors that may prevent African-American battered women from receiving effective intervention by health care professionals and other providers. Afrocentric perspectives are presented to provide an alternative context for understanding the traditions, beliefs, and behaviors that should be considered when providing care for African-American battered women. These perspectives are integrated into discussions of suspected contributions to the incidence of violence in the lives of African-American women. They also are incorporated into suggested interventions and a case study exploring nursing considerations that may be unique to providing effective care for African-American battered women.

Nursing care of low-income battered Hispanic pregnant women.

Nurses working with pregnant Hispanic women can create barriers in the health care system by not understanding or accepting the variety of ways in which the Hispanic culture perceives and treats pregnancy. This article describes nursing care of low-income, battered Hispanic pregnant women within the context of the Hispanic culture and discusses clinical and nursing implications for interventions. To deliver effective culturally competent care to battered Hispanic pregnant women, nurses need to have a thorough understanding of the variables that influence the health care of Hispanics in the United States, such as the scope of wife abuse in the Hispanic population, sociodemographic characteristics of the Hispanic population in the United States, Hispanic women's access to health care, pregnancy in the Hispanic population, and health care practices of Hispanics in the United States. This will facilitate screening, education, and guidance without upsetting the often precarious security of this period.

Nursing care of Native American battered women.

Native American nations and peoples have experienced hundreds of years of oppression, prejudice, poverty, and the lack of self-determination. This has resulted in a disintegration of self-esteem and traditional values that are manifested in high rates of self-inflicted injury and other violence, including suicide, homicide, alcoholism, and domestic violence. Nurses have a key role to play in addressing violence in Native American communities. Cultural sensitivity is central to effective intervention.

Violence in transience: nursing care of battered migrant women.

Nurses working with migrant farm worker women face serious challenges. Poverty, language, and cultural differences between farm worker women and health care providers present substantial barriers to women obtaining access to the health care system. These differences are especially important in instances of domestic violence. The transient life style of migrant farm workers, combined with geographic and social isolation, make it especially difficult for health care providers to meet the needs of migrant battered women. Strategies for working with migrant battered women are offered.

Nursing care of rural battered women.

Rural battered women face enormous challenges when they attempt to end the abuse in their lives. Success depends on overcoming difficulties such as geographic isolation from sources of help; lack of accessible services for battered women and their children; limited opportunities for higher education, employment, and affordable housing for women; and strong allegiance to the land, kinship ties, and traditional gender roles. Through community education, routine assessment for abuse, responding in a helpful manner to women who disclose abuse, and forming links with existing programs for battered women and their children, nurses in rural areas can positively influence the health and safety of rural battered women.

Changing women's lives: the primary prevention of violence against women.

Significant numbers of women in the United States experience violence and abuse in their intimate relationships that compromise the health and safety of the women and their children. This article discusses the problem of violence against women and outlines strategies for responding to violence and abuse in the primary care setting. Nurses can play a vital role in the primary prevention of abuse by implementing abuse screening and education on the issue of violence against women. This article presents strategies for the primary prevention of abuse and guidelines for mobilizing support for women. Collective prevention strategies aimed at eliminating violence against women at the institutional, community, professional, and political level are highlighted.

Woman abuse: educational strategies to change nursing practice.

Nurses and other health care providers are ideal persons to intervene with women who are experiencing violence and abuse in their intimate relationships. All women are not assessed for this health care problem because of lack of education on the part of their health care providers. This article presents principles and methods for the provision of education about women abuse to practicing nurses and students in graduate and undergraduate nursing programs. By redressing this lack of knowledge and skills, nurses will be empowered to provide clinical intervention and leadership in addressing this major health and social problems. Sample outlines and objectives are provided.

Domestic violence. The pregnant battered women.

Nurses need to understand the theoretic debates that attempt to explain why men batter women. Nurses can participate more effectively in preventing and reducing the incidence of physical violence directed against women in intimate relationships. A raised feminist consciousness will expand the nurse's repertoire of interventions to assist in the identification and treatment of victims.

Assessment of domestic violence by nurse practitioners.

Domestic violence has reached epidemic proportions in American society. In the normal course of supplying medical care to women and children, NPs will encounter victims of physical, sexual, and psychological violence. It is imperative that NPs know how to assess for victimization and safety and that they provide patients with needed information about community services.

Battered women: understanding, identification, and assessment. A psychosociocultural perspective, Part 1.

The clinical implications of research with battered women and their families are discussed using the holistic framework of nursing and anthropology. Moving beyond superficial answers to "Why do battered women stay?," barriers to leaving that stem from the sociocultural roots of violence are examined. Understanding these obstacles and the characteristics of violent men is fundamental to sensitive interaction with abused women who frequently enter and leave health care systems with no direct attention given to their primary problem of abuse. Assessment techniques are suggested, and triage and comprehensive assessment protocols are presented to aid nurse practitioners and nurses in their response to this urgent public health problem.

Witnessing family violence: the children's experience.

A phenomenological study was conducted in order to describe the experience of children as they accompany their mothers who are leaving abusive relationships. Thirteen children were interviewed. The children describe their experience as having three components: living with violence, living in transition and living with Mom. Themes within these components are identified, and implications for nursing practice are discussed.