Domestic Violence: How Many Steps Forward? How Many Steps Back?
May 2, 2002
in response to Domestic Violence: The Challenge for Nursing by Claire Burke Draucker, RN, PhD, CS (January 31, 2002)
In reviewing the Introductory articles on the topic of Domestic Violence, I was struck with the focus on case-finding and clinical screening. This is the same focus I have see in the literature starting in the 1970's and continuing through the 1980's and the 1990s. Where's the progress?
Although Emergency Department (ED) personnel increasingly screen for domestic violence, I have seen little new information to help the luckless women who present themselves to an ED for clinical assessment following domestic violence. Too often ED personnel fail to consider important implications of injuries that may well result from the abuse, such as minor brain injury.
Treatment for minor brain injury in too many health care facilities fails to respect the implications of this injury, even for emotionally benign etiologies such as sports trauma or less serious accidents. My observations have revealed evidence for attentional impairment for as much as a month after such injuries. Additionally, researchers frequently report that attention is impaired when individuals are under heavy stress, as is the case in domestic violence.
Although we know that such physical and stress-related impairments alter our ability to make the simplest of decisions, ED patients are often subjected to an environment of chaos and confusion. Healthcare information may be thrust at them, and they may be asked to make hard and complex decisions about their life, under conditions that would make a healthy person pause. And we wonder why the survivors hesitate, why they seem perplexed, why they are back in our emergency bay weeks later? One problem may be that we are asking these survivors to make complex and difficult decisions under such difficult conditions they are lucky if they can remember our name.
I see a problem both in the domestic violence literature in general, and in this journal where an entire issue has been devoted to domestic violence. Although in this issue domestic violence incidence and case-finding strategies are well described, interventions are noted only in passing. I propose we need more research that will guide us in how to best care for these survivors. Nursing needs to move beyond case finding and into interventions that will prevent/treat complications from the injuries associated with domestic violence.
I am in the early stages of studying damage to a person's attention mechanism when a person is subjected to emotional and physical abuse. I would like to hear from others who, in working with survivors of domestic violence, have noted such evidence of minor brain injury.
Thomas Brewer, PhD, APRN, DAPA
University of Connecticut School of Nursing