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I made him hit me! Strategies for Spousal/Partner Abuse
Detection of Spousal or Partner Abuse
Here’s what the latest statistics tell us about this frightening phenomenon:
How can you detect if someone is being abused? Here are the signs, according to Dr. Sylvia Gearing:
Detecting Intimate Partner Violence
Testing a Shorter Screening Tool for IPV
We developed the PErpetration RaPid Scale (PERPS) by validating a shortened version of the PAPS consisting of three questions:
Unlike the PAPS, which uses a Likert scale for its 25 questions, PERPS has the potential to be administered more quickly because it uses only "yes/no" questions. To validate PERPS, we asked 214 patients presenting to a busy ED to complete both PERPS and PAPS screens. A positive PERPS result occurred when any of the three questions was answered with a "yes." We found that the PERPS positively predicted IPV perpetration with high accuracy when compared with the PAPS. PERPS had a sensitivity of 66%, specificity of 93%, negative predictive value of 87%, positive predictive value of 78%, and an accuracy of 85%. Importantly, PERPS took less than 1 minute for ED patients to complete, and clinicians weren’t required to perform calculations to evaluate responses.
Applications to Practice
When it’s determined that patients are a perpetrator of IPV, it’s important to discuss the ramifications of this violence and offer education about programs that can help. IPV education can also be provided with videos played on televisions in the ED waiting area. Computer-based educational programs can be developed to enable patients to complete PERPS screenings on a touchscreen computer. Considering the chaos of busy EDs and the fact that providers are often time constrained, a self-administered computer option of PERPS screens might prove to be ideal for IPV perpetration screening.
Cross-cultural factors in disclosure of intimate partner violence: an integrated review
According to Garcia-Moreno et al. (2005), a cross-cultural review of over 50 population-based studies performed in 35 countries prior to 1999 indicated that between 10% and 52% of women around the world reported physical abuse, sexual abuse or both, by an intimate partner at some point in their lives. In a qualitative study, Nicolaidis et al. (2003) found that some women who survived attempted homicide had no memory of having ever discussed their lives being in danger with healthcare providers and/or counselors. In addition, the violence perpetrated against women worldwide has an enormous impact on all those women, family and children who witness the violence (Garcia-Moreno et al. 2005).
Intimate partner violence was once considered solely a private matter. According to Richie (2006) only recently has violence against women been acknowledged as a social problem, meriting attention from society and placing it on political agendas. The women’s movement in the 1970s initiated the disclosure of IPV and shed light on violence against women (Davis & Srinivasan 1995, Tjaden & Thoennes 1998, Kilpatrick 2004, Tjaden 2004). However, it was not until 30 years later, through the hard work of many, especially researchers and political activists, that violence against women was acknowledged at the governmental level. New policies and laws protecting women against violence slowly began to be enacted in several countries. The USA enacted its ﬁrst law in 1994, The Violence Against Women Act. Guatemala and El Salvador enacted laws in their countries in 1996, called Intrafamily Violence and Prevent, Punish and Eradicate Intrafamily Violence respectively. China passed a Domestic Violence Ordinance law in 1997. Colombia enacted a penal code, Intrafamily Violence, in 2000 and Japan passed a law in 2001, The Prevention of Spousal Violence and the Protection of the Victims (Annual Review Law Harvard n.d.). Mexico’s national law, enacted in 2007, is recognized as the ﬁrst federal measure to address violence against women and domestic abuse (International Herald Tribune 2007).
According to Klevens (2007), most of the literature examining violence against women has focused on white women. Tjaden and Thoennes (2000) suggested that more work is needed to support estimates of IPV prevalence among diverse groups and issues of disclosure may or may not be attributed to social, demographic and environmental factors or their ethnicity/race.
Throughout the literature, the term, IPV is used interchangeably with the terms domestic violence, partner violence, battered women, gender violence, violence against women and spousal abuse (Institute of Medicine 2002). Recent literature has indicated the need for a more consistent deﬁnition of the types of violence, particularly violence against women (Mitchell & Lacour 2001). Most recently, the Centers for Disease Control and Prevention (2006) has used the term intimate partner violence. Although both men and women experience IPV, women experience it at a much higher rate (U.S. Department of Justice 2006). Nurses worldwide continue to face challenges in providing care to abused women using appropriate strategies.
The experiences of women in IPV cross-culturally may be similar; however, in speciﬁc groups of women they are very different. Moreover, little is known based on race, culture, country of origin or factors inﬂuencing disclosure of abuse by women in IPV. Table 1 summarizes the studies by speciﬁc ethnicity/race and factors identiﬁed within each group. Women from different cultures identiﬁed fear as a common factor, with the exception of South Asian women (Gill 2004), immigrants from Mexico (Belknap & Sayeed 2003) and Vietnamese women (Shiu-Thornton et al. 2005). In two separate studies, women from the Japanese culture described fear and shame as two of the many factors interfering with disclosure of abuse (Yoshihama 2002, Nemoto et al. 2006).
Six studies were conducted with Asian women. One of these included South Asian women living in the United
Fox et al. (2007) found that black African women in Johannesburg suffered in silence within their culture. However, in two separate studies conducted in the USA, AfricanAmerican women survivors of IPV did not identify a culture of silence as a factor (Nash 2005, Morrison et al. 2006).
Women from cultures in which there is not generally disclosure were Jordanian (Gharaibeh & Al-Ma’aitah 2002, Latina (Crandall et al. 2005) and Vietnamese (Shiu-Thornton et al. 2005). Belknap and Sayeed (2003) found that immigrant women attributed non-disclosure to the perception that providers were not listening. Similar experiences were found in one other study with women participants in Melbourne, Australia, who described providers as not interested (Hegarty & Taft 2001). There were no studies found on MexicanAmerican women related to this issue.
Detecting Intimate Partner Violence More Quickly
Reflection Exercise #7
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