DOMESTIC VIOLENCE
Unmasking our
prejudices and biases

Health professionals at six California hospitals are learning how to work with patients who have been battered by their partners thanks to a pilot project funded by the Family Violence Prevention Fund in San Francisco.

Many nurses and physicians were uncomfortable bringing up such a personal subject with patients, said Emily Alvarez, MPA, RN, who heads a Level 2 emergency department at Kaiser Permanente South San Francisco. "Once you open that up, you open a Pandora’s Box," Alvarez said. "It draws you more and more into the patient’s care, and some people aren’t comfortable with that."

Alvarez said many clinicians don’t think they have time. Actually, healthcare workers can do adequate screening and intervention in about five minutes, according to Debbie Lee, the Prevention Fund’s associate director.

Diane McGrogan, LCSW, manager of social service programs for ScrippsHealth, recalls some apprehension among staff when protocols were implemented at Scripps Memorial Hospital-La Jolla. "I think most of it was fear and uncertainty," she said. "They thought, ‘My God, what if she says yes? What do I do then?’ "

Surveys at the beginning of the project revealed that many hospital staff harbored the same misconceptions about domestic violence as the public. Many believed it occurs mostly among low-income families, ethnic minorities, or those with little education. But research has shown that domestic violence rates don’t vary significantly by income, geography, or ethnicity.

The program helped staff at Sonora Community Hospital discard their notion that domestic violence wasn’t happening in their rural, tight-knit community, said Nancy Drews, MS, RN, the hospital’s patient care executive. "In a rural area we try to isolate ourselves from it. It’s more put under the rug," she said.

For other participants, the realization that many staff members were victims brought home the universality of domestic violence. After nearly every domestic violence training session McGrogan has conducted at ScrippsHealth, an employee has approached her to say she’s being abused.

The hospitals found education and communication were the best antidotes to the apprehension surrounding domestic violence. The more time spent explaining the dynamics of domestic violence, the better equipped staff were to help abused patients. Scripps Memorial Hospital holds "debriefings" to help healthcare workers deal with their feelings after a serious intervention. LAC-USC conducts ongoing staff training because it has a constantly changing roster of medical residents. Though the participating hospitals vary in size, location, and resources, one common factor appeared crucial: respect and sensitivity toward victims.

Respect is conveyed in simple but important ways: a gentle tone of voice, open posture, sincerity, and listening without judging.

Not judging means resisting the tendency to tell a woman she must leave the abusive relationship. Often, complex factors—like children, economics, and fear—make it unfeasible for a woman to leave immediately. "Everyone thinks, ‘Why don’t you just leave?’ " Alvarez said. "Women don’t want to hear that. They just want someone to say, ‘Can I help you?’"

This open attitude isn’t easy for healthcare professionals, who are trained to fix problems, McGrogan said. To feel good about the domestic violence program, many healthcare workers had to revise their idea of what success is, she said. Experts point out that abused women commonly leave the relationship five to eight times, then return, before leaving for good.

Having established their domestic violence protocols in the ED, the hospitals in the pilot project are expanding them to other departments. Research is under way to measure the project’s impact, but participants say they know it’s helping. At Scripps Memorial Hospital, domestic violence interventions have tripled since protocols were put in place. And abused women regularly approach the staff saying they’ve heard of the program and want help. At Sonora Community Hospital, staff are identifying domestic violence in cases they had missed before.

And there are the occasional, rewarding developments that break down walls of silence and denial. "I’ve had patients say, ‘Thank you. I finally got the guts to face up to this problem,’ " Drews said.

Recognizing and helping victims of domestic
violence, Part 1

Recognizing and helping victims of domestic
violence, Part 2