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Women in the intervention group received phone calls within 48 to 72 hours after the initial contact. The researchers asked questions such as, “Have you ever hidden money?” and “Have you ever had available birth certificates (yours and children)?” Five more phone calls followed at intervals of one, two, three, five, and eight weeks. During these calls, the nurses asked the same questions, changing the beginning to “Since the last time we talked, have you 85 ?”

The intervention calls were conducted in either Spanish or English, and investigators would make suggestions, such as hiding money and documents in an empty tampon container.

Some of these simple acts, like buying a spare car key, required great effort and courage from the women, McFarlane said. Women told her of sneaking car keys off the abuser’s key chain while he slept and taking a bus to have a duplicate made and then returning the key without the man noticing. Some women had been so controlled by the abusive partner that they had no idea how to find their way around the city and had to learn how to use the bus schedules.

All the women in the study were contacted at three, six, 12, and 18 months to determine what safety strategies they had adopted and retained. Those in the intervention group had performed on average two more safety behaviors than women in the control group and had retained the behaviors for 18 months.

Researchers concluded that the interventions could work if offered in a routine health assessment if a woman had experienced a recent violent episode — a time when she would be most open to seeking help to stop the abuse. McFarlane recommends further research to determine the effectiveness of such interventions in relation to the time that has passed since the women’s last violent episode. More research is needed to see if the safety measures prevent future trauma and subsequent health care costs.

McFarlane started her research into domestic violence more than 25 years ago when a nursing student asked her if women were abused when they were pregnant.

The question came up during a one-hour domestic violence class McFarlane was teaching. She knew that women were abused during pregnancy, but there was no research to back up her instinctual knowledge. So she and the student embarked on a research project to document intimate-partner violence against pregnant women.

“That’s what nurses do,” McFarlane said. “We ask questions to improve care and then we do the research.”

Since then, she’s been involved in dozens of domestic violence studies and seen the research focus shift from documenting the existence of intimate-partner abuse to looking at ways to diagnose and intervene in the cycles of violence.

Stop the abuse

Nursing programs now include courses in family violence. At Texas Woman’s University College of Nursing, where McFarlane holds the Parry Chair in Health Promotion and Disease Prevention, students learn about family violence at all of life’s stages, from child abuse and neglect to
elder abuse.

“We have come a long way,” McFarlane said. “Our new nurses are trained. We want to get the word out to practicing nurses.”