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Her
ex-husband used to threaten to burn down
the house with her and her daughter inside.
If she left him, he said, he would kill
her. Sometimes, he’d wrap her tightly
in a blanket and hit her, joking about it.
Other times, he would keep her up all night
haranguing her for her faults.
Although she was a registered
nurse in a psychiatric department who worked
with abused women, for a long time she didn’t
realize that she was involved in an abusive
marriage. The turning point came when one
of her patients killed herself and another’s
husband set her on fire.
“Through them, I could
see my future,” she said. “I
decided to leave.”
The 61-year-old RN, now
happily remarried, is one of 12 women featured
anonymously in Kaiser Permanente’s
“Silent Witness” tribute.
The life-size display carries
the stories of Kaiser employees, some of
them nurses, who survived family violence
and how they broke away from their dangerous
situations.
Although all the women highlighted
are survivors, not all are able to break
away from abuse in time.
The display is dedicated
to three Kaiser workers who have been killed
in the past five years: Lisa Munoz, Cassandra
Floyd, and Stephanie Zalot.
The
“Silent Witness” display, accompanied
by brochures on where to get help, was unveiled
in January and will circulate to all of
Kaiser’s Northern California Region
facilities during the next two years as
part of the health plan’s effort to
raise awareness about domestic violence.
-Donna Hemmila
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The U.S. Department of Health and Human Services
would like to reduce incidents of intimate-partner
abuse by 20% by 2010. Many health plans, hospitals,
nursing associations, and public agencies have
made intimate-partner violence detection and treatment
a high priority.
The Emergency Nurses Association’s policy
on domestic violence encourages emergency nurses
to take an active role in domestic violence programs
and supports mandatory training and continuing
education for all health professionals.
Although training alone won’t end domestic
violence, an emphasis on training for health professionals
can deliver results.
STAND! Against Domestic Violence, a nonprofit
advocacy agency based in the San Francisco Bay
area, saw a jump in referrals from health care
providers after it started offering training for
health plans and facilities.
In 1999, 28 women were referred and, in 2002,
the number nearly tripled to 79, said David Lee,
STAND!’s Central County regional director.
“Frequently, we have people coming forward,
and it’s the first time anyone had ever
asked about it,” he said in describing the
impact a practitioner
can make.
Violence detectors
Nurses, who often have the most frequent patient
contact, have always been on the forefront of
treating abuse, Lee said, but a multidisciplinary
approach to training works best. Physicians, nurses,
social workers, and patient educators all need
to be involved.
That is the approach taken at Kaiser Permanente’s
Northern California Region medical centers, said
Brigid McCaw, MD, MS, MPH, clinical leader of
the health organization’s Family Violence
Prevention Services. Kaiser is making an effort
to detect intimate-partner abuse.
Patients diagnosed with domestic violence in
the Northern California region in 2000 totaled
761. In 2003, the number rose to 2,500. The highest
number of cases was diagnosed in behavioral health
departments followed by primary care units and,
lastly, emergency departments.
“We’re increasing screening and referral
wherever the patient connects with the health
plan,” McCaw said.
Kaiser has stepped up patient outreach with strategies
like placing domestic violence awareness posters
and brochures inside restrooms where victims can
stealthily collect the information. A traveling
display called “Silent Witness” documents
the experiences of Kaiser employees, including
nurses and physicians who have suffered and survived
partner abuse. And the organization continues
training and education for staff.
Routine screening
In spite of all the education and screening efforts,
more routine screening and more comprehensive
education still need to be done, said April Gerlock,
ARNP, APRN, PhD, who works with both victims and
perpetrators of intimate-partner violence at the
Veterans Administration Puget Sound Health Care
System in Tacoma, Wash. More routine screening
in all health care settings needs to happen, she
said, and facilities need to make time for more
domestic violence training.
“I think we’re always trying to get
the quick-and-dirty 30-minute training,”
Gerlock explained. “It’s so hard to
deal with domestic violence in 30 minutes.”
At the same time, any training or intervention
is better than remaining passive. When Gerlock
suspects that she is dealing with a victim or
perpetrator, she follows up on the next visit.
“Just checking can make a difference,”
Gerlock said.
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