Improving Healthcare for Tens of Millions of Americans

Intimate partner violence (IPV) is a global public health crisis whose victims are in desperate need of skilled care by our community of nurses, physicians, and other providers.

IPV affects people from all walks of life, regardless of age, gender, sexual orientation, ability, race, or social standing. IPV can be committed by a current or former spouse or romantic or dating partner and may or may not include sexual violence. It impacts at least 10 million adults in the U.S. annually¹, and the World Health Organization estimates that about one in three women aged 15-49 worldwide have been victims of IPV².

There is a critical need to address this crisis in the healthcare sector. All nurses, physicians, and other healthcare providers must understand the life-threatening consequences of IPV. We all must be prepared to identify patients who are victims of IPV and to provide trauma-informed, patient-centered care specific to each patient. All nurses, physicians and other providers must understand that each patient is at risk for short- and long-term health consequences, and the care we provide has health, social, and legal implications.

We are responsible to provide care that can put each patient on the path to healing.

Now, as a result of the release of the U.S. Department of Justice Office on Violence Against Women (OVW) National Protocol for Intimate Partner Violence Medical Forensic Examinations, providers have a valuable, evidence-based resource to assist them in providing a standard best practice approach to assess, treat, and support victims of IPV regardless of healthcare setting.

The Effect of Clinical Standardization

Historically, publication of recommendations like the National IPV Protocol has led to development or enhancement of existing local protocols, and has encouraged the adoption of similar recommendations globally.

Beyond improved protocols, they have led to expanded nursing, physician education, and clinical training programs. Ultimately, that trickle-down effect means better patient care because healthcare professionals are trained at a higher level and have specific, evidence-based clinical guidelines to help standardize their work.

As the guidelines are adopted and clinical training is improved, patients affected by IPV will receive the care they deserve.

About IPV

IPV includes physical violence, sexual violence, stalking and psychological aggression (including coercive tactics) by a current or former spouse, boyfriend/girlfriend, dating partner, or ongoing sexual partner³. The exact types of behaviors, the rate at which they occur, and their impacts vary. IPV often leads to economic, physical, and psychological consequences, including behavioral and mental health issues in children living in a home where violence occurs.

Types of Abuse in IPV

• Psychological aggression —the use of verbal and non-verbal communication with the intent to harm a partner mentally or emotionally and/or to exert control over a partner.
• Sexual violence —forcing or attempting to force a partner to take part in a sex act, sexual touching, or a non-physical sexual event (e.g., sexting) when the partner does not or cannot consent. Sexual violence can occur in person, online, or through technology, such as posting or sharing sexual pictures of someone without their consent, or non-consensual sexting.
• Physical violence — when a person hurts or tries to hurt a partner by hitting, kicking, or using another type of physical force.
• Stalking —a pattern of repeated, unwanted attention and contact by a partner that causes fear or concern for one’s own safety or the safety of someone close to the victim.⁴

Incidence & Prevalence

• Thirty percent of women globally have been subjected to IPV. ⁵
• More than 61 million women and 53 million men in the U.S. have reported psychological aggression by a partner in their lifetime. ⁶
• The overall number of U.S. children who have lived in homes where violence occurs is more than 15 million.⁷
• Worldwide, approximately 38 percent of murders are committed by a male partner, and up to 852 million women report being abused.⁸
• Worldwide, almost one third (27 percent) of women aged 15-49 years who have been in a relationship report that they have been subjected to some form of IPV by their partner.

Health Consequences of IPV

IPV causes both acute and long-term health consequences in adolescent and adult victims, as well as in children who have witnessed family violence.

The high prevalence of children’s exposure to IPV places adolescents at risk for mismanagement of their emotions, mental health conditions (such as anxiety, depression, PTSD), and poor coping behaviors (such as impulsiveness, unsafe sexual activity, and substance abuse).⁹

About 75 percent of female IPV survivors and 48 percent of male IPV survivors experience some form of injury related to IPV. ¹⁰ Health consequences for adult victims of IPV may also include:

• Mental health — anxiety, depression, PTSD, insomnia/sleep difficulties, suicidal ideation ¹¹
• Neurologic — traumatic brain injury, dizziness, headaches, stroke, arterial dissection¹²
• Substance abuse — higher incidences of alcohol consumption, smoking, intravenous drugs or generalized substance use¹³
• Cardiovascular — chest pain, hypertension, hyperlipidemia, heart disease ¹⁴
• Female reproductive — pelvic pain, dyspareunia, recurrent vaginal infections, pregnancy (unintended/unwanted), higher risk of labor and birth adverse outcomes, such as preterm birth or low birth weight ¹⁵
• Cancer — cervical cancer ¹⁶
• Infectious diseases — human immunodeficiency virus (HIV), increased risk of sexually transmitted infections (STIs) ¹⁷
• Chronic conditions — diabetes, chronic pain, liver failure, musculoskeletal problems, kidney and/or urinary problems, respiratory illnesses, gastrointestinal conditions, fibromyalgia

Healthcare Responsibility

It is essential that all healthcare professionals understand the health, social and legal implications of IPV, and that there is no one-size-fits-all approach. A clinician is responsible for providing patients with healthcare, support, and resources while ensuring they have been informed of their options in a manner that allows the patient to retain autonomy over their own decision-making, regardless of whether that choice is to leave their abuser and/or report their abuse to local law enforcement.

Equally important is clinician education regarding what does and does not fall under mandatory reporting laws. For example, if an adult seeking treatment following IPV does not wish to report it to law enforcement, clinicians may not be mandated to report it.

All patients experiencing IPV — not just those who experience sexual violence or strangulation — should be offered a medical forensic examination. The medical forensic examination is a comprehensive assessment that prioritizes the patient’s health and well-being while planning for or preserving information for potential use by the legal system.

The National Protocol for Intimate Partner Violence Medical Forensic Examinations includes tools and resources for the clinician performing a medical forensic examination, including:

• medical forensic history
• physical assessment
• treatment of injuries
• addressing and providing care for additional health concerns
• gathering samples for evidence
• written and photo documentation
• safety planning and discharge instructions
• targeted referrals to meet the patient’s needs

There is also an interactive, mobile-friendly version of the protocol that puts mobile-ready resources and technical assistance into the hands of those treating victims of IPV. The interactive version was adapted to be user-friendly for healthcare professionals. Highlights include:

• Expanded clinical terms and definitions with added images and graphics
• Interactive informational graphics
• Downloadable forms, templates, and resources
• “Read More” sections linked to additional full-text research articles
• Easily accessible at your desk or on-the-go via phone or tablet

Forensic Nurses

Forensic nurses are registered or advanced practice nurses who have received specialized education and training to address the acute and long-term health consequences and criminal justice needs of patients affected by violence, including IPV. A forensic nurse is often one of the first professionals to provide medical care to a victim of violence and is trained to coordinate the resources necessary to address both the medical needs of the individual, and if appropriate, the evidentiary needs of the victim for potential use in the criminal justice system.

IAFN is the world’s leading forensic nursing organization that establishes the standards of practice in forensic nursing and collaborates regularly with U.S. government agencies to develop innovative programs to best train forensic nurses and improve patient care.

IAFN provides training and technical assistance to nurses and others health and multidisciplinary professionals responding to individuals who have experienced IPV or other types of violence. IAFN also offers an online Intimate Partner Violence Nurse Examiner Certificate Program designed to improve nurses’ skill specific to the comprehensive medical forensic examination of patients who are victims of IPV. Course information is available in the IAFN online course catalog.

Jennifer Pierce-Weeks is the IAFN Chief Executive Officer.