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Step-by-step procedures may help health care providers treat victims of intimate partner violence

One in three women is a victim of intimate partner violence (IPV). This violence causes serious mental and physical health problems ranging from alcohol and drug abuse to depression, gynecological problems, and gastrointestinal complaints. IPV may be emotional, physical, and/or sexual, and it involves coercion and control by one partner over the other. Unfortunately, many health care providers do not know how to intervene when an IPV victim discloses abuse. A new critical pathway that was developed with input from battered women may help them. It outlines step-by-step procedures for clinicians to follow when they encounter an IPV victim.

Several guidelines for the screening and management of IPV have been published. The critical pathway, developed with support from the Agency for Healthcare Research and Quality (HS10342), is one way to integrate these guidelines by providing a visual summary of care processes, their timing, and the roles of each provider, explains lead author, Jacqueline Dienemann, Ph.D., R.N., of the University of North Carolina at Charlotte. Dr. Dienemann and her colleagues developed the pathway using information from the research literature and from five focus groups in which IPV survivors discussed their preferences for what nurses, physicians, or counselors should do when women disclose IPV. The pathway was validated through a three-round Delphi process with four researchers and 13 clinicians, including physicians, nurses, social workers, and one chaplain.

The pathway is organized into categories of physical assessment and treatment (for example, the presenting complaint, sexual trauma, or pain), psychiatric/mental health assessment and treatment (for example, substance abuse or depression), and social assessment and treatment. Social assessment includes, for example, asking if the woman wants to see an IPV counselor; whether she is married to or stalked by the abuser; and whether she has children who have witnessed the violence, are traumatized, and are safe. Social treatment ranges from explaining police and legal services to advising women how to seek help or plan to leave the abuser.

See "A critical pathway for intimate partner violence across the continuum of care," by Dr. Dienemann, Jacquelyn Campbell, Ph.D., R.N., Nancy Wiederhorn, D.N.Sc., R.N., and others, in the Journal of Obstetric, Gynecologic & Neonatal Nursing 32(5), pp. 594-603, 2003.

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