Domestic Violence: The Challenge for Nursing

  • Claire Burke Draucker, RN, PhD, CS
    Claire Burke Draucker, RN, PhD, CS

    Claire Burke Draucker, RN, PhD, CS is a Professor and Director of the Graduate Program in Psychiatric Mental Health Nursing in the College of Nursing at Kent State University. She is a licensed psychologist in the State of Ohio and a Certified Clinical Specialist in Psychiatric Mental Health Nursing. Dr. Draucker has conducted studies on early family experiences and later victimization in the lives of women, the healing processes of women and men who were sexually abused as children, and women's responses to sexual violence by male intimates. She is the author of Counseling Adult Survivors of Childhood Sexual Abuse (Sage).

Abstract

Domestic violence is a serious public health and human rights concern and an on-going challenge for nursing. This article provides an overview of the three major types of domestic violence: intimate partner abuse, child abuse, elder abuse. The scope, history, and health consequences of each type of violence are addressed. Despite advances in research, public awareness, legislative initiatives, and public policy, these types of interpersonal violence continue to affect millions worldwide.

Key words: violence, domestic violence, intimate partner abuse, child abuse, elder abuse, interpersonal violence, victimization

Introduction

Domesticviolenceisrecognizedgloballyasacriticalpublichealthproblemandahumanrightsviolationthatrobsvictimsof"fullandequalparticipationinallspheresoflife"(UnitedNations,1995,p3)Womenandchildrenworldwideareespeciallyvulnerabletoaggression,violence,andabusebyfamilymembers,caretakers,andintimatesDomesticviolencehasbeendefinedas:
Physical,sexual,oremotional/psychologicalviolencedirectedtowardmen,women,children,oreldersoccurringincurrentorpastfamilialorintimaterelationswhethertheindividualsarecohabitingornotandincludingviolencedirectedtowarddatingpartners(AACN,2001,p1)

Domesticviolenceisbestunderstoodwithinaculturalcontext(Campbell,Moracco,&Saltzman,2000;Hoff,2001)Forexample,TheBeijingDeclarationandPlatformforAction,resultingfromthe1995FourthWorldConferenceonWomenstressed,"Violenceagainstwomenderivesessentiallyfromculturalpatterns,particularlytheharmfuleffectsofcertaintraditionalpracticesandallactsofextremismlinkedtorace,sex,languageorreligionthatperpetuatewomen'slowerstatus"(UnitedNations,1995,p7)Campbelletal(2000)arguedthatviolenceresearchdemandsaculturalcompetencythatextendsbeyondculturalsensitivitytoincludeanin-depthappreciationofgroupnorms,beliefs,andlifewaysCulturalcompetencyisreflectedbytheacknowledgmentthatviolenceoccursinagenderedsocioculturalcontext,anunderstandingoftherelationshipbetweencolonialpracticesandviolenceandoppression,anawarenessofculturalpracticesandattitudesthatsupport,aswellasdeter,domesticviolence,advocacyforcross-culturalresearch,andacommitmenttoopposeoppressionexperiencedbyminoritygroupsandthosemarginalizedbytheirsociety(eg,womenofcolor,migrantwomen,immigrantwomen,andlesbianwomen)(Campbell,Campbell,1996;Campbelletal,2000,Hoff,2001)

Domesticviolenceisassociatedwithvariedandsignificanthealth-relatedconsequencesInadditiontoimmediatephysicalinjuriesstemmingfromanassaultandacutepsychologicaldistressrelatedtovictimization,domesticviolenceisassociatedwithlong-termpsychological,physical,social,andeconomiceffectsNursesandotherhealthcareprovidersplayakeyroleindomesticviolenceidentificationandinterventionandhavebeenvisibleadvocatesforthepreventionofdomesticviolencethroughouttheworldManyhealthcareprofessionalshavehadpersonalexperienceswithdomesticviolenceandareforcedtoconfronttheirownconcernsrelatedtoviolenceastheyattempttohelpothers

Thisarticlewillprovideanoverviewofthethreemajortypesofdomesticviolence:intimatepartnerabuse,childabuse,elderabuseThescope,history,andhealthconsequencesofeachtypeofviolencewillbedescribed

Spouse/partnerabuse

Walker(1999)arguedthat"thesinglemostpowerfulriskmarkerforbecomingavictimofviolenceistobeawoman"(p23)Whilestrangersoracquaintancescommitthemajorityoftheassaultsagainstmen,womenaremuchmorelikelytoberaped,assaulted,ormurderedbyromantic/intimatepartners(Mahoney,Williams,&West,2001)

Unlikestreetviolence,domesticpartnerviolenceoccursinthecontextof"shared"lives

Intimatepartnerabuseincludesabusebycurrentorformerspousesorromanticorco-habitatingpartnersPartnerabusedoesnottypicallyinvolveasingleviolentassault;itisacyclic,progressiveprocessinwhichviolenceisusedtocontrolone'spartnerMostviolenceagainstwomenbymalepartnersisbestdescribedasbattering-thatis,"apatternofbehaviorsthroughwhichonepersoncontinuallyreinforcesapowerimbalanceoveranotherinanintimate/romanticrelationshipcontext"(Mahoneyetal,2001,p15)Intimatepartnerabuseincludesavarietyofabusiveandcoercivebehaviorsthatmaybeofaphysical,psychological,sexual,oreconomicnature(Ganley,1998)Itisestimated,forexample,that0to5%ofbatteredwomenalsoexperienceforcedsexbymalepartners(Campbell,1998)

Unlikestreetviolence,domesticpartnerviolenceoccursinthecontextof"shared"livesInadditiontoaffectiveties,thevictimandtheperpetratorshare,orhaveonceshared,aresidence,financialobligationsandresources,children,and/orfriendsTheabuseoftenoccursinthecontextofanon-goingorrecentlyseveredrelationship;perpetratorsmaythereforehaveon-goingaccesstothevictimBecauseintimatepartnerviolenceisconsidereda"familyconcern,"itisoftentakenlessseriouslythanstrangerorstreetviolenceVictimsoftenexperiencesocialandeconomicbarrierstoendingtherelationship(Ganley,1998)

Scope

Manyhealthcareprofessionalshaveexperienceddomesticviolenceintheirpersonallives

FindingsfromtheNationalViolenceAgainstWomenSurvey,atelephonesurveyofanationalrandomsampleof8,000USmenand8,000USwomen,indicatedthatapproximately221%ofthesurveyedwomenwerephysicallyassaultedbyacurrentorformerspouse,co-habitatingpartner,boyfriendorgirlfriend,ordateintheirlifetime;13%ofthesurveyedwomenreportedsuchviolenceduringthepreviousyearBasedonthesefindingsandUSCensusdata,theresearchersestimatedthatapproximately13millionwomenarephysicallyassaultedannuallybyanintimatepartnerorex-partnerInaddition,77%ofthesurveyedwomenwererapedbyacurrentorformerintimatepartneratsometime;02%experiencedsuchviolenceinthepreceding12monthsItisestimated,therefore,thatover200,000womenarerapedeachyearintheUnitedStatesbyanintimatepartner(Tjaden&Thoennes,2000a)

ManyhealthcareprofessionalshaveexperienceddomesticviolenceintheirpersonallivesEllis(1999)surveyed0registerednursesemployedinalargeemergencydepartmentandfoundthat575%reportedapersonalexperiencewithdomesticviolenceWhile35%reportedhavingbeenhit,kicked,orpunched,only25%ofthisgroupidentifiedtheseexperiencesasabuseInasurveyof275nursesinperinatalpractice,31%reportedabuseofthemselvesortheirfamilymembers(Moore,Zaccaro,&Parsons,1998)

SignificantcontroversyexistsabouttheprevalenceandthenatureoffemaleviolenceagainstmalepartnersSomeexpertsmaintainthatwomenareasviolentasarementotheirpartners,whereasothersmaintainthatfemaletomaleviolencedifferssignificantlyinbothfrequencyandseverity,andisoftenusedinself-defense(Tjaden&Thoennes,2000b)ResultsoftheNationalViolenceAgainstWomenSurveysupportthelatterviewWhereas221%ofthewomensurveyedhadbeenphysicallyassaultedbyacurrentorformerpartneratsometime,only7%ofthemenhadexperiencedsimilarviolenceWomenwerethusmorethan29timesaslikelyasmentoreportabusebyapartneroftheoppositesexSurveyresultsalsoindicatedthatthefrequencyofvictimizationwasgreaterforwomen(71incidentsvs7incidents),aswasthedurationoftheviolence(38yearsvs33years)Thefemalevictimsalsoexperiencedsignificantlymorelifethreats(33%vs26%)andfearofbodilyinjury(5%vs20%)Theauthorsconcludedthatmaleandfemaleviolenceinrelationshipsisasymmetricalaswomenexperiencemale-perpetratedviolencemorefrequently,andtheabuseismorerepetitiousandphysicallyinjurious

History

AccordingtoEnglishcommonlaw,womenwereviewedaschattel-firstaspropertyoftheirfathers,andthenoftheirhusbandsWhenawomanmarried,herlegalexistencewasconsolidatedintothatofherhusband;shewasconsideredtobeunderhisprotectionandinfluenceandcouldnotinheritproperty(Schornstein,1997)PhysicalviolencewasusedfrequentlybyhusbandsagainstwivesAccordingtothe"ruleofthumb"law,amancouldbeathiswifewitharodnobiggerthanhisthumb(Barnett,Miller-Perrin,&Perrin,1997)

Schornstein(1997)providedseveralexamplesof19thcenturyUScourtrulingsthatreflectedtheprinciplesofEnglishcommonlawandupheldtherightofahusbandtophysicallydisciplinehiswifeIn186,theSupremeCourtofNorthCarolinaruledinStatevBlackthatahusbandcouldnotbeconvictedofbatteringhiswifeunlessheinflictedapermanentinjury,usedexcessiveviolence,orexhibitedmalignityorvindictivenessIn1868,theSupremeCourtofSouthCarolinainStatevRhodesrefusedtoholdahusbandcriminallyresponsibleforhavingbeatenhiswifewithasmallstick

Inthelate1800s,legalreformrelatedtodomesticviolencebeganintheUnitedStates(Barnettetal,1997)Inthe1870s,AlabamaandMassachusettsintroducedthefirstlegislationmakingitillegaltobeatone'swifeSeveralotherstatesfollowedwithsimilarlegislationFewarrestsweremade,however,anddistrictattorneyswereunlikelytoprosecuteIn1882,thestateofMarylandpassedlegislationthatoutlawedwifebeatingandmadeitacrimepunishableby0lashesorayearinjail(Schornstein,1997)

GrassrootsfeministsbroughttheproblemofviolenceagainstwomentopublicattentionintheUSinthel960sand1970sandbegantoestablishanumberofcommunity-basedprogramsforbatteredwomenHavenHouseinPasadena,California,thefirstshelterforbatteredwomenandtheirchildren,wasopenedin196OrganizationssuchastheNationalOrganizationofWomenandtheNationalCoalitionAgainstDomesticViolencepushedforsocialservicesandlegislativereformtobetterprotectbatteredwomen(Barnettetal,1997)

In1979,LenoreWalkerpublishedTheBatteredWoman,aninfluentialbookthatdefinedthebatteredwomen'ssyndrome(BWS)ThemajorcomponentsofBWSarethepost-traumaticstresssymptomsandlearnedhelplessnessthatdevelopwhenthewoman'sattempttoendtheabuseprovesfutileWalker'sworkwassignificantasthesymptomsexperiencedbybatteredwomenwereidentifiedasresponsestoon-goingabuse,challengingthetraditionalassumptionthatawoman'spsychologicalvulnerabilitycausesorcontributesto,ratherthanresultsfrom,herbattering

In1982,theUSCommissiononCivilRightspublishedareportentitledUndertheRuleofThumb:BatteredWomenandtheAdministrationofJusticeevaluatingthetreatmentofvictimsofdomesticviolencebythecriminaljusticesystemandsocialserviceagenciesThereportconcludedthatpoliceofficers,prosecutors,andjudgesprovidedlittlereliefforvictimsofdomesticviolencebecausetheyconsidereddomesticviolenceaprivatematterratherthanacrime(Schornstein,1997)

TheformerUSSurgeonGeneral,EverettKoop,designatedthebatteringofwomenasasignificanthealthproblemandconvenedTheSurgeonGeneral'sWorkshoponViolenceandPublicHealthin1985(USDHHS,1986)The150attendeeswereadvocates,practitioners,educators,andresearchersconcernedwithviolenceagainstwomenMandatorytrainingandexaminationofhealthprofessionalsintheessentialsofdomesticviolenceinterventionwasamajorrecommendationfromtheworkshop(Hoff,2001)

In199,CongresspassedtheViolenceAgainstWomenAct(VAWA)asapartoftheViolentCrimeControlandLawEnforcementActTheVAWAisa"groupofindividuallyconceivedlegislativepiecesthatwerejoinedtogethertocreateapackageoffederallawsandgrantprogramsspecificallyaddressingdomesticviolence,sexualassault,andstalking"(Valente,Hart,Zeya,&Malefyt,2001,p285)TheVAWAwasthefirstfederallawtocriminalizedomesticviolenceThelegislationauthorizedgrantstostates,NativeAmericantribunals,andlocalgovernmentstoimprovecriminaljusticeresponsetodomesticviolenceItincludednewfederalstatutesforinterstatedomesticviolence,introducedacivilrightscauseofaction,fundedawideassortmentofprograms,initiatednewfederally-fundedresearchondomesticviolence,andcreatedanationaldomesticviolencehotline(Schornstein,1997)In1995,theViolenceAgainstWomenOfficeoftheOfficeofJusticeProgramswascreatedtoimplementtheVAWA(USDepartmentofJustice,2001)

Sincethe1970s,nursinghasbeeninvolvedineffortstocombattheproblemofintimatepartnerabuse

TheViolenceAgainstWomenActof2000,whichwasamendedtotheVictimsofTraffickingandViolenceProventionActof2000,reauthorizedcriticalgrantprograms,establishednewprograms,andstrengthenedfederallawsrelatedtodomesticviolence,sexualassault,andstalkingVAWA2000providescoveragefordatingviolence,supervisedvisitationcenters,civillegalassistanceandjudicialeducation,andincreasedprotectionforbatteredimmigrantwomen(USDepartmentofJustice,2000)

Sincethe1970s,nursinghasbeeninvolvedineffortstocombattheproblemofintimatepartnerabuseNurseswerestronglyrepresentedattheSurgeonGeneral's1985workshopTheNursingNetworkonViolenceAgainstWomenInternational(NNVAWI),whichaimsto"endviolenceagainstwomen,empowerbatteredwomen,andchangethehealthcaresystemtobemoreresponsivetotheneedsofabusedwomenandtheirchildren"(Campbell&Parker,1999,p51)wasfoundedin1986In1997,thePublicHealthServiceOfficeonWomen'sHealthcoordinatedaNationalNursingTaskForceonViolenceAgainstWomenwithmembersrepresenting30nationalnursingorganizationsThegroup'sworkresultedinnationalpolicyrecommendationsthatwerepresentedduringtheNationalNursingSummitonViolenceAgainstWomen(USPublicHealthService,2001)Severalnursingorganizationshaveissuedpositionstatementsacknowledgingviolencerecognition,prevention,andinterventionashealthcarepriorities(theAmericanAssociationofCollegesofNursing,2001;theAmericanNurses'Association,1991;theNationalBlackNurses'Association,Inc,199;theAmericanCollegeofNurse-Midwives,1997;theEmergencyNursesAssociation,1998)Duringthe1990s,therehasbeenaproliferationofprogramsinhospitalsandcommunity-basedhealthcentersthatprovidespecializeddomesticviolencepreventionandinterventionprogramsforbatteredwomenandtheirchildren(Sheridan,1998)

HealthConsequences

Thephysicalconsequencesofbatteringrangefromminorinjuriestopermanentdisability,disfigurement,anddeathTheNationalViolenceAgainstWomenSurveyfoundthat302%ofthewomeninjuredduringtheirmostrecentphysicalassaultand356%ofthewomeninjuredduringtheirmostrecentrapereceivedsometypeofmedicaltreatmentWomenwhoareassaultedorrapedbyacurrentorformerpartnerareatthegreatestriskforinjury(Tjaden&Thoennes,2000a)Nurseresearchershavedocumentedthat22%to35%ofwomenwhoseektreatmentathospitalemergencydepartmentsdosoforinjuriesrelatedtodomesticviolence(Campbell,Pliska,Taylor,&Sheridan,199)

Domesticviolenceinjuriesfrequentlyincludelacerations,bruisesandcontusions,musculoskeletaldamage(brokenbones,tendon&ligamentinjuries),neurologicalproblems(hearingandvisionloss,impairedconcentration),and,inthecaseofsexualassault,vaginalandanaltears(Warshaw,1998)Stress-relatedconsequencesofbatteringmayincludepersistentheadaches,chronicirritablebowelsyndrome,chronicpain,andeatingdisorders(Campbell,1998;Warshaw,1998)Sexualviolencemayresultinincreasedriskforanumberofgenito-urinaryproblems,includingpelvicinflammatorydisease,sexually-transmitteddiseases,bladderinfections,sexualdysfunction,pelvicpain,andurinarytractinfectionsBatteringduringpregnancyisalsoconsideredamajorhealthrisk,andmayresultinmiscarriages,placentalseparation,antepartumhemorrhage,fetalfracture,ruptureoftheuterus,andpretermlabor(Warshaw,1998)Batteringduringpregnancyhasbeenassociatedwithlowbirthweightinfants,perhapsthroughtheinfluenceoffactorssuchassmoking,lowweightgain,andsubstanceabuse(Campbelletal,2000)Mentalhealtheffectsmostfrequentlyassociatedwithbatteringincludedepressivesymptoms,posttraumaticstressdisorder,substanceabuse,andsuicidality(Campbell,1998;Warshaw,1998)Themostgrimconsequenceofdomesticviolenceisdeath;themajorityofwomenwhoarekilledintheUnitedStatesarekilledbyacurrentorformerintimatepartner(Campbell,1998)

Childhoodabuse,likepartnerabuse,isasignificanthealthissueacrosstheglobe

ChildAbuse

Childhoodabuse,likepartnerabuse,isasignificanthealthissueacrosstheglobeChildhoodabusemaybephysical,sexual,orpsychologicalinnature,ormayinvolvepsychologicalorphysicalneglectDefinitionsofchildhoodabuseandmaltreatmentvarywidelyLegaldefinitionsofchildhoodabuse,forexample,differfromstatetostateWhileallstatestatutesacknowledgethatphysicalabuseincludesnon-accidentalphysicalinjurythatresultsinharmorsubstantialriskofharm,somestatutesspecifythetypesofacts(eg,strikingwithanobject)orovertconsequences(eg,visiblebruises)thatconstitutephysicalabuse(Barnettetal,1997)Considerabledisagreementexistsbothamongthepublicandchilddevelopmentprofessionalsastowhatseparates"normal"corporalpunishment(eg,spanking)fromabuseSpanking,paddling,andslappingchildrenasaformofdisciplineisacommonpracticeintheUnitedStatesandsuchbehaviorsaretypicallynotlabeledasabusivebymostadultsOntheotherhand,someexpertshavearguedthatspankingisalwaysharmfulbecauseitlegitimizesviolenceandmayengenderotherformsofinterpersonalaggression(eg,siblingabuse,violenceoutsidethehome)(Straus,199)AsKolko(1996)argued,"Thetaskofdeterminingwhenparentalbehaviorsareexcessive,unwarranted,dangerous,andultimatelyabuseremainsacomplexone"(p22)

Definitionsofchildhoodsexualabusearedependentuponhistorical,cultural,andsocialcontextsandvarywidelyEmotionalabuseandchildneglectareperhapsthemostprevalentformsofchildhoodmaltreatment,andthemostdifficulttodefineBernsteinandFink(1998)haveidentifiedsomecommondefinitionsofchildabuseandneglectfoundinthechildhoodtraumaliterature:

Emotionalabusereferstoverbalassaultsonachild'ssenseofworthorwell-being,oranyhumiliating,demeaning,orthreateningbehaviordirectedtowardachildbyanolderpersonPhysicalabusereferstobodilyassaultsonachildbyanolderpersonthatposeariskof,orresultin,injurySexualabusereferstosexualcontactorconductbetweenachildandolderperson;explicitcoercionisafrequentbutnotessentialfeatureoftheseexperiencesEmotionalneglectreferstothefailureofcaretakerstoprovideachild'sbasicpsychologicalandemotionalneeds,suchaslove,encouragement,belonging,andsupportPhysicalneglectreferstofailureofcaregiverstoprovideachild'sbasicneeds,includingfood,shelter,safety,andsupervision(p2)

Scope

TheThirdNationalIncidenceStudyofChildAbuseandNeglect(NIS-3),conductedbytheNationalCenteronChildAbuseandNeglect,wasmandatedbyCongresstoprovideofficialestimatesofthesephenomenonintheUnitedStatesTheNIS-3followstheNIS-1,publishedin1981,andtheNIS-2,publishedin1986ThefindingsoftheNIS-3arebasedonanationallyrepresentativesampleofover5,600professionalsin82agenciesin2counties,andreflectthenumberofabuseandneglectcasesinvestigatedbychildprotectiveservicesorservedbycommunityagenciesDatawerecollectedin1993andcomparedtodatacollectedintheNIS-2surveyTheNIS-3usedtwostandardsChildrenwhohadalreadyexperiencedharmfromabuseorneglectwereconsideredabusedbytheHarmStandard;childrenwhoexperiencedabuseorneglectthatputthematriskforharmwereconsideredabusedbyEndangermentStandardUsingtheHarmStandard,surveyfindingssuggestthatin1993,1,553,800childrenwereabusedorneglected;thisestimateraisesto2,815,600undertheEndangermentStandardOutlinedinTable1arethenumberofchildrenestimatedtohavebeensexuallyorphysicallyabusedandphysicallyoremotionallyneglectedTheauthorsofthesurveyconcluded,"ThefindingsoftheThirdNationalIncidenceStudyofChildAbuseandNeglect(NIS-3)showasharpincreaseinthescopeoftheproblem,whethermaltreatmentisdefinedusingtheHarmStandardortheEndangermentStandard"(Sedlak&Broadhurst,1996,p7)

Table1

EstimatedincidenceofchildabuseintheUSin1993fromtheThirdNationalIncidenceStudyofChildAbuseandNeglect(Sedlak&Broadhurst,1996)

HarmStandardEndangermentStandard

Sexuallyabused

217,700

83%*

 

300,200

125%*

Physicallyneglected

338,900

102%*

 

1,335,100

163%*

Emotionallyneglected

212,800

333%*

 

585,100

188%*

Physicallyabused

381,700

2%*

 

61,100

97%*

Totalabusedorneglected

1,553,800

67%*

 

2,815,600

98%*


*IncreaseoverNIS-2estimatesin1986

OfficialestimatessuchasthosederivedfromtheNIS-3surveyarebasedononlythosechildrenwhocometotheattentionofauthoritiesorhelpingprofessionalsTheactualincidenceofabuseandneglectofchildrenintheUSislikelytobemuchhigherParticipantsintheNationalViolenceAgainstWomenSurvey,forexample,wereaskedaseriesofbehaviorallyspecificquestionsaboutarangeofphysicalassaultscommittedbyadultcaretakersMorethanhalfoftherespondentshadexperiencedatleastonephysicalassaultbyacaretaker(Tjaden&Thoennes,2000a)InanationalUStelephonesurveyof2,626adults,27%ofthewomenand16%ofthemenreportedexperiencingsexualabuseduringtheirchildhood(Finkelhor,Hotaling,Lewis,&Smith,1990)

Throughouthistory,parentsandothercaretakershavemaltreatedchildren

History

Throughouthistory,parentsandothercaretakershavemaltreatedchildrenManysocietiespracticeinfanticideandtheabandonmentofunwantedchildrenIndustrializedsocietieshaveusedchildrenfordangerousandexhaustingwork(Barnettetal,1997)Girlsaroundtheworldareespeciallyatriskforsexualabuse,childmarriage,childprostitutionandpornography,andfemalegenitalmutilation(Kendall-Tackett,2001)

IntheUS,childrenhavehistoricallybeenconsideredpropertyoftheirparentsandwithoutlegalrightsIn187,thefirstUSchildabusecasewastriedinNewYork;itresultedinaconvictionofawomanforassaultandbatteryonher8year-oldstepdaughter,MaryEllen(Barnettetal,1997)MaryEllenhadbeenbeatendaily,starved,andprohibitedfromleavingthehouseThiscaseattractedconsiderablepublicattentionandledtothefoundingoftheSocietyforthePreventionofCrueltytoChildren(SPCC)

Intheearly1900s,statelegislaturesbegantoenactstatutescriminalizingtheabuseandneglectofchildrenandprovidingprotectivemeasuresformistreatedchildrenBetween1899and1920,almostallstatesintheUnitedStatesinstitutedstatewidejuvenilecourtsystems(Bulkley,Feller,Stern,&Roe,1996)Inthe1900s,severalchildprotectiveorganizationswerefounded,includingtheNationalCommitteetoPreventChildAbuse,theFamilyResourceCoalition,theChildren'sDefenseFund,theNationalCenterforMissingandExploitedChildren,andtheChildWelfareLeagueofAmerica(Barnettetal,1997)

In1962,CHenryKempe,apediatricianattheUniversityofColorado,andhiscolleaguesidentifiedthe"batteredchildsyndrome"-aconstellationofphysicalandpsychologicalsymptomsresultingfromphysicalchildabuse(Kempe,Silverman,&Stele,1962)Kempe'sworkresultedinincreasedrecognitionandreportingofchildhoodphysicalabusebyhealthprofessionalsandmobilizedadvocacyforgreatergovernmentinterventionforchildwelfareIn197,CongressenactedtheChildAbusePreventionandTreatmentAct(CAPTA),providingfederalfundsforstatesthatpassedlegislationrequiringthereportingofchildabusebycertainprofessionals(eg,teachers,healthcareprofessionals)ItalsoestablishedtheNationalCenterforChildAbuseandNeglect(Barnettetal,1997)The1980sand1990ssawaproliferationofhealth-systemandcommunity-basedinterventionsforthepreventionandtreatmentofphysicalchildabuse(Barnettetal,1997)

Thethird"discovery"ofchildhoodsexualabuseoccurredduringthe1970swiththeadventofthewomen'smovementAlongwithissuesofrapeandwifebattering,activistsandsurvivorsbroughtchildhoodsexualabuseintopublicawareness

Historically,professionalsandthepublicdidnotconsidersexualabusetobeaprevalentortraumaticexperienceinthelivesofchildrenHerman(1981)identifiedthree"discoveries"ofincestInthefirst"discovery,"Freudinitiallyreportedthatfemalepatientsinpsychoanalysisfrequentlydescribedincestuouschildhoodexperiences,andthattheseexperiencesweretherootcauseofadulthysteriaHelaterrepudiatedthisclaimintheserviceofprotectingthecultureofthepatriarchalfamilyandsuggestedinsteadthatthewomen'sclaimswereincestuousfantasiesratherthanactualchildhoodeventsFollowingthisrepudiation,therealityandprevalenceofchildhoodsexualabusewereagaindeniedInthe190s,incestwas"discovered"againbysocialscientistsconductinglargescalesurveysofsexualpractices,suchastheearlyKinseystudiesDespitethefactthattheprevalenceofchildhoodsexualabusewassubstantiatedinthesestudies,HermansuggestedthattherealityoftheexperiencewasminimizedBecausetheresearcherswereattemptingtoencourageenlightenmentandtoleranceofsexualattitudes,theyfailedtohighlightthevictimizingnatureoftheexperiencesThethird"discovery"ofchildhoodsexualabuseoccurredduringthe1970swiththeadventofthewomen'smovementAlongwithissuesofrapeandwifebattering,activistsandsurvivorsbroughtchildhoodsexualabuseintopublicawarenessInthe1980sand1990s,therewasaproliferationofscholarly,clinical,andself-helpliteratureonthetopic

ThesexualabuseofchildrenalsobegantoreceivelegislativeattentionintheUSinthe1970sIn1978,theProtectionofChildrenAgainstSexualExploitationActwaspassedIn1986,theChildSexualAbuseandPornographyActmadeitafederalcrimetosexuallyexploitchildrenortopermitachildtoengageinpornography(Barnettetal,1997)

HealthConsequences

Childabusecanhavesignificantpsychologicalandphysicalconsequencesforchildren,aswellaslong-termeffectsthatmayextendintoadulthoodBarnettandcolleagues(1997)identifiedthemostfrequentlyreportedeffectsofphysicalabuseonchildrenPhysicalconsequencesmayincludebruises;head,chest,andabdominalinjuries;burnsandfracturesAbusedchildrenoftenexhibitanumberofcognitivedifficulties,includingdeficitsinverbal,reading,math,andperceptual-motorskills;poorschoolachievement;andimpairedmemoryBehavioralproblems,suchasaggression,noncompliance,andantisocialbehaviors,havealsobeenassociatedwithabuse,ashaveavarietyofemotionaldifficulties,includingdepression,lowself-esteem,andincreaseddailystressLong-termeffectsinadultsmayincludecriminal/violentbehavior(foradultmales),substanceabuse,andavarietyofsocialandemotionalproblems,includingsuicidality,anxiety,hostility,dissociation,andinterpersonaldifficultiesExpertsstress,however,thatphysicalchildabusedoesnotaffectindividualsinconsistentandpredictablewaysThenegativeeffects,infact,canbemitigatedbyanumberoffactors,especiallybythepresenceofsupportiveadultsinthechild'slife(Barnettetal,1997)

Barnettandcolleagues(1997)havesummarizedthemostfrequentedsubstantiatedeffectsofchildsexualabuseaswellPhysicalconsequencesofchildsexualabuseoftenincludegenitalbruising,bleeding,pain,anditching;enuresis;encopresis;andavarietyofstress-relatedsymptoms,includingsleepandeatingdisturbances,stomachaches,andheadachesShort-termeffectsofchildsexualabuseincludeemotionalproblems,suchasanxiety,depression,aggression,andlowself-esteem,aswellasavarietyofbehavioralandlearningdifficultiesLong-termeffectsexhibitedbyadultsurvivorsofchildsexualabuseincludeemotionaldifficulties,suchasdepression,anxiety,andposttraumaticstresssymptoms;interpersonalandsexualproblems;andcertainbehaviorproblems,suchaseatingandsubstanceabusedisordersAswithphysicalabuse,individualresponsestochildsexualabusearehighlyindividualizedandcanbemediatedbyanumberoffactors,includingthevictim'ssubjectiveperceptionoftheeventsandavailablesocialsupport(Barnettetal,1997)

AmyriadofeffectshavealsobeenassociatedwithchildhoodneglectChildhoodneglectmayresultinsocialdifficulties,includingimpairmentofparent-childinteractionsandproblematicpeerinteractions;intellectualdeficits;andavarietyofemotionalandbehaviorproblems,includinglowself-esteem,ineffectivecoping,aggression,andnegativeaffectThephysicalconsequencesofchildneglectincludefailuretothriveanddeathTheeffectsofpsychologicalmaltreatmenthavenotbeenstudiedextensively,butseemtoincludeavarietyofnegativeeffects,includingdifficultiesininterpersonaladjustment,intellectualdeficits,andaffective-behavioralproblems(Barnettetal,1997)

Expertssuggestthatdomesticelderabuseisperhapsthemostunderreportedcrime

ElderAbuse

TheUSAdministrationonAgingreportsthatthereare3millionAmericansovertheageof60,and3millionwhoare85orolderDuetoimprovedhealthandstandardsofliving,itispredictedthatbytheyear2030,morethan85millionAmericanswillbeover60andmorethan8millionwillbeovertheageof85(AdministrationonAging,2001)Whileotherissuesaffectingtheelderly,suchasretirementsecurityandaffordablelong-termcare,havereceivednationalattention,theabuseandneglectoftheelderlyhashistoricallybeenignored(NationalCenteronElderAbuse,2001)Elderabusehastraditionallybeenassociatedwithstreetcrimes,abuseinnursinghomes,andfinancialfraud(Quinn&Tomita,1997)Onlyrecentlyhaselderabusebyfamilymembersandintimatesattractedscholarlyattention,publicoutrage,andpublicfundingforpreventionandeducation

ExpertssuggestthatdomesticelderabuseisperhapsthemostunderreportedcrimeOlderadultsmaybeespeciallyreluctanttoreportabusebecausetheyareashamedtoadmitthattheirspouseorchildrenhavemistreatedthem,fearretaliation,ordreadbeinginstitutionalizediftheyareremovedfromthecareoftheabuser(Payne,2000,Quinn&Tomita,1997)Inaddition,cognitiveandphysicalimpairmentsmaymakeitimpossibleforsomeelderlyindividualstoreporttheirabuseUnlikechildrenwhomustattendschool,abusedeldersmayremainisolatedintheirhomes

ElderabusehasbeenparticularlydifficulttodefineThereisconsiderabledisagreementoverwhatconstitutesabuseandtheageatwhichonebecomeselderlySomeexpertsbelievethetermelderabuseshouldbelimitedtophysicalorpsychologicalabuseofimpairedanddependentseniors;othersbelievethatfailuretoprovideappropriatecarealsoconstitutesabuseTheNationalCenteronElderAbuse(2001)definesdomesticelderabuseas"anyofseveralformsofmaltreatmentofanolderpersonbysomeonewhohasaspecialrelationwiththeelder(eg,aspouse,asibling,achild,afriend,oracaregiverintheolderperson'shomeorinthehomeofthecaregiver)"(p1)Elderabuseincludesphysicalabuse,sexualabuse,emotionalorpsychologicalabuse,neglect,abandonment,andfinancialormaterialexploitationAswithchildabuse,legaldefinitionsofelderabusevaryfromstatetostate

Scope

TheNationalElderAbuseIncidenceStudy(NEAIS),conductedbytheNationalCenteronElderAbuse,collecteddataondomesticelderabuse,neglect,andself-neglectthroughanationallyrepresentativesampleof20countiesin15states(NationalCenteronElderAbuse,1998)DatawerecollectedfromlocalAdultProtectiveServicesagenciesandfromprofessionalsincommunityagencieswhohadfrequentcontactwiththeelderlyThemethodologywasdesignedtobeconsistentwiththeNationalIncidenceStudiesconductedbytheNationalCenteronChildAbuseandNeglectBasedontheNEAISfindingsandUSCensusdata,itisestimatedthatatotalof9,92personsaged60andoverexperiencedabuseand/orneglectindomesticsettingsin199670,92ofthesecases(16%)werereportedtoandsubstantiatedbyAPSagencies;378,982(8%)werenotTheresearchersalsofoundthatfemalesareabusedmorefrequentlythanmales,andthateldersover80areatthegreatestriskforabuseandneglectIn90%oftheincidentsofelderabuseandneglectbyaknownperpetrator,theperpetratorisafamilymember;two-thirdsoftheperpetratorsareadultchildrenorspouses

PillemerandFinkelhor(1988)conductedalargescale,randomsampletelephonesurveyofelderabuseandneglectTheyinterviewed2,020Bostonarearesidentsovertheageof65andfoundthat32%(N=63)oftherespondentsreportedbeingmaltreatedFortyrespondents(2%)hadexperiencedphysicalabuse,26(11%)chronicverbalaggression,and7(0%)neglectThirty-fiveoftheperpetratorswerespouses,10weresons,5weredaughters,and11wereotherpersons(eg,grandchildren,siblings)Onthebasisofthesesurveyfindings,theauthorsestimatethatonly1in1casesofelderabuseisreportedtotheauthorities

History

Elderabusefirstcametopublicattentioninthe1960swhenitwasdiscussedinBritishmedicaljournalsunderthemisguidedlabelof"grannybashing"In1979,TheBatteredElderSyndromewaspublishedbyBlockandSinnot(1979),bringingtheproblemofelderabusetotheattentionofhealthprofessionalsandhumanservicescholars

Inthelate1960s,theUSDepartmentofSocialandRehabilitationServicesbeganfundingNationalProtectiveServicesThefirstcongressionalhearingonelderabusewasheldin1979bytheHouseSelectCommitteeonAgingIn1981,theNationalCenterforAdultAbusewasestablishedBy1982,everystatedevelopedanadultprotectionprogramand2stateshadadoptedamandatoryelderabusereportinglaw(Payne,2000)

In1987,amendmentstotheOlderAmericansAct(OAA)mandatedthatstatesprovideoutreachservicestoidentifyelderabusecases,deviseprocedurestoprocesselderabusereports,andconductpubliceducationTitleVII,asubsequentamendmenttotheOAA,includedprovisionsforlongtermcareombudsmen,legalassistance,andservicestopreventabuseThroughTitleIVoftheOAA,theAdministrationonAging(AoA)providedfundingforresearchandservicedeliveryprojectsTheAoAalsofundedanationalresourcecenterandanationalsurveyontheincidenceofelderabuse,neglect,andexploitation(Nerenberg,1997)Severalnationaladvocacygroups,suchastheAmericanAssociationofRetiredPersons,theOlderWoman'sLeague,andtheNationalOrganizationofWomen,haveheldforums,assembledcommittees,andorganizedcongressionalhearingstoaddresstheproblemofelderabuseRecently,health-caresystemandcommunity-basedservicesforabusedandneglectedeldershavebeguntobedeveloped(Barnettetal,1997;Vinton,2001)

HealthConsequences

Likeotherformsofdomesticviolence,elderabuseisassociatedwithamyriadofphysicalconsequencesQuinnandTomita(1997)listedanumberofphysicaleffectsthatareindicatorsofelderabuse,includingscratches,cuts,andbruises;sprainsanddislocations;pressuresores,fractures,anddetachedretinasSignsandsymptomsofpossiblesexualabuseincludegenitalorurinaryirritation,injuryorscarring,andintensefearinreactiontoaninvasivepelvicprocedureSignsandsymptomsofpossiblephysicalneglectincludepoorhygiene(bodyodor,mattedhair,unexplainedrashes),hypothermia,untreatedsores,failuretothrive,malnutritionanddehydrationThepsychologicalconsequencesofelderabusehavenotbeensystematicallyresearched

Summary

Despitethefactthatintimatepartnerabuse,childabuse,andelderabusehavecapturedtheattentionofthepublic,socialscienceresearchers,healthcareprofessionals,andpolicymakersworldwide,domesticviolencecontinuestobeaprevalentproblemthatbringssufferingtomillionsandenormouscoststoallsocietiesMahoneyandcolleagues(2001),forexample,argue:

Evenafter25yearsofresearchandadvocacy,intimateviolenceagainstwomenremainsatepidemicproportions,affectingwomenofallagegroupsandallwalksoflife;frompreteengirlstoelderwomen,andwomenofallraces,cultures,sexualorientations,andphysicalabilities(p13)

Despitethefactthatintimatepartnerabuse,childabuse,andelderabusehavecapturedtheattentionofthepublic,socialscienceresearchers,healthcareprofessionals,andpolicymakersworldwide,domesticviolencecontinuestobeaprevalentproblemthatbringssufferingtomillionsandenormouscoststoallsocieties

Nursesandotherhealthcareprofessionalshaverespondedtotheproblemofdomesticviolencebyengaginginincreasinglysophisticatedresearch,designingpreventionandinterventionprograms,andadvocatingforsocialchangeWhilewecelebratethestridesmadeintacklingtheproblemofdomesticviolence,wemustaskwhy,despitesuchconcertedeffortstoaddresstheproblem,domesticviolenceremainsa"plagueinourland"(AmericanAcademyofNursing,1995)

Conclusion

FuturedirectionsfornursescommittedtocombatingdomesticviolencemustoccuronseverallevelsDomesticviolenceisrootedincomplexsociologicalandeconomicfactorsincludingpoverty,sexism,racism,ageism,substanceabuse,familybreakdown,violenceinthemediaandthereadyavailabilityofhandgunsNursesmustadvocateforpolicythatenhanceseconomicopportunitiesandtheredistributionofpowerinoursociety,aswellassupportstateandnationallegislationthatwillfunddomesticviolenceprograms,preventinsurancediscriminationagainstvictimsofdomesticviolence,enhanceimmigrationprotectionsforabusedwomen,ensuretherightsofwomenandchildrenaffectedbywelfarereform,andenhanceprotectionsforolderanddisabledwomenwhoareabusedNurseshavebecomeincreasinglyvocalinsupportoflegislationforhandguncontrolandtheabolishingofdangerousammunition

Onthepracticelevel,nursesinallsettingsmustconsiderroutinescreeningforabuseasastandardofcareWhileuniversalhealthcarescreeningfordomesticviolenceisrecommendedbymosthealthcareorganizations,itismostsuccessfullyimplementedinfacilitiesthathaveaformalinstitution-widecommitmenttothepracticeandcomprehensiveprotocolsthatoutlineintervention,aswellasassessment,strategiesWithinputfromstakeholders,nursesshouldcontinuetosupport,design,andevaluatepreventionandinterventionprogramsthataremulti-disciplinary,innovative,andculturallyspecificCoordinatedresponseprograms,thatarecollaborativecommunity-wideendeavorsinvolvingmultipleagencieschargedwithdomesticviolencepreventionandintervention,seemtoholdthemostpromiseAschildabuseis"thegatewaytomanyothersocialandmaladaptiveproblems"(Thomas,1995,p60),nursesandotherhealthcareprofessionalsshouldbecomeinvolvedincommunity-basedfamilysupportinitiatives,familyskillstrainingprograms,andfamilypreservationservicesSchool-basedprogramsthatidentifyandintervenewithchildrenatriskandthatteachskill-buildingandconflictresolutionskillsarealsoessential

Severalexpertshavesuggestedthatdomesticviolenceserviceshavebeenineffectivebecausetheyarenotculturallyspecific(Koss&Hoffman,2000;Thomas,1995)Programsoftendonotprovideculturallycompetentcounselors,usethetargetlanguageofthegroupsserved,orrespectthetraditionalhealingpracticesofthecommunity(Koss&Hoffman,2000)NurseshavebeguntodescribeculturallyspecificclinicalinterventionsForexample,informationisavailableonprovidinghealthcareforbatteredwomenwhoareAfricanAmerican(Campbell&Gary,1998),NativeAmerican(Bohn,1998),andHispanic(Torres,1998)Thespecialneedsofimmigrantwomen(DasDasgupta,1998),migrantfarmworkerwomen(Rodriguez,1999),ruralwomen(Fishwick,1998),andlesbianwomen(Renzetti,1998)havealsobeenaddressedFuturedirectionsmustinvolveutilizingsuchinformationinpracticesettingsandexpandingourknowledgebaserelatedtotheneedsofethnicgroupsandothermarginalizedpopulations

Finally,nursesmustcareforthemselvesNursesandotherprofessionalswhohaveexperienceddomesticviolencemustbesupportedintheireffortstofindunderstanding,safety,peace,andhealingintheirownlives

Author

ClaireBurkeDraucker,RN,PhD,CS
E-mail-cdraucke@kentedu

ClaireBurkeDraucker,RN,PhD,CSisaProfessorandDirectoroftheGraduatePrograminPsychiatricMentalHealthNursingintheCollegeofNursingatKentStateUniversitySheisalicensedpsychologistintheStateofOhioandaCertifiedClinicalSpecialistinPsychiatricMentalHealthNursingDrDrauckerhasconductedstudiesonearlyfamilyexperiencesandlatervictimizationinthelivesofwomen,thehealingprocessesofwomenandmenwhoweresexuallyabusedaschildren,andwomen'sresponsestosexualviolencebymaleintimatesSheistheauthorofCounselingAdultSurvivorsofChildhoodSexualAbuse(Sage)

TheAdministrationonAgingandtheOlderAmericansActwwwaoadhhsgov/aoa/pages/aoafacthtml

AmericanAcademyofNursing(AAN)(1995)Violence:AplagueinourlandWashington,DC:Author

AmericanAssociationofCollegesofNursing(AACN)(2001)Positionstatement:Violenceasapublichealthproblemwwwaacnncheedu/Publications/positions/violencehtm

AmericanCollegeofNurse-Midwives(ACNM)(1997)Positionstatement:Violenceagainstwomenwwwacnmorg/prof/violenchtm

AmericanNursesAssociation(ANA)(1991)Positionstatement:Physicalviolenceagainstwomenhttp://nursingworldorg/MainMenuCategories/HealthcareandPolicyIssues/ANAPositionStatements/social/viowomen1525aspx

Barnett,OW,Miller-Perrin,CL,&Perrin,RD(1997)FamilyviolenceacrossthelifespanThousandOaks,CA:Sage

Bernstein,DP&Fink,L(1998)CTQ:ChildhoodTraumaQuestionnairemanualSanAntonio:HarcourtBrace

Block,MR&Sinnott,JD(Eds)(1979)Thebatteredeldersyndrome:AnexploratorystudyCollegePark,MD:UniversityofMarylandCenteronAging

Bohn,DK(1998)ClinicalinterventionswithNativeAmericanbatteredwomenInJCCampbell(Ed),Empoweringsurvivorsofabuse:Healthcareforbatteredwomenandtheirchildren(pp21-258)ThousandOaks,CA:Sage

Bulkley,JA,Feller,JN,Stern,P,&Roe,R(1996)ChildabuseandneglectlawsandlegalproceedingsInJBriere,LBerliner,JABulkley,CJenny,&TReid(Eds),TheAPSAChandbookofchildmaltreatment(pp271-296)ThousandOaks,CA:Sage

Campbell,DW&Gary,FA(1998)ProvidingeffectiveinterventionsforAfricanAmericanbatteredwomenInJCCampbell(Ed),Empoweringsurvivorsofabuse:Healthcareforbatteredwomenandtheirchildren(pp229-258)ThousandOaks,CA:Sage

Campbell,JC(1998)Makingthehealthcaresystemanempowermentzoneforbatteredwomen:Healthconsequences,policyrecommendations,introduction,andoverviewInJCCampbell(Ed),Empoweringsurvivorsofabuse:Healthcareforbatteredwomenandtheirchildren(pp21-258)ThousandOaks,CA:Sage

Campbell,JC&Campbell,DW(1996)CulturalcompetenceinthecareofabusedwomenJournalofNurse-Midwifery,1(6),57-62

Campbell,JC,Moracco,KE,&Saltzman,LE(2000)Futuredirectionsforviolenceagainstwomenandreproductivehealth:Science,prevention,andactionMaternalandChildHealthJournal,(2),19-15

Campbell,JC&Parker,B(1999)Clinicalnursingresearchonbatteredwomenandtheirchildren:AreviewInASHinshaw,SLFeethum,&JLFShaver(Eds),Handbookofclinicalnursingresearch(pp535-560)ThousandOaks,CA:Sage

Campbell,JC,Pliska,MJ,Taylor,W,&Sheridan,D(199)Batteredwomen'sexperienceintheemergencydepartmentJournalofEmergencyNursing,20(),280-288

DasDasgupta,S(1998)Women'srealities:Definingviolenceagainstwomenbyimmigration,race,andclassInRKBergen(Ed),Issuesinintimateviolence(pp209-218)ThousandOaks,CA:Sage

Ellis,JM(1999)BarrierstoeffectivescreeningfordomesticviolencebyregisterednursesintheemergencydepartmentCriticalCareNursingQuarterly,22(1),27-1

EmergencyNursesAssociation(ENA)(1998)Positionstatement:Domesticviolencewwwenaorg/services/posistate/data/domviohtm

Finkelhor,D,Hotaling,GT,Lewis,IA,andSmith,C(1990)Sexualabuseinanationalsurveyofadultmenandwomen:Prevalence,characteristics,andriskfactorsChildAbuseandNeglect,1,19-28

Fishwick,N(1998)IssuesinprovidingcareforruralbatteredwomenInJCCampbell(Ed),Empoweringsurvivorsofabuse:Healthcareforbatteredwomenandtheirchildren(pp280-290)ThousandOaks,CA:Sage

Ganley,AL(1998)UnderstandingdomesticviolenceInCWarshaw&ALGanley(Eds),Improvingthehealthcareresponsetodomesticviolence:Aresourcemanualforhealthcareproviders(pp15-5)SanFrancisco:FamilyViolencePreventionFund

Herman,JL(1981)Father-daughterincestCambridgeMA:HarvardUniversityPress

Hoff,LA(2001)InterpersonalviolenceInCEKoop,CEPearson,&MRSchwarz(Eds),Criticalissuesinglobalhealth(pp260-271)SanFrancisco:Jossey-Bass

Kempe,CH,Silverman,FN,&Steele,BF(1962)ThebatteredchildsyndromeJournaloftheAmericanMedicalAssociation,181,107-112

Kendall-Tackett,KA(2001)VictimizationoffemalechildrenInCMRenzetti,JLEdleson,&RKBergen(Eds),Sourcebookonviolenceagainstwomen(pp101-116)ThousandOaks,CA:Sage

Kolko,DJ(1996)ChildphysicalabuseInJBriere,LBerliner,JABulkley,CJenny,&TReid(Eds),TheAPSAChandbookofchildmaltreatment(pp21-50)ThousandOaks,CA:Sage

Koss,M&Hoffman,K(2000)Survivorsofviolencebymalepartners:GenderandculturalconsiderationsInRMEisler&MHersen(Eds),Handbookofgender,culture,andhealth(pp71-90)Mahwah,NJ:LawrenceErlbaumAssociates

Mahoney,P,Willliams,LM,andWest,CM(2001)ViolenceagainstwomenbyintimaterelationshippartnersInCMRenzetti,JLEdleson,&RKBergen(Eds),Sourcebookonviolenceagainstwomen(pp13-178)ThousandOaks,CA:Sage

Moore,ML,Zaccaro,D,&Parsons,LH(1998)AttitudesandpracticesofregisterednursestowardwomenwhohaveexperienceddomesticviolenceJOGNN,27,175-182

NationalBlackNurses'Association(NBNA)(199)NBNApositionstatement:Violenceagainstwomenwwwnbnaorg/paper_violencehtml

NationalCenteronElderAbuse(NCEA)(1998)Thenationalelderabuseincidencestudy:Executivesummarywwwaoadhhsgov/abuse/report/Cexecsumhtml

NationalCenteronElderAbuse(NCEA)(2001)Thebasics:Whatiselderabuse?RetrievedAugust29,2001,fromhttp://elderabusecenterorg/basic/indexhtml

Nerenberg,L(1997)ForwardInMJQuinn&SKTomitaElderabuseandneglect:Causes,diagnosis,andinterventionstrategiesNewYork:Springer

Payne,BK(2000)Crimeandelderabuse:AnintegratedperspectiveSpringfield,Il:CharlesCThomas

Pillemer,K&Finkelhor,D(1988)Theprevalenceofelderabuse:ArandomsamplesurveyTheGerontologist,28(1),51-57

Quinn,MJ&Tomita,SK(1997)Elderabuseandneglect:Causes,diagnosis,andinterventionstrategies(2ed)NewYork:Springer

Renzetti,C(1998)Violenceandabuseinlesbianrelationships:TheoreticalandempiricalissuesInRKBergen(Ed),Issuesinintimateviolence(pp117-128)ThousandOaks,CA:Sage

Rodriguez,R(1998)ClinicalinterventionswithbatteredmigrantfarmworkerwomenInJCCampbell(Ed),Empoweringsurvivorsofabuse:Healthcareforbatteredwomenandtheirchildren(pp271-279)ThousandOaks,CA:Sage

Schornstein,SL(1997)Domesticviolenceandhealthcare:WhateveryprofessionalneedtoknowThousandOaks,CA:Sage

Sedlak,AJ&Broadhurst,DD(1996)ExecutivesummaryoftheThirdNationalIncidenceStudyofChildAbuseandNeglectRetrievedAugust6,2001,fromwwwcalibcom/nccanch/pubs/statinfo/nis3cfm

Sheridan,DJ(1998)Health-carebasedprogramsfordomesticviolencesurvivorsInJCCampbell(Ed),Empoweringsurvivorsofabuse:Healthcareforbatteredwomenandtheirchildren(pp23-32)ThousandOaks,CA:Sage

Straus,MA(199)Beatingthedeviloutofthem:CorporalpunishmentinAmericanfamiliesLexington,MA:LexingtonBooks

Thomas,J(1995)Violence:Conflictsandchallenges,anursingperspectiveViolence:Aplagueinourland(Pp9-58)Washington,DC:AmericanAcademyofNursing(AAN)

Tjaden,P&Thoennes,N(2000a)Fullreportoftheprevalence,incidence,andconsequencesofviolenceagainstwomen:FindingsfromtheNationalViolenceAgainstWomenSurveyRetrievedAugust18,2001,fromwwwncjrsorg/txtfiles1/nij/183781txt

Tjaden,P&Thoennes,N(2000b)Prevalenceandconsequencesofmale-to-femaleandfemale-to-maleintimatepartnerviolenceasmeasuredbytheNationalViolenceAgainstWomenSurveyViolenceAgainstWomen,6(2),12-161

Torres,S(1998)InterveningwithbatteredHispanicpregnantwomenInJCCampbell(Ed),Empoweringsurvivorsofabuse:Healthcareforbatteredwomenandtheirchildren(pp259-270)ThousandOaks,CA:Sage

UnitedNations(UN)(1995)FourthWorldConferenceonWomen,Beijing,-15SeptemberRetrievedJuly30,2001,fromfile:///A/PLWebDocumentbeijingdeclarationhtm

USDepartmentofHealthandHumanServices(USDHHS)(1986)SurgeonGeneral'sWorkshoponViolenceandPublicHealthWashington,DC:HealthResourcesandServicesAdministration

USDepartmentofJustice(USDOJ)(2000)VictimsofTraffickingandViolencePreventionActof2000RetrievedAugust7,2001,fromwwwojpusdojgov/laws/vawo2000

USDepartmentofJustice(USDOJ)(2001)AbouttheviolenceagainstwomenofficeRetrievedAugust7,2001,fromwwwojpusdojgov/vawo/abouthtm

USPublicHealthService,OfficeonWomen'sHealth(USPHS)(2001)Factsheet:AbouttheUSPHSOfficeonWomen'sHealthRetrievedAugust3,2001,fromwwwwomengov/owh/pub/aboutphsowh/2htm

Valente,RL,Hart,BJ,Zeya,S&Malefyt,M(2001)TheVAWAof199:Thefederalcommitmenttoenddomesticviolence,sexualassault,stalking,andgenderbasedcrimesofviolenceInCMRenzetti,JLEdleson,&RKBergen(Eds),Sourcebookonviolenceagainstwomen(pp297-302)ThousandOaks,CA:Sage

Vinton,L(2001)ViolenceagainstolderwomenInCMRenzetti,JLEdleson,&RKBergen(Eds),Violenceagainstwomen(pp179-192)ThousandOaks,CA:Sage

Walker,LE(1979)ThebatteredwomanNewYork:Harper&Row

Walker,LEA(1999)PsychologyanddomesticviolencearoundtheworldAmericanPsychologist,5(1),21-29

Warshaw,C(1998)Identification,assessment,andinterventionwithvictimsofdomesticviolenceInCWarshaw&ALGanley(Eds),Improvingthehealthcareresponsetodomesticviolence:Aresourcemanualforhealthcareproviders(pp9-86)SanFrancisco:FamilyViolencePreventionFund


©2002OnlineJournalofIssuesinNursing
ArticlepublishedJanuary31,2002

Citation: Draucker, Claire Burke (January 31, 2002). "Domestic Violence: The Challenge For Nursing" Online Journal of Issues in Nursing. Vol. 7 No. 1, Manuscript 1.