Conclusion

Future directions for nurses committed to combating domestic violence must occur on several levels. Domestic violence is rooted in complex sociological and economic factors including poverty, sexism, racism, ageism, substance abuse, family breakdown, violence in the media and the ready availability of handguns. Nurses must advocate for policy that enhances economic opportunities and the redistribution of power in our society, as well as support state and national legislation that will fund domestic violence programs, prevent insurance discrimination against victims of domestic violence, enhance immigration protections for abused women, ensure the rights of women and children affected by welfare reform, and enhance protections for older and disabled women who are abused. Nurses have become increasingly vocal in support of legislation for handgun control and the abolishing of dangerous ammunition.

On the practice level, nurses in all settings must consider routine screening for abuse as a standard of care. While universal health care screening for domestic violence is recommended by most health care organizations, it is most successfully implemented in facilities that have a formal institution-wide commitment to the practice and comprehensive protocols that outline intervention, as well as assessment, strategies. With input from stakeholders, nurses should continue to support, design, and evaluate prevention and intervention programs that are multi-disciplinary, innovative, and culturally specific. Coordinated response programs, that are collaborative community-wide endeavors involving multiple agencies charged with domestic violence prevention and intervention, seem to hold the most promise. As child abuse is "the gateway to many other social and maladaptive problems" (Thomas, 1995, p. 60), nurses and other health care professionals should become involved in community-based family support initiatives, family skills training programs, and family preservation services. School-based programs that identify and intervene with children at risk and that teach skill-building and conflict resolution skills are also essential.

Several experts have suggested that domestic violence services have been ineffective because they are not culturally specific (Koss & Hoffman, 2000; Thomas, 1995). Programs often do not provide culturally competent counselors, use the target language of the groups served, or respect the traditional healing practices of the community (Koss & Hoffman, 2000). Nurses have begun to describe culturally specific clinical interventions. For example, information is available on providing health care for battered women who are African American (Campbell & Gary, 1998), Native American (Bohn, 1998), and Hispanic (Torres, 1998). The special needs of immigrant women (Das Dasgupta, 1998), migrant farm worker women (Rodriguez, 1999), rural women (Fishwick, 1998), and lesbian women (Renzetti, 1998) have also been addressed. Future directions must involve utilizing such information in practice settings and expanding our knowledge base related to the needs of ethnic groups and other marginalized populations.

Finally, nurses must care for themselves. Nurses and other professionals who have experienced domestic violence must be supported in their efforts to find understanding, safety, peace, and healing in their own lives.

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