Women and Heart Disease/Domestic Violence - Assignment Example

? Domestic Violence A form of violence occurring in a home setting referred to as domestic violence has been a subject of much research based on the vast negative impact it has on individuals and the society at large, with women being the majority victims. Despite 25% to 30% of women experiencing domestic violence annually, spontaneous reporting remains low. This paper indicates the prevalence of domestic violence on women as being higher than in men and focuses on pregnant women in particular. The analysis of the care offered to the clients of domestic violence enlightens on the roles of nurses and consideration during assessment based on the impact attributed to this form of violence on the client, newborns and their families. Finally, the paper provides possible solutions from a nurse’s perspective. Introduction Violence refers to the intentional employment of physical force or power against oneself or other persons with a high likelihood of leading to death, injury, deprivation or psychological harm. To a large extent, this would take place at homes where victims would experience repeated attacks. According to the Royal College of Nursing, RCN domestic violence refers to “the actual or threatened physical, sexual, financial or emotional abuse of a person by someone with whom they have, or have had, an intimate, familial or emotional relationship” (2012, 2). Also referring to this as intimate partner violence, Rutherford, Zwi, Grove and Butchart (2007) appreciate domestic violence as a chronic syndrome which would be characterized by episodes of physical violence, emotional abuse and psychological abuse which would be used by the perpetrators to uphold control over their respective partners. Quoting the UN Secretary General, Ban Ki-Moon, the World Bank notes that “violence against women and girls continues unabated in every continent, country and culture” (2011). Despite there being cases of men as victims, Brownridge et al. (2011) recognize that the impact would be more severe among the women. In the US, 1.3 million fall victim of domestic violence annually as compared to 835,000 male victims. In its studies, RCN (2012) noted that the prevalence of domestic violence varies in various countries with the rates in Japan and Ethiopia of women reporting being victimized standing at 15% and 71% respectively. With a sample of 24,000 women and men from Canada, the studies indicated that 7% and 6% of women and men reported being victims. There exists intertwining causes of domestic violence particularly against women, encompassing cultural, legal, economic and even political factors. Vaccher and Sharma (2010) link it greatly to alcohol use noting that this increases the severity and occurrence of domestic violence. Domestic Violence and Pregnancy Pregnant women experiencing domestic violence would be at a greater risk of adverse outcomes other than the risks to themselves. While comparing the women who were victims of domestic violence in their pregnancy and those that were not, Brownridge et al. (2011) observed varied risk factors that would propagate violence among pregnant women. The major factors articulated by this study include being single, young, unemployed, socially isolated and having lesser education during pregnancy. Devries et al. (2010) found from their study that in addition, pregnant women residing in rural areas would be more likely to be victims of domestic violence just as would be the case with Africans and Latin Americans as contrasted to Europeans and Asians. The researchers note that the women who get abused during pregnancy would be more likely to be severely abused than their counterparts not abused during pregnancy. This violence explains the mental and physical detrimental outcomes and their 3 times more likelihood of committing femicide as compared to the non-abused pregnant women. Of those abused, only 66.7% seek medical treatment on the same. Nursing Care Considerations in Domestic Violence Assessment The victims have shown to be more responsive to nurses showing empathy and give emotional support (Rutherford et al., 2007). In order to encourage spontaneous reporting of domestic violence so as to provide the needed treatment and care, it would be important to devise culturally competent screening processes that would be implemented in private settings and with use of non-judgmental questions and keeping the findings confident as dictated by the principle of confidentiality. RCN (2012) supports this approach noting that psychological healing comes through believing together with a non-judgmental attitude. In addition, the nurses have to be informed on domestic violence in their community of operation and collaborate with local forums so as to offer appropriate and supportive care. Impact The impact of domestic violence could be severe. To the client, other than the immediate injuries suffered, the battered women could suffer from gastrointestinal disorders, chronic pain, eating problems and psychosomatic symptoms. The victims would be more at risk of early or unplanned pregnancies and even sexually transmitted diseases. Due to trauma, they could resort to substance abuse. Pregnant women victims would most likely experience medical difficulties during their pregnancy. The victims would exhibit greater tendencies to committing suicide. According to Devries et al. (2010), domestic violence could be fatal, whether intentional or not, with the researchers observing strangulation as a common tactic among batterers in the US. With pregnant women, the risk posed by domestic violence on the outcome of the pregnancy would be higher. While conducting research on pregnant women and domestic violence, Devries et al. (2010) observed that the newborns from such an experience would record low birth weights and preterm births. The physical violence on maternal abdomen could cause fetal fractures and other complications to the mother such as hypertension and diabetes which negatively affect the outcome of the pregnancy. Additionally, domestic violence has been linked to miscarriages and still births. Rutherford et al. (2007) put into perspective the effect of domestic violence on the family. The researchers note the poor health and welfare outcome among children brought up in families where parents would be involved in domestic violence due to ineffective parenting. The sustained exposure to physical violence has been noted to cause physical development changes in children’s brains which could eventually culminate to the damaging impact of neurological atrophy. Brownridge et al. (2011) expound on this postulation citing the attachment theory which explains the emotional and social development of children pegged on the early care-giving relationships. Domestic violence breaks up families therefore affecting their social interactions. Economically, the resources spent in seeking for treatment and battling court cases deplete the economic resources of the family which could subject them to poverty in the long run. Assessment of Domestic Violence Client With the risk for chronic and acute physical and mental health consequences that domestic violence poses on victims and indeed their families, the need for routine and indicator-based screening arises. While the former would be carried out with or without the presence of an indicator, the latter would only be undertaken in the presence of an indicator pointing towards domestic violence. Among the physical assessment pointers towards domestic violence on a client would include injuries, increase in frequency and severity of injuries over time, pregnancy or recent birth and recent or intended separation from the partner. Such clients would be found to have illnesses such as musculoskeletal complaints, insomnia, chronic pain, chest pain, gastrointestinal disorders, numbness, malaise, stiff neck and headaches, migraines and dizziness. Other physical assessments include hyperventilation, eating disorders, signs of pulled out hair, lacerations and ruptured eardrums. Studies by (Brownridge et al., 2011) indicate that clients of domestic violence would score highly on instruments for anxiety, depression, depression and somatization. Such persons exhibit tendencies of committing suicide or even attempted to commit suicide in the past. While studying an Indian case, Vachher and Sharma (2010) observed a positive correlation between exposure to domestic violence and unhealthy mental status including mental stress, disturbed sleep, chronic headache and anxiety at 34.1%, 26.4%, 15.1% and 21.8% respectively. Solution Nurses should adopt supportive and empowering approaches in handling victims of domestic violence through a structured framework. Based on their roles, RCN (2012) identifies five roles that a nurse plays to effectively address the issue of domestic violence: identification, assessment, documentation and reporting, planning for safety and referral. On safety planning, after the immediate needs of the patient have been met, it would be critical for the nurse to determine the safety of the client’s home and refer unsafe clients to appropriate institutions for care. Before discharging such clients, it would be helpful to give information on available support groups, crisis lines, counseling services and legal aid among others. Conclusion Domestic violence being one of the most prevalent crimes in the modern society, especially on women affects not only the victim but also the children and their families at large. As such, nurses need to empower women and promote attitudes that deter its happening. During assessment, nurses must observe confidentiality, privacy and exhibit a non-judgmental, empowering and believing response so as to provide adequate information to help curb the menace. References Brownridge, D. A., Tallieu, T. L., Tyler, K. A., Tiwari, A., Chan, K. L. & Santos, S. C. (2011). Pregnancy and intimate partner violence: risk factors, severity, and health effects. Violence Against Women, 17(7), 858 – 881. Devries, K. M., Kishor, S., Johnson, H., Stockl, H., Bacchus, L. J., Garcia-Moreno, C. & Watts, C. (2010). Intimate partner violence during pregnancy: analysis of prevalence data from 19 countries. Reproductive Health Matters, 18(36), 158 – 170. Royal College of Nursing (2012). Domestic violence: guidance for nurses. Retrieved 31 January 2013 from http://www.rcn.org.uk Rutherford, A., Zwi, A. B., Grove, N. J. & Butchart, A. (2007). Violence: a glossary. Journal of Epidemiology and Community Health, 61(8). Retrieved 31 January 2013 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652990/ World Bank (2011). Gender-based violence, health and the role of the health sector. Retrieved 31 January 2013 from http://web.worldbank.org Vaccher, A. S. & Sharma, A. K. (2010). Domestic violence against women and their mental health status in a colony in Delhi. Indian Journal of Community Medicine, 35(3), 403 – 405. Summary of the Key Articles Used Brownridge, D. A., Tallieu, T. L., Tyler, K. A., Tiwari, A., Chan, K. L. & Santos, S. C. (2011). Pregnancy and intimate partner violence: risk factors, severity, and health effects. Violence Against Women, 17(7), 858 – 881. This research study compared the women victims of intimate partner violence, IPV who were victimized during pregnancy as compared to their counterparts who were not victimized. A survey study design was employed in this research. The data was collected from secondary source – Statistics Canada 1993. This was analyzed using cross tabulations with the employment of Chi-square significance tests. The results indicated that the victims of IPV during pregnancy would exhibit severe forms of violence and adverse health outcomes. Among the risk factors observed, verbal abuse and economic dependence were found to be more contributory. Devries, K. M., Kishor, S., Johnson, H., Stockl, H., Bacchus, L. J., Garcia-Moreno, C. & Watts, C. (2010). Intimate partner violence during pregnancy: analysis of prevalence data from 19 countries. Reproductive Health Matters, 18(36), 158 – 170. This study focused on 19 countries with the aim of describing intimate partner violence prevalence during pregnancy. The researchers used Demographic and Health Surveys data between 1998 and 2007 to carry out a secondary analysis. The prevalence was found to be lowest in Australia, Denmark, Philippines and Cambodia at about 2% and highest in Uganda at 13.5% indicating the high prevalence in Asian and European countries as opposed to Latin American and African countries. Vaccher, A. S. & Sharma, A. K. (2010). Domestic violence against women and their mental health status in a colony in Delhi. Indian Journal of Community Medicine, 35(3), 403 – 405. The research aimed at assessing the impact of domestic violence specifically on mental health of those women in their reproductive ages. A cross-sectional research design was adopted. Stratified random sampling gave 350 women aged between 15 and 49 drawn from Raj Nagar-I, Delhi for the study. Data was collected using questionnaires and SPSS 12 software used to analyze the collected data. The results indicated that 12% of the 48% women who reported being victims of violence suffered from mental illness. Thus, the research associated domestic violence resulted with mental illness. Read More