Injury Patterns among Female Trauma Patients: Recognizing Intentional Injury

Ocular Injuries and Intimate Partner Violence: A Review of the Literature

Purpose of Review

Intimate partner violence (IPV) is a leading cause of death and disability across the world. We sought to investigate the prevalence and clinical presentation of ocular injuries in IPV.

Recent Findings

Literature review revealed 16 published studies that evaluated ocular injuries in IPV, of which the study types included 9 retrospective studies, 2 prospective, 1 review, 1 invited commentary, 2 case reports, and 1 population-based cross-sectional survey. These studies suggest that 45% of IPV incidents involve ocular injury. Various injury types have been described including traumatic cataract, dislocated lens, retinal detachment, intraocular hemorrhage, orbital and zygomaticomaxillary complex fractures, optic nerve avulsion, and open globe injuries. Implementation of IPV screening programs in various clinical settings, including an emergency department evaluating ocular trauma, suggests a positive association with identification of IPV and improving access to resources.

Summary

Within IPV, ocular injuries are a prevalent and important cause of vision loss. Various injuries have been reported affecting nearly every anatomical region of the eye. Routine screening for IPV among patients that present with ocular injuries and evaluating for visual complaints among patients experiencing IPV are both important. Future work focused on prospective studies and evaluation of screening techniques may be impactful.

Comparison of modified rapid deployment hemostat dressing with standard haemostat as part of standardized perihepatic packing for major liver trauma in a level 1 trauma center

Introduction

Uncontrolled hemorrhage is a major cause of mortality in surgery and trauma. Damage control surgery (DCS) is essential in the management of these cases. The use of topical hemostatic agents has increased over the last two decades with the evolution of DCS and trauma-induced coagulopathy. The aim of this study was to compare the performance of standard perihepatic packing with the addition of either a MRDH (modified rapid deployment hemostat) or a non-MRDH hemostatic dressing.

Methods

This was a retrospective, comparative analysis of prospectively collected data held in the registry of a level I trauma center in Bologna, Italy, between 2005 and 2019. 33 patients with grade IV/V liver injuries who underwent a standardized perihepatic packing with hemostatic dressings were enrolled in the study. The study group included 21 patients treated with standard packing plus MRDH. The control group included 12 patients treated with standard packing plus a combination of fibrillar absorbable hemostat and human fibrin sealant.

Results

The two groups were homogeneous in terms of age and American Association for the Surgery of Trauma (AAST) grade although the MRDH one seemed to have more severe injury: hemodynamic instability was present in 95% of MRDH patients vs. 83% in the control group. Also, Injury Severity Score (ISS) and New Injury Severity Score (NISS) were 41 vs 35.5 and 47 vs 39.1, respectively. The incidence of re-bleeding requiring repacking at the second-look laparotomy was 4.7% in MRDH patients vs. 16.7% in non-MRDH patients ( p = .5, OR = 4). The overall complication rate was of 23% after the introduction of MRDH vs. 81% in the control group.

Conclusion

Despite the potential effectiveness of MRDH, this study does not seem to confirm a significant superiority of this hemostat over the standard.

Case stories and Post-violence behavior of women seeking medical attention at the emergency department due to physical violence

SUBJECT

The objective of this study is to determine the violence experienced by women who presented to the Emergency Department (ED) due to Intimate Partner Violence (IPV) and their previous experiences of violence.

METHOD

The descriptive study was conducted with 96 women. The data was analyzed in SPSS 17.0 statistics package program.

FINDINGS

The average age of the women is X = 35.33 ± 11.72, 35.4% of them are in the 31-40 age group, 69.6% are married, 44.8% are high school graduates, 60.4% are unemployed. It was determined that women who were IPV victims were exposed to violence by being beaten (punching, kicking etc.) at the highest rate (82.3%), and nearly half of them (47.9%) were injured in the head and neck regions. The vast majority of women (86.5%) have been subjected to violence before, only %13.5 of them stated that they experienced violence for the first time. It was found that the majority of women (69.8%) continued to live with the perpetrator after violence. Only three of the women (3.4%) attempted to initiate legal action, and the majority (76.5%) did not intend to take legal action.

CONCLUSIONS

Healthcare professionals should be aware that most woman presenting to the ED with IPV has a history of violence before it, and that this will probably not be the last. Healthcare professionals should also consider the fact that the victims may be exposed to different types of violence at the same time. It is also recommended that healthcare professionals be trained on policies regarding IPV management and equipped to provide women with the right way out.

The Plastic Surgeon's Role in the COVID-19 Crisis: Regarding Domestic Violence

Pandemics are associated with increased rates of intimate partner violence (IPV). IPV-related physical abuse is most commonly inflicted through craniofacial assault and upper extremity injury. Plastic surgeons are frequently consulted for recommendations in the management of head-and-neck and hand trauma, thereby are uniquely positioned to encounter patients who have experienced IPV. However, IPV training is not routinely offered in surgical education. We provide a review of the increasing prevalence of IPV during the COVID-19 pandemic and its pertinence to plastic surgery consultation in the emergency room. This article aims to increase providers' confidence in recognizing IPV-suspicious injuries and propose an educational, interactive tool for discussing IPV with patients.

Patterning of fractures in a case of intimate partner homicide (IPH)

South Africa is a country overwhelmed by crime and violence, with very high incidences of abuse against women and children. It is not often that a case of intimate partner homicide is seen in a forensic anthropological context. Here, we report on such a case where the remains of the victim had been buried for some time. The victim was a middle-aged female, while the suspect was a younger adult male. The deceased had suffered massive, repeated trauma during her lifetime with healed fractures and evidence of soft tissue trauma to virtually all parts of her body. A partly healed rib fracture indicates that the abuse continued until shortly before her death. She ultimately succumbed after suffering trauma to her head and face after reportedly being hit by a brick, evidence of which can be seen as perimortem fractures of the face. It is important for forensic anthropologists to identify specific patterns and report on the presence of healed fractures, as they can raise suspicion as to the possibility of chronic abuse. In this case, the evidence suggests a very long period of extreme and repeated trauma, which were apparently not reported or noticed by family members or the medical fraternity.

Comparison of male and female victims of intimate partner homicide and bidirectionality-an analysis of the national violent death reporting system

BACKGROUND

Intimate partner violence (IPV) is a public health crisis, affecting at least 1:4 women and 1:9 men. A recent multicenter trial on universal screening in trauma patients showed similar rates of positive screens between men and women. Few studies have explored the bidirectional violence in opposite-sex or same-sex relationships. Our goal was to estimate prevalence and risk factors for the most severe manifestation of IPV: intimate partner homicide.

METHODS

This is a 2003-2015 retrospective review of the National Violent Death Reporting System, a Centers for Disease Control and Prevention database of surveillance data. Deaths were coded IPV if the primary relationship between the suspect and victim fell into the categories of current partner or ex-partner. Bivariable and multivariable analysis examined differences between groups for factors and circumstances.

RESULTS

A total of 6,131 persons in opposite-sex relationships and 181 in same-sex relationships were murdered as a result of IPV. Women and Black men were disproportionately affected, and alcohol and preceding arguments were a factor in a higher proportion of male victims. Abuse preceded homicide in many women with almost half of male suspects attempting or committing suicide at the time of intimate partner homicide. Women were more likely than men to use a stabbing instrument, although firearms were still the most common means for each group. In 46.5% of homicides of women, the male suspect attempted suicide (p < 0.001). Bidirectionality was highest in male victims of female perpetrators and in same-sex pairings regardless of sex of the victim.

CONCLUSION

Homicide caused by IPV is a significant public health crisis for both men and women, with women and Black men at particular risk. Firearms are the most commonly used weapon for homicide in both sexes, and mental illness is not a common risk factor. A staggering proportion of these homicides involve suicide of the suspect, suggesting that each potential incident has two victims to target for prevention and intervention. Interventional programs to prevent such bidirectional mortality are urgently needed.

LEVEL OF EVIDENCE

Retrospective secondary data analysis, level III.

It doesn't just happen to "Other" people - An exploration of occupation and education level of women who die from intimate partner violence

INTRODUCTION

While age, sex, and race/ethnicity of victims of intimate partner violence (IPV) have been described, little has been examined regarding other characteristics. We aim to characterize occupation and education levels of female victims of IPV homicide.

METHODS

We retrospectively reviewed the National Violent Death Reporting System from 2003 to 2015 for victims of IPV homicide. Occupation, industry, and education fields were examined to categorize victims according to the 2010 Standard Occupation Classification.

RESULTS

4931 female victims of IPV were included. When clustering by job type, no single group dominated. Most victims had completed at least high school, with approximately 20% having at least some college.

CONCLUSION

Occupation and education level of women victims do not predict or protect against homicide in IPV, and these details are often omitted in data collection. This underscores the societal ubiquity of this public health crisis and argues for universal screening and better data collection, including in surgical populations.

Intimate partner violence in ophthalmology: a global call to action

PURPOSE OF REVIEW

Intimate partner violence (IPV) is a leading cause of death and disability worldwide. Despite increasing public awareness of IPV, little information is available regarding the prevalence, associated injury patterns, and impact of IPV as a mechanism of ocular and orbital trauma. The purpose of this review is to summarize the literature regarding the impact of IPV in ophthalmology and provide team members with guidance on appropriate practices for screening and referral.

RECENT FINDINGS

Data from 48 population-based studies estimates that the lifetime prevalence of IPV ranges from 10 to 69% among women internationally. Head, neck, or facial trauma is 7.5 times more likely in female patients presenting to the emergency department than female patients with other injury patterns. Forty-five percent of injuries acquired from IPV involve the eyes. IPV is the third leading cause of orbital fractures and traumatic ocular injuries from IPV tend to be severe in nature with a large percent of women sustaining scleral rupture.

SUMMARY

The high prevalence of IPV as a mechanism of orbital and ocular injury demands training all members of the ophthalmology team in identifying IPV, providing support, and making appropriate referrals to improve patient safety and well-being.

Intimate partner violence: an underappreciated etiology of orbital floor fractures

PURPOSE

To evaluate the prevalence of intimate partner violence (IPV) in a large population of female orbital floor fracture patients and provide recommendations on effectively identifying and referring IPV survivors.

METHODS

Retrospective review of facial fracture patients examined at the University of Iowa Hospitals and Clinics between January 1995 and April 2013. International Classification of Diseases, Ninth Revision, codes and medical record review were used to determine the prevalence of IPV victimization and clinical outcomes.

RESULTS

A total of 1,354 women and 4,296 men sustained facial fractures. Of these, 405 women and 1,246 men sustained orbital floor fractures. Leading mechanisms of orbital floor fractures in women were motor vehicle collisions (29.9%) and falls (24.7%). Twenty percent had no etiology documented. Intimate partner violence-associated assault was the third leading documented cause of orbital floor fractures in women (7.6%) followed by non-IPV-associated assault (7.2%). Among women with orbital floor fractures due to assault, leading patterns of injury included the following: isolated orbital floor fractures (38.7%, 12/31 in IPV patients; 55.2%, 16/29 in non-IPV patients), zygomaticomaxillary complex fractures (35.5%, 11/31 in IPV patients; 17.2%, 5/29 in non-IPV patients), and orbital floor plus medial wall fractures (16.1%, 5/31 in IPV patients; 24.1%, 7/29 in non-IPV patients). Involvement of ancillary services was documented in 20.0% (7 law enforcement and 5 social service agencies, 12/60) of assault-related orbital floor fracture cases. Ascertainment of patient safety was documented in 1.7% (1/60) of these cases.

CONCLUSIONS

Ophthalmologists treating orbital floor fracture patients should maintain a high index of suspicion for IPV and screen accordingly. Following IPV disclosure, patient safety should be assessed and referral provided.

Social benefit payments and acute injury among low-income mothers

BACKGROUND

Human error due to risky behaviour is a common and important contributor to acute injury related to poverty. We studied whether social benefit payments mitigate or exacerbate risky behaviours that lead to emergency visits for acute injury among low-income mothers with dependent children.

METHODS

We analyzed total emergency department visits throughout Ontario to identify women between 15 and 55 years of age who were mothers of children younger than 18 years, who were living in the lowest socio-economic quintile and who presented with acute injury. We used universal health care databases to evaluate emergency department visits during specific days on which social benefit payments were made (child benefit distribution) relative to visits on control days over a 7-year interval (1 April 2003 to 31 March 2010).

RESULTS

A total of 153 377 emergency department visits met the inclusion criteria. We observed fewer emergencies per day on child benefit payment days than on control days (56.4 v. 60.1, p = 0.008). The difference was primarily explained by lower values among mothers age 35 years or younger (relative reduction 7.29%, 95% confidence interval [CI] 1.69% to 12.88%), those living in urban areas (relative reduction 7.07%, 95% CI 3.05% to 11.10%) and those treated at community hospitals (relative reduction 6.83%, 95% CI 2.46% to 11.19%). No significant differences were observed for the 7 days immediately before or the 7 days immediately after the child benefit payment.

INTERPRETATION

Contrary to political commentary, we found that small reductions in relative poverty mitigated, rather than exacerbated, risky behaviours that contribute to acute injury among low-income mothers with dependent children.

Detecting intimate partner violence: more than trauma team education is needed

BACKGROUND

Intimate partner violence (IPV) is an underappreciated cause of morbidity and mortality in female trauma patients. We investigated the impact of a domestic violence education program for trauma residents on the detection of IPV.

STUDY DESIGN

In January 2008, an educational IPV program was implemented for all trauma residents. A retrospective review of all female patients evaluated by the trauma service before and after institution of the IPV program was performed. Medical records were reviewed for demographic data, injury mechanism, social habits, and IPV documentation. Chi-square and Fisher's exact tests were used to compare patients before and after institution of the educational IPV program.

RESULTS

The records of 645 female trauma patients evaluated in 2007 and 2008 were reviewed. Patients were not routinely asked about IPV, despite implementation of the educational program; 39.9% were asked about IPV in 2007 versus 46.1% in 2008 (p = 0.11). The positive disclosure of IPV did not increase from 2007 to 2008 (20.1% versus 21.2%; p = 0.83). Documentation about social habits increased considerably. In 2008, patients were asked more regularly about alcohol (71.8% versus 80.8%; p = 0.01), drugs (64.1% versus 73.7%; p = 0.01), and tobacco use (67.0% versus 78.1%; p = 0.002). Importantly, patients with documented IPV (n = 57) frequently presented to the trauma team with nonviolent mechanisms of injury (n = 30, 52.6%).

CONCLUSIONS

IPV is a frequent finding in female trauma patients. Despite increased education, questions about IPV are not documented routinely. In addition, screening at-risk patients by mechanism will underestimate the prevalence of IPV. Universal screening should be mandated to increase IPV detection and enhance opportunities for intervention.

Orofacial injuries as markers for intimate partner violence

Health care professionals have increasingly recognized that intimate partner violence (IPV) is a highly prevalent public health problem with devastating effects on individuals, families, and communities. However, there are no obvious clinical characteristics of IPV. Interventions may prevent future IPV-related injuries, but they cannot be initiated until the diagnosis is made. Because of the frequency of IPV-related orofacial injuries, oral and maxillofacial surgeons (OMSs) may be the first and only health care providers to see these patients. Therefore, OMSs are in a pivotal position to diagnosis IPV-related injuries and expedite referral for interventional therapy. This article presents data that support the use of orofacial injuries as a prime predictor variable in identifying victims of IPV and provides: (1) an overview of the epidemiology of IPV-related orofacial injuries; (2) a discussion of the role of head, neck, and facial injuries as markers of IPV, and their role as a diagnostic tool to facilitate the early diagnosis and referral for management of IPV; (3) a list of the advantages and limitations of using orofacial injuries as indicators of IPV; and (4) future directions to improve efforts to educate OMSs in identifying patients who are at high risk for an IPV-related injury.

Care provided in visits coded for intimate partner violence in a national survey of emergency departments

PURPOSE

This article describes the health status of and care provided to patients in visits coded to intimate partner violence (IPV) victims in a national survey of emergency departments (EDs). Visits coded for IPV were defined by International Classification of Diseases, 8th edition-Clinical Modification (ICD-9-CM) codes.

METHODS

Data from the National Hospital Ambulatory Medical Care Survey for 1997-2001 were analyzed. The sample consisted of 111 ED visits with ICD codes for IPV (or 12 IPV visits per 10,000 ED visits, and 21 female IPV visits per 10,000 female ED visits).

FINDINGS

The majority of visits coded to IPV were for patients who presented with mild to moderate pain (86%), physical or sexual violence (50%), and injuries to the body (38%). The majority of patients in visits coded to IPV received radiologic testing, wound care, and pain medications (odds ratios [ORs], 1.6, 3.3, and 2.3 respectively). Disposition was mostly referral to another physician or clinic (42%) or return to the ED when needed (20%), but much less to nonphysician services such as social services, support services, and shelters (14%). Uninsured IPV patients were more likely to receive radiologic testing and pain medications (ORs 5.1 and 3, respectively). Patients seen by nurses were 9 times more likely to receive wound care.

CONCLUSION

Caution should be exercised when interpreting the study results because they reflect only coded IPV visits in the ED and these might be the most obvious IPV cases. The results signal the need for further studies to evaluate access to and the quality of care for IPV patients and to improve screening, documentation, coding, and management practices.

Ontario chiropractors' knowledge, attitudes, and beliefs about intimate partner violence among their patients: a cross-sectional survey

OBJECTIVE

This study assessed chiropractors' attitudes, beliefs, knowledge, and experience about intimate partner violence (IPV) and identified if any differences exist between age groups, sex, and year of graduation of respondents.

METHODS

Five hundred five Ontario chiropractors were sampled from the Canadian Chiropractic Association membership using a randomization program. This study used a cross-sectional survey. The sample was mailed an introductory postcard and 3 subsequent Provider Surveys, demographic forms, and information letters depending on nonresponse. The data were analyzed using descriptive statistics, Kruskal-Wallis analyses of variance and Mann-Whitney U tests.

RESULTS

A response rate of 61% was attained. Of the respondents, 88% reported that IPV was rare or very rare in their practice. Significant sex differences were identified. Female respondents were almost twice as likely to strongly disagree with victim-blaming statements and were almost twice as concerned for their safety as male chiropractors when broaching the topic with batterers. Older practitioners were significantly more likely to inquire about IPV depending on symptoms, blame victims, have less fear of offending victims, and have fewer safety concerns. Earlier graduates were significantly more likely to inquire about IPV depending on clinical presentation but were also more likely to blame victims.

CONCLUSIONS

Ontario chiropractors have very little experience identifying IPV. Chiropractors would benefit from educational programs that would enable them to better identify and manage patients experiencing IPV. Sex, age, and experience were important modifiers in Ontario chiropractors' perceptions and behaviors regarding IPV among their patients.

Acute injury patterns of intimate partner violence victims

Although millions of women receive injuries from intimate partner violence (IPV) each year in the United States alone, there has been only limited research of acute injury patterns and the types, locations, and mechanisms of IPV injuries. The mechanism of being punched to the face with a fist resulting in blunt trauma-related injuries is most commonly reported. Strangulation, especially manual strangulation, is a frequently cited mechanism of injury; however, less is known about the types of injuries that result from strangulation. In general, clinicians should assess all patients who present for treatment of head, neck, and face injuries for IPV. There is little consistency between and much inaccuracy with medical terms used to describe types of injuries. To increase the accuracy and generalizability of findings from studies of acute IPV injuries, researchers need to use more standardized medical forensic terminology.

Exploring the feasibility of email-mediated interaction in survivors of abuse

There is a growing use of email-based provision of information, development of health-related skills and interventions; however, use of email to assist women and children experiencing abuse after receiving Protection from Abuse (PFA) court order has not been explored. The specific aim of this research was to test the feasibility of an email device called MIVO for use in interacting with women and children after receiving PFA. This qualitative design used a three-step recruitment, screening and email interaction with mothers and their adolescent child after obtaining informed consent and training in the use of an email device. Sample included six pairs of mother and child (n = 12) who have received a PFA within the past 6 months. Demographic data were gathered using the sociodemographic questionnaire. Qualitative data were gathered using email messages from mother and child pairs. Results showed that email interaction is a feasible and acceptable way of providing support and information to survivors of abuse after their PFA. The following themes in their order and rank of appearance were found in the email interaction between the nurse and survivors: (1) safety issues; (2) job-related issues; (3) school-related issues; (4) parenting-related issues; and (5) health-related issues. Themes identified for the children were school work and friends. Privacy, confidentiality and respect for individual rights are paramount in email interactions. Email interaction is useful in education, screening, safety instructions and follow-up care. Technological devices such as MIVO may have usefulness as an email interaction device among women, their child and a nurse to reduce their risk for further interpersonal violence/abuse and to increase disclosure of abuse. Healthcare providers need to identify technological developments, and through evidence-based research examine their feasibility and adaptability for translation into practice specifically, in caring for survivors of abuse.

Screening for intimate partner violence in medical settings

Intimate partner violence (IPV) is associated with negative health consequences. Universal screening for IPV offers many opportunities for successful intervention, yet this practice in medical settings is controversial. This article examines the potential impact of the U.S. Preventive Services Task Force (USPSTF) recommendations for IPV screening and the emerging literature supporting measurable health benefits resulting from screening interventions in medical settings. Several screening tools and methods of administration that have been evaluated in various clinical settings, with goals to increase their sensitivity and to determine a best method of administration, are reviewed in this article. Mandatory reporting is closely linked to screening practices and may influence healthcare worker practice and patient disclosure. Mandatory reporting studies are lacking and show variable physician compliance, victim acceptance, and scant outcome data. Informed consent prior to screening, explaining the process of mandatory reporting statutes and victim options should be evaluated to increase sensitivity of screening tools.

Musculoskeletal Manifestations of Physical Abuse After Intimate Partner Violence

BACKGROUND

Domestic violence is the most common cause of nonfatal injury to women in the United States, with an estimated cost of $50 billion annually. Little is known about the spectrum of musculoskeletal injuries in victims of domestic violence. We examined the characteristics of abused women, the prevalence of musculoskeletal injuries, and the variables associated with increasing frequency of physical violence against women.

METHODS

We identified all female survivors of intimate partner violence who were referred to the Minnesota Domestic Abuse Program from January 1, 2002, through December 31, 2003. Characteristics of each woman's background, abuse history, and injuries were obtained by a trained program therapist in an in-depth, 2-hour intake interview. Specific data forms were completed for each interview. Five forms of experienced abuse were explored (physical, emotional, psychological, sexual, and financial). Injuries were subcategorized as (1) head and neck, (2) musculoskeletal, (3) chest, (4) abdomen, and (5) skin (integumentary system). We conducted regression analyses to determine factors associated with the frequency of physical abuse.

RESULTS

Of 270 potentially eligible women, 263 (97%) with complete records were included. Women were commonly Caucasian (62%) in their third decade of life with one or more children (87%). A history of abuse was recalled by over half of the women (54%). The most prevalent forms of abuse were emotional (84%), psychological (68%), physical (43%), sexual (41%), and financial (38%). Child protective services were concomitantly involved in half of the women living in abusive relationships. Among those women who reported physical abuse, 36% sought medical attention. We identified 144 injuries in 218 physically abused women. Head and neck injuries were the most prevalent after intimate partner violence (40%). Musculoskeletal injuries were the second most common manifestation of intimate partner violence (28%). The spectrum of injuries included sprains (n = 21 injuries), fracture/dislocations (n = 17 injuries), and foot injuries (n = 2 injuries). Our analysis identified seven variables associated with increasing physical abuse frequency. These included (1) younger age (p = 0.04); (2) shorter length of relationship (p = 0.049); (3) emotional abuse (p = 0.02); (4) psychological abuse (p = 0.003); (5) sexual abuse (p = 0.004); (6) drug dependency (p = 0.05); and (7) alcohol dependency (p = 0.045).

CONCLUSIONS

Among women presenting to a domestic violence therapy program seeking counseling, head and neck and musculoskeletal injuries were most common. Frequency of physical abuse was most likely to be associated with younger women who are in short-term relationships, have chemical and alcohol dependency, and concomitant emotional, psychological, and sexual abuse. Recognizing musculoskeletal injuries in women as a potential result of intimate partner violence is warranted. Identifying children exposed to abusive situations may further alert treating surgeons to the potential for intimate partner violence in the mother.

The relationship between intimate partner violence and other forms of family and societal violence

Intimate partner violence was previously considered a private matter sometimes requiring law enforcement intervention. It is increasingly accepted as not only a medical issue for the victim, but a public and safety issue. Some of these other related issues, including unplanned pregnancy, same-sex relationships, overlap with elder, child, and animal abuse, and effects on workplace and school violence are explored. Screening, medical manifestations, documentation, reporting intervention, and referral are also discussed.

Intimate partner violence: implications for critical care nursing

IPV presents a serious health risk to many women. Emergency and critical care nurses are in a prime position for identification of and intervention with these women. Careful assessment and recognition of symptoms and conditions associated with IPV helps nurses to identify victims and potential victims. Building a trusting and supportive environment, where women feel comfortable disclosing abuse, precedes effective intervention. Nursing practice can incorporate the myriad resources and successful programs to provide victims with quality care. Before discharge from the critical care unit or ED, nurses can help women to identify their risk and plan for safety. Effective nursing care in IPV combines the traditional critical care nursing skills synergistically with provision for the biopsychosocial needs of patients.

Chiropractors' Perceptions About Intimate Partner Violence: A Cross-Sectional Survey

OBJECTIVE

The aim of this study is to assess chiropractors' attitudes, beliefs, knowledge, and experience about intimate partner violence (IPV).

METHODS

This cross-sectional survey was developed by members of the Violence Against Women Health Research Collaborative. The survey was disseminated to a voluntary, nonrandom convenience sample of chiropractors attending a 3-day continuing education seminar. Surveys were distributed at the entrances of the seminar session rooms and placed on luncheon tables. Respondents returned surveys to collection boxes.

RESULTS

Ninety-three doctors of chiropractic completed the survey. Respondents estimated that only 5.2% (95% confidence interval, 3.3%-7.0%) of their female patients were victims of IPV. General knowledge of IPV was good among respondents. Knowledge of clinical indicators and victim's management was fair to poor. Only 22% of respondents identified the most commonly injured body regions among battered women. Lack of knowledge, personal discomfort, and time constraints were all cited as barriers to IPV screening.

CONCLUSIONS

Our survey indicates that doctors of chiropractic underestimate the prevalence of IPV among their female patients. Like other health care specialists, chiropractors cite multiple IPV screening barriers, especially lack of knowledge. Doctors of chiropractic would benefit from education and training in IPV to enable them to better identify and assist patients who are victims of IPV.

Effects of a social support intervention on health outcomes in residents of a domestic violence shelter: a pilot study

This pilot study tested the feasibility and effectiveness of a social support intervention with women (n = 24) while they were in a domestic violence shelter. Health outcomes were examined pre and postintervention using a randomized control design. The intervention group had greater improvement (p = .013) in psychological distress symptoms and greater improvement in perceived availability of social support (p = .016) than the control group. The intervention group showed less health care utilization (p = .032) than the control group. Social support interventions for women in shelters are effective in improving health outcomes. Further research should be aimed at testing the effectiveness of different types of interventions on health and abuse outcomes in women who experience interpersonal violence.