November 9, 2009, 12:07 am

Domestic Violence – Did I Miss You?

spit:nursepostcard:zwerdling nursing archivesApparently once you remember that tuberculosis is spread by spitting…

You are then allowed to spit.

Reminds me of an incident.

Elderly lady.

Elegant, actually.

Didn’t speak English.

Smiled at everyone she passed.

She smiled at me.

Just before turning her head, clearing her throat and spitting three feet across the hallway.

Then she smiled and continued down to her husband’s room.

I didn’t take it personally. I did, however, feel my jaw hit the floor…

(Postcard courtesy of Michael Zwerdling, RN of the Zwerdling Nursing Archives.)


Emily over at really is CRZE this week! She’s doing Grand Rounds on Tuesday and Change of Shift on Thursday!

Help send her over the edge and get your CoS submissions in! You can send them to me and I’ll forward or send them directly to Emily at “emily at crzegrl dot net”.


Browsing through my October ENA Connection the other day, I noticed the theme was “Government and Advocacy”. Came across an article on domestic violence. It’s a short article, written by Carrie Norman, RN, CEN, member of the Government Affairs Committee. The quotes below are taken from Carrie’s article.

“The CDC estimates that 37 percent of women who sought emergency department care were victims of domestic violence.”

What? 37 out of every 100 women I have triaged?


“Domestic violence victims are more likely to seek treatment for chronic and psychological conditions.”

Okay. But no way have I been taking care of victims of domestic abuse – I mean, hello, wouldn’t it be obvious? The hovering, overbearing abuser who answers all the questions for the patient? The bruises that aren’t explained by the story?

You know, the stereotypical, classic scenario?

“The stress of physical/emotional abuse has been linked to many chronic conditions such as: chronic pain, fibromyalgia, frequent migraines and abdominal and gastrointestinal complaints.”

Well, yeah, I knew that.


I screen them, right? It’s part of triage.

Well, actually I check one of two boxes. Abuse: “Not suspected” or “Yes”.

And unless someone says “He/she hit me”, I check “Not suspected.”

What kind of a screening is that? How can you screen for a problem when you don’t even have to ask the question, you just have to “not suspect” it?


How many women have I missed?

When you came in for the fifth time in a month with abdominal pain for which no etiology could be found and for which you never sought follow up…

Did I miss you?

I’ll never know.

I didn’t ask.

When you presented with migraines on such a regular basis for so many years I got to know you like family…

Did I miss you?

I’ll never know.

I never asked.

When you sat in triage inconsolably sobbing over a skinned knee at 3:00 am because you “tripped in the garden”…

I missed you, didn’t I?

Because I never asked.


“Many women experience some form of violence in their home. I’m here to listen and I may have some suggestions to help.”

Hopefully, there is something we can do immediately.

Or, the patient may not be ready, may not feel it is a safe time to leave.

But, just having someone ask the question and offer resources for when she is ready can let her know she has options.

And give her a sense of empowerment to make the decisions she needs to make.

The bottom line?

Ask the question.

I am.

Should have been doing it all along.


  • Maggie

    November 9, 2009 at 5:56 am

    What a great awareness!

    …and, a the sister of a brother whose wife was abusive, I have to ask: is there any reason not to make that question one you ask of everybody?

  • whitecap nurse

    November 9, 2009 at 9:07 am

    We DO ask it of everybody and you know what? People don’t admit to being abused unless they’re already dealing with it. I know women who have been severely battered and WERE asked and they still denied it.

  • J

    November 9, 2009 at 12:34 pm

    Don’t ask unless you have a plan to help. A number of years ago, I was in a situation where my teenage stepdaughter was violent and threatening to me. (It took getting out of the situation to realize that the bigger problem was that my then-husband enjoyed seeing me nervous and scared.) I was in urgent care and the ER fairly often during that time period because I hadn’t yet found out that I could just learn to inject myself with the 3rd line migraine reversal meds and my migraines were poorly controlled (not surprising given the situation.) Their policy was to always ask about domestic violence, but no one EVER offered any help or resources (sympathy and compassion, yes, resources no.) I already felt like I had no options and I’d been looking, I didn’t need that reinforced.

  • Caroline

    November 9, 2009 at 12:44 pm

    Hi there, I found your blog through twitter, and wanted to tell you that this is a really great post. I know some social workers who work with batter women, and all of the social workers say that it makes a huge difference to have health professionals (and other people in their potential support circles) ask them if they are experiencing violence. Though opening the door to the conversation may not “work” immediately, but just hearing you ask alerts survivors to your sensitivity to their type of situation, and tells them that you are on their side.

    Anyhow, keep up the great work, and the great blog!

  • DVhelp

    November 9, 2009 at 1:01 pm

    Good article and a great blog. It makes you think how much consideration do professionals give to this issue. Doctors, nurses, probation officers, dentists.

  • Rosie

    November 10, 2009 at 8:13 am

    As a woman who finally developed the courage to leave a life-threatening situation, let me say this: I would have denied the abuse if someone asked, because I knew that allegations entail investigations, and on the surface the bastard was a model citizen. He even went around telling people how much he loved his wife. At the same time, I was slowly isolated and alienated from people who could have been a support network or a bridge to escape. And until I presented at ER with an injury so gross I would have had to be taken into protective custody, I would have had to endure the investigation (and possibly a resultant gross injury or death) at home with the man I feared. At least, that’s how I perceived it at the time.

    My self-worth and psyche had been so beaten down over the years that ALL my energies were poured into just surviving one more day…and one more night. I couldn’t risk a botched escape, because then he might surely retaliate in a way that ended my life.

    Women (or men) who are terrified need to know what their options and resources are, even if they don’t admit to abuse. They need to be convinced that those options are real; that those who promise help and protection will follow through. I finally memorized phone numbers to shelters and legal aid, calling to ask questions more than once to feel sure that I would be protected if I left.

    In the end, I did escape–barely–with my life. That was 16 years ago. It has taken time, but I’ve healed. I have a wonderful husband now, and four beautiful children, and all being well I’ll soon graduate and pass NCLEX.

    Your patient might deny abuse, but the fact you seemed to notice enough to ask will make her feel less invisible and more cared for. Don’t give up!

  • Marjorie

    November 12, 2009 at 4:29 am

    In my “circulating nurse” role in the OR, I have witnessed several occasions where a day surgery/holding room nurse and surgeon send patients family/friends to the waiting room and tell them that we’re going back to OR. After they would leave, the hope was that maybe the suspected domestic abuse victim would tell the real story on her multiple fractures. Unfortunately, I haven’t seen someone use that opportunity to ask for help. Maybe one of these days…

  • dawn

    November 12, 2009 at 5:22 pm

    I too have to say that we ask each and every adult domestic abuse questions……the answer is always “No”. I think they are too scared, just as the commentor above wrote. I hope each of them, one day, will leave their abuser and seek help.
    I work in the Pediatric ER on a regular basis, as well as triaging adults, and if I even have the slightest inclination that there is abuse, I discuss with the Dr. and call social services. Abuse in children is not always physical violence, alot of times I’ve made the call due to children who are pulling their trachs out on a regular basis because they aren’t being properly monitored at home. Calling social services makes some parents angry, it’s exactly the ones who get angry that I worry about the most.

    Great post and much more awareness needs to be brought up about abuse, especially to health care workers who “aren’t asking.” It’s so important to know that abusive can’t be negated with a cursory glance.

  • NPs Save Lives

    November 12, 2009 at 6:15 pm

    I have seen patients in my office that have suffered domestic abuse. I do ask the hard questions and let them know where the resources are in my community. One patient recently came in with bruises on her face wearing sunglasses. I rolled up and pulled her glasses off and stared directly into her eyes and asked if someone was beating the hell out of her. She denied it but I offered her the option to get some help and told her that if she needed to call anytime to do so. We have paperwork hanging in the bathroom and in all of the patient rooms with phone numbers on them to local resources. I hope that those who need it will get help.

  • Shawn Kennedy

    November 13, 2009 at 5:50 am

    Great reminder. Reminds me of a piece by our former editorial director

  • AlisonH

    November 24, 2009 at 6:47 pm

    I spent 20 years keeping in touch with an old high school buddy because she needed me to: I was 3000 miles away, a safe distance, and therefore the only person she would tell anything to about what was going on. She had a standing offer from my husband and me–still does–for a plane ticket 24/7, with firm instructions to call at 4 am if need be. It was the best she would let us do.

    Her now-ex is in the psych ward as a threat to society for attempted murder, and should he be deemed mentally well enough somehow, he will then stand trial on those charges. If he gets out? She might finally take us up on that plane ticket now.

    But the thing is, it took him being away from her and in custody for her to wake up and see it straight. Physical distance. And now, at last, after 18 months of freedom from him, she will never ever go back.

    The epilogue? I had a black eye after having an eyelash cauterized that was growing into my eye. So. Some woman I didn’t know stopped me and asked me point blank if I were being abused and if I needed help. It startled me, and then I thanked her profusely and explained why I was thanking her: on behalf of that old friend. Who’d needed to be asked, by many people, for years, and to be offered a way she herself could see to get out that was safe.

    She is finally safe.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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