Nurses often treat victims of domestic violence. During normal times, they may be able to assist them in getting help to escape their cycle of abuse. But what happens during a pandemic? What happens when they are being told to quarantine? How can nurses assist in this case?
Valerie Weir, BSN, RN, FNE-A/P, CMSRN, SAFE Domestic Violence Program Coordinator and Forensic Nurse Examiner for the GBMC (Greater Baltimore Medical Center) SAFE and Domestic Violence Program, answered our questions to provide nurses with the crucial information they need to help as many victims of domestic violence during this time.
Nurses often see victims of domestic violence in the ER or when they’re admitted. If a patient who is a victim of domestic violence comes to the ER, but is going to be sent home to quarantine, what can nurses do to help?
People currently living in an abusive situation may be at an increased risk for abuse while practicing social distancing and self-quarantine. Often in these situations, they will not have access to their traditional support system and their normal autonomy. Isolation is a key tactic used by an abuser, and a crisis situation provides opportunity for the abuser to exert that control.
Victims will usually wait until they are alone to reach out for help. They will wait for their abuser to go to work and their children to go to school. Currently, that is not an option. Victims are unable to have that conversation when their abuser is in the home; often abusers will monitor the use of cell phones and other electronic devices. The current “no visitor” recommendations in hospitals provide an opportunity for providers to speak with that patient without the abuser being present.
Many domestic violence service providers remain fully functional during the coronavirus pandemic, although they have shifted many of their services to phone and virtual consultations when safe. Shelters and safe house also remain open and have taken measures to keep staff and those living in the shelters protected.
What resources are out there that nurses can utilize?
If you are fortunate enough to have a domestic or family violence program within your institution – use them! That is what they are here for. The SAFE and Domestic Violence Program at GBMC will remain open throughout the pandemic, providing medical-forensic and advocacy services 24 hour a day, 7 days a week.
If you do not have that resource in your hospital, our local community partners are also committed to providing services to victims of sexual and intimate partner abuse. Some have adopted a modified intake process to maintain safety of staff and survivors, and some offices will be closed to the public. But essential staff will be onsite to answer calls and provide services to clients.
Here are some resources available to victims of sexual assault and domestic violence that are available 24/7:
- GBMC Sexual Assault Forensic Examination (SAFE) & Domestic Violence (DV) Program: 443-849-3323 – www.gbmc.org/safe-dv
- Turn Around: 443-279-0379 – https://turnaroundinc.org/
- House of Ruth Maryland: 410-889-7884 – https://hruth.org/
- Family Crisis Center: Office: 410-285-4357, Shelter: 410-285-7496 – https://familycrisiscenter.net/
- Baltimore County Domestic Violence/Sexual Assault Hotline: 410-828-6390
- SARC (Harford County): 410-836-8430 – https://www.sarc-maryland.org/
- National Domestic Violence Hotline: 1-800-7990-7233 – https://www.thehotline.org/
What are the best actions that nurses can take when presented either with someone who has to leave the ER and return home or a patient who is being sent home after a hospital stay? Should they get other health care workers like social workers involved? Please explain.
Listen to the patient. Truly listen. Let them know that they are not alone—you are there for them, and there are others ready and willing to help too. At GBMC, we are fortunate to have the direct resource of our DV Victim Advocates within the SAFE & DV Program. Our victim advocates are ready and available to offer support and resources 24/7. SAFE and DV services at GBMC are free, confidential, and can be anonymous if desired by the patient.
Social workers are an invaluable resource to have involved. They are equipped to provide additional emotional and psychological support, in addition to assisting with safety planning and coordinating any other care and services the patient may need.
What are some things that nurses should *never* do in these kinds of situations?
- Don’t ignore the signs of abuse. As nurses, we are a lifeline to our patients.
- Don’t be judgmental. We may never know the details of someone’s situation, but we can always be caring and supportive.
- Don’t rush, especially during these uncertain times. In order to build and maintain a trusting relationship with your patient, they need to feel heard. Their abuser has likely already filled their head with self-doubt and toxic thoughts. Be aware of that as you are asking questions, they may become defensive. Remain calm and non-judgmental, and allow your patient the time he or she needs to process and discuss the abuse.
- Don’t betray their trust. Inform patients of any mandatory reporting requirements at the beginning of your conversation. In Maryland, to protect patient confidentiality, domestic abuse is not a mandatory report. You cannot report suspected or confirmed domestic violence unless the adult victim consents. Cases involving abuse of a child or vulnerable adult, however, are mandated reports to Child Protective Services and Adult Protective Services respectively.
What else should nurses know for dealing with this situation?
Understand that while imposed isolation is necessary for decreasing the spread of COVID-19, it can also put victims in a more vulnerable position and at a greater risk of abuse.
Don’t be afraid to address this topic with your patient—you may be the only one who does.
Understand that these patients often carry feelings of embarrassment and shame surrounding their abuse. In turn, victims of domestic violence will often discuss their experiences only if they are approached in a non-judgmental and empathetic way. Let them know that they are not alone.
Encourage your patient to reach out for support and assistance. There are several hotlines within each state—and nationwide—that are available 24 hours a day, 7 days a week so patients can make a call at whatever time is safest for them.