11 ABUSE ANDVIOLENCE 213
Initially the honeymoon period may last weeks
or even months, causing the woman to believe that
the relationship has improved and her husband’s be-
havior has changed. Over time, however, the violent
episodes are more frequent, the period of remorse
disappears altogether, and the level of violence and
severity of injuries worsen. Eventually the violence
is routine—several times a week or even daily.
Assessment
Because most abused women do not seek direct help
for the problem, nurses must be able to help identify
abused women in various settings. Nurses may en-
counter abused women in emergency rooms, clinics,
or pediatrician offices. Some victims may be seeking
treatment for other medical conditions not directly
related to the abuse or for pregnancy. Identifying
abused women who need assistance is a top priority
of the Department of Health and Human Services.
The generalist nurse is not expected to deal with this
complicated problem alone. He or she can, however,
make referrals and contact appropriate health care
professionals experienced in working with abused
women. Above all, the nurse can offer caring and sup-
port throughout. Table 11-1 summarizes techniques
for working with victims of partner violence.
Many hospitals, clinics, and doctor’s offices ask
women about safety issues as part of all health histo-
ries or intake interviews. Because this issue is delicate
and sensitive and many abused women are afraid or
embarrassed to admit the problem, nurses must be
skilled in asking appropriate questions about abuse.
Box 11-2 gives an example of questions to ask using
the acronym SAFE (Stress / Safety, Afraid /Abused,
Friends / Family, and Emergency plan). The first two
categories are designed to detect abuse. The nurse
should ask questions in the other two categories if
abuse is present. He or she should ask these questionsDarlene sat in the bathroom trying to regain her balance
and holding a cold washcloth to her face. She looked in
the mirror and saw a large red, swollen area around her
eye and cheek where her husband, Frank, had hit her.
They had been married for only 6 months, and this was
the second time that he had gotten angry and struck her
in the face before storming out of the house. Last time he
was so sorry the day after it happened that he brought
her flowers and took her out to dinner to apologize. He
said he loved her more than ever and felt terrible about
what had happened. He said it was because he had had
an argument with his boss over getting a raise and went
out drinking after work before coming home. He had
promised not to go out drinking anymore and that it
would never happen again. For several weeks after he
quit drinking, he was wonderful, and it felt like it was be-
fore they got married. She remembered thinking that she
must try harder to keep him happy because she knew he
really did love her.
But during the past 2 weeks he had been increasingly
silent and sullen, complaining about everything. He didn’t
like the dinners she cooked and said he wanted to go outCLINICALVIGNETTE: SPOUSEABUSE
to eat even though money was tight and their credit cards
were loaded with charges they couldn’t pay off. He began
drinking again. After a few hours of drinking tonight, he
yelled at her and said she was the cause of all his money
problems. She tried to reason with him, but he hit her and
this time he knocked her to the floor and her head hit the
table. She was really frightened now, but what should she
do? She couldn’t move out; she had no money of her own
and her job just didn’t pay enough to support her. Should
she go to her parents? She couldn’t tell them about what
happened because they never wanted her to marry Frank
in the first place. They would probably say, “We told you
so and you didn’t listen. Now you married him and you’ll
have to deal with his problems.” She was too embar-
rassed to tell her friends, most of whom were “their”
friends and had never seen this violent side of Frank. They
probably wouldn’t believe her. What should she do? Her
face and head were really beginning to hurt now. “I’ll talk
to him tomorrow when he is sober and tell him he must
get some help for the drinking problem. When he’s sober,
he is reasonable and he’ll see that this drinking is causing
a big problem for our marriage,” she thought.Cycle of violence