INTIMATE PARTNER

VIOLENCE (IPV)

Sandeep
Athwal

THE NURSING PROCESS:

A.D.O.P.I.E.
Assessment : collecting data about the client/health
status
Diagnosis : identifying the problems that require
intervention
(Bocarile, 2014)

THE NURSING PROCESS

Outcome Identification: coming up with a realistic,
measurable, and client focused goal that will later serve as the guideline for
evaluation

Planning: coming up with a strategy of all of the interventions that

will be needed

(Bocarile, 2014)

THE NURSING PROCESS

Implementation: performing the nursing
interventions/teaching/demonstrating

Evaluation: assessing the results of the interventions provided. this is an

ongoing process because a nurse will constantly reassess and make decisions on
what is needed next to achieve the goal outcomes set forth for the client.

(Bocarile, 2014)

DEFINITION
INTIMATE PARTNER VIOLENCE (IPV):

Physical and/or sexual violence (use of physical force) or

threat of such violence
OR

Psychological/emotional abuse and/or coercive tactics

when there has been prior physical and/or sexual violence
between persons who are spouses or non-marital partners
or former spouses or non-marital partners
(Jarvis, 2012)

PHYSICAL SIGNS &

SYMPTOMS
Bruise
Laceration
Ecchymosis
Petechiae
Cuts
Incision
Stab Wounds
Hematoma

(Jarvis, 2012)

Traumatic Alopecia
Patterned Injury
Pattern of injuries

JOES STORY
Joe has been married to her husband since she
graduated high school. Joes husband had already
dropped out of high school when she was in 12 th grade.
He made her feel as though she had to always be
obedient to him in order to prove her love for him
throughout the relationship.

20 years later, even though Joe was now a teacher at a Junior

High School, the couples relationship had continued to get
increasingly violent.
Joe was not allowed to go shopping without her husbands
permission.
Joe was not allowed to socialize with coworkers outside of school
because her husband wanted them both to be each others best
friend.
Joe was to make sure dinner was to her husbands liking so she
could be the best wife to her husband.

If Joe remained a good wife, her husband

would buy her flowers and would let her
choose what movie they went to see for their
occasional dates.
After every week, Joe hoped that she had
made her husband happy enough to not be
disciplined with physical or sexual force.

DISCUSSION
What are some unhealthy traits of Joe and her
husbands relationship?
What are some nursing diagnoses that can apply to
Joe?

ASSESSMENT
-Introduce yourself, provide privacy, open ended questions, non judgemental
manner, document accurately and thoroughly
-Physical assessment, listen to verbal complaints, nonverbal cues
-Assess for coping ability, depression, and suicide ideation.
-During conversation, go from general questions to more specific.
Examples:
How do you cope with sadness or anger?
Have you ever felt so sad that you though of hurting yourself?
Do you feel like hurting yourself now?

(Jarvis, 2012)

ABUSE ASSESSMENT SCREEN

Because domestic violence is so common in our society today, we ask all
women (or men)
these questions
1. When you and your partner argue, are you ever afraid of him (her)?
2. When you and your partner verbally argue, do you think he (she) tries to
emotionally hurt/abuse you?
3. Does your partner try to control you? Where you go? Who you see? How
much money you can have?
4. Has your partner (or anyone) ever slapped you, pushed you, hit you, kicked
you, or otherwise physically hurt you?
5. Since you have been pregnant (when you were pregnant), has your partner
ever bit you, slapped you, pushed you, hit you, kicked you, or otherwise
physically hurt you?
6. Has your partner ever forced you into sex when you did not want to
participate?
If any of these questions are answered with a yes: Thank you for sharing. Can

DANGER ASSESSMENT
- A 19 question assessment tool that asks yes or no questions and serves as an indicator of
the risk of homicide the client might be at
-It includes a calendar in which the client can mark down how many times and on what
dates certain violent episodes occurred.
-Even if the client does not answer yes to many items on the assessment form, there are
other signs that can Intimate Partner Violence:
Gynecologic Problems
Chronic Irritable Bowel Syndrome
Back pain
Depression
Symptoms of PTSD (Post Traumatic Shock Disorder)- such as panic attacks or trouble
sleeping

(Jarvis, 2012)

KEEP IN MIND
Show concern regarding the violence that the client describes
Relay that the violence was not the clients fault at least a couple times throughout the
conversation
Be careful of the client minimizing the level of violence because this happens often there
is trauma involved from violence. In this case, allow the client to relay more information
about the minimized descriptions.
Documentation must be:
DETAILED
VERBATIM
DO NOT LEAVE OUT THE EXPLICIT WORDS THAT IDENTIFY THREATS
NONBIASED
USE OF INJURY MAPS
PHOTOGRAPHIC DOCUMENTATION (OBTAIN CONSENT BEFORE TAKING PHOTOS) (Jarvis, 2012)

DIAGNOSIS
Risk for other-directed violence with a risk factor of history of abuse
Anxiety r/t threats, situational crisis, crisis of abuse
Impaired verbal communication r/t psychological barriers of fear
Compromised family coping r/t abusive patterns
Insomnia r/t psychological stress
Post-trauma syndrome with a risk factor of inadequate social support
Powerlessness r/t lifestyle of helplessness
Situational low self-esteem r/t negative family interactions
(McGarry & Westbury & Kench & Furse, 2014)

OUTCOME IDENTIFICATION
Client will develop safe plan for leaving the situation or
avoiding abuse by the end of the appointment (It is clients
decision to leave the abuser or not)
Client will verbalize at least two resources to contact if and
when he or she decides to leave the abuser.
Client will verbalize at least two resources to contact when
he or she decides to seek help for traumatic response or
depression.
(McGarry & Westbury & Kench & Furse, 2014)

PLANNING
A thorough assessment will be performed to exclude and treat injuries.
Education will be provided.
An assessment will be performed at subsequent appointments.
A report will be filed.
Resource information will be given.
Thorough documentation will be done.
Information will be kept confidential except in the mandated report and
those involved in the direct care of the client.
(McGarry & Westbury & Kench & Furse, 2014)

IMPLEMENTATION
As a mandated reporter, inform client about required report. Then, also submit the report.
Therapeutic communication (open ended questions, non-judgemental attitude, inform of
resources available to help client, perform thorough assessment to assess for injury, perform
mental status exam, refer to social worker, document thoroughly,
Educate regarding the possible link of psychological issues with the violence.
Educate regarding the resources available to the client for psychological support or even when
client wants to leave the abuser.
Educate the client regarding the high risk of homicide in victims of intimate partner violence.
Educate the client regarding the high risk of reoccurrence of violent episodes.
Provide emotional support.
Allow for expression of feelings and verbalization of violent events.
If the client verbalizes decision to leave the abuser, help the client to come up with an
emergency plan that includes when to leave safely, safe location, financial resources).
Referral to support group.

EVALUATION
At the end of the appointment, assess for willingness to leave. If
yes, ask or him to describe or his plan.
Ask her or him verbalize at least two resources to contact if and
when he or she decides to leave the abuser.
Ask her or him to verbalize at least two resources to contact when
he or she decides to seek help for traumatic response or
depression.
Ask her or him if there are any questions.
(McGarry & Westbury & Kench & Furse, 2014)

RESOURCES
Bocarile, John. (2014). Nursing outcome classification. Academia.edu. Retrieved from
http://www.academia.edu/3671057/Nursing_Outcome_Classification
Jarvis, Carolyn (2012) Physical Examination & Health Assessment (6th ed.). St. Louis,
Missouri: Elsevier.
McGarry, J., Westbury, M., Kench, S., & Furse, B. (2014). Responding to domestic violence in acute
hospital settings. Nursing Standard, 28(34), 47-50.