Florida Domestic Violence

About

➀ Read and Learn

The following course content

This fulfills the continuing education requirement of Domestic Violence for the state of Florida.

Florida domestic violence is defined as violent or aggressive behavior occurring within the home and usually involves the abuse of a spouse or partner.  In the United States alone, it is estimated that more than 10 million adults have been subjected to domestic violence during the course of a year. This statistic translates to an incident of domestic violence occurring every 3 seconds.  Due to the increasing prevalence of domestic violence in society, there is a high probability that all healthcare professionals will evaluate and treat a victim (and quite possibly a perpetrator as well) of domestic violence at some time during their healthcare career.  The importance of ongoing education and global awareness cannot be understated.  

Introduction

Domestic violence is defined as violent or aggressive behavior occurring within the home and usually involves the abuse of a spouse or partner. In the United States alone, it is estimated that more than 10 million adults have been subjected to domestic violence during the course of a year. This statistic translates to an incident of domestic violence occurring every three seconds. The National Coalition Against Domestic Violence reports some daunting statistics [1][6]:  

• 1 in 3 women and 1 in 4 men have experienced some form of physical violence by an intimate partner.  
• 1 in 4 women and 1 in 7 men have been victims of severe physical violence (such as beating, burning, strangling) by an intimate partner in their lifetime.  
• On average, more than 20,000 phone calls placed to domestic violence hotlines nationwide.  
• The presence of a gun in a domestic violence situation increases the risk of homicide by 500%; 19% of domestic violence involves a weapon; Most intimate partner homicides are committed with firearms. 
• 1 in 15 children are exposed to intimate partner violence each year, and 90% of these children are eyewitnesses to this violence.  
• From 2016 through 2018, the number of intimate partner violence victimizations in the United States increased 42%.  

Due to the increasing prevalence of domestic violence in society, there is a high probability that all healthcare professionals will evaluate and treat a victim (and quite possibly a perpetrator as well) of domestic violence at some time during their healthcare career. The importance of ongoing education and global awareness cannot be understated.  

In 2020, the COVID-19 pandemics' stay at home/shelter in place orders resulted in spikes in calls to domestic violence hotlines. From layoffs and loss of income to decreased availability of shelters and backlogged courtrooms, fewer resources were made available to victims of domestic violence. These measures resulted in increases in both the incidence and severity of domestic violence. Sadly, the effects of this pandemic, especially on this issue, continue well into today [2].

Forms of Domestic Violence  

Domestic violence may encompass physical abuse, sexual abuse, emotional and verbal abuse, and spiritual and economic abuse. Defined as a pattern of behavior used to gain power or control over an intimate partner, a domestic violence abuser may use tactics that frighten, intimidate, hurt, blame, or injure a person. These behaviors often escalate over time in intensity and have resulted, at times, in life-threatening injuries or death of a victim [3].  

Intimate partner violence (IPV) is abuse or aggression that occurs in a romantic relationship. The term "intimate partner" refers to both current and former spouses and dating partners, including heterosexual and same-sex couples. The Centers for Disease Control and Prevention (CDC) further delineates IPV into four separate groups: physical violence, sexual violence, stalking, and psychological aggression [4].  

• Physical violence may include hitting, kicking, and punching someone.
• Sexual violence may include using force to get a partner to partake in a sexual act.
• Stalking may include unwanted and threatening phone calls or text messages.
• Psychological aggression may include insults, threats, name-calling, or belittling a partner.  

Teen Dating Violence (TDV) is defined as dating violence affecting millions of teenagers annually [5]. In addition to the threats from physical and sexual violence and other forms of aggression, TDV is often done electronically through repeated texting and placing sexual pictures of a person online without permission.  

The CDC statistics on teen dating violence report:  

• Nearly 1 in 11 female and about 1 in 15 male high school students report having experienced physical dating violence in the last year. 
• About 1 in 9 female and 1 in 36 male high school students report having experienced sexual dating violence in the last year. 
• 26% of women and 15% of men who were victims of contact sexual violence, physical violence, and/or stalking by an intimate partner in their lifetime first experienced these or other forms of violence by that partner before age 18.  

Domestic violence transects every community and affects all people, regardless of age, socio-economic status, race, religion, gender, or nationality [6]. Whether the violence results in physical or psychological injury, the effects can last a lifetime and affect multiple generations.  

Healthcare professionals are in a pivotal position to impact the lives of those affected by domestic violence positively. Oftentimes, they may be the first person to encounter a victim of domestic violence. Their ability to effectively evaluate the situation and provide time-sensitive, patient-centered care (including but not limited to treatment interventions, appropriate referrals, and follow-up care) can enhance immediate victim safety and reduce further injury, and improve the home front circumstances, moving forward.  

Healthcare professionals must be able to identify and assess all patients for suspected abuse, and be able to offer treatment, counseling, education, and referrals, as appropriate. These referrals may extend out to shelter options, advocacy groups, child protection services and legal assistance [7].  

Profiles of Victims and Abusers  

Anyone can become a victim of domestic violence. Victims of domestic violence come from all walks of life, all age groups, all socio-economic groups, all religions, and all nationalities [8]. Violence can occur in any relationship when one person feels they are entitled to control another person through whatever means of abuse possible. This abuse is cyclical and usually increases in frequency and intensity. Victims of such violence report feelings of isolation, helplessness, guilt, anxiety, and embarrassment. They may become suicidal, start abusing drugs and alcohol, and feel that they have no one to turn to for help.  

Although there isn't a specific set of factors that result in "being a victim," there are many thoughts as to what might affect a person's active willingness to remain in a violent relationship. The following lists serve only as general guidance to inform the healthcare professional of possible underlying causes. Again, anyone can become a victim of domestic violence.  

Victims of Domestic Abuse

There is no single "characteristic" or risk factor that automatically causes a person to become a victim of domestic violence. Instead, it may be a series of events that cause a person to become more vulnerable and enter and remain within an abusive relationship [9].  

Domestic violence victims may have experienced violence during childhood, experienced total financial dependence on another person, or lacked basic social support (family and friends). These factors affect both the physical and psychological make-up of a person. Without intervention, these victims can develop personal esteem and confidence issues, further social isolation, economic dependency, and general feelings of insecurity. These effects may negatively affect the decision to stay in an abusive relationship.  

Researchers have found the following factors may place a person at a higher risk of becoming a victim of domestic violence, including (but not limited to) [10]:  

• Poor self-image/ low self-esteem 
• Financial dependence on the abuser 
• Feeling powerless to stop the violence or leave the relationship 
• Personal belief that jealousy is an expression of love 

Common characteristics of victims of domestic violence include, but are not limited to:  

• A history of abuse  
• A history of alcohol or substance abuse (for themselves or their partners) 
• Financial and family stressors- low income, limited family/friends contact, poverty status 
• A member of an ethnic minority/ immigrant group; Limited English vocabulary 
• Holds traditional beliefs that they should be submissive in a relationship 

Reasons a victim may choose to stay in the relationship:  

• A desire to end the abuse but not necessarily the relationship; they do love their abuser  
• Feelings of isolation and helplessness  
• Fear of judgment if they reveal the abuse by seeking help 
• Feelings that they may not be able to support themselves if they leave their abuser 
• Fears for the safety of children involved in the relationship  
• Fear of backlash from community or family and friends/lack of knowledge of services available  
• Strong religious/cultural belief system that reinforces staying in a relationship at all costs  

Abusers/Perpetrators of Domestic Violence

As with the DV victim, there is no one set of traits to identify a domestic violence abuser/perpetrator correctly. There are, however, some signs that may raise the red flag of suspicion when observed in a suspected domestic violence case.  

The National Coalition on Domestic Abuse has created a list of "red flag" indicators, including but not limited to the following [11]:  

• Extreme jealousy and possessiveness  
• Verbally abusive  
• Extremely controlling behavior  
• Blaming the victim for anything bad that happens  
• Control over all the finances in the relationship  
• Demeaning the victim publicly or privately  
• Humiliating or embarrassing the victim in front of other people  
• Control over what the victim wears  
• Abuse of other family members, including children (and even pets)  

The following is a general list of indicators that "may" help identify an abuser [12].  

• History of abuse within one's family  
• History of personal physical or sexual abuse  
• A lack of appropriate coping skills  
• Low self-esteem  
• Codependent behavior  
• Untreated mental illness  
• Drug or alcohol abuse
• Socio-economic pressures related to the lower income status
• Prior criminal history

Screening for Domestic Violence 

Screening rates are as low as 1.5% to 13% among emergency and primary care physicians. The Academy of Medicine recommendation suggested that all women should be screened for sexual violence. Research found that healthcare providers working in emergency departments only screened 20–25% of their encounters. As a result, this decreased opportunities for intervention, increased safety, and prevention of future violence [13].  

Domestic violence (including Intimate partner violence) is an unfortunate cycle that may not be broken with a single emergency department visit; however, identifying and providing resources is necessary to make a difference, increase confidence and safety, and improve the overall health outcome for patients.  

Initial Interaction 

Compassionate, nonjudgmental screening by healthcare professionals affords the best opportunity for domestic violence victims to disclose their abuse. By recognizing signs of abuse and inquiring further, the nurse validates that the victim is worthy of care and confirms that the violence is a legitimate concern [14].  

The screening for domestic abuse should be done in a private environment. Language interpreters, not family and friends, should be utilized if needed. Universal screening should be used; therefore, preventing any victim from being "singled out" and ensuring all potential victims are screened appropriately. All healthcare professionals should remain nonjudgmental and compassionate during the screening process [15].  

During the interview process, assure the victim that all patients are screened for domestic violence. Also, inform the victim that DV affects many families, and that services are available to everyone who may be concerned about violence in their home.  

Screening Tools 

Examples of the following four screening tools can be found in the CDC’s Intimate Partner Violence and Sexual Violence Victimization Assessment Instruments for Use in Healthcare Settings. 

Hurt, Insult, Threaten and Scream (HITS)   

5-question screening tool assessing physical and verbal interactions with the partner; scores rank 1 (never) -5 (frequently); a score of 10 is considered positive.  

1. Physically hurt you?  
2. Insult or talk down to you?  
3. Threaten you with harm?  
4. Scream or curse at you?  
5. Force you to do sexual acts that you are not comfortable with?  

http://www.ctcadv.org/files/4615/6657/9227/HPO_HITS_Screening_Tool_8.19.pdf   

Woman Abuse Screening Tool (WAST)  

8-question screening tool assessing physical, emotional, and sexual intimate partner violence.  

http://womanabuse.webcanvas.ca/documents/wast.pdf  

Partner Violence Screen (PVS)  

3-question screening tool for interpersonal violence  

1. Have you been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?  
2. Do you feel safe in your current relationship?  
3. Is there a partner from a previous relationship who is making you feel unsafe now?  

http://www.nnepqin.org/wp-content/uploads/2018/08/Screening-Tools-Partner-Violence-Screen-PVS.pdf   

Abuse Assessment Screen (AAS)  

A multiple section assessment tool for sexual and physical violence, including body maps for documentation of injuries. 

https://idph.iowa.gov/Portals/1/Files/FamilyHealth/abuse_assessment_tool.pdf    

Potential Signs of Domestic Violence 

The Crisis Prevention Institute (CPI) encourages to always be aware of physical signs and injuries that could be related to domestic violence, including but not limited to the following [16]:  

• Bruising in the chest and abdomen  
• Multiple injuries  
• Minor lacerations  
• Ruptured eardrums  
• Delay in seeking medical attention  
• Patterns of repeated injury  
• Injuries inconsistent with the presenting complaints  

Oftentimes, a domestic violence victim may seek medical attention for issues unrelated to a physical injury, such as:  

• A stress-related illness  
• Anxiety, panic attacks, stress, and/or depression  
• Chronic headaches, asthma, vague aches, and pains  
• Abdominal pain, chronic pelvic pain
• Vaginal discharge and other gynecological problems
• Joint pain, muscle pain
• Suicide attempts, psychiatric illness   

Other observations that may indicate a suspected domestic violence situation include:  

• Appear nervous, ashamed, or evasive 
• Seem uncomfortable or anxious when around their partner 
• Accompanied by their partner, who controls the conversation  
• Reluctant to follow advice 

As you continue to assess the patient, encourage them to talk and then listen carefully. Only upon listening will you have a better understanding of the patient's current state and provide the necessary resources and referrals for them to find safety. Above all else, maintain open lines of communication in a safe, accepting environment and assure the victim that they do not deserve the abuse.  

Importance of Trauma-Informed Care  

While nurses play a critical role in recognizing suspected domestic abuse victims, they often do not feel confident in their role or the screening process itself. This may be due to a lack of communication skills, ongoing training on domestic violence or simple confusion over what victim assistance programs and resources are available [17].  

Facility-wide education on domestic violence should be ongoing. Policies and procedures should be on file, and collateral relationships should be in place with the local community and national resources. Finally, nurses should be trained in the delivery of trauma-informed care to ensure the highest quality of interaction with victims of domestic violence, much less all victims of trauma.  

Trauma-informed care has been defined as the patient-centered approach that encourages healthcare professionals to provide care that does not retraumatize the patient and the staff [18]. Trauma-informed care ensures that policies and practices in the healthcare setting are not only safe but non-threatening to the physical and mental well-being of those involved. Perceived threats can cause a "flight or fright" mentality that impacts both the ability to administer care and receive immediate care and follow-up recommendations.  

The experience of seeking medical care, whether in an emergency department setting or a clinic, can in and of itself bring another source of trauma. Trauma-informed care aims at reducing the impact of trauma on both the patient and provider by focusing on various checkpoints overseeing all interactions: safety, trustworthiness, empowerment, and respect.  

The following examples are practical tips that encourage trauma-focused care, ensuring the delivery of care in the least threatening manner to a suspected human trafficking victim (as well as each patient you may intersect with).  

• Always introduce yourself and your role within the patient's care with every interaction.  
• Use open body language (direct eye contact, avoid standing "over" the patient as it may be perceived as threatening).  
• Explain procedures and timelines for results ("wait times") to give patients a sense of control. Keep them informed of any changes/delays in their care.  
• Always ask before you touch a patient. This is a sign of respect and gives the patient a sense of control over their own bodies.  
• Protect patient privacy. Ask them who they would like present during their care; limit visitors if requested; close room doors (with their permission).  

During the interview and intervention process, it is also equally important that some things not be said to a suspected victim of domestic violence, such as negating, challenging, or doubting the victim. Examples include:  

• Why haven't you called the police before now?  
• Some level of fighting occurs in all relationships.  
• Maybe you're both going through a phase; it will probably stop on its own.  
• You wouldn't stay in this situation if you really care about yourself/ your kids.  
• What did you do to make them get so angry?  
• Why didn't you leave the first time you were hurt?  

By applying trauma-informed care to all your patients, you lower the risk of perceiving any (nursing and medical) interventions being perceived as a threat. This ensures a higher level of trust and respect, and safety for all patients (and staff) across the care spectrum.

Legal Issues: Florida Mandatory Reporting Laws  

The United States Department of Justice, defines domestic violence to include felony or misdemeanor crimes of violence committed by [19]:  

• a current of former spouse or intimate partner of the victim,   
• by a person with whom the victim shares a child in common,  
• by a person cohabitating with or has cohabitated with the victim as a spouse or intimate partner,  
• by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction receiving grant monies,  
• by any other person against an adult or youth protected from that person's acts under the jurisdiction's domestic or family violence laws.  

The Florida Department of Children and Families defines domestic violence as patterns of actions or behaviors that adults or adolescents use against their partners or former partners to establish power and control. It can potentially include physical abuse, sexual abuse, emotional abuse, and economic abuse. It may also include threats, isolation, pet abuse, using children, and a variety of other behaviors used to maintain fear, intimidation, and power over one's partner (19)." [28]. 

Under Florida law [21], Domestic Battery is classified as a first-degree misdemeanor, with penalties including up to one year in jail or twelve months' probation and a $1,000 fine [21][29][30]. In addition, the accused may face additional penalties of a mandated Batterer Intervention Program [31].  

RAINN (Rape, Abuse, and Incest National Network) is the nation's largest anti-sexual violence organization [22]. Under the “Laws of your state” section, they outline the mandatory reporting laws for Floridaall states. Florida’s mandated reporting law can be viewed there or on the Florida Courts website. 

Mandatory Reporting Requirements on Children 

Children are defined as any unmarried person under the age of 18 years who has not been emancipated by court order.  

Who is required to report (from a healthcare professional standpoint):  

• Physicians 
• Osteopathics physicians 
• Medical examiners 
• Chiropractors
• Nurses
• Some hospital personnel
• Nursing Home and assisted living facility staff
• Health or mental health professionals
• Social workers
• Paramedics
• Emergency medical technicians 

When is a report required:  

• When any person knows or has cause to suspect that a child is abused, abandoned, or neglected by a parent, legal custodian, caregiver, or another person responsible for the child's welfare, or that a child is in need of supervision and care and has no one to provide care.  
• When any person knows or has cause to suspect that a child is abused by an adult other than a parent, legal custodian, or another person responsible for the child's welfare.  
• When any person knows or has cause to suspect that the child is a victim of childhood sexual abuse or the victim of a known or suspected juvenile sexual offender.  

Reports can be made to the Department of Children and Families abuse hotline at 1-800-96-ABUSE (1-800-962-2873) or at Florida DCF Reporter Portal.

Elements of a Safety Plan (Escape Plan)  

Abusers may go to extremes to prevent a victim from leaving. This may result in the decision to escape an abusive relationship – one of the most dangerous times for the victim of domestic violence. The creation of a safety plan can assist in enhancing the safety of a victim during all phases of a relationship and during the planning phase of actually leaving the abuser.  

Knowledge of the various elements of a safety plan will enable the healthcare professional to initiate dialogue with a victim and guide them in the development of a personalized plan of safety moving forward. Discussion of safety plans/escape plans can be very difficult during the limited interactions of an emergency room or clinic visit; therefore, familiarity with the key elements of a plan will help navigate the victim to the most appropriate resources for their situation.  

The following overviews of a safety plan are from Safe Horizon and the National Domestic Violence Hotline [23][24]. The Safe Horizon is a victim assistance nonprofit for victims of violence and abuse in New York City since 1978. The following outline provides a detailed overview of the many aspects to consider when formulating a safety plan. Review the entire plan outlined on their website Safe Horizon. Consider creating a template handout for your facility to distribute to domestic violence victims.  

A safety plan is an outline that includes ways to remain safe while in a relationship, planning to leave, or after you leave [23]. A personalized safety plan assists in coping with emotions, telling friends and family about the abuse, and the steps to be taken in the event of necessary legal action. An effective safety plan should have specific details tailored to your unique situation.  

Considerations in creating your safety plan:  

• Do you have a trusted confidant - a friend, family member, or neighbor?  
• What are some areas in your neighborhood you could go to in an emergency?  
• Are there phone numbers you need to memorize in the event of an emergency?  
• Do you have children that need to be part of your safety plan? Where would your children go if they witnessed violence?  
• Do you need a safety plan for work or school?  
• Where can you safely store your safety plan? Computer? Phone?  

Before Leaving  

The decision to leave an abusive relationship requires courage and preplanning. Consider these measures before leaving to reduce the risk of violence [23]:  

• Record evidence of physical abuse  
• Plan with children and identify a safe place where they can go during moments of crisis. Reassure them that their job is to stay safe, not to protect you.
• Call ahead to see what the shelter's policies are. They can provide information on how they can help and secure a space when it is time to leave.
• Try to set money aside or ask trusted friends or family members to hold money for you.  

When Leaving  

The following list of items serves as a guide for what to take [23]:   

Identification 

• Driver's license or state I.D. card, social security card  
• Birth certificate and children's birth certificates  
• Money and/or credit cards   
• Checking and/or savings account books  

Legal papers  

• A protective order, if applicable  
• Health and life insurance papers  
• Legal documents, including divorce and custody papers 
• Marriage license  

Emergency numbers 

• Local domestic violence program or shelter  
• Trusted friends and family members  
• The Hotline  

Other items to keep in mind: 

• Medications and refills (if possible)  
• Emergency items, like food, bottles of water, and a first aid kit  
• Multiple changes of clothes   
• Emergency money  
• Address book  
• Safe cell phone, if possible  

After Leaving  

The safety plan should always include ways to ensure your continued safety after leaving an abusive relationship. Here are some precautions to consider [23]:  

• Change locks and phone numbers if possible.  
• If possible, change work hours and the typical route.  
• Alert school authorities of the situation.  
• If a protection order is present, keep a certified copy present at all times, and inform friends, neighbors, and employers that you have a protection order in effect.  
• Consider renting a post office box or using a trusted friend's address for mail (remember that addresses are used for restraining orders and police reports) 
• Use different stores and frequent different social spots.  
• Alert neighbors and work colleagues about how and when to seek help.  

If comfortable, tell people who can take care of your children or transport them to/from school and activities. 

Again, these suggestions provide an extensive overview of an escape plan. They are meant to assist a victim in the required methodical preplanning of a safety plan that reduces the threat of violence. Not all sections will apply to every victim, but healthcare professionals should be comfortable in discussing any aspects of a safety plan specific to the individual victim. 

The Effects of COVID-19 on Domestic Violence  

As discussed at the beginning of this course, the COVID-19 pandemic has negatively affected domestic violence incidence. Stay at home /shelter in place orders, job losses, mounting financial concerns, and lack of available shelters in many areas became the norm. Domestic violence victims were met with further hurdles to their safety and well-being, as they found themselves sheltering in place with their abuser, along with fewer resources available to them in their time of crisis.  

Domestic violence hotlines prepared for an increase in calls. However, many organizations found the opposite occurring. Calls to hotlines dropped, in some places greater than 50 percent. Victims were not able to safely connect with necessary services [25].  

Due to the restrictions of movement (curfews, travel bans, 14-day quarantine advisories), not only was it more difficult to escape, but injury from abuse may have gone unnoticed by family and friends as face-to-face interactions had been sidelined. In addition to job losses and financial insecurities, this isolation may have forced a victim to become even more dependent on their abuser [26].  

In March 2020, U.S. police departments reported an increase in domestic violence calls as high as 27% after stay-at-home orders were implemented. The number of Google searches for family violence-related help during the outbreak had been substantial. This increase in domestic violence had not only affected the United States. In the United Kingdom, calls to the Domestic Violence Helpline increased by 25% in the first week after implementing lockdown measures. Furthermore, in China, domestic violence had reportedly increased three times in Hubei Province during the lockdown [27]. The importance of ongoing domestic violence education and awareness cannot be overstated.  

In review, healthcare staff often treat victims of domestic violence. Trauma-informed care that is patient-focused affords both the staff and patient (victim) the best outcome in terms of successfully navigating the challenges of domestic violence and mandatory reporting laws.  

Facility-wide protocols should be in place regarding all aspects of patient care for suspected victims of domestic violence, including national hotline numbers, community resources, scene safety protocols, and house-wide education. Staff should be regularly educated on interviewing techniques, suspected DV victim indicators, and ongoing community collateral relationships. Improved recognition of these victims and knowledge on how to proceed with specific treatment protocols will lead to a higher level of positive outcomes for domestic violence victims and other forms of abuse.  

Time is of the essence when dealing with victims of DV. There may be a small window of opportunity to help these victims when they come to your facility. There may be numerous needs identified quickly (transportation, housing, interpretation services, crisis intervention, case management, safety planning, transitional shelter, and protective orders, to name a few). Staff must feel confident in their abilities to identify possible victims, guide them through the process of seeking help, and advocate for their safety and well-being. Knowledge of their facility protocols and community, state, and national resources will afford them the opportunity to deliver optimal care.

Case Study  

Mary, 26 years old, presents to the emergency department with complaints of abdominal pain, vague body aches, and a headache. During the triage screening, Mary has minimal eye contact with the nurse and appears inadequately dressed for the cold weather, arriving in only jeans, a t-shirt, gym shoes, and a light sweater. While the nurse helps Mary change into a hospital gown in a private examination room, she notices various bruises on Mary's lower back, arms, and legs, all varying size and color. Mary states she slipped and fell recently at home. You observe that Mary is now avoiding all eye contact, staring down at the ground. She keeps looking at the door, and wall clock, mumbling, “He can't know I'm here.”  

• What are your initial thoughts about Mary's physical appearance?  
• What can you do to make Mary feel more relaxed, comfortable, and safe during her emergency room visit?  

Mary lives with her boyfriend, Bill. He works part-time; she is currently unemployed. She admits to the occasional use of alcohol and recreational use of marijuana “to help me relax. My anxiety is very bad lately.”  She mentions that her anxiety has increased because “Bill's hours at work have been cut due to COVID-19 and we’re strapped for money. He is under a lot of pressure.”  

On further examination and laboratory testing, including a pelvic examination, it is confirmed that Mary is approximately six weeks pregnant and has a suspected sexually transmitted infection. Mary bursts into tears and says, “He is going to kill me. We can't afford a baby. What am I going to do?!”  

• What are your concerns about this scenario? How will you address these concerns with your patient Mary?  
• Why might healthcare professionals, in general, feel uncomfortable speaking with Mary?  
• What are the top priorities of Mary's care at this time?  
• What information would you document in the patient record during this visit?  

Mary begins to feel comfortable speaking to you about her situation. She reluctantly tells you that Bill pushed her down the back stairs yesterday after an argument but quickly apologized afterward. On another occasion, Bill “beat me up” when he ran out of beer before payday. She states he has been really angry lately over his hours being cut at work and is looking for another job. “A baby now,” Mary confides, “would be a terrible thing for Bill, but I want it. It's my first, and I want it. Please help me.” Mary gives consent for you to contact your department social worker for additional guidance but does not want law enforcement notified.  

• What other key staff members need to be part of the care team for Mary?  
• What local and national resources can you refer Mary to at this time?  
• How would your plan of care change if Mary did not give consent for the social worker to be notified?  

Mary wants to “go back home” tonight so as not to upset Bill when he returns later this evening. “It will be better this way.” She promises to leave him tomorrow and follow-up with the community referrals you gave her. Knowing that these plans may change, you advise Mary to create a safe escape plan “just in case.”  

• What items should be part of a safe escape plan?  
• How safe is it for Mary to return home?  
• What are your legal obligations to Mary regarding Florida's mandatory reporting laws?  

As you are getting ready to leave at the end of your shift hours later, you see Mary arrive by ambulance. She is visibly injured with a broken nose and bloody lip. The emergency medical response team stated the neighbors called 911 when they heard Mary screaming in her apartment next door. No one else was in the apartment when they entered, and Mary would not tell them who injured her. You escort them to a private examination room. Mary sees you and yells, “He's coming after me. Help me. He is going to kill me.”  

• What are your top priorities for Mary and the staff at this time?  
• What other hospital departments need to be notified?  

Mary’s boyfriend shows up, intoxicated, at the triage window, demanding to see Mary. He threatens to kick in the door to the main examination room if he cannot see Mary immediately. He is pacing back and forth in the triage area and refuses to sit down.  

• What additional security measures need to be in place upon the boyfriend's arrival?  

Mary's boyfriend is removed from the premises by local law enforcement. Mary is given the national hotline number and is contacting the local shelter at this time. Upon discharge, she is escorted by security personnel to the exit and leaves the facility with a shelter representative.

Florida-Specific Domestic Violence Resources 

Community Legal Services of Mid-Florida  

A full service civil legal aid law firm that promotes equal access to justice, providing professional legal aid on domestic violence to help low-income people protect their health, and their families.  

https://www.clsmf.org/violence-protection/ 

Coast to Coast Legal Aid of South Florida  

The Family Law Unit primarily focuses on representing victims of domestic violence in family law matters, such as obtaining an injunction (restraining order), dissolution of marriage cases (divorce), and custody litigation.  

https://www.coasttocoastlegalaid.org/   

Domestic Shelters.org  

Overview of 58 Florida based organizations offering domestic violence services in 47 different cities.  

https://www.domesticshelters.org/help/fl.florida 

Florida Department of Children and Families  

Florida Family Policy Council  

Resources to assist victims (and family members) to find help, safe shelter, legal aid, transitional services, and counseling.  

https://www.flfamily.org/get-help/domestic-violence   

Florida Department of Children and Families: 

Child Protective Services:  

https://www.myflfamilies.com/service-programs/abuse-hotline/  

Florida Abuse Hotline:  

The Florida Abuse Hotline accepts reports 24 hours a day and 7 days a week of known or suspected child abuse, neglect, or abandonment and reports of known or suspected abuse, neglect, or exploitation of a vulnerable adult.  

1-800-96-ABUSE (1-800-962-2873)  

TTY: 1-800-955-8771  

https://reportabuse.dcf.state.fl.us/  

MyFlFamilies.com  

These services include emergency shelter, counseling, safety planning, case management, child assessments, information, and much more.  

These shelters may be viewed on the MyFlFamilies.com website. Healthcare professionals should be familiar with shelters available in their surrounding area.  

Domestic Violence Hotline: 1-800-500-1119  

https://www.myflfamilies.com/   

Harbor House of Central Florida  

Offering housing placements service, legal aid, safety planning, support groups, and crisis intervention.  

(407) 886-2856  

https://www.harborhousefl.com/get-help/safety/  

The 15th Judicial Circuit of Florida Batterers Intervention Program (BIP)  

The Florida BIP is a 6-month intensive program to address root causes of domestic violence; it is at least 26 weeks of group counseling sessions. A list of statewide providers is available on this site.  

https://www.15thcircuit.com/program-page/bip   

The Salvation Army  

Offering emergency and transitional housing, as well as counseling and rehabilitation services.  

https://salvationarmyflorida.org/domestic-violence-program/ 

National Domestic Violence Resources 

Amend, Inc.  

AMEND is a nonprofit organization working to end domestic violence by providing counseling to men who have been abusive, advocacy and support to their partners and children, and education to the community. Based in Colorado. 

http://www.amendinc.org/ 

Emerge  

Emerge is a Massachusetts Certified Batterer Intervention Program & Training Site, offering abuser education groups and batterer intervention. Based in Massachusetts. 

617-547-9879   

https://www.emergedv.com/  

National Domestic Violence Hotline  

1-800-799-SAFE (7233)  

https://www.thehotline.org/  

Domestic Violence Prevention, Inc   

501C3 nonprofit offering education, counseling, and support services to domestic violence clients in multiple counties in Texas and Arkansas.  

903-793-HELP (4357)  

https://www.dvptxk.org/   

National Center on Domestic Violence, Trauma and Mental Health  

Offering direct website links to multiple national organizations working with domestic violence cases. 

http://www.nationalcenterdvtraumamh.org/resources/national-domestic-violence-organizations/ 

National Network to End Domestic Violence  

Offers a range of programs and initiatives to address the complex causes and far-reaching consequences of domestic violence.  

https://nnedv.org/   

New York Model for Batterer Programs National Organization for Men Against Sexism (NOMAS) Model for DV Offender Accountability 

Court-ordered program for batterer education, which includes a court-imposed consequence if the offender does not attend. Based in New York. Formerly known as the New York Model for Batterer Programs. 

845-842-9125 

https://www.nymbp.org/ https://nomas.org/ 

Women's Law  

Providing state-specific legal information and resources for survivors of domestic violence.  

https://www.womenslaw.org/ 

Conclusion

Domestic violence is a national crisis that can lead to poor outcomes for victims. Nurses have the responsibility to ensure that victims are properly screened, provided appropriate education, and supported with resources for safety. Creating a safe space for victims to share concerns, helping them to create escape plans, and respecting their decision to stay or leave the relationship is all a part of providing the best care possible. 

➁ Complete Survey

Give us your thoughts and feedback