Intimate Partner Violence — Community Response

The patient has bruises in different stages of healing and reports a fall down the stairs. The nurse's next question determines whether this patient gets help or goes home to be hurt again.

Intimate partner violence (IPV) affects approximately 1 in 4 women and 1 in 10 men in the United States. The community health nurse encounters IPV across all settings — prenatal clinics, emergency departments, pediatric visits (witnessing violence harms children), home health, and primary care. The USPSTF recommends screening all women of reproductive age for IPV and providing or referring to intervention services. Validated screening tools include the HITS (Hurt, Insult, Threaten, Scream), AAS (Abuse Assessment Screen used in pregnancy), and STAT (Slapped, Threatened, And Thrown). The nurse screens in private — NEVER with the partner present. If the patient discloses abuse, the nurse's priorities are: assess immediate safety (does the patient have a safe place to go tonight?), document injuries objectively using a body map and the patient's own words in quotation marks, provide information about community resources (National Domestic Violence Hotline, local shelters, legal advocacy), develop a safety plan (packed bag with essentials, copies of important documents, emergency contacts, escape route), and respect the patient's autonomy — leaving an abusive relationship is a process, not a single event. The nurse does NOT pressure the patient to leave, call police without the patient's consent (unless mandatory reporting applies), or express judgment. Mandatory reporting laws for IPV in adults vary by state — some states require reporting only if a weapon caused injury. When children are present in an IPV household, the nurse assesses child safety and reports to CPS when abuse, neglect, injury, threat, or state-mandated exposure criteria are met. During pregnancy, IPV often escalates. The nurse screens at the first prenatal visit, at least once per trimester, and postpartum.

Key Distinctions

IPV mandatory reporting for adults differs from child abuse mandatory reporting. Child abuse is universally mandated across all states. Adult IPV reporting requirements vary by state — in many states, nurses report IPV in adults only when the injury involves a weapon or meets specific criteria. When children are present in an IPV household, the nurse assesses child safety and reports to CPS when there is evidence of child abuse, neglect, injury, threat, or when state law defines exposure to IPV as meeting mandatory reporting criteria — mere presence alone is not an automatic mandatory report in every jurisdiction. Students confuse 'the nurse should call the police' with the correct response — the nurse respects the adult patient's autonomy unless mandatory reporting applies. Leaving takes an average of 7 attempts. The nurse who says 'just leave' does not understand the dynamics of abuse.

Clinical Pearl

Screen in private, document in quotes, plan for safety, respect their timeline. The most dangerous time is right after leaving — a safety plan matters more than a lecture about leaving.