Assessment and screening

Healthcare facilities should have a plan that provides for assessing, screening, and referring patients for domestic violence. How to do referrals, documentation, and follow-up should be included.

Barriers to screening for domestic violence such as lack of training, time constraints, and a lack of privacy for patients to address the issues need to be also addressed. Although awareness has increased, many patients and health professionals are still hesitant to discuss abuse (Huecker et al., 2024).

According to Huecker et al. (2024) these are some of the processes to use when assessing victims of domestic abuse.

1. Assess if injuries are life and/or limb-threatening. The underlying issues that brought the victim to the healthcare facility are initially the most important.
   
2. Carry out a detailed history and physical examination. Follow agency protocols for domestic abuse assessments.
   
3. Be aware of barriers to screening such as patients being reluctant to discuss abuse, particularly if the abuser is nearby.
   
4. Look for the common signs and symptoms of domestic abuse – facial bruising, bites, cuts, broken bones, concussions, burns, knife or gunshot wounds.
   
5. It is important to distinguish between signs and symptoms of abuse from accidental injuries. Domestic injury patterns typically include injuries and bruises to the head, face, neck, breast, chest, abdomen, and musculoskeletal injuries. Accidental injuries more commonly involve the extremities.
   
6. Assess injuries in various stages of healing, particularly fractures.

The assessment should also include laboratory tests, x-rays, CT, or MRI as indicated. Social workers, psychiatrists, and psychologists who specialize in the care of battered partners and children should also be called in if the patient is willing to speak to one of them.

In the Ramsay et al. (2012) study, the test of nurses’ actual knowledge showed their ability to identify warning signs of violence, including frequent injuries (86.5%), anxiety (79.8%), and depression (79.8%), but the identification of substance abuse related to DFV was low (37.1%).