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Rcasa’s Sunday Book/Article Review Review: Health Needs and Barriers….

In Advocacy, Sexual Assault Awareness on December 13, 2009 at 9:00 am

This week, we are reviewing the following article: “Health Needs and Barriers to Healthcare of Women Who Have Experienced Intimate Partner Violence” from the Journal of Women’s Health , 1485-1498.

I’m Tanya Singleton, and I’m a Master’s Intern @ RCASA.   I’m a registered nurse and I also have a Masters in Public Health.  Intimate partner violence (IPV) is a growing, recognized public health issue.  According to Wilson (2007), et. al. “Intimate partner violence , defined as actual or threatened physical, sexual, psychological, and emotional abuse by a current or former partner, affects approximately 25% -43% of women in their lifetime” (p. 1485).  In the state of Virginia, half of all adult female homicide victims are killed by intimate partners. (VDH, Project RADAR).   IPV has impact on many facets of a victims life – not only the obvious and immediate physical and emotional impact; but this violence can precipitate chronic physical ailments related to the injuries sustained, mental health problems such as depression, anxiety, PTSD, and spiritual effects such as alienation from religious community.

Wilson et. al. conducted at study at Duke University which consisted of interviews of 25 women clients and staff members at a local crisis center.  This group was demographically mixed, with 20% Latina immigrants.  The age range of participants was 18-48, the group was representative of black, white, Native American, Asian, mixed race, and Latina. Forty percent were employed, 36% were high school graduates and 28% had some college or technical education.  Most of the women were single, separated, or divorced.

This study was conducted to examine actual and perceived barriers to healthcare for women experiencing IPV. 

Health problems reported most commonly were “chronic pain (32%), gastrointestinal problems, (24%) , sleep disorders (20%), back pain (16%), physical injury due to IPV(16%), and hypertension (16%).

Barriers to getting healthcare existed at the systemic as well as the individual level.  Most of the women were unemployed and uninsured, which rendered them unable to afford the cost of medical care, medication, or mental health services.  Latina participants experienced language barriers as well as fear of government agencies and perceived discrimination.  Women in shelters were more concerned with finding housing and employment; other women were dealing with control issues from the abuser which created barriers to healthcare.  Many women reported the overpowering shame and embarrassment for being in an abusive relationship as a barrier, especially with an IPV related injury.  Not surprisingly, these same women were very concerned for the health of their children, and needed the suggestion that their children needed them to stay healthy in order to encourage them to focus on their own healthcare needs.

I attended a wonderful workshop facilitated in part by Dr. Jacqueline Campbell, who has done extensive work on IPV – I have followed her work for approximately twenty years.  She appeals to all healthcare providers and crisis workers to perform a danger assessment – her tool is available for no charge on the website listed in the references for this blog.

I recall several years ago as a clinical nurse educator who often did patient care alongside the staff of an incident of a young lady who came into labor and delivery because she “just wanted to make sure the baby is okay”.  She reported that she fell down an escalator in the Metro – “I’m just so clumsy since I became pregnant.”  I followed the nurse’s assessment of the patient, and her conclusion was that “she fell down an escalator”.  I had to point out to her that the patterns of bruising was NOT consistent with the injury reported. . .bruises, cuts and scratches in various degrees of healing, defensive wounds, etc.  This nurse did not feel that it was her “business” to question the woman’s story.  So when the nurse took a break, I gently asked the woman. . .”so how often do you fall?  Have you fallen in other places?” When she asked me why, I said, “well, these look like old bruises to me and from something other than falling.”  As she began to tear up, I softly told her –“its okay, you are safe here and now.  Let’s talk about it.”  Sometimes that’s all someone needs to hear.

References

Campbell, J. (2003) http://www.dangerassessment.com

Wilson, K. S. (2007). Health needs and barriers to healthcare of women who have experienced intimate partner violence. Journal of Women’s Health , 1485-1498.

Virginia Department of Health – http://www.ProjectRadarVA.com; http://www.vahealth.org/civp

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