Domestic and Intimate Partner Violence
Key Points
- Domestic violence and IPV include physical, sexual, emotional, and financial abuse within close relationships.
- Survivors may present with subtle patterns rather than direct disclosure.
- Universal, private, trauma-informed screening is a core nursing safety intervention.
- Nursing care prioritizes autonomy, safety planning, and resource linkage instead of directive commands.
Pathophysiology
IPV produces cumulative physical injury and psychologic trauma through repeated coercion, fear conditioning, isolation, and loss of control. Abuse dynamics often follow repeating escalation and reconciliation patterns that can complicate help-seeking.
Reproductive coercion and sexual violence within IPV can increase unintended pregnancy risk, STI exposure, and long-term reproductive harm. Chronic abuse is also associated with anxiety, depression, sleep disturbance, and somatic symptom burden.
Classification
- Violence forms: Physical, sexual, emotional/psychologic, financial, and coercive-control behaviors.
- Relationship context: Current or former intimate partners and household/family violence overlap.
- Risk pattern domain: Escalating control behaviors, isolation, and repeated unexplained injuries.
- Clinical impact domain: Immediate safety threats plus chronic trauma-related health consequences.
Nursing Assessment
NCLEX Focus
Assess privately, normalize screening, and determine immediate danger before any planning discussion.
- Screen all women of childbearing age and other at-risk patients using confidential, direct language.
- Assess injuries, delay patterns in care-seeking, recurrent anxiety/depression visits, and partner-controlling behaviors.
- Evaluate reproductive coercion, sexual violence, and barriers to leaving.
- Determine immediate lethality risk and presence of children/dependents in danger.
- Document objective findings and patient statements exactly.
Nursing Interventions
- Provide validation and avoid blaming or pressuring language.
- Assist with individualized safety planning (housing, children, work, emergency contacts, documents).
- Connect to social work, shelters, counseling, legal resources, and crisis hotlines.
- Follow state and institutional reporting requirements.
- Arrange follow-up that protects confidentiality and ongoing safety.
Leave-Now Directive Harm
Telling a survivor to leave immediately without a practical safety plan can increase short-term danger.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| anxiolytics | Acute crisis symptom contexts | Short-term support only; must be paired with safety and psychosocial intervention. |
| antidepressants | Persistent trauma-related mood symptoms | Useful when integrated with counseling and violence-recovery services. |
Clinical Judgment Application
Clinical Scenario
A patient arrives with recurrent bruising, requests rapid discharge, and is accompanied by a partner who refuses to leave the exam room.
Recognize Cues: Injury pattern and partner control suggest possible IPV. Analyze Cues: Disclosure may be unsafe in partner presence. Prioritize Hypotheses: Priority is private screening and immediate safety assessment. Generate Solutions: Separate patient safely, screen, document, and activate social-work support. Take Action: Begin survivor-led safety planning and referral. Evaluate Outcomes: Patient receives confidential support and an actionable safety pathway.
Related Concepts
- violence-against-women-incidence-history-and-psychosocial-factors - Epidemiologic and theory foundation for IPV assessment.
- sexual-abuse-and-assault-care - Sexual violence may coexist with IPV.
- psychological-trauma-of-violence-against-women - Mental-health sequelae require longitudinal care.
- therapeutic-communication - Trust and validation improve disclosure.
- culturally-competent-care - Identity-sensitive care reduces barriers to support.
Self-Check
- Which interaction cues suggest coercive control even without direct disclosure?
- Why must safety planning be survivor-led rather than provider-directed?
- What documentation practices best support both care and legal integrity?