Policy Manual sample

MDT Home Health Care Agency, Inc. DOMESTIC VIOLENCE PURPOSE · To prevent violence in the home · To promote healthy and caring household relationships RELATED PROCEDURES · Child and Dependent Elder Abuse and Neglect · Safety in the Community GENERAL INFORMATION Assessing for family violence or abuse in the home is a major challenge for the home health nurse. The code of silence and veil of secrecy about what occurs behind closed doors in the inner sanctum of the home parallels an invisible shield. Family members have learned to guard these secrets, often without being told to do so. Domestic violence is rapidly reaching epidemic proportions in the United States. It is cyclic in nature, with psychosocial abuse commonly escalating to physical abuse. It is not uncommon for one perpetrator to victimize more than one individual in the household. Children are often kept under emotional hostage when domestic violence is occurring in the home, and their development can be arrested because of continuous exposure to trauma. In addition, children of battered women are commonly physically abused themselves or seriously neglected at a rate 15 times greater than the national average. Therefore it is important that the home health nurse assess for violence in the home during each visit. Abuse is always about manipulation, power, and control. It is never about love, protection, or respect. It is essential that the home health nurse assessing for domestic violence never lose sight of the dynamics underlying domestic violence. The prevalence of domestic violence, with its physical and psychological sequelae, necessitates routine screening of every woman for relationship abuse. It should be included in every initial health history. PROCEDURE 1. Assess for evidence of domestic violence in the home. 2. Be aware that battered women want some caring person to ask about abuse. A nonjudgmental, supportive, and receptive manner will usually encourage women to disclose problems with abuse. 3. Arrange to be alone with the patient when the topic of abuse/domestic violence is discussed (this includes not having children, relatives, or friends present). 4. Find a private place to talk without interruption. (It may be necessary to use a bathroom, front porch, or some other place not routinely used for taking a health history or doing an assessment. The patient must be assured of confidentiality to take the risk to disclose.) 5. Avoid judgmental comments because these may precipitate defensiveness and communication barriers. It isessential not to make comments such as, “Why don’t you just leave him?” or “Maybe you could try harder to not make him angry.” Comments like these convey to the woman that she is responsible for her partner’s abusive behavior when in fact she can only be responsible for her behavior and response to the battering. L-52 Home Health Agency Client Assessments