Domestic Violence and Death

Question 1

Discuss who and how to screen for domestic abuse

Answer 1

Routine Screening 
- female trauma victms
- female emergency room patients
- women with chronic headaches or abdominal pain
- pregnant women with injuries
- women with STI
Screening (How often does your partner and rating 1-5)
- hurt you physically
- insult you or talk down to you
- threaten to harm you
- scream or curse at you

Question 2

Discuss the risks for domestic violence

Answer 2

• young female <24
• low level of education
• unemployment or below SES
• prior hx of domestic violence
• experience or witness violence as child
• alcohol or drug use
• income or education disparity between partners
• dominance and control of relationship by male
• excessive jealousy

Question 3

Discuss the presentation of domestic violence

Answer 3

Physical
- injuries to face, neck, thorax and abdomen
- finger pad bruises
- impression bruising
- wrap around bruising
Psychological
- patient evasiveness
- avoidance of eye contact
- inappropriate affect
- patient become hostile

Question 4

Discuss the management of domestic violence

Answer 4

Assess for
- current level of fear regarding situation
- immediate safety needs
- future safety needs
Referral
- domestic violence advocate
- hospital social worker
- domestic violence hotline
Safety Plan
- emergency kit including documents, keys, money, essential items
- safe residence
- signal for others to call 911

Question 5

Discuss the approach to giving bad news

Answer 5

- SPIKES
Setting
- silent, private area
- eye-to-eye contact without any distractions or distance between members
Perception of Patient
- learn about what they understand and know about situation
Invitation
- elicit how much they want to know about condition
Knowledge
- give information patient request
- warn of bad news
- provide information in chunks
Empathy
- compassion and understanding
Summary
- offer recommendation and summarize main points

Question 6

Discuss when to report death to coroner

Answer 6

Death Involves any of

• Violence
• Misadventure
• Negligence
• Misconduct
• Malpractice
• During pregnancy or following
• Sudden and unexpected
• Disease not treated by practioner
• Any cause other than disease (accident, suicide, homicide)
• Require investigation (investigation by police, hospital, children’s aid)