October 29, 2004

VUSN abuse-cycle study links past and present

Featured Image

From left, Katie Wilkerson, R.N., an infection control practitioner, Cindy Irwin, R.N., a clinical risk manager, Maria Fonseca-Kheshtl with utilization management, Tracey Bunch, an anesthesia technician, and Kelly Cole, R.N., talk about washing up during Hand Hygiene Awareness Day on Wednesday. Members of the VUMC Hand Hygiene Task Force visited patient care units to hand out cookies and spread the message that improved adherence to basic hand hygiene presents the biggest opportunity to reduce infections acquired in hospitals. The effort includes new annual training requirements, more alcohol gel dispensers for hand washing, ongoing monitoring of hand washing practices and other changes. Elements of the hand hygiene campaign have been under way since this summer at the Monroe Carell Jr. Children's Hospital at Vanderbilt.
photo by Dana Johnson

VUSN abuse-cycle study links past and present

Researchers at Vanderbilt University School of Nursing are shedding a brighter light on the vicious cycle of family violence with new findings that confirm what many have long suspected — that children who are abused are at a higher risk for being in an abusive relationship as adults.

The findings are published in the September-October issue of the Journal of Pediatric Health Care in a paper authored by Melanie Lutenbacher, Ph.D., associate professor of Nursing and director of the Ph.D. in Nursing Science Program, Alison Cohen, M.S.N., lecturer and clinician; and graduate student Nichole Conner. “Many providers don't understand the linkages between aversive childhood experiences and adult abuse experiences,” said Lutenbacher. “This research was done to examine the experiences of battered women and reveal a connection to childhood abuse experiences, so providers can develop better screening tools and guidelines for addressing the problem,” she added.

Researchers interviewed 40 battered women individually using open-ended questions and administration of standardized measures. The results showed 60 percent of women who participated described abuse during their childhood and indicated a high potential risk for child abuse now. The physical abuse described ranged from having objects thrown at them, to being pushed, shoved, kicked, hit or threatened with weapons. Yet Cohen says the women reported they received little assistance during abusive situations in their childhood or as an adult from health care providers. “Many women reported the disconnect between their childhood and adult experiences in their homes and perceptions of others on the outside,” Cohen said. “Often the women felt health care providers had a sense of what was happening in their homes, but neither acknowledged the problem nor offered assistance. Perhaps for pediatric health care providers, it is easier to respond to child abuse versus spouse abuse, because there is a legal mandate to do so,” Cohen added.

Previous surveys of pediatric providers found that only 12 percent to 15 percent routinely screen young patients for domestic violence at well-child care visits, and as many as 75 percent reported they never or rarely screen for domestic violence, and a mere 16 percent of providers reported having an office guideline for dealing with victims of family violence. Statistics from the 2004 National Clearinghouse on Child Abuse and Neglect show nearly a million children were victims of abuse in 2001, and another 4 million are currently tied up in referrals to Child Protective Services, while the U.S. Department of Justice reports 2.5 million women are the victims of violence each year.

Lutenbacher said these figures point to the overwhelming need for pediatric health care providers to be better equipped to tackle the problem.

“Pediatric health care providers must routinely screen for abuse in mothers and children with a family-centered approach. They must be able to identify indicators of abuse and intervene when necessary to improve the quality of life of many families in the United States, and to limit the consequences of abuse,” said Lutenbacher.

Researchers said implementing aggressive education for health care providers, educators, clergy and law enforcement officers — those on the front lines in dealing with families at risk — is an important step in stopping the cycle of family violence.

“The process of living in, leaving and eventually healing from an abusive relationship can last a lifetime,” said Lutenbacher. “As health care providers, we need to work toward services that are coordinated, long term, and family oriented.”