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{"id":8577,"date":"2016-03-08T11:00:20","date_gmt":"2016-03-08T16:00:20","guid":{"rendered":"http:\/\/circulatingnow.nlm.nih.gov\/?p=8577"},"modified":"2020-10-29T13:59:18","modified_gmt":"2020-10-29T17:59:18","slug":"change-is-possible","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2016\/03\/08\/change-is-possible\/","title":{"rendered":"Change is Possible"},"content":{"rendered":"<p><em>This post is the last in a <a href=\"http:\/\/circulatingnow.nlm.nih.gov\/category\/series\/confronting-violence\/\">series<\/a> exploring the history of nursing and domestic violence from the guest blogger <a href=\"http:\/\/circulatingnow.nlm.nih.gov\/2015\/09\/17\/from-private-matter-to-public-health-crisis\/\">Catherine Jacquet<\/a>, Assistant Professor of History and Women\u2019s and Gender Studies at Louisiana State University and guest curator of NLM’s exhibition <\/em><a title=\"NLM's Pictures of Nursing Exhibition\" href=\"http:\/\/www.nlm.nih.gov\/exhibition\/confrontingviolence\/index.html\">Confronting Violence: Improving Women\u2019s Lives<\/a><em>.<\/em><\/p>\n<figure id=\"attachment_8579\" aria-describedby=\"caption-attachment-8579\" style=\"width: 232px\" class=\"wp-caption alignright\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11101.png?ssl=1\" rel=\"attachment wp-att-8579\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"8579\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2016\/03\/08\/change-is-possible\/ob11101\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11101.png?fit=929%2C1200&ssl=1\" data-orig-size=\"929,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"\u201cThe Battered Woman,\u201d 1989\" data-image-description=\"<p>The Battered Woman<br \/>\nacog: technical bulletin<br \/>\nNumber 124<br \/>\n\u2014<br \/>\nJanuary 1989<br \/>\nDefinition<br \/>\nDomestic violence and spouse abuse are terms referring to violence occurring between<br \/>\npartners in an ongoing relationship, regardless of whether they are married (1). A battered<br \/>\nwoman has been defined as any woman over the age of 16 with evidence of physical abuse on at<br \/>\nleast one occasion at the hands of an intimate male partner (2). The battered wife syndrome has<br \/>\nbeen defined as a symptom complex occurring as a result of violence in which a woman has at<br \/>\nany time received deliberate, severe, and repeated (more than three times) physical abuse from<br \/>\nher husband, with the minimal injury of severe bruising (3). Richwald and McCluskey have<br \/>\ncategorized violent acts from the least to the most severe, from verbal abuse, threat of violence,<br \/>\nthrowing an object, throwing an object at someone, pushing, slapping, kicking, hitting, beating<br \/>\nup, threatening with a weapon, and use of a weapon. Most definitions also incorporate concepts<br \/>\nof intentionality and the repetitive nature of the assaults (4).<br \/>\nIt can be seen from these definitions that violence is viewed most often as physical abuse. In<br \/>\nmost violent relationships, however, mental abuse and intimidation are an integral component of<br \/>\nthe abuse syndrome. Regardless of how it is defined or the form it takes, abuse represents<br \/>\na<br \/>\nsignificant clinical problem that warrants further evaluation. In 1985, the Surgeon General of the<br \/>\nUnited States sponsored a workshop on violence and public health in an effort to focus attention<br \/>\non this and similar problems, in the hope of helping to reduce the incidence of violence in society<br \/>\nand providing more effective help for its victims (5).<br \/>\nIncidence<br \/>\nIt is difficult to ascertain the exact incidence of domestic violence. One estimate based on<br \/>\nthe work of several investigators has placed the annual<br \/>\nnumber of cases of domestic violence in<br \/>\nthe United States at 1.5 million; it has also been estimated to occur in up to 50% of all familial<br \/>\nrelationships (1, 6, 7). A study performed at Yale University reported that 3.8% of women who<br \/>\ncame to the surgical services and 3.4% of women who came to the psychiatric services of the<br \/>\nemergency department had been victims of battering (2). The U.S. Department of Justice\u2019s<br \/>\nBureau of Justice Statistics reports that 57% of 450,000 annual cases of family violence were<br \/>\nco<br \/>\nmmitted by spouses or ex-spouses and that the wife was the victim in 93% of cases. In one-<br \/>\nquarter of these cases, at least three similar incidents had been reported within the previous 6<br \/>\nmonths (8). Furthermore, it has been estimated that between one-third and one-half of all female<br \/>\nhomicide victims are murdered by their male partners (9). For a variety of social, emotional, and<br \/>\neconomic reasons, the incidence of battered women is probably severely underreported<br \/>\nthroughout the world.<br \/>\nPublic Health Impact<br \/>\nIt is difficult to obtain statistics on the morbidity of battering. In the Yale study, 19% of<br \/>\nthe women in the series had received serious injuries to the head, 5% had lacerations requiring<br \/>\nsutures, and 62% had contusions and soft tissue injuries (2). In all series, the areas most<br \/>\ncommonly injured in women were the<br \/>\nOB11101<\/p>\n\" data-image-caption=\"<p>The American College of Obstetricians and Gynecologists define for member physicians \u201cThe Battered Woman,\u201d 1989<br \/>\nCourtesy American College of Obstetricians and Gynecologists<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11101.png?fit=232%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11101.png?fit=793%2C1024&ssl=1\" class=\"size-medium wp-image-8579\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11101.png?resize=232%2C300&ssl=1\" alt=\"Cover of \u201cThe Battered Woman\u201d \" width=\"232\" height=\"300\" \/><\/a><figcaption id=\"caption-attachment-8579\" class=\"wp-caption-text\">The American College of Obstetricians and Gynecologists define for member physicians \u201c<a href=\"https:\/\/www.nlm.nih.gov\/exhibition\/confrontingviolence\/exhibition4.html?slide=1\">The Battered Woman<\/a>,\u201d 1989<br \/><em>Courtesy American College of Obstetricians and Gynecologists<\/em><\/figcaption><\/figure>\n<p>By the early 1990s, change was on the horizon. Several of the major professional medical organizations recognized domestic violence as a significant health issue and urged their constituencies to take action\u2014this reinforced over a decade of advocacy and activism by nurses and their allies. In January 1989, the American College of Obstetricians and Gynecologists (ACOG) announced a campaign to combat domestic violence. With Surgeon General C. Everett Koop, former ACOG president Dr. Luella Klein held a press conference declaring that, \u201cviolence against women is not tolerable in our society.\u201d Klein announced that all 27,000 members of the ACOG would be receiving information \u201cthat will equip them to detect when one of their patients is the victim of battering.\u201d This could make a significant difference in the lives of thousands of women. \u201cBecause ob\/gyns are the health professionals who care for many women,\u201d Klein continued, \u201cthey play a vital role in at least being in a position to detect when a woman may be the victim of abuse.\u201d That same month the ACOG released a technical bulletin titled \u201c<a href=\"https:\/\/www.nlm.nih.gov\/exhibition\/confrontingviolence\/exhibition4.html\">The Battered Woman<\/a>,\u201d which outlined the definition, incidence, and public health impact along with the importance of identifying abuse victims and methods for intervention.<\/p>\n<p>Three years later, in January 1992, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) followed suit and required that all accredited hospitals implement policies and procedures to identify, treat, and refer victims of abuse. This requirement included an educational component in domestic violence, elder abuse, and child abuse for all hospital staff.<\/p>\n<figure id=\"attachment_8581\" aria-describedby=\"caption-attachment-8581\" style=\"width: 205px\" class=\"wp-caption alignleft\"><a href=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11102.png?ssl=1\" rel=\"attachment wp-att-8581\"><img data-recalc-dims=\"1\" loading=\"lazy\" decoding=\"async\" data-attachment-id=\"8581\" data-permalink=\"https:\/\/circulatingnow.nlm.nih.gov\/2016\/03\/08\/change-is-possible\/ob11102\/\" data-orig-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11102.png?fit=820%2C1200&ssl=1\" data-orig-size=\"820,1200\" data-comments-opened=\"1\" data-image-meta=\"{"aperture":"0","credit":"","camera":"","caption":"","created_timestamp":"0","copyright":"","focal_length":"0","iso":"0","shutter_speed":"0","title":"","orientation":"0"}\" data-image-title=\"\u201cAmerican Medical Association Diagnostic and Treatment Guidelines on Domestic Violence,\u201d 1992\" data-image-description=\"<p>Archives of Family Medicine<br \/>\n:<br \/>\nSeptember 1992<br \/>\nHow<br \/>\n much do your patients know about fats and cholesterol? See page 74<br \/>\nAmerican Medical Association Diagnostic and Treatment Guidelines on Domestic Violence Substance Use in Rural Midwestern<br \/>\nPregnant Women,<br \/>\nB.<br \/>\nP. Yawn, R. A. Yawn, D. L. Uden<br \/>\nClinical Competence of Family Physicians: The Patient Perspective,<br \/>\nA. G. Mainous III, A. K. David<br \/>\nHuman Gene Therapy: A Role for the Primary Care Physician, C.J. Schmeichel, J. M. Loeb<br \/>\nPatients\u2019 Knowledge About Fats And Chol<br \/>\nesterol In the Community Cholesterol Survey Project,<br \/>\nR. B. Kelly, J. A. Hazey, S. H.<br \/>\nMcMahon<br \/>\nExtrapulmonary Tuberculosis: A Review,<br \/>\nN. C. Elder<br \/>\nAmerican Medical Association<br \/>\n:<br \/>\nPhysicians dedicated to the health of America<br \/>\nSpecial Article<br \/>\nAmerican Medical Association Diagnostic and Treatment Guidelines on Domestic Violence<br \/>\nThe A<br \/>\nRCHIVES<br \/>\nis proud to be able to present the American Medical Association\u2019s Diagnostic and Treatment Guidelines on violence. In<br \/>\nthis issue, we will begin with the Guidelines on Domestic Violence. Over the next three issues, we will publish the Guidelines on<br \/>\nChild Physical Abuse and Neglect, Child Sexual Abuse, and Elder Abuse.<br \/>\nPhysical and sexual violence against women is a public health problem that has reached epidemic proportions. An estimated 8<br \/>\nto 12 million women in the United States are at risk of being abused by their current or former intimate partners. This violence causes<br \/>\nserious physical, psychological, and social sequelae for these women and their families. (Arch Fam Med. 1992<br \/>\n;<br \/>\n1:39-47)<br \/>\nDomestic violence, also known as partner-<br \/>\nabuse, spouse abuse, or battering, is one facet of the larger problem of family<br \/>\nviolence. Family violence occurs among persons within family or other intimate relationships, and includes child abuse and elder<br \/>\nabuse as well as domestic violence. Family violence usually results from the abuse of power or the domination and victimization of a<br \/>\nphysically less powerful person by a physically more powerful person.<br \/>\nMost research has focused on women who have<br \/>\nbeen battered by male partners, and, in fact, women are more likely than men to<br \/>\nbe seriously injured by their partners. However, the terms spouse abuse and partner abuse reflect an awareness that men also can be<br \/>\nabused in intimate relationships. The extent to which findings about battered women can be applied to men who are abused by<br \/>\nwomen,<br \/>\nor to the underrecognized problem of violence within gay and lesbian relationships, is not known. In clinical practice, these<br \/>\nis<br \/>\nsues also must be addressed in a sensitive and nonjudgmental manner.<br \/>\nUntil the mid-<br \/>\n1970s, assaults against wives were considered misdemeanors in most states, even when an identical assault against<br \/>\na stranger would have been considered a felony. The current consensus among state and federal policy makers is:<br \/>\n\u2022<br \/>\nDomestic violence is a crime.<br \/>\n\u2022<br \/>\nSafety for victims of domestic violence and their children must be a priority.<br \/>\n\u2022<br \/>\nChanges in traditional services, including medical care, are needed to meet the needs of abused women.<br \/>\nMost states have improved the legal remedies available to battered women, and a number of state health departments have<br \/>\ndeveloped protocols for health care providers. Since January 1992, the Joint Commission on Accreditation of Healthcare Or-<br \/>\nganizations (JCAHO) has required that all accredited hospitals implement policies and procedures in their emergency departments<br \/>\nThese guidelines were prepared by Anne H. Flitcraft, MD, New Haven, Conn; Susan M. Hadley, MPH, Minneapolis, Minn; Marybeth<br \/>\nK. Hendricks-Matthews, PhD, Barberton, Ohio; Susan V. McLeer, MD, Philadelphia, Pa; and Carole Warshaw, MD, Chicago, III.<br \/>\nReviewers included Elaine Carmen, MD, Boston, Mass; Richard F. Jones III, MD,<br \/>\nHartford, Conn; Rhoda M. Powsner, MD, Ann Arbor, Mich; Patricia Salber, MD, Larkspur, Calif; and Dorothy A. Starr, MD,<br \/>\nWashington, DC.<br \/>\nA<br \/>\nrch Fam Med\/Vol 1, Sep<br \/>\n1992<br \/>\n39 <\/p>\n<p>OB11102<\/p>\n\" data-image-caption=\"<p>American Medical Association “Diagnostic and Treatment Guidelines on Domestic Violence,\u201d Archives of Family Medicine, 1992 Courtesy National Library of Medicine<\/p>\n\" data-medium-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11102.png?fit=205%2C300&ssl=1\" data-large-file=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11102.png?fit=700%2C1024&ssl=1\" class=\"size-medium wp-image-8581\" src=\"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/02\/ob11102.png?resize=205%2C300&ssl=1\" alt=\"First page of Journal Article\" width=\"205\" height=\"300\" \/><\/a><figcaption id=\"caption-attachment-8581\" class=\"wp-caption-text\">\u201c<a href=\"https:\/\/www.nlm.nih.gov\/exhibition\/confrontingviolence\/exhibition4.html?slide=2\">American Medical Association Diagnostic and Treatment Guidelines on Domestic Violence<\/a>,\u201d <em>Archives of Family Medicine<\/em>, 1992<br \/><em>Courtesy National Library of Medicine<\/em><\/figcaption><\/figure>\n<p>Of particular significance, the American Medical Association issued “<a href=\"https:\/\/www.nlm.nih.gov\/exhibition\/confrontingviolence\/exhibition4.html?slide=2\">Diagnostic and Treatment Guidelines on Domestic Violence<\/a>” in September 1992. Prepared by pioneer reformers including Anne Flitcraft, MD, Susan Hadley, MPH, and Carole Warshaw, MD (none of whom were members of the AMA), these guidelines marked a critical turning point in the history of medicine and domestic violence. Recalling the publication of the guidelines, <a href=\"https:\/\/www.nlm.nih.gov\/exhibition\/confrontingviolence\/exhibition5-profiles.html?slide=2\">Anne Flitcraft<\/a> explained in an interview, it gave \u201cthe imprimatur of real medicine\u2026 this says violence against women, domestic violence, is <em>real<\/em> medicine.\u201d In addition, both the Council on Ethical and Judicial Affairs and the Council on Scientific Affairs of the AMA published reports on violence against women in the June 1992 issue of the <em>Journal of the American Medical Association<\/em> (JAMA). The Council on Ethical and Judicial Affairs stated that physicians had an ethical obligation to intervene in cases of domestic violence and the Council on Scientific Affairs issued policy recommendations which included undertaking a campaign to educate the healthcare community on violence against women and training physicians to identify, validate, and refer victims of violence to the appropriate resources. These JAMA publications marked a sea change from 14 years prior when a 1978 article in the same journal reported that the discussion of spouse abuse in the medical literature was rare. After over a decade of advocacy and education, nurses, physicians, social workers, public health officials and other reformers within the healthcare system had made a significant impact in the identification and treatment of victims of domestic violence.<\/p>\n<p>By 1992, Jacquelyn Campbell could <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/1436723\">write<\/a> with confidence, \u201cNo one doubts any more that violence is a serious health problem. No one doubts that the health care system must become involved in decreasing violence.\u201d Nurses played a critical role in this transition. As they came to consciousness about the issues facing battered women, nurses advocated, educated, and organized nationally. In various capacities, nurses sought to both alleviate injury and ultimately prevent violence against women. Their impact was significant. Following 15 years of working and education on the issue of battering, Campbell wrote, \u201cI am deeply gratified to see the official health policy-making bodies recognize what many of us in nursing have been working on for a long time. I am proud that nursing has taken a leadership role in changing health care policy about violence.\u201d<\/p>\n<p><em>Learn more about <a href=\"http:\/\/infocus.nlm.nih.gov\/2015\/10\/29\/confronting-violence-improving-womens-lives-why-nlm-is-hosting-this-important-show\/\">why NLM is hosting this important exhibition<\/a>, and read about the traveling banner exhibition in <a href=\"https:\/\/www.washingtonpost.com\/national\/health-science\/nurses-helped-make-us-understand-domestic-violence-as-a-serious-health-issue\/2018\/08\/17\/2eaa7b80-a00f-11e8-83d2-70203b8d7b44_story.html?utm_term=.dc8b14f5fb21\">The Washington Post<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This post is the last in a series exploring the history of nursing and domestic violence from Dr. Catherine Jacquet.<\/p>\n","protected":false},"author":19605840,"featured_media":17679,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"Change is Possible - the last in a 5 part series from the curator of Confronting Violence: Improving Women's Lives #NoViolenceNLM","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[42333869,12763,51873791,2029,51014,2347],"tags":[24743,5967,678875802,9807,96,7193,97077],"class_list":["post-8577","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-archives-manuscripts","category-collections","category-confronting-violence","category-exhibitions","category-guests","category-series","tag-1970s","tag-advocacy","tag-confronting-violence","tag-domestic-violence","tag-journal","tag-nursing","tag-womens-history"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2016\/03\/OB11102_feature.jpg?fit=900%2C400&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3xcDk-2el","jetpack-related-posts":[],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/8577","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/users\/19605840"}],"replies":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/comments?post=8577"}],"version-history":[{"count":13,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/8577\/revisions"}],"predecessor-version":[{"id":20081,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/8577\/revisions\/20081"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media\/17679"}],"wp:attachment":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media?parent=8577"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/categories?post=8577"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/tags?post=8577"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}} |