Domestic violence is a critical healthcare problem across the nation, and Florida is no exception. One of the problematic issues regarding domestic violence is the ambiguity of abuse definitions. In the state of Florida, domestic violence is defined as any assault, aggravated assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury or death of one family member or household member by another family member.1
Domestic violence does not discriminate. It crosses every socioeconomic level and is not limited to a particular race, ethnic, or age group. More than half of those who abuse their partners also abuse their children and are potential abusers of elders.2 Barnett et al3 cite that professionals fail to report in approximately 50% of the suspected cases. Florida law mandates that nurses and other healthcare professionals report child and elder domestic violence, but blurs about interpartner violence unless serious injury is involved.1
In 2005, the Florida Department of Law Enforcement reported 120,386 incidents of domestic violence involving spouses, parents, children, siblings, other family members and cohabitants, a figure up from 119,727 in 2004.4 In Hillsborough County (population 1,131,546), 10,050 cases were reported in 2005, up by 2.5% from 2004.4 Experts on the Governor's Domestic Violence Task Force believe that domestic violence is seriously underreported. Often times, a nurse is the first professional to come in contact with victims of domestic violence, therefore their role in reporting is paramount. The purpose of this research was to explore barriers nurses (in Hillsborough County, Florida) face in the reporting of domestic violence. The information gained in this study is crucial in order to raise awareness of the problem and guide interventions that will ultimately lead to improved reporting.
The research design chosen for this study was a quantitative survey approved by the institutional review board. The questionnaire asked nurses to identify barriers that have prevented them from reporting domestic violence. Total anonymity was maintained because of the subject matter.
Sixteen variables were provided for participants to select in identifying barriers to reporting domestic violence. Individuals were encouraged to offer additional perceived barriers. Recollections of personal experience with domestic violence were selected as a qualitative component of this study. Demographic information was also collected including age, gender, educational level, years of experience, and area of expertise.
Questionnaires were mailed to 1,000 registered nurses and nurse practitioners randomly chosen from a list made available to the public by the Florida Board of Nursing. All participants maintained addresses in Hillsborough County, Florida, and had an active license.
The survey was accompanied by a cover letter stating the purpose of the study. Anonymity was maintained because no tracking was done in mailing or returning the questionnaire. A self-addressed, stamped envelope was provided for returning the survey. Returned envelopes were destroyed by the principal investigator before distribution of the survey to the team. Informed consent is implied by return of the questionnaires.
Questionnaires were assigned a numerical value and responses were coded and entered into an Excel spreadsheet. From this, data were analyzed in SPSS. Parametric, descriptive statistics were calculated using χ2 analyses, frequencies, percentages, and grounded theory.
Forty-nine nurses (27%) responded that they suspected abuse but did not report, reflecting that the barrier “not enough evidence” was the most frequent barrier selected (32.1%). Serious ramifications were associated with reports of domestic violence that might contribute to hesitancy in reporting. The second most common consideration is that the “patient did not want the episode reported” (16.51%). Victims' responses may be solely a method of self-preservation, not protection of an abuser. “Nurse/patient confidentiality” (9.17%) is yet another example of the nurses' dedication to respect the patients' autonomy. Table 1 lists barriers and their values.
Demographic data were compiled for analysis. Of the 184 respondents, 68% (n = 1, 25) possessed at least a bachelor's degree. The study population was primarily Caucasian; however, input data were collected from Hispanics, African Americans, black Caribbeans, Asians, and Native Americans. Table 2 provides demographic data of the respondents. Most respondents were women (n = 176), which correlates with their overall predominance in nursing. The median age range of nurses answering the survey was from 46 to 65. No significance was observed between age and reporting. This held true for years of experience, with the most common being more than 25 years.
Of the 181 responses, 73 (39.7%) respondents had reported abuse and 108 had never reported abuse. When reports of abuse were compared with personal experience with abuse, a significant difference in proportions was observed among the 165 valid responses (χ2 = 13.54, P < .001). Of the 73 respondents who did report abuse, 30 (44.8%) had had personal experience with domestic violence and 37 (66.2%) had not had personal experience with abuse. However, among the 108 (58.7%) respondents who had not reported abuse, only 16 (18.4%) had had personal experience with abuse, whereas 60 (81.6%) had not had personal experience with it (strong likelihood ratio = 13.54, P < .001).
Forty-five percent (82/184) of the survey respondents indicated that they have been exposed to domestic violence in their personal life, some from more than 1 source. Fifty-one percent involved a family member, most commonly mother or daughter. Twenty-one percent were themselves victims of domestic violence. Alcohol use/abuse was cited as an inciting factor in several cases. The vast majority of abusers were men, specifically husbands. The spectrum of abuse included verbal, sexual, and physical assaults, as well as many other forms of domination and oppression. Some of the victims sought the assistance of police, filed restraining orders, fled to shelters, and divorced their abusers in pursuit of safety. Unfortunately, the children and elderly victims were essentially helpless against the violence. Reports of extreme cases provided insight into the potential for devastating outcomes. One respondent detailed the account of her neighbor who returned home to her abuser several times and “ was shot several times in the back and died.” Another was strangled, and then her abuser committed suicide. According to grounded theory, these data indicate that nurses hold an informed personal perspective with regard to domestic violence, and are therefore uniquely qualified to identify the signs of abuse and intervene appropriately.
This study was limited by its sample size. A total of 1,000 questionnaires were mailed, and 253 were returned. Sixty-nine did not complete the barrier section, thus leaving 184 for analysis. Reporting laws are state specific, therefore Florida laws may not apply to other states.
Education is crucial to the development of a greater awareness and an increased understanding of domestic violence. It is essential that there be appropriate multidisciplinary training that is culturally sensitive. Mandatory reporting laws are imperative to provide realistic guidance to healthcare and other professionals. Policy makers must clarify legal definitions and establish protocols. Healthcare professionals need to examine their own attitudes toward domestic violence. The results of this study demonstrate that nurses are not hindered by their own experience; in fact, those who have experienced violence are much more likely to report.