Chapter 28: Promoting the Safety of Women and Families

Intimate partner violence encompasses physical, sexual, psychological, and economic harm inflicted by current or former partners, with approximately one-third of women experiencing it during their lifetime. The chapter explains the cycle of violence as a three-phase pattern beginning with tension building, followed by an acute violent episode, and concluding with a reconciliation phase characterized by remorse and affection, which paradoxically reinforces the victim's decision to remain in the relationship. Understanding the distinctions between physical abuse, sexual coercion, emotional manipulation including gaslighting, stalking, and financial control is essential for nurses to recognize abuse in its various manifestations. Nursing assessment requires universal screening protocols and attention to clinical indicators such as multiple injuries in different healing stages, injuries concentrated on the central body rather than extremities, and reports of partner surveillance or isolation. Strangulation represents a particularly dangerous form of abuse with potentially fatal consequences and may leave minimal visible evidence despite serious internal trauma. The chapter emphasizes trauma-informed care principles, which center on recognizing trauma's impact, validating the victim's experiences, maintaining confidentiality, and ensuring safety planning occurs within a framework of patient autonomy and non-judgment. Documentation practices must be precise and thorough, using patients' own language and body mapping diagrams to create evidence suitable for legal proceedings. Sexual assault management involves specialized Sexual Assault Nurse Examiner training for forensic evidence collection and coordination of medical interventions including prophylaxis for sexually transmitted infections, non-occupational postexposure prophylaxis for HIV exposure, and emergency contraception. The chapter addresses mandatory reporting requirements that vary by jurisdiction and the tension between legal obligations and patient autonomy, emphasizing that safety planning should prioritize the victim's agency and recognize that leaving an abusive relationship often represents the highest-risk period for severe harm.