Understanding Domestic Violence ______________________________________________________________
Over the next few of months, the nurse continued to see Monique for pregnancy follow-up. By the time Monique was eight months pregnant, she had to cancel three appointments because Sam refused to let the nurse in the home without him present. At one visit the nurse arrived at the door, and Monique told her Sam was out with friends and she was unable to let her in. During Monique’s last trimester, Sam’s abuse escalated in frequency and severity. On several occasions, Monique threatened to leave Sam. He responded at first by laughing and telling Monique she could never make it on her own, but then he began to threaten to kill Monique if she tried to leave. The nurse noticed Monique’s change in behavior. Sam continued to be present at all visits. The nurse’s suspicion of intimate partner violence was growing stronger. The nurse reported this situation to their supervisor. During the time the nurse has seen Monique, she has presented with a broken finger, a displaced shoulder, an injured foot, and a laceration on her arm. Because Sam has always been present for the visits, the nurse was unsure of the true nature of the injuries. One day Monique called the nurse to come for a prenatal visit as soon as possible. The nurse arrivesdand Sam was not present. A week after the nurse’s visit, Monique called and informed the nurse that Sam hurt her again and has threatened to kill her if she leaves. When the nurse asks Monique if she’s okay, she says she is fine and just needs to get herself together. She says she will be home at noon and asks the nurse to visit. The nurse determines it will be safe to visit Monique in her home. When the nurse arrives, Monique states she is afraid, and they decide to call the police.
be placed in foster care either temporarily or permanently. In any case, it is crucial for professionals working with family members to provide information about the potential outcomes and, whenever possible, to communicate with the CPS case- worker and accompany the family to court hearings (Center for Substance Abuse Treatment, 1997). CASE STUDY 3 Monique is a 25-year-old woman who lives with her mother in a small home. She currently works in the accounting office at a nearby elemen- tary school. Monique began seeing Sam, a mechanic from a nearby town. Sam is attentive and interested in being part of Monique’s life. After three months of dating, Sam moved in with Monique and her mother. Monique became pregnant and was a bit nervous about how they would afford their growing family, but she is happy to have a baby with Sam. Sam seemed indifferent to the pregnancy at first, but then showered Monique with care and presents. One night Monique arrived home late from work and Sam was angry. As she walked in the house, he yelled “Where the hell have you been?! I come home early one day and you’re out with God-knows-who doing whatever you please when you’re supposed to be here when I get home. Who were you with?!” Monique tried to explain, but Sam’s anger scared her, and she wanted to resolve the conflict as quickly as possible. Sam stormed out the door and drove off. An hour later, he returned and apologized to Monique. He told her, “I don’t know why I got so angry—it’s just been a bad day at work. And you know I don’t really like that friend of yours very much. I’m sorry, honey.” Two months later, when Monique was four months pregnant, another argument occurred. Monique and Sam began yelling at one another and Sam pushed Monique, knocking her backwards into the table and onto the floor. Monique was stunned and hurt. Her hip was bruised, and her finger felt broken. Sam saw Monique may have been hurt and was alarmed. He apologized many times, told Monique he loved her, and suggested they keep this secret. Because Monique was embarrassed, she agreed. The obstetrics (OB) nurse who will be caring for Monique through the pregnancy saw her for the first visit the following day. The OB nurse noticed the bruises and that Monique was favoring her finger. The nurse asked Monique about the injuries, and she stated she tripped and fell. Monique’s pregnancy was unremarkable for the next couple of months and Sam and Monique decide to move to an apartment, away from her mother. Sam seemed happy with the pregnancy; however, Sam hit Monique three different times when they had disagreements. Monique usually became quiet and attempted to restore peace. She became increasingly anxious and unusually quiet during medical visits. The OB nurse continued to visit the family and observed Monique’s behav- ior change. She has also heard from Monique’s mother about Sam’s temper. Monique continued to deny she was being hurt or felt unsafe in her home; however, the nurse suspected Monique was experiencing intimate partner violence.
Self-Assessment Questions
8. What behaviors did Monique display that could indicate she was experiencing intimate partner violence? A) Excuses for injuries and/or inconsistent stories B) Increasingly anxious and unusually quiet during nurse visits C) Withdrawal D) None of these 9. Considering the determinants of health for this family (biology, individual behavior, health services, social factors, and policies), what are the risk factors for experiencing intimate partner violence in this case study? A) Increased stress on family (pregnancy, moving with each other) B) History of abuse as children C) Stable childhood with no history of abuse D) None of the above
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