Domestic Violence: The Florida Requirement _ ____________________________________________________
In 2007, the Domestic Violence Leave Act was signed into law by Governor Charlie Crist [21]. This law requires employers with 50 or more employees to provide guaranteed leave for domestic violence issues. In 2020, the FDLE reported 106,736 domestic violence offenses [8]. In general, domestic violence rates have been declining since 1998. An estimated 19.5% of domestic violence incidents involved spouses and 27.8% involved cohabitants; 11.6% of the victims were parents of the offenders. Domestic violence offenses resulted in the death of 217 victims in Florida in 2020, a number that has been decreasing since 2014 [8]. Domestic violence accounted for 16.9% of the state’s murders in 2020 [8]. In their 2019 Annual Report, Fatality Review Teams summa- rized 31 cases of domestic violence fatalities and near fatalities [49]. The most significant findings included the following observations [49]: • The perpetrators were predominantly male (94%) with female victims (90%) and had prior criminal histories, non-domestic-violence-related (67%) and for domestic violence specifically (69%). • In 31% of fatalities, the perpetrators had a known “do not contact” order filed against them, and 13% of perpetrators had a known permanent injunction for protection against them filed by someone other than the victim. • Substance abuse histories by the perpetrator was identified in 77% of the cases and diagnosed mental health disorders in 45%. • In most cases, neither the decedent nor perpetrator sought help from the various intervention programs available to them. To obtain a copy of the most current Florida Statewide Domestic Violence Fatality Review report, please visit https:// www.myflfamilies.com/services/abuse/domestic-violence/ resources/domestic-violence-reports-publications.
Many victims of abuse sustain injuries that lead them to present to hospital emergency departments. Research has found that 49.6% of women seen in emergency departments reported a history of abuse and 44% of women who were ultimately killed by their abuser had sought help in an emergency department in the two years prior to their death [25; 50]. Another study of 993 police-identified female victims of IPV found that only 28% of the women were identified in the emergency depart- ment as being victims of IPV [26]. These alarming statistics demonstrate that healthcare professionals who work in acute care, such as hospital emergency rooms, should maintain a high index of suspicion for battering of the patients that they see. Healthcare professionals who work in these settings should work with hospital administrators to establish and institute assessment mechanisms to accurately detect these victims. For every victim of abuse, there is also a perpetrator. Like their victims, perpetrators of domestic violence come from all socioeconomic backgrounds, races, religions, and walks of life [1; 4]. Accordingly, healthcare professionals should likewise be aware that seemingly supportive family members may, in fact, be abusers. PREGNANT WOMEN Because a gynecologist or obstetrician is frequently a woman’s primary care physician, the American College of Obstetricians and Gynecologists (ACOG) recommends that all women be routinely assessed for signs of IPV (i.e., physical and psycho- logic abuse, reproductive coercion, and progressive isolation), including during prenatal visits, and providers should offer support and referral information for those being abused [25]. According to the ACOG, IPV affects as many as 324,000 pregnant women each year [25]. A meta-analysis of 92 inde- pendent studies found that the average reported prevalence of emotional abuse during pregnancy was 28.4%, physical abuse was 13.8%, and sexual abuse was 8% [51]. As with all domestic violence statistics, these estimates are presumed to be lower than the actual incidence as a result of under-reporting and lack of data on women whose pregnancies ended in fetal or maternal death. This makes IPV more prevalent among pregnant women than some of the health conditions included in prenatal screenings, including pre-eclampsia and gestational diabetes [25]. Because 96% of pregnant women receive prenatal care, this is an optimal time to assess for domestic violence and develop trusting relationships with the women. Possible factors that may predispose pregnant women to IPV include being unmarried, lower socioeconomic status, young maternal age, unintended pregnancy, delayed prenatal care, lack of social support, and use of tobacco, alcohol, or illegal drugs [25; 51]. The overarching problem of violence against pregnant women cannot be ignored, especially as both mother and fetus are at risk. At this particularly vulnerable time in a woman’s life, an organized clinical construct leading to immediate diagnosis and medical intervention will ensure that therapeutic oppor-
IDENTIFYING GROUPS AT RISK FOR DOMESTIC VIOLENCE
Healthcare professionals are in a critical position to identify domestic violence victims in a variety of clinical practice set- tings. Nurses are often the first healthcare provider a victim of domestic violence will encounter in a healthcare setting and should therefore be prepared to provide care and support for these victims. Although women are most often the victims, domestic violence extends to others in the household as well. For example, domestic violence includes abused men, children abused by their parents or parents abused by their children, elder abuse, and abuse among siblings [3].
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