Intimate partner violence (IPV), defined as 'behaviour adopted . . . to control [the] victim which results in physical, sexual and/or psychological damage, forced social isolation, or economic deprivation, or behaviour which leaves [the victim] . . . living in fear' (Easteal 1994: 86-93), has in recent times received much attention in the media. This reflects a change from IPV as nobody's business but the immediate family's to an issue that should be everybody's business. One of the factors instrumental in bringing about this change has been a number of studies, within Australia and internationally, that have highlighted the prevalence, risk factors and social and health consequences, for the family, society and individual, of women experiencing IPV (VicHealth 2004; Rodriguez et al. 2001; Yam 2000). The publication of findings from national studies, such as the VicHealth Study (2004), could be said to have heralded a campaign to bring about change in the way the general public perceives and deals with IPV. One aspect of this campaign was to educate the public through such means as television advertisements, currently being aired throughout Australia. The aim of these advertisements is to create a cultural shift in attitude and response to IPV. However, in order for real change to occur, women also have to feel they have somewhere to turn for help and to believe that, when they disclose issues of IPV, they will get the care, support and assistance they need.
Findings from a number of studies in Australia, Britain and North America suggest inadequate screening for women experiencing intimate partner violence at the primary health care level including EDs, with many not recognized as experiencing violence within their homes (Rodriguez et al. 2001; Webster & Creedy 2002; Gerard 2000; Yam 2000; Pakieser et al. 1998). Thus the question is raised, if women seek help from an ED, when and why are they likely to disclose, or be identified as, experiencing IPV? Following on from this, if disclosure is made, do these women then receive appropriate care and support? Exploring these issues allows nurses the opportunity to examine the care they provide to women experiencing IPV, to determine whether their individual and organizational care is indeed following current best practice.
With this in mind, this paper reviews the literature related to IPV to establish the extent of the problem and the risk factors for IPV as well as exploring the cost of IPV to women, their families and the community. The influence and impact of different types of care on women and the way women understand their experiences of care, is then explored.
Medline and CINAHL electronic databases were searched using 'intimate partner violence', 'domestic violence', 'nursing' and 'emergency department' as keywords. The reference lists of published paper were checked for additional sources and the Internet searched for reports and other relevant documents.
EXTENT OF THE PROBLEM
The World Health Organization (1999) estimates that between 10-69% of women worldwide experience IPV. Current research suggests 20-41% of women report IPV experiences in Western societies such as Australia, United States of America and Great Britain (VicHealth 2004; Yam 2000; Pakieser et al. 1998). While acknowledging the many facets of IPV, when discussing its prevalence, research is generally focused on the more easily measurable, physical violence. Therefore, it seems likely that these estimates significantly underestimate the true prevalence of IPV within our community. Studies conducted within Australia, Great Britain and the United States of America, find that between 30 54% of women will experience at least one episode of physical IPV within their lifetime (Pakieser et al. 1998; Gerard 2000; Richardson et al. 2002; Greenwood et al. 2002; Davis et al. 2003; VicHealth, 2005).
Similar results are provided when examining the prevalence of IPV in Australia, United States of America and Great Britain. …