As some on TV talk shows wonder aloud, humorously or otherwise, what nurses really do, it's important to understand the role they have played in changing health care. This is especially true in how the entire medical sector looks at and responds to domestic violence.
This history is documented in a new exhibit at the National Library of Medicine that highlights some of our research. "Confronting Violence, Improving Women's Lives" tells the story of nurses who pushed the medical community to identify victims of battering, adequately respond to their needs and work toward the prevention of domestic violence.
When nurses began mobilizing around domestic violence in the late 1970s, they faced a dismal situation. Women who were battered routinely faced dismissal, neglect or hostility when they sought medical services.
One woman who suffered excessive beatings by her husband reported that she was given "little pills to relax me and told to take things a little easier. I was just too nervous. … I did go to two more doctors. One asked me what I had done to provoke my husband. The other asked if we had made up yet." Her story is reinforced by similar accounts from thousands of other abused women at the time.
Consistent with larger legal and social trends, most medical professionals viewed the issue of battering as a "private matter," one the provider sought to keep at a distance. As one doctor explained, when presented with a woman who he suspected may have been hit by her husband, "We don't have the time or the inclination to go into sociological background as for the reason of the assault. … it's a personal problem between a man and wife."
During the mid-1970s, grassroots feminist activists launched a nationwide battered women's movement, calling attention to the plight of abused women and exposing the failures of the law, medicine and society-at-large in responding to the 2 million to 4 million women a year who were beaten in their homes. Nurses took up this call to action.
Emergency department nurses at Brigham and Women's Hospital in Boston in 1977 were the first in the nation to initiate and implement a protocol for the identification and treatment of women who were battered. Under this protocol, the examining nurse was to approach the patient openly and sensitively, use techniques of crisis intervention and offer counseling services. If she agreed to counseling, the woman would then meet with a social worker who would provide emotional, legal and community support. In the first three years of service, the program identified 211 battered women.
The problem of domestic violence was so pervasive that a nursing expert wrote in a professional journal in 1981 that her "rule of thumb, learned after many years of working with battered women, is to suspect nearly any woman with trauma of having been battered, unless there's incontrovertible evidence to the contrary."
Speaking to their unique role, nurse reformers in Kentucky wrote, "You may be the first person who expresses awareness of and concern about her problem."
Another nurse explained that medical personnel could "raise women's consciousness and tell them, 'Help is available. You do not have to put up with this.' Then we hope that, ultimately, they will seek it out."
In 1985 U.S. Surgeon General C. Everett Koop convened a workshop on Violence and Public Health. Nurses who attended the workshop created The Nursing Network on Violence Against Women, an organization founded "to encourage the development of an informed nursing practice on the range of health issues relating to violence against women."
The workshop also galvanized the public health community to identify domestic violence as a priority health issue in the late 1980s. By the 1990s, all the major medical and nursing organizations recognized domestic violence as a significant health issue and urged their members to take action.
Domestic violence is an issue that continues to require significant attention, both from within the medical community and outside of it. Nurses, and all of society, must redouble their efforts to confront this epidemic. History tells us activism can make a difference.
Jacquelyn Campbell (firstname.lastname@example.org) is a professor and holds the Anna D. Wolf Chair at the Johns Hopkins School of Nursing. Catherine Jacquet (email@example.com) is an assistant professor of history and women's and gender studies at Louisiana State University. Their research is a key part of NLM's new exhibit "Confronting Violence: Improving Women's Lives."