Identifying domestic abuse is difficult even for physicians committed to helping victims. Physician reports illustrate the need to frame questions and develop indirect approaches that foster patient trust. Given the many barriers to screening and the rarity of direct patient disclosure, it may be more productive to redefine the goals of universal screening so that compassionate asking in and of itself constitutes the first step in helping battered patients.

This qualitative study aimed to describe, from the perspective of domestic violence survivors, what helped victims in health care encounters improve their situation and thus their health, and how disclosure to and identification by health care providers were related to these helpful experiences. Semi-structured, open-ended interviews were conducted with a purposeful sample of survivors in the San Francisco Bay Area. Data were analyzed using constant comparative techniques and interpretative processes. Twenty-five women were interviewed, the majority being white and middle-class, with some college education. Two overlapping phenomena related to helpful experiences emerged: (1) the complicated dance of disclosure by victims and identification by health care providers, and (2) the power of receiving validation (acknowledgment of abuse and confirmation of patient worth) from a health care provider. The women described a range of disclosure and identification behaviors from direct to indirect or tacit. They also described how-with or without direct identification or disclosure-validation provided "relief," "comfort," "planted a seed," and "started the wheels turning" toward changing the way they perceived their situations, and moving them toward safety. Our data suggest that if health care providers suspect domestic violence, they should not depend on direct disclosure, but rather assume that the patient is being battered, acknowledge that battering is wrong, and confirm the patient's worth. Participants described how successful validation may take on tacit forms that do not jeopardize patient safety. After validating the patient's situation and worth, we suggest health care providers document the abuse and plan with the patient for safety, while offering ongoing validation, support, and referrals.

No abstract

No abstract

This study describes the personal experiences of pregnancy for African-American women. Data were obtained from two group interviews with four African-American nurse-midwives who had experienced pregnancy and had extensive professional experience in the provision of health care services to pregnant African Americans. Three major themes were constructed from the interview narratives. The first concerned the experience of pregnancy as a transition experience from childhood to adulthood and from womanhood to motherhood, involving heightened senses of maturity, self-esteem, and intimacy. The second identified stresses experienced by African-American women, including the lack of material resources and emotional support. The last theme concerned the provision of effective support in pregnancy. The significance of interpersonal relationships with the pregnant women's mothers, other significant women, and their partners was described. Implications for practice included suggestions for the provision of effective emotional support from health care professionals such as attentive listening and the elimination of environmental factors that communicate lowered personal value.