 |
|
 |
|
 |
|
|
|
|
Strive-Intimate Partner Abuse and the Role of the Dental Hygienist August, 2011 edition Intimate Partner Abuse and the Role of the Dental Hygienist By MariAnna Galeno An intimate relationship with another individual should provide both partners with feelings of satisfaction, belonging, confidence, excitement, joy and security. But for some, being in an intimate relationship provides feelings of worthlessness, fear, depression, anxiety, pain and dependency. Intimate partner abuse (IPA), or intimate partner violence (IPV), can include any type of abuse, whether physical, psychological/emotional, verbal or sexual, or any of these in combination. It occurs in an estimated 4 to 6 million relationships each year in the United States.[1] Contrary to many individuals’ beliefs, abuse is not experienced solely by females on the receiving end of their male partners’ actions. In fact, female abusers may be abusive to their heterosexual or lesbian partners, and homosexual males may abuse their male partners. A dental hygienist’s professional responsibility, in whichever clinical setting they choose to work, is to educate, screen for health issues, and offer preventive treatment procedures related to the patient’s oral cavity. It is very important, however, for a clinician to remember they are not dealing just with the oral cavity, but instead treating an entire individual—one who may or may not choose to share their problems, but most definitely will benefit from their help. It is also important for both clinician and patient to understand the patient’s right to privacy outlined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Patients’ private information is safeguarded under the Privacy Rule, a Federal law issued by the U.S. Department of Health and Human Services (HHS), which limits the use and disclosure of such information, whether it is medical, personal or financial, to strictly necessary uses.[2] Obviously, if the reporting of IPV is mandated in the jurisdiction in which the dental hygienist is practicing, then that would be considered a necessary disclosure of the patient’s private information. Discussed here are the most common reasons why people abuse others, and the types of abuse people suffer, in an effort to express the importance of clinicians taking an active role in helping the victims of abuse with whom they may come into contact in a clinical setting. Many factors have been recognized as causes why people abuse others, two of them being alcohol abuse and drug abuse. In fact, alcohol consumption is associated with increased risk for all forms of interpersonal violence, including, inconsistently, IPA by both men and women.[2] Another cause is related to the abuser’s own past experience of abuse, whether receiving it or observing it. According to Jewkes, The sons of women who are beaten are more likely to beat their intimate partners and, in some settings, to have been beaten themselves as children. The daughters of women who are beaten are more likely to be beaten as adults. Women who are beaten in childhood by parents are also more likely to be abused by intimate partners as adults. Experiences of violence in the home in childhood teach children that violence is normal in certain settings.[3] Different cultures have different opinions about abuse as well. In many cultures, abuse is encouraged as a form of punishment for misbehavior or as a way to ensure that one sex remains dominant over the other. Jewkes cites cross-cultural research suggesting that societies in which male dominance is prevalent have more intimate partner violence.[3] The stress associated with poverty is another factor regarded as contributory to IPA; although violence occurs in all socioeconomic groups, it is both more frequent and more severe in lower socioeconomic groups in diverse settings including the U.S., Nicaragua and India.[3] The reasons behind abuse vary just as much as the ways in which it manifests. Physical abuse may or may not be visible clinically. The physically abused might be kicked, punched, bitten, burned, grabbed, shoved, slapped or anything else the abuser can imagine that will cause pain. Sometimes the abuser will choose to inflict harm on areas of their victim’s body that they know outsiders will not be able to see without the victim intentionally revealing the injuries. According to Elaine Alpert, MD, MPH, of the Massachusetts Medical Society’s Campaign Against Violence, “Those who are abused in relationships often don’t ‘look battered.’ In fact, there may be no physical evidence of abuse at the time of your encounter with the patient.”[4] Psychological and emotional abuses can take place without any physical contact. The abuser can threaten their partner and make them fearful of actions that may happen rarely or never. The abused may be made to fear for his or her life, the lives of loved ones and possibly the safety of beloved pets. Abusers may also continuously put their partners down, making them believe they deserve the treatment they’re receiving; and, in turn, the abused may begin to agree. Some abused persons hear the specific and repeated messages of inadequacy that the abuser expresses and internalizes them, taking responsibility and blame for their own abuse, while others believe that they deserve abuse because of their choice of intimate partner.[4] Hurtful statements are made in every relationship; sometimes partners say things they know will hurt each other, and regret it soon after. It is a common occurrence, and apologies are usually made. But this behavior becomes abusive when it is done repeatedly, with intention, and is typically not the result of an impulse disorder or anger management problem.[4] Sexual abuse takes place when the abuser forces the partner to have intercourse or perform sexual acts against his or her will. According to Campbell, 40 percent to 45 percent of battered women experience a combination of physical and sexual abuse, and as result, their risk of health problems, particularly gynecological problems, is higher than for women who suffer physical abuse that is not sexual.[5] It is important to remember that men are victims of abuse just as women are, and that includes sexual abuse. Unless victims have recourse to help, constant abuse at the hands of someone they love can drive a person to extremes including self-injury or suicide. There is also the risk of being killed by the abuser. Though the legal obligation to report suspicions of IPV exists in only six states, as clinicians, dental hygienists must be aware of every clue they may observe from a patient that may indicate the desire to discuss their abuse.[6] Good rapport with their patients can help dental hygienists achieve a level of comfort at which an individual may choose to talk about his or her struggle. According to Rodriguez et al., found that 38 percent of women who had never had a discussion about abuse with a health care professional believed that clinicians would not be interested in discussing it, and 37 percent of this group were concerned about the practitioner maintaining confidentiality, versus 25 percent and 21 percent, respectively, among women who had already discussed abuse with a health care provider.[1] Something as simple as listening to someone express the difficult things that are going on in his or her life is sometimes all it takes to make a difference. If an individual does say that they are being abused, the clinician should refer to the appropriate agency for help. That could be a shelter, a law enforcement agency, or even a hotline with experienced professional available to offer them guidance. It is important to realize that not everyone who is in this type of situation will be open to the idea of letting someone close enough into their lives to help. But there are more subtle ways that help can be offered without even the exchange of words. Providing in-office resource pamphlets and information on shelters and other organizations available to help those in need is a wonderful way of offering this type of help without making the patient feel as though their privacy is being invaded. These materials could be left in common areas such as waiting rooms and even restrooms. The physical signs of IPA are not always visible to the dental hygienist unless they directly are related to the head and neck region or oral cavity. For this reason, clinicians must make themselves sensitive to patients’ behavior, emotional state and speech. An abused individual may not realize they appear to be in need, but an observant clinician may be able to identify a need and recommend the help available. Individuals in abusive relationships are often too afraid to discuss their home lives, so it is extremely important not to push, potentially offending them and completely turning them away. Offering oneself in any capacity—that includes just listening—may make all the difference to someone in need. It is important to be a source of support, not judgment. Comparable to our duty to report child abuse, this may indeed be a life-saving action.
Resources
References 1. Rodriguez MA, Sheldon WR, Bauer HM, Pérez-Stable EJ. The factors associated with disclosure of intimate partner abuse to clinicians. J Fam Pract. 2001; 50(4). Available at: www.jfponline.com/Pages.asp?AID=2211. 2. United States Department of Health and Human Services. Summary of the HIPAA privacy rule. USDHHS. Available at www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html. 3. Jewkes R. intimate partner violence: causes and prevention. Lancet. 2002; 359: 1423-9. Available at www.ayamm.org/english/Violence%20against%20women%201.pdf. 4. Alpert EJ. Intimate partner violence. the clinician’s guide to identification, assessment, intervention, and prevention. 2010. Available at: www.massmed.org/AM/Template.cfm?Section= 5. Campbell JC. Health consequences of intimate partner violence. Lancet. 2002; 359: 1331-6. Available at: www.nnvawi.org/pdfs/alo/Campbell_1.pdf. 6. Malecha AT, Lemmey D, McFarlane J et al. Mandatory reporting of intimate partner violence: safety or retaliatory abuse for women? Journal of Women’s Health & Gender-Based Medicine. 2000; 9(1): 75-8. Available at: www.nnvawi.org/pdfs/alo/Fredland_mandatory_reporting.pdf. MariAnna Galeno resides in Staten Island, New York and is a second-year student at New York University College of Dentistry currently working as a dental assistant. She will receive her associate’s degree in Applied Science in Dental Hygiene in 2012. She is passionate about dental hygienists becoming aware of and intervening in all aspects of human abuse. The faculty mentor for this project was Winnie Furnari, RDH, MS, FAADH, assistant professor, Dental Hygiene Department at New York University College of Dentistry.
|
|||
|
|||
|
|
