Domestic and Intimate Partner Violence

Core Concepts

What counts as IPV

The key word is pattern. A single push during an argument is concerning, but IPV is defined by a pattern of coercive control — the abuser uses a mix of tactics (physical, sexual, psychological, economic) to keep power. This is why two people can describe different "types" of abuse and still both be experiencing IPV. Coercive control also explains why someone can be abused without ever being hit: threats, isolation, and financial control are abuse too.

IPV and pregnancy

Pregnancy changes the dynamics of abuse in ways nurses must anticipate:

• Abuse may begin during a first pregnancy or escalate in frequency and severity.
• The pregnant person may be hit in the abdomen or breasts, or sexually assaulted.
• Fear and control may lead to delayed or missed prenatal care, hiding the pregnancy, or avoiding care because the partner will not allow it.
• The stress of living with violence can affect the pregnancy, and after birth the newborn enters a household where violence continues.

The cycle of violence

A classic framework describes three phases that can repeat: tension building (the abuser becomes irritable and controlling; the survivor tries to keep the peace), acute explosion (an incident of physical or severe psychological abuse), and honeymoon (the abuser apologizes, promises change, and is affectionate). The honeymoon phase is why many survivors hope the abuse will stop and why leaving is so hard. Important caveat: this cycle is a model, not a universal law — some abuse has no honeymoon phase, and some is constant rather than cyclical. Treat it as one tool for understanding, not a checklist that must fit every situation.

Screening and assessment

Perinatal standards support universal screening — asking every pregnant person about IPV, not just those who look "at risk." Best practice elements:

• Ask when the partner, family members, and any children over about age 2 are not in the room; asking in front of a partner is unsafe.
• Use simple, direct, validated questions (e.g., "Has your partner ever hit, choked, or physically hurt you? Has your partner ever made you feel unsafe or forced you to do something sexual?"). Exact wording and screening tools vary by institution.
• Offer the same questions to everyone so that no one is singled out.
• Document objectively: record the person's words in quotes, describe visible injuries with a body diagram if available, and avoid conclusions such as "patient is lying" or "patient provoked the abuse."
• Know your state's mandatory reporting rules: requirements differ for abuse of minors, older adults, and people with certain disabilities, and some states have specific duties around pregnant people. Institutional policy governs who files what — flag uncertainty for review rather than guessing.

The nurse's role and safety planning

The nurse does not "fix" the situation or force a decision to leave — leaving is a process and can be the most dangerous time. The nurse's role is to validate, inform, and connect:

• Believe the person; thank them for telling you; make clear the abuse is not their fault.
• Provide information about local resources (advocacy programs, shelters, hotlines) in a form the person can take discreetly, and ask how they would prefer to receive it.
• Help them think through a safety plan (what to do during an incident, where to keep important documents, a code word with a trusted person) — this is often done with a social worker or advocate.
• Never confront the partner, and never hand the patient printed resources if the partner controls the mail or phone.
• Follow the scope of practice for your role: an RN screens, supports, documents, and refers; initiating certain interventions or counseling may require advanced practice or social work involvement per institutional policy.

Common Confusions