Detail of engraving style illustration of a woman holding up a hand in defense.

Change is Possible

This post is the last in a series exploring the history of nursing and domestic violence from the guest blogger Catherine Jacquet, Assistant Professor of History and Women’s and Gender Studies at Louisiana State University and guest curator of NLM’s exhibition Confronting Violence: Improving Women’s Lives.

Cover of “The Battered Woman”
The American College of Obstetricians and Gynecologists define for member physicians “The Battered Woman,” 1989
Courtesy American College of Obstetricians and Gynecologists

By the early 1990s, change was on the horizon. Several of the major professional medical organizations recognized domestic violence as a significant health issue and urged their constituencies to take action—this reinforced over a decade of advocacy and activism by nurses and their allies. In January 1989, the American College of Obstetricians and Gynecologists (ACOG) announced a campaign to combat domestic violence. With Surgeon General C. Everett Koop, former ACOG president Dr. Luella Klein held a press conference declaring that, “violence against women is not tolerable in our society.” Klein announced that all 27,000 members of the ACOG would be receiving information “that will equip them to detect when one of their patients is the victim of battering.” This could make a significant difference in the lives of thousands of women. “Because ob/gyns are the health professionals who care for many women,” Klein continued, “they play a vital role in at least being in a position to detect when a woman may be the victim of abuse.” That same month the ACOG released a technical bulletin titled “The Battered Woman,” which outlined the definition, incidence, and public health impact along with the importance of identifying abuse victims and methods for intervention.

Three years later, in January 1992, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) followed suit and required that all accredited hospitals implement policies and procedures to identify, treat, and refer victims of abuse. This requirement included an educational component in domestic violence, elder abuse, and child abuse for all hospital staff.

First page of Journal Article
American Medical Association Diagnostic and Treatment Guidelines on Domestic Violence,” Archives of Family Medicine, 1992
Courtesy National Library of Medicine

Of particular significance, the American Medical Association issued “Diagnostic and Treatment Guidelines on Domestic Violence” in September 1992. Prepared by pioneer reformers including Anne Flitcraft, MD, Susan Hadley, MPH, and Carole Warshaw, MD (none of whom were members of the AMA), these guidelines marked a critical turning point in the history of medicine and domestic violence. Recalling the publication of the guidelines, Anne Flitcraft explained in an interview, it gave “the imprimatur of real medicine… this says violence against women, domestic violence, is real medicine.” In addition, both the Council on Ethical and Judicial Affairs and the Council on Scientific Affairs of the AMA published reports on violence against women in the June 1992 issue of the Journal of the American Medical Association (JAMA). The Council on Ethical and Judicial Affairs stated that physicians had an ethical obligation to intervene in cases of domestic violence and the Council on Scientific Affairs issued policy recommendations which included undertaking a campaign to educate the healthcare community on violence against women and training physicians to identify, validate, and refer victims of violence to the appropriate resources. These JAMA publications marked a sea change from 14 years prior when a 1978 article in the same journal reported that the discussion of spouse abuse in the medical literature was rare. After over a decade of advocacy and education, nurses, physicians, social workers, public health officials and other reformers within the healthcare system had made a significant impact in the identification and treatment of victims of domestic violence.

By 1992, Jacquelyn Campbell could write with confidence, “No one doubts any more that violence is a serious health problem. No one doubts that the health care system must become involved in decreasing violence.” Nurses played a critical role in this transition. As they came to consciousness about the issues facing battered women, nurses advocated, educated, and organized nationally. In various capacities, nurses sought to both alleviate injury and ultimately prevent violence against women. Their impact was significant. Following 15 years of working and education on the issue of battering, Campbell wrote, “I am deeply gratified to see the official health policy-making bodies recognize what many of us in nursing have been working on for a long time. I am proud that nursing has taken a leadership role in changing health care policy about violence.”

Learn more about why NLM is hosting this important exhibition.

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