It is not just about hitting or punching. It is a pattern of assaultive and coercive behavior, including psychological, sexual and physical abuse" (Salber & . Taliaferro). The syndrome of dominance and control the perpetrator initiates leads to the victim's increasing entrapment, also known as the "battering syndrome." Domestic violence, "Practice standards for working with women affected by domestic and family violence (2002), an Australian publication explains, denotes violence between individuals indicated in the domestic violence legislation. DV encompasses physical abuse such as hitting, punching, slapping, shoving, as well as other varieties of physical and sexual assault. DV includes:

Determined injury;

Determined damage to property;

harassment or intimidation, includes stalking;

Indecent behavior toward the spouse/partner without the spouse consenting; and A threat or effort to commit whichever of the above ("Practice standards…," 2002).

In addition to physical abuse, DV may include various other behaviors to gain/maintain power and control over the victim and/or frighten the victim, for example, the abuser may threaten "to injure or otherwise harm the spouse or the spouse's children, or constantly following a spouse. It is the important elements of fear and intimidation that distinguishes between conflict in a relationship and domestic violence" ("Practice standards…," 2002, p. 8). Physical violence, one major risk factor for the development of mental illness in women, may contribute to anxiety disorders such as post traumatic stress disorder (PTSD). According to Baca-Garcia, Perez-Rodriguez, Mann and Oquendo (2008), higher rates of domestic violence or sexual abuse link to increased risk for mental health disorders, suicidal ideation and attempts. Pailler et al. (2007) concur that those individuals who suffer repeated physical violence report more symptoms of posttraumatic stress disorder and depression. Therefore, the researcher asserts, identifying the risk factors which increase the probability of women becoming victims of recurring violent acts, along with identifying those currently being abused, proves vital. The development and implementation of evidence-based practice protocol to identify victims of DV, the primary focus of this capstone, the literature reveals, comprises a significant study effort.

Study Aim and Objectives

As this Capstone project investigates the development and implementation of an evidence-based practice protocol in the researcher's clinical specialty area, domestic violence and Hispanic women, the researcher also identifies and describes this current critical concern. The objects for this study include:

To review and analyze the current research and clinical literature pertinent to the key issues of an EPBB, relating to domestic violence and Hispanic women, including published standards.

To implement an existing EBPP in the researcher's clinical setting in work as an APN.

To provide a theoretical base for the proposed EBPP: physiological/psychological/pathophysiological, behavioral, developmental theories.

To describe/develop the EBPP, and describe the process for its implementation in the researcher's practice setting, including EBPP document as appendix.

To identify ways in which the effectiveness of the EBPP will be evaluated and documented; to identify outcomes.

To describe the cost implications of the new EBPP, and how the implementation of this EBPP will be financed.

To summarize the significance of this case to the APN role, e.g., identify relevant specialty competencies.

To create a letter of inquiry for submission to relevant journal to determine possibility for publication of project paper.

The next section of this Capstone relates a synopsis of literature related to this study's focus to fulfill the aim and objectives. During the process, the reader's understanding of DV, as well as IPV, confirmed to be a primary public health concern, not only in the U.S., but worldwide will increase. The researcher's hope for this study includes the desire that the related information regarding EBPP will ultimately contribute to helping decrease reported and unreported statistics regarding DV.

RELATED LITERATURE

"My abuser didn't learn it [to be an abuser] off the TV.

My husband learned it from his dad"

(Tilley & Brackley, 2004, Developmental critical…section, ¶ 4).

Increasing Concerns

The prevalence of domestic violence among Hispanic women in the United States reportedly increases each year, simultaneously posing a high threat for the development of mental illness among this population. According to Rodriguez, Heilemann, Fielder, Ang, Nevarez, and Mangione (2008), Hispanic women who experience physical violence are at increased risk for mental and physical problems including depression, anxiety and substance abuse. To increase reports of domestic violence, it proves crucial on understand sthe cultural beliefs and practices of Hispanic women. This knowledge and awareness consequently will facilitate healthcare providers to specifically assess Hispanic women who present with...

Some of these women are brought up in homes with male role models who controlled and manipulated other family members. A number of these women also suffered sexual abuse when a child. It is common for Hispanic women to perceive violence as acceptable since many grew up in abusive homes. Young females who become involved in abusive relationships during early adulthood often come from a family with history of intimate partner violence (Pailler, Kassam-Adams, Datner, & Fein, 2007).
For Latino women, the family is of utmost importance. Therefore, women frequently neglect their own health needs. Maternidad Latina (2008) observes that pressure to "keep the family together" may come from family or church members, even if it means suffering more abuse. Religious and societal beliefs may contribute to woman feeling guilty if/when she leaves her abusive partner or acts against his will. Hispanic women, particularly immigrants, may not be familiar with U.S. laws that protect women and children against violence, and not realize these laws may differ considerably from those in other countries. The Hispanic woman may also fear involving the law because of her immigration status. Other factors which may restrain Hispanic women from seeking help include the language barrier and lack of financial means.

One vital element for developing an evidenced-based protocol for Hispanic women suffering from domestic violence and mental illness involves providing cultural sensitive interventions. According to National Alliance of Mental Illness, the first component is the education of Hispanic women about domestic violence, as well as the negative effects of DV on mental and physical health. The women also need to be advised of specific available community resources for victims of domestic violence and treatment options.

In 2006, statistics reported the percentages of females with mental health disorders to be higher than in males. Furthermore, Hispanics reportedly have the highest percentage for mental illness and substance abuse. During 2006, this was noted be as high as 86.9% for the Hispanic population, according to the Substance Abuse and Mental Health Service The percentage of women treated for psychiatric disorders, reportedly has increased each year. The researcher presents a significant amount of quantitative data on this population, accessed from the Substance Abuse and Mental Health Service Administration (SAMHSA) in this Capstone's Appendices. SAMHSA reports include demographic data such as gender, age distribution, race/ethnic distribution, employment status, and living situation (Table 1, 3 & 4).

Studies indicate that mental health disorders are more prevalent among females than in males. A large volume of this researched evidence suggests the reason relates to the higher rate of sexual and physical abuse in females. According to Dixon, Howie, and Starling (2005), as noted in this Capstone's introduction, abuse serves as an overwhelming risk factor for depression and posttraumatic stress disorder in females. In the study Dixon, Howie, and Starling conducted, 70% the female participants who suffered from posttraumatic stress were victims of domestic violence and sexual assault.

Due to the physical abuse they experience, many adolescent females, Dixon, Howie, and Starling note, also have dual diagnosis of depression, panic disorder, and/or substance abuse. Several interventions that will impact and improve the health and quality of life of this population include:

Prompt and accurate assessment of physical abuse through a domestic violence assessment tool; and Proper use of mental health resources and referrals.

Myths and Facts Regarding DV

The online publication, "Myths and facts about domestic violence" (2009) clarify the following five myths relating to DV:

MYTH 1

Domestic violence does not affect many people.

FACTS

A woman is beaten every 15 seconds. (Bureau of Justice Statistics, Report to the nation on Crime and Justice. The Data. Washington DC Office of Justice Program, U.S. Dept. Of Justice. Oct 1983)

Domestic violence is the leading cause of injury to women between ages 15 and 44 in the United States - more than car accidents, muggings, and rapes combined. (Uniform Crime Reports, Federal Bureau of Investigation, 1991)

Battered women are more likely to suffer miscarriages and to give birth to babies with low birth weights. (Surgeon General, United States, 1992)

MYTH 2

Battering is only a momentary loss of temper.

FACTS

Battering is the establishment of control and fear in a relationship through violence and other forms of abuse. The batterer uses acts of violence and a series of behaviors, including intimidation, threats, psychological abuse, isolation, etc. To coerce and to control the other person. The violence may not happen often, but it remains as a hidden (and constant) terrorizing factor. (Uniform Crime Reports, Federal Bureau of Investigation, 1990)

"One in five women victimized by their spouses or ex-spouses report they…