- WITHIN THE LAST YEAR, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
If YES, by whom?_____________
Total number of times__________
- SINCE YOU’VE BEEN PREGNANT, have you been hit, slapped, kicked, or otherwise physically hurt by someone?
MARK THE AREA OF INJURY ON THE BODY MAP.
SCORE EACH INCIDENT ACCORDING TO THE FOLLOWING SCALE:
Scale Abuse Score 1 Threats of abuse including use of a weapon 2 Slapping, pushing; no injuries and/or lasting pain 3 Punching, kicking, bruises, cuts and/or continuing pain 4 Beating up, severe contusions, burns, broken bones 5 Head injury, internal injury, permanent injury 6 Use of weapon; wound from weapon
- WITHIN THE LAST YEAR, has anyone forced you to have sexual activities?
If YES, by whom?__________
Total number of times_____________
Developed by the Nursing Research Consortium on Violence and Abuse. Readers are encouraged to reproduce and use this assessment tool.
Source: McFarlane & Parker, (1994). In Fishwick, N. (1998). Assessment of women for partner abuse. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 27, 661-670. Reproduced with permission.
Note: this tool is validated