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Preparation is key in leaving an abusive relationship or situation. Nurses and healthcare providers must understand the tremendous courage required to leave. Empathy, encouragement, and proven tips may help individuals create an escape plan. Suggestions from the National Domestic Violence Hotline (1-800-799-7233) can be used to make an action plan, as violence may escalate once the decision to leave has been made.


An action plan should include steps for preparing for leaving, when leaving, and after leaving. In addition, the victim must consider the following areas for planning:


* Safety while living with an abusive individual


* Safety planning with children


* Safety planning with pets


* Safety planning during pregnancy


* Emotional safety planning



Remind patients of the need to create ways to ensure continued safety after leaving an abusive relationship. Planning with the help of healthcare professionals, friends/family, or trained personnel may offer strength and courage to leave. For an informed response see, "When Partners Turn Violent" in this issue.


National Domestic Violence Hotline. (2019). What is a safety plan? Retrieved from



A "patient-centered" focus using telephone intervention can effectively improve depression in military veterans, according to a recently published randomized clinical trial (Naik et al., 2019).

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The Journal of the American Medical Association (JAMA) Network Open published the results on August 7, 2019, in which veterans in the United States with uncontrolled diabetes and significant clinical depression participated. The results of a telephone-delivered, collaborative goal-setting intervention showed improved depression symptoms among the 225 study participants who were categorized as high-risk. The intervention also attempted to improve glycemic control, but the results did not show improvement in the veterans' diabetes.


Trained healthcare staff, including nurses, made the individualized calls to conduct behavioral counseling outside the healthcare setting. During the biweekly, then monthly, calls using the Healthy Outcomes Through Patient Empowerment intervention, healthcare professionals helped each veteran identify what was most meaningful to him or her, then set behavior goals to achieve those interests.


The results are significant considering that one-third of patients with diabetes have significant depression; these comorbid conditions increase the risk of functional impairment and death, while also increasing the need for healthcare access. Study authors noted the potential for alleviating depression using collaborative goal setting and behavior changes, and the value of care for chronic conditions that is delivered by telephone.


See also, "Out of the Foxhole: Spiritual Support for Veteran Nursing Students" in this issue.


Naik A. D., Hundt N. E., Vaughan E. M., Petersen N. J., Zeno D., Kunik M. E., Cully J. A. (2019). Effect of telephone-delivered collaborative goal setting and behavioral activation vs enhanced usual care for depression among adults with uncontrolled diabetes: A randomized clinical trial. JAMA Network Open, 2(8), e198634. doi:10.1001/jamanetworkopen.2019.8634 [Context Link]



Bloom (2013) reminds us to keep our eyes on God and what he says:


What Jesus did for James and the other disciples when he quieted the storm was a fear-transfer. One moment they feared the storm and the next moment they feared Jesus, with a holy, reverent fear. This storm was a gift from God to them because it taught them just how powerful Jesus was and deepened their faith in him. And it prepared them to weather other, even more deadly kinds of storms that lay ahead of them.


When the storms of life hit, they almost always appear stronger to us than God's Word. It is crucial for us to remember that our perceptions can be deceptive. When circumstances strike fear into your hearts, the questions we must ask ourselves is, where is your faith?


What God wants is for you to trust what he says over what you see. p. 25


-From Bloom, J. (2013). Not by sight: A fresh look at old stories of walking by faith. Wheaton, IL: Crossway.


PulseBeats is compiled by Karen Schmidt and Cathy Walker