Background. The transtheoretical model of change (TTM) was used as a framework to examine the steps that women took to disclose intimate partner violence (IPV) in urban emergency departments. Methods. Mapping methods portrayed the evolving nature of decisions that facilitated or inhibited disclosure. This paper is a secondary analysis of qualitative data from a mixed methods study that explored abused women’s decision making process about IPV disclosure. Findings. Change maps were created for 19 participants with movement from the precontemplation to the maintenance stages of the model. Disclosure often occurred after a significant “turning point event” combined with a series of smaller events over a period of time. The significant life event often involved a weighing of options where participants considered the perceived risks against the potential benefits of disclosure. Conclusions. Abused women experienced intrusion from the chaotic nature of the emergency department. IPV disclosure was perceived as a positive experience when participants trusted the health care provider and felt control over their decisions to disclose IPV. Practice Implications. Nurses can use these findings to gauge the readiness of women to disclose IPV in the emergency department setting. 1. Introduction The emergency department may offer a “window of opportunity” for women to discuss their experiences of intimate partner violence (IPV) with nurses and other health care providers. Exposure to IPV impacts women’s health leading to acute and long-term physical and mental impairment [1–4]. Lifetime prevalence of IPV reported in the emergency department ranged from 37% [5] to as high as 50% [6]. The emergency department is a health care setting where abused women often seek treatment and may disclose at higher rates than other health care settings [7–9]. Due to the frequency with which abused women seek health care, many health care settings continue to adopt IPV-screening initiatives, and health care providers are encouraged to ask about violence as part of their routine care of women [4, 10, 11]. While abused women may seek care in the emergency department, many travel through the system without being recognized as exposed to violence [12]. This is problematic in that nurses, who may be the first point of contact for abused women, may miss an important opportunity for assessment. This is compounded by the fact that emergency department nurses, like other health care providers, continue to face challenges in the detection and documentation of IPV [13–15]. Common barriers to
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