a nurse is preparing to discharge a patient of family violence. what is priority

"Safety and security don't just happen: they are the result of collective consensus and public investment. We owe our children—the most vulnerable citizens in whatsoever society—a life free from violence and fearfulness. In social club to ensure this, nosotros must become tireless in our efforts not merely to attain peace, justice and prosperity for countries, but also for communities and members of the same family unit. We must accost the roots of violence."

—Nelson Mandela

Introduction

Information technology is at present xxx years since domestic violence first began to emerge every bit a meaning issue. Initially efforts focused on ensuring safety for women and children fleeing violent partners.

Over the years, this focus has broadened to include the serious effects of domestic violence on children, what can be done to assist perpetrators of corruption, and the needs of those affected past abuse in all areas including social services, housing, legal and most recently, health services.

While an enormous corporeality of piece of work has been washed to improve the safety of women and children in our customs, at that place is now a heightened concern nearly the many aspects of interpersonal violence that have an impact on the bones human right to alive a life free of violence and abuse, with recent data indicating violence against women remains a substantial problem within our community.

A office for nurses

Nurses are a large group of service providers who have a cardinal ethic of caring and an agenda of early on intervention and health promotion in their work to improve the health status of communities.

Equally a group of wellness workers, nurses traditionally take been reluctant to consider domestic violence as a health event, preferring instead to consider information technology to be the domain of social workers, psychologists and psychiatrists. Nurses have also been reluctant to embrace this consequence in hospital settings.

Despite this, nurses have an important role to play in their work in hospital and community settings, to assist women (and their children) who are victims of abuse/violence in a domestic state of affairs.

Evidence shows the furnishings of corruption/violence have a profound impact on women's and children'southward health, and that women regularly seek services from health care workers, including nurses, for health concerns related to this abuse/violence.

While domestic violence remains a serious and frequent aspect of women'south intimate relationships, and women and children suffer health consequences as a result, nurses take a significant role to play in working toward the prevention and early intervention of domestic violence.

Imagine what could be accomplished if all nurses were equally informed about domestic violence as they are about wound care, or diabetes management, for example?

What would it mean to nurses who are themselves living in abusive/fierce relationships, or other women living with abuse/violence whom nurses come across in the course of their work, if this topic could exist discussed in informed and supportive ways?

Information technology is imperative that nurses are prepared to educate themselves, and face their fears, values and beliefs, while working towards creating an environments for this to occur.

Definitions of domestic violence

These days it is common for the term 'intimate partner violence' to exist used. Others include 'family unit violence' (particularly in the context of violence in Aboriginal and Torres Strait Islander communities) or 'relationship violence'.

All of these terms refer to violence that occurs between people who are, or were formerly, in an intimate human relationship.

This violence can occur on a continuum of economic, psychological and emotional corruption, through to physical and sexual violence.

Men tin also be victims of this violence, merely evidence indicates the bulk of victims are women, and it is women who are more likely to suffer health consequences.

It is also known that such violence occurs across all cultural and socio-economical groups.

But also as understanding what domestic violence is, nurses require some insight into the nature of these relationships. Such relationships are not about isolated incidents of physical violence followed by long periods of harmony. Rather, they are extremely stressful, with women investing significant energy in preventing violent episodes, maintaining peace and harmony, caring for children while protecting them from the touch on of the abuse/violence, every bit well as living with the fear of precarious personal safe.

Very oftentimes women do non share this aspect of their relationship with others, or if they practice, are often not believed and therefore unable to get the help and support they need. Significantly, many women practice not desire the human relationship to end; but they exercise nonetheless want the violence to stop.

Occurrence

It is important for nurses to appreciate the scope of this problem. A national survey conducted past the Australian Bureau of Statistics found the prevalence of domestic violence in Commonwealth of australia is alarmingly high, with one in five women reporting beingness subjected to violence at some time in their adult life.

Health impact of violence

A recent review of international literature on abuse/violence identified a wide range of associated physical, neurological, psychological and psychogenic health problems.

Women who have been assaulted by their partner generally accept worse heath than other women. Health issues include chronic bug with digestion, stomach, kidney and bladder function and headaches, poorer pregnancy outcomes and lower birthweight babies.

Recognition by nurses almost the extent of these wellness consequences is primal to their commitment to working with women to accost the underlying cause of poor wellness.

Strategies and skills for nurses

Research suggests women who have been subjected to violence tend not to ask professionals directly for aid. In a recent women'south safety survey, 79% of women who had experienced physical attack and 81.25% who had experienced sexual assault had not sought whatever professional assist.

The range of barriers to disclosing domestic violence include:

• Fear for own prophylactic, or condom of children or other family;
• Deprival or atheism;
• Emotional attachment to, or love for partner;
• Commitment to relationship;
• Hope the behaviour would change;
• Shame and embarrassment;
• Staying for the sake of the children;
• Low and stress;
• Isolation;
• Lack of faith in other people's ability to help; and
• Belief in the value of cocky-reliance and independence.

When women do tell someone nearly the violence, few approach domestic violence services of the police. They are more probable to approach friends, family or the helping professions, and the response to disclosure is significant in determining the woman'south subsequent aid seeking behaviour.

Photograph: Pears2295/iStock

Assessment

When assessing women, nurses should be enlightened that some of the following concrete signs of injuries might exist related to domestic violence:

• Bruising in the breast and abdomen;
• Multiple injuries;
• Pocket-size lacerations;
• Ruptured eardrums;
• Delay in seeking medical attention; and
• Patterns of repeated injury.

All the same it is unlikely women will nowadays with a physical injury. They will more likely present with problems such as:

• A stress-related illness;
• Anxiety, panic attacks, stress and/or depression;
• Drug corruption including tranquilisers and alcohol;
• Chronic headaches, asthma, vague aches and pains;
• Abdominal pain, chronic diarrhoea;
• Sexual dysfunction, vaginal discharge;
• Joint hurting, muscle pain;
• Sleeping and eating disorders;
• Suicide attempts, psychiatric illness; or
• Gynecological problems, miscarriages, chronic pelvic pain.

The woman may also:

• Announced nervous, ashamed or evasive;
• Describe her partner as controlling or prone to anger;
• Seem uncomfortable or anxious in the presence of her partner;
• Be accompanied by her partner, who does most of the talking;
• Give an unconvincing explanation of the injuries;
• Exist recently separated or divorced;
• Be reluctant to follow advice.

If nurses recall a adult female in their intendance may be experiencing domestic violence, the particular of questioning volition depend on how well they know the adult female and what indicators they accept observed. Nurses should brainstorm with broad questions, such every bit:

• 'How are things at domicile?'
• 'How are you and your partner relating?'
• 'Is there annihilation else happening that may exist affecting your health?'

Specific questions linked to clinical observations could include:

• 'Yous seem very anxious and nervous. Is everything all right at home?'
• 'When I see injuries like this, I wonder if someone could have injure you?'
• 'Is there annihilation else that we haven't talked well-nigh that might be contributing to this condition?'

More direct questions could include:

• 'Are there ever times when you are frightened of your partner?'
• 'Are you lot concerned almost your safety or the prophylactic of your children?'
• 'Does the way your partner treats you ever make you experience unhappy or depressed?'
• 'I think there may be a link betwixt your affliction and the fashion your partner treats you. What exercise y'all think?'

How to respond

The response of nurses to women in these circumstances tin have a profound outcome on their willingness to open up upward or to seek assistance. Some responses to assist successful advice in these circumstances could include:

• Listening: Being listened to tin can exist an empowering experience for a woman who has been driveling.
• Communicating conventionalities: "That must have been very frightening for you."
• Validating the decision to disclose: "It must accept been hard for y'all to talk about this." "I'm glad you lot were able to tell me near this today.'
• Emphasising the unacceptability of violence: "You exercise not deserve to be treated this manner."

Photograph: XiXinXing/iStock

What non to say

Nurses should avert responses that undermine the woman'due south actions, such as:

• "Why do you stay with a person similar that?"
• "What could y'all have done to avoid the situation?"
• "Why did he hit yous?"

Profitable prophylactic

It is too imperative to assist the woman by assessing her condom and the safe of her children. To practise so, speak to the woman solitary and enquire her:

• Does she experience rubber going dwelling house after the date?
• Are her children safe?
• Does she need an immediate place of safety?
• Does she need to consider an culling exit from your building?
• If immediate safety is not an issue, what nigh her hereafter safety? Does she accept a plan of activeness if she is at chance?
• Does she have emergency telephone numbers (i.e. police force, women's refuges)?
• Help make an emergency plan: Where would she go if she had to go out? How would she get there? What would she have with her? Who are the people she could contact for support?
• Document these plans for future reference.

Act now

Nurses tin play an important role in working toward the creation of a violence complimentary community only they must showtime get informed. They must and then insist the organisations in which they work accept this responsibility and work together to create environments that support people experiencing domestic violence.

There is a growing sensation and commitment at wellness department level to address the personal, social and economical costs of abuse/violence, and then the time is ripe for nurses to act and ensure serious inroads are made in improving the wellness of all communities.

Charmaine Power, RN, Ph.D. is a senior lecturer in the school of nursing and midwifery at Flinders Academy, South Australia.

References

• WHO, Earth Report on Violence and Wellness, World Health Organisation, Geneva, 2002.
• ABS, Women's Safety Australia, Australian Agency of Statistics, Canberra, 1996.
• VicHealth, The wellness costs of violence: Measuring the burden of disease caused past intimate partner violence, Country Government of Victoria, 2004.
• Power, C. Reconstituting Self: A feminist post-structural analysis of women's narratives of domestic violence. Unpublished PhD Thesis, Flinders University, Adelaide, 1998.
• ABS, op cit.
• Campbell, J. Health consequences of intimate partner violence, The Lancet, 359, 2002, pp. 331-336.
• Renker, P. Keep a blank face. I need to tell y'all what has been happening to me: Teen'southward stories of corruption and violence before and during pregnancy, The American Periodical of Maternal Child Nursing, 27:2, 2002, pp. 109-116.
• McFarlane, J., Malecha, A., Gist, J., Watson, K., Crossbar, E., Hall, I. and Smith, S. An intervention to increase safety behaviours of abused women: Results of a randomised clinical trial, Nursing Research, 51:6, 2002, pp. 347-354.
• ABS, op cit.
• The Domestic Violence and Incest Resource Centre and Women's' Health W, Identifying Family Violence, Partnerships Against Domestic Violence, Canberra, 2002, p. 15.
• Keys, Immature. Against the odds: How women survive domestic violence—the needs of women and children experiencing domestic violence who exercise non use domestic violence and related crisis services, Function of the Status of Women, Canberra, 1998.
• The Domestic Violence and Incest Resource Centre and Women'southward' Wellness West, op. cit. p. 16. ibid. pp. 16-17. ibid. p. 18. ibid. p. 18.

Reprinted with permission of the ANJ. Power, C. Domestic violence: What can nurses do? Australian Nursing Journal, 12:5, 2004, pp. 21-23.

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