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Domestic violence can seriously damage your health

Debbie Mehaffy

Women's Aid
Northern Ireland

It might surprise you to learn that one in four women will, at some time in their life, experience domestic violence, either directly or indirectly. This article explores how nurses working in primary care can assist women who are suffering abuse, by asking the right questions ...

"I will qualify as a learning disability nurse in a couple of weeks. I want to offer help in any form to do with women in my field, eg, Easy-Read Booklets. I have been through domestic violence myself. Thanks - A"

Dear A,
Thank you for your written comments when asked by Women's Aid, "Have you any further suggestions on how we can work together to eliminate domestic violence?" at the recent Nursing in Practice event in Belfast. Your enquiry highlights the real need for discussion about this issue through seminars and workshops such as these.

When Women's Aid poses the statement "Domestic violence can seriously damage your health", whose health are we referring to? Well, we know from our work that one in four women will, at some time in their life, experience domestic violence, either directly or indirectly.

Consider for a moment how many women such as you are working within the nursing/caring field and yet also have personal experience of domestic violence? Think, too, of the many female patients being seen every day throughout your work-based practice who are similarly affected. We also know from UK research in 2007 carried out over a 100-day period by NSPCC, that it is estimated 205,000 children will witness domestic violence. Here in Northern Ireland a minimum of 11,000 children and young people live with domestic violence every day.

In Northern Ireland we have a government strategy entitled Tackling Violence at Home, which raises the issue of domestic violence across all government departments and voluntary agencies. An action plan is developed each year and one of the actions highlighted is to financially support a 24-hour freephone Helpline managed by Women's Aid. Between 2008 and 2009, 27,663 calls were made to the domestic violence Helpline, which is open to anyone affected by domestic violence. All callers to the Helpline are signposted to the appropriate support service. It is important to note, however, that domestic violence is considerably under-reported, so the statistics are unable to fully reflect the extent of the problem.

With over 30 years' experience of working with women on the issue of domestic violence, Women's Aid recognises that many women struggle to keep the issue hidden everyday, and for some, this may mean within their professional lives.

You may already know from your own experience that domestic violence takes many forms. Many women speak in terms of physical, emotional, sexual, verbal, and financial abuse, and how it can impact on the woman's role as a mother. We know from our work within Women's Aid that it can impact on women, children and young people's health and quality of life in the form of depression, insomnia, anxiety and unexplained somatic symptoms such as stomach pains, palpitations and headaches.

We know there are also many women who experience substance abuse issues, eating disorders and experience low self-esteem. I'm not sure if, within your own experience of domestic violence, you experienced physical abuse, but we know many women who have had physical injuries, such as bruises, burns, black eyes and have endured stillbirths and miscarriage.

Research carried out by the Northern Ireland Office for Statistics and Research Branch in 2008 entitled Experience of Domestic Violence noted that over 30% of all domestic violence starts during pregnancy.  Women's Aid in Northern Ireland has worked alongside maternity units to support the implementation of Routine Enquiry. As a result, all expectant mothers are now asked a series of questions in relation to their safety within their intimate relationships. If the issue of domestic violence is disclosed by the expectant mother, the nurse practitioner's role is to support the woman into appropriate services. 

The vision for the future involves routine enquiry in Northern Ireland being rolled out to other areas of health such as A&E, GPs, Well Woman Clinics, occupational health and all other health professionals. As well as work-based policies for staff and volunteers, I'm sure you would agree it would make disclosure for those experiencing domestic violence perhaps a little less painful if, as a society, within all our roles we spoke out and highlighted domestic violence as being wrong and a crime.

Within Women's Aid we recognise the apprehension of individuals and agencies, and we commonly hear, "But that will be like opening a can of worms!" Together with training, work-based policies and procedures we can support each other to ask the questions, with the overall aim to support and direct women, children and young people who are experiencing domestic violence into appropriate services.

How and when do we raise the question? 
With the patient on her own and with indirect questions such as, "How are you feeling?", "Is everything all right at home/do you get the support you need at home?" and "Do you get on well with your partner?" More direct questions could include, "Are you frightened of your partner?", "Do you feel unsafe at home?", "How did you get your injuries", "Has your partner ever hurt you?", "Has your partner ever hurt your children?" and "Do you have family or friends to support you?"
And then, if domestic violence is disclosed:

  • Respect the wishes of the individual involved and discuss the individual's immediate needs, eg, healthcare, personal safety, etc.
  • Accept what you hear and reassure her that the violence is not her fault.
  • Be sensitive and allow her to discuss her fears.
  • Let her know that she is not alone in being abused.
  • Refer into appropriate support agencies.
  • If it is believed that children are at risk, child protection policies and procedures must be adhered to.
  • Respect her right to choose to stay in the relationship.

Even then, with all the relevant policy and procedures in place, you still may not receive a disclosure. Be mindful of the fact that the person who is experiencing domestic violence is ultimately the only one who can predict the risks she faces, and the likelihood of further violence, and this may influence the timing of disclosures. However, remember too that you may be the first person who has said to the woman that domestic violence is wrong. You have planted the seed.

In acknowledging your own disclosure, I wonder in your experience when and where you received the message that domestic violence was wrong, and that you had the right to feel safe? Did you see any information leaflets, Helpline cards or posters in your work? Perhaps your workplace has a domestic violence policy. However, if you struggled to find the information, think how women may be struggling in your setting. If you're not seeing it, how will your patients? Or perhaps this is the first time acknowledging your own experience and making this disclosure. Women's Aid support services are here for you too.

Many women speak of the heartbreak of splitting up a home, of loving their partner and wanting their children not to be without a dad. Women experiencing domestic violence have taught Women's Aid through the years that they love the man, but they dislike his behaviour, as do children and young people - they love their dad, they just hate the way he behaves.

Leaving a violent relationship is not an event, it is a process, and it takes time. At no point does a woman, child or young person decide to be abused by the one they love. When there are signs of abuse or actual abuse, and the perpetrator states that they are sorry, from the woman, child or young person's perspective, there is hope. Hope that behaviours will change and the family will be like any other happy family. We cannot underestimate the investment in the feelings of hope. However, domestic violence will only stop when a perpetrator is willing to take responsibility for their behaviour.

So, A, when you replied as above, Women's Aid would like to acknowledge your own journey through domestic violence and offer you the support services available, if required, to continue your own personal journey. We would also very much like to accept your kind offer of support in bringing about further change in the form of easy-read leaflets to ensure we are reaching ALL women in as many environments as possible.

Women just like ourselves represent the one in four statistics throughout the UK who may be experiencing domestic violence, and who have a right to be informed of their right to feel safe, all of the time. This includes strong messages such as, "There is nothing so awful that you can't talk about it" and information on who to contact and the support services available.

Resource
Women's Aid Northern Ireland
24 Hour Domestic Violence Helpline: 0800 917 1414

To view our interesting new guide to counselling your patient as part of the Nursing in Product Outreach Programme, click here

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"There needs to be more awareness of emotional/psychological abuse" - Christina Milligan, Scotland