1 Remember that domestic abuse doesn’t always leave physical evidence
Many practice nurses will have spotted evidence of domestic violence and abuse in patients where there is injury. But vigilance for less overt signs of abuse – such as bullying, self-harm or neglect, forced marriage and medication abuse – is vital.
2 Listen, observe, communicate and act
These steps will help identify patients at risk of domestic abuse. Remember that victims cannot be objectively stereotyped or characterised and will represent diverse members of the community.
3 Listen to how the patient communicates
Listening to patients can reveal hidden abuse that may not be evident physically but is more subtly presented. Hints in the language or lack of communication where it is known the patient can or usually does express their wishes, may suggest there is an issue that they need encouragement to speak about. For example, consultations where the patient is always accompanied and appears not permitted to speak, may prompt concern.
4 Observe the non-verbal behaviour of patients in a care setting
Identifying non-verbal, challenging or unusual behaviour can indicate care needs that have not been explored. Observation of the person may indicate the physical signs and symptoms of domestic abuse that cannot be fully explained. Alternatively, observation of living conditions can reveal issues that may require further consideration.
5 Check how the patient manages their own health
It is similarly important to observe how people manage their health as this may also indicate domestic abuse. For example, patients may not be allowed money to pay for essential medications and present for care more frequently than is normal for them. Attendance for care with little evidence of a need for the appointment may also cause concern if it is not in character for the patient.
6 Communicate your concerns if domestic abuse is suspected
If domestic abuse is suspected, it is important to not only explore this with the patient but also remember that their safety is paramount at all times. For some practice nurses this may be challenging in terms of time management and the fear that this may lead to ramifications if their suspicions are correct or cause distress in the patient if they are incorrect. Therefore, sensitively communicating concern to the patient about their personal circumstances is important and this may enable them to speak about their situation. It is also unlikely that sensitive communication around this subject will cause offence.
7 Act accordingly when abuse is disclosed
Engaging with education and training to ensure that current guidelines for practice are known is essential.1,2 It is important to know what guidelines are in place in your own practice to support those who disclose abuse, and this may include the provision of specialist support or helpline numbers. There are many training initiatives available locally, often delivered by specialist agencies and organisations.
8 Know the up-to-date definition of domestic violence and abuse
‘Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse: psychological, physical, sexual, financial or emotional.’
This definition also includes so called ‘honour’-based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.3
9 Understand controlling behaviour
It includes a range of acts designed to make a person subordinate or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape, and regulating their everyday behaviour.3
10 Understand coercive behaviour
This is an act or pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish or frighten the victim.3
- NICE. Domestic violence and abuse: Quality standards. London;NICE:2016
- NICE. Domestic violence and abuse: how social care, health services and those they work with can identify, prevent and reduce domestic violence and abuse. London;NICE:2014
- Home Office. Guidance: Domestic violence and abuse. London;gov.uk:2013
- Independent Domestic Abuse Services. Domestic Abuse: Basic Awareness Training idas.org.uk/training/
- Safe Lives. Ending domestic abuse safelives.org.uk/
Dr Julie McGarry is a registered adult and mental health nurse and an associate professor at the University of Nottingham
Jacqui Carr is an assistant professor of adult nursing at the University of Nottingham