Domestic Violence: Nursing’s Silent Epidemic

During the COVID-19 lockdowns, reports of domestic violence increased significantly across the UK, and the latest figures show there has been little improvement.

All nurses need to understand and feel confident to respond when they are concerned about domestic violence, but it is a complex issue. And a problem that many nursing staff might face in their personal lives as well.

We spoke to nurses about their experiences and the many ways you can support your patients and colleagues facing abuse.

What is domestic violence?

The domestic violence charity Women’s Aid defines domestic violence as: an incident or series of incidents of controlling, coercive, threatening, degrading and violent behavior, including sexual violence.

Domestic violence can take different forms, including:

• physical violence
• psychological or emotional abuse, including gaslighting
• sexual abuse
• financial abuse
• coercive and controlling behavior
• digital/online abuse
• harassment or stalking
• Abuse based on “honor”
• forced marriage
• female genital mutilation (FGM).

Who may be affected?

Domestic violence can often go unnoticed, sometimes because there are misconceptions about who may be affected by it.

Abuse is not limited to a specific gender, race, sexual orientation, ability/disability, religion, culture or age group: it can happen to anyone.

Every community nursing service, unit and team will have at least one nursing staff member who is a victim of domestic violence.

And it’s not just a partner who can be abusive, but other family members can be perpetrators as well – including a child, sibling, parent or guardian.

Although women are more likely to be victims of violence, research from the Crime Survey for England and Wales estimates that between March 2022 and March 2023, 1.4 million women and 751,000 men experienced some form of violence domestic.

But it is the healthcare staff who are most at risk. In 2016, the Cavell Nurses Trust found that nurses are 3 times more likely to be victims of domestic violence than the average person.

Unfortunately, these findings still ring true: the nurses we spoke to all expressed despair over the prevalence of domestic violence among nursing professionals.

We spoke to an adult safeguarding manager at an acute general hospital, who wished to remain anonymous. He stated :

“Domestic violence is a silent epidemic in nursing. In some areas the prevalence in the general population is 1 in 3 – so statistically every ward, unit and community nursing team will have at least one nursing staff member experiencing domestic violence.

How to spot the signs

Nurses working in the community and GP practices are more likely to discover patients experiencing domestic violence, but everyone needs to know what to look out for, whether it’s our patients or our colleagues.

Sarah Murphy, counselor at the RCN Counseling Service, said: “Domestic abuse is everyone’s responsibility, and everyone has a role to play – whether you are an employer, representative, colleague or friend. »

Staying alert for signs of domestic violence in those around you is one way you can play your part. Although domestic violence takes many forms, there are some common factors.

Be careful :

• Physical injuries.
• Heavy clothing or makeup worn to cover injuries. Someone can cover up even in hot weather or wear sunglasses indoors or on cloudy days.
• Someone who is afraid or anxious about pleasing their partner.
• Someone who can’t access their own money. They may be unable to pay by card or may be trying to use a card in their partner’s name.
• Someone who is reserved and reluctant to engage in friendly conversation.
• Someone who is meek, fearful, or extremely apologetic.

How to start a conversation

A person experiencing domestic violence will likely be very hesitant to speak up at first.

If you have concerns about a patient or colleague, Sally Wilson, RCN UK professional lead for older people, people with dementia and adult safeguarding, suggests being patient and making every contact count . She says:

• Talking about domestic violence for the first time can be difficult for many survivors, who may experience feelings of guilt, doubt, and/or shame.
• As nurses, it’s important to understand this and try to create opportunities for people to talk – in clinics, in emergency departments and during routine visits.
• Asking questions about personal safety and whether people feel safe where they live is a useful opening question and should be incorporated into as many assessment forms as possible — make every contact count.
• Patients may confide in you when you provide one-on-one care or if you have been caring for them for some time and have developed mutual trust and respect. While workplaces can provide a safe space for colleagues experiencing domestic violence.
• The more we talk about domestic violence, the easier it is to talk about it. This allows healthcare workers and their patients to have a more “normalized” view of domestic violence. Over time, survivors will feel empowered to reveal their stories and seek help.

Counselor Sarah also advises keeping the conversation open: “Sometimes people come to us to discuss a different issue, not recognizing that they are experiencing domestic violence until we alert them, especially if it’s more subtle. »

Mary’s story

Maria escaped an abusive and controlling marriage and rebuilt her life and career. She now works in mental health nursing, but has discovered that restraining patients can trigger her past trauma.

Although she was exempt from attendance requirements, she found that some colleagues were unsupportive when she did not participate. “I felt like I was avoiding my tasks or being lazy,” says Maria.