  |
EDITORIAL
Family Violence: The Imperative for Nurses to Respond
Whanau/families are the fabric of our society, thus their health and functioning are essential for communities to work well. For members who are subjected to ongoing abuse and violence, families do not provide the expected safe haven. Family violence is a national and global concern (Ellsberg, 2006). Among the OECD countries New Zealand has the 4th highest child death rate resulting from maltreatment. Family violence spans all sectors of society, with an apparent over-representation of women and children – especially those experiencing high levels of deprivation and poverty. Women and children, in particular, are at risk of serious injury and harm with 14 women and 10 children, on average, murdered a year.
The long-term effects of family violence are well established, and negatively affect all whanau/family members (Anda et al., 2006; Campbell, 2002; Fanslow & Robinson, 2004). The experience affects their social connectedness, their development as human beings, and their long-term health and wellbeing. Testament to this is the ongoing intergenerational effects of living in a combat zone of abuse and violence in a place that should be safe and nurturing. The very nature of abuse, violence and neglect occurring within families makes it difficult for victims to simply leave, disclose their experiences, or ask for help, especially when they perceive that they are at risk of further abuse.
Family violence has now been identified as a health issue. The recently introduced Violence Intervention Programme within the health sector and the Campaign for Action on Family Violence makes family violence an issue for everyone, and one in which nurses have a special role. There is an expectation that the nursing input will increase the level of disclosure, however while many District Health Boards (DHBs) have violence intervention programmes (Adams, Giddings, Koziol-McLain & Davies, 2007), the intention to have nurses screening women for abuse and neglect is not shared by all. Some reservations relate to nurses believing they do not have the necessary attributes and skills to respond effectively. Others claim that asking women about abuse and violence will discourage them from disclosing. The reality is that neither of these stances is supported by evidence.
So what part do nurses have to play in responding to this call to screen women for family violence? Women and children experiencing abuse and violence within the context of the whanau/family are more likely in their everyday lives to utilise health services before they come to the attention of justice and social services. Research indicates they are high users of health services for a range of health issues, and enquiries into high-profile child deaths confirm that the mothers and their children had numerous interactions with various well-child and other health services. The Elder Abuse and Neglect Guidelines (Glasgow & Fanslow, 2006) were launched earlier this year, although the Ministry of Health has been working on reducing violence within whanau/families for some time. Since 2000 reducing interpersonal violence has been a Ministry of Health priority, culminating in the release in 2002 of the Family Violence Intervention Guidelines (Ministry of Health, 2002). These were endorsed by a variety of professional groups including nursing. Specific groups of nurses such as those working in Emergency Departments, areas of child and family health, sexual health, and Plunket, were targeted for training.
Recent pressure for nurses to be included in the screening of all women engaging with health services is an acknowledgement that they are ideally situated and have the necessary characteristics and skills to undertake this role effectively. Nurses have a professional and ethical imperative to ensure that all women and children they come into contact with are safe, and the skills of cultural safety they bring to their practice informs how they can work with women in this area. Choosing not to screen or ask a woman about her personal safety within the context of her home and family, denies her the opportunity to disclose and possibly talk about her experiences. The psychological sequel of partner violence often leaves women thinking they somehow deserve the abuse and violence, making it difficult to name and see clearly what it is they are experiencing – abuse.
When women choose to disclose abuse there is a high likelihood their children (if they have them) are also being abused. In these situations, women need support and children need protection. The evidence strongly demonstrates that abuse and violence compromise women’s ability and efficacy to parent. Embroiled in trying to manage and survive in an often unpredictable and volatile environment they are unable to protect their children. When women present to health services, there are expectations that nurses will care, keep them safe, and recognise the indicators that all is not well. The reality for many is that they are confronted with indifference, judgements, and insensitivity. Choosing not to ‘see’ or ‘ask’ women and children who are being abused and battered is to be indifferent. Elie Wiesel (1999, p. 216-217) describes the consequences of indifference:
..indifference can be tempting – more than that, seductive. It is so much easier to look away from victims. It is so much easier to avoid such rude interruptions to our work, our dreams, our hopes. It is, after all awkward, troublesome, to be involved in another person’s pain and despair. Yet, for the person who is indifferent, his or her neighbours are of no consequence. And, therefore, their lives are meaningless. Their hidden or even visible anguish is of no interest. Indifference reduces the other to an abstraction.
Nurses can effectively identify abuse and violence, affirm women’s experiences, assess for safety risks, and refer them to the appropriate resources for support and assistance. To do this, it is important that they become knowledgeable about family violence by attending courses and reading research based literature. They need to familiarise themselves with the policies and procedures within their work setting, and talk about family violence with their work colleagues and decide how they can be more responsive as a group. There may be colleagues who have been in, or who are, experiencing family violence, and who need support. It is no longer acceptable for nurses to ignore, or fail to respond to family violence.
Denise Wilson
RN, PhD, FCNA(NZ)
Senior Lecturer in Nursing (Maori Health), School of Health Sciences, Massey University, Auckland
Associate Professor Jane Koziol-McLain
RN, PhD
Interdisciplinary Trauma Research Unit, AUT University
References
Adams, J., Giddings, L., Koziol-McLain, J., & Davies, E. (2007). Hospital responsiveness to family violence: Enablers, barriers, and sustainability. Auckland, NZ: Auckland University of Technology.
Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J.D., Whitfield, C., Perry, B. D. et al. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry & Clinical Neuroscience, 256(3), 174-186.
Campbell, J. C. (2002). Health consequences of intimate partner violence. Lancet, 359, 1331-1336.
Ellsberg, M. (2006). Violence against women and the Millennium Development Goals: Facilitating women’s access to support. International Journal of Gynaecology and Obstetrics, 94(3), 325-332.
Fanslow, J., & Robinson, E. (2004). Violence against women in New Zealand: Prevalence and health consequences. New Zealand Medical Journal, 117(1206), U1173.
Glasgow, K., & Fanslow, J. L. (2006). Family violence intervention guidelines: Elder abuse and neglect. Wellington: Ministry of Health.
Ministry of Health (2002). Family violence intervention guidelines: Child and partner abuse. Wellington: Author
Wiesel, E. (1999, April 12). The perils of indifference. In Smith-Davis Publishing (Eds). (2005). Speeches that changed the world: The stories and transcripts of the moments that made history (pp. 216-217). Millers Point, NSW: Murdoch Books.
Wilson, D. (2000). Care and advocacy: Moral cornerstones or moral blindness when working with women experiencing partner abuse? Journal of Nursing Law, 7(2), 43-
|