Domestic abuse crosses all walks of life, and all professions, genders and sexualities. The next patient you talk to could be looking for someone they can confide in.
As a trusted health care professional, and someone who spends one-to-one time with patients and service users, you may be the only person they can trust.
But this isn’t just about patients – colleagues may also be survivors or perpetrators of domestic abuse, and sometimes they just need someone to ask how they are too.
It’s important that we get this right, and this might mean adjusting the way we all think and talk about the issue.
You can take vital first steps by widening your understanding of the issue. It’s important to know who might be affected, how individuals may present in different health care settings, how the subject could be approached, and importantly, what you can do to help and support victims of abuse.
This starts with being ready to listen to individuals who may be behaving in unexpected and perhaps challenging ways.
Think about what’s happened to these patients, rather than wondering why they’re behaving in these ways
Victims of domestic abuse may be hostile, uncooperative, quiet, withdrawn or more anxious than others. They may also be constantly accompanied by a perpetrator or hiding bruises and injuries.
You can help by taking a trauma- informed approach to care. This is when we think about what’s happened to these patients, rather than wondering why they’re behaving in these ways.
You also need to be open-minded when considering who that perpetrator could be: some people may assume it’s going to be a former or current partner or spouse.
But it could be another significant person in their life, such as a grown-up child, while perpetrators in forced marriages could be other family members.
You might need to adjust your expectations of what someone might want to do after disclosure too. Domestic violence is a complex issue and a victim of abuse can’t always just walk away.
It won’t be helpful to tell a person to leave a relationship if they’re not ready to. The best thing you can do is address the issues and support people with patience and compassion.
It’s never too early to act. Even if this is an issue you’ve never encountered before, ask your employer about domestic abuse and safeguarding training so you’re ready and able to help if one day a patient needs you.
This isn’t an easy subject to discuss but it’s essential that you feel prepared and confident to support a patient who needs help.
‘We are familiar and trusted’
"I’d been nursing an older man in his 80s for some time. One day we were in the bathroom together when I noticed he was visibly distressed. 'What’s the matter?' I asked him.
"He cried as he told me he was being forced out of his own home by his son and daughter-in-law. They’d already got rid of the furniture he loved and were now trying to push him into moving to a care home, so they could live in his home, as they had no house of their own.
"There was no reason why he couldn’t go back to his home when he was discharged so I reassured him and escalated the case to the registered nurse. He was eventually helped to get back to his home, and his granddaughter acted as his advocate.
He cried as he told me he was being forced out of his own home
"Patients often feel more comfortable speaking to nursing support workers because we are familiar and trusted – often carrying out care more regularly than anyone else.
"People regularly open up to me when we’re in the bathroom together. Perhaps they feel more comfortable there as we’re working with them in a one-to-one private setting, where we won’t be interrupted, and trust and dignity is paramount."
Top tips for talking about domestic abuse
- Listen and be supportive so patients feel confident when speaking to you. Make sure the conversation takes place in private.
- Acknowledge it takes strength to trust someone enough to talk to them about experiencing abuse.
- Use an official interpreter if the individual doesn’t speak English.
- Acknowledge this is a frightening and difficult situation. Give people time to talk, but don’t push for detail if they don’t want to give it.
- State that no one deserves to be threatened or abused.
- Check if there are children in the home and consider any concerns regarding safeguarding.
- Ask if individuals have suffered physical harm that might need medical intervention.
- If you believe someone is imminent risk of danger, contact the police and the local safeguarding lead.
- Be prepared to signpost to appropriate supportive external organisations. In large workplaces there will be a staff member with expertise in safeguarding within your area, who you can get advice from. Work within your employer guidance which will be underpinned by national guidance and legislation.
- Look after yourself too. Speak to your employer if you need support afterwards.
Some tips adapted from Women’s Aid advice
- RCN position statement on domestic abuse (publication code: 009 373).
- Domestic abuse: Guidance for nurses and midwives to support those affected by domestic abuse (publication code: 009 301).
- Women’s Aid.
- Safe lives.
- Stand Up to Domestic Abuse.
- Home Office factsheets.
- National domestic abuse helplines: England 0808 2000247; Scotland 0800 0271234; Wales 0808 8010800; Northern Ireland 0808 8021414. (Freephone 24 hours a day.)
- Respect (an advice line for men): Freephone 0808 8010327.
- Find our more about Safety and Wellbeing Advice for Survivors (April 2020).