Advice for nurses on supporting victims of domestic violence

A serious case review this week has highlighted the tragic case of Kayleigh-Anne Palmer who was killed by her boyfriend when she was 16 years old and 24 weeks pregnant. She died after enduring years of domestic abuse and controlling behaviour from her boyfriend Aston Robinson, aged 18, in 2014. 

Ms Palmer had engaged with several professional agencies in relation to her injuries, mental health and abuse. She had visited the emergency department (ED), neighbours had raised concerns, and the police and social services had been involved. However, she still ended up losing her short life to domestic abuse.

It has been reported that a neighbour told police that Robinson had knocked Ms Palmer to the ground and kicked her in the stomach when she was pregnant. In another incident she went to hospital saying she had been punched by a man but she refused to give his name and left with a bleeding nose. 

A&E toolkit

Staff working in emergency care need confidence and knowledge to protect vulnerable people who are often unable to accept help because they are so afraid of their abuser. 

Statistics state that victims on average have five engagements with health service providers before receiving effective support that helps them move towards leaving an abusive relationship (SaferLives, 2010). Victims are unlikely to disclose domestic violence if they don’t feel that they will be safe or that your organisation has no understanding of the issue.

The Royal College of Emergency Medicine recognises there is a role for emergency department staff to recognise and respond to victims of domestic abuse. Up to 12% of ED attendances are related to domestic abuse and 30% of domestic abuse starts during pregnancy. ED staff are often in a good position to identify people who are being abused. 

Staff can access a multiagency risk assessment conference (MARAC) toolkit for emergency departments on the Safe Lives website. This toolkit helps staff direct questions and includes flowcharts highlighting the key steps for approaching a MARAC and outlining where common pitfalls occur. It will help staff assess a patient's safety and allows for referral to a MARAC if the patient safety is compromised. 

About 100,000 women every week seek medical treatment for injuries sustained in the home in the UK. Healthcare professionals need toolkits, policy and guidance to follow to keep victims safe and raise awareness. They also need to have the assurance and backing to be able to share information with other professional agencies.

Confidentiality concerns

Section 115 of the 1998 Crime and Disorder Act allows you to share information without consent if you believe there is risk of significant harm to the individual concerned. Information sharing can sometimes be difficult for medical professionals who are trained to protect confidentiality at all costs. 

However, where welfare and immediate safety is a concern, healthcare workers are protected by the Data Protection Act, Human Rights Act and Caldicott principles. Local information sharing agreements can also be made with the support of safeguarding teams and support agencies. 

RCN Congress overwhelmingly passed a resolution  in June 2016 for all staff involved in health care to receive mandatory training covering all aspects of domestic abuse. Work has already begun to produce online resources, training packages, and to raise awareness of domestic abuse in healthcare settings. This education project has the potential to save lives and help victims leave abusive, unhealthy relationships much earlier than the current average of seven years. 

All healthcare professionals have a responsibility to support victims of abuse and they are well placed to engage with them. Education provided by the Home Office covering female genital mutilation is now mandatory, and we have a legal requirement to report any disclosures or any observed physical signs that it has occurred.

Free online training is available from most charity organisations involved in supporting victims of abuse. Ask your safeguarding team for your organisation's policy and guidance when dealing with victims of abuse. 

Together, we can make a difference, and help girls and women like Kayleigh-Anne Palmer and prevent needless violent deaths.

Amanda's advice for healthcare professionals

How to create the right environment for disclosure

All healthcare workers can follow this brief guidance to encourage disclosure by creating the right environment.

• Victims are unlikely to disclose domestic abuse if they don’t feel that they will be safe or that your agency has no ‘understanding’ of the issue.  
• Display posters in prominent positions that clearly send the message that your agency is aware of the issue, it cares and it wants to do something to help. 
• Provide national helpline numbers and details of local agencies that provide support. A victim has the right to choose who they disclose to, and it may not be you. Make sure you only offer information when it is safe to do so.
• Offer private interviews – victims will not want to discuss abuse in a public area where they can be overheard, and never when the perpetrator is present. 
• Offer female staff – this may not always be possible, but could be important to the person you are trying to reach out to.

How to have a safety planning conversation with a victim 

Healthcare staff can find it difficult when a victim of domestic abuse decides to return to the home of the perpetrator. Staff need to be educated to understand that leaving an abusive relationship is a high-risk event that requires planning and professional support.

However, conversations for safety planning can take place, and healthcare staff need to consider the following: 

• Does the victim of abuse have access to a phone? Encourage them to call 999 if they are in danger.
• Could they get help from their neighbours? Could they tell their neighbours what has been happening and tell them what they should do in an emergency?
• Do any children involved in the case know how to contact the police or an agreed person?
• Do the children have a safe hiding place? This could be introduced as a game of hide and seek for younger children.
• Encourage the victim to keep a list of contact numbers in a 'leave bag'. This should be stored in a secret, safe place. 
• Encourage them to get photographic evidence of any injuries using a phone or camera that can be kept safe and hidden.