Opinion

Why is it so hard to identify domestic abuse in emergency departments?

More than 1.3million women experience domestic abuse in England and Wales every year, yet many cases go unrecognised in emergency departments. Why is this?
domestic abuse

More than 1.3 million women experience domestic abuse in England and Wales every year, yet many cases go unrecognised in emergency departments. Why is this?

My final year of nurse training was spent on management placement in a large emergency department (ED), where I decided to base my dissertation on a review of literature about the difficulty nurses had identifying domestic abuse.

Shocking results

What I found shocked me. Between March 2014 and March 2015 it is estimated 8.2% of the female population over the age of 16 in England and Wales (1.3 million women) were survivors of domestic abuse (Office for National Statistics 2016).

Approximately 400 people who have attended hospital for domestic abuse-related injuries go on to commit suicide, 200 of these dying on the day of

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More than 1.3 million women experience domestic abuse in England and Wales every year, yet many cases go unrecognised in emergency departments. Why is this?

domestic abuse
What more can be done to identify domestic abuse? Picture: iStock

My final year of nurse training was spent on management placement in a large emergency department (ED), where I decided to base my dissertation on a review of literature about the difficulty nurses had identifying domestic abuse.

Shocking results

What I found shocked me. Between March 2014 and March 2015 it is estimated 8.2% of the female population over the age of 16 in England and Wales (1.3 million women) were survivors of domestic abuse (Office for National Statistics 2016).

Approximately 400 people who have attended hospital for domestic abuse-related injuries go on to commit suicide, 200 of these dying on the day of their attendance (Living Without Abuse 2016).

These figures are appalling, yet many cases of domestic abuse go unrecognised when presented to the ED, despite one of the most significant indicators of domestic abuse being repeated attendance at healthcare services for treatment of injury (Trevillion et al 2013).

Receptive treatment

The time immediately after a domestic abuse incident has been described across literature as the time survivors are at their most receptive to support and intervention, yet often women who present with physical injuries and/or symptoms of domestic abuse are treated solely for these with the underlying cause ignored.

The attitude of nurses providing care to a domestic abuse survivor can have a phenomenal influence over successful or failed attempts to engage the patient with support services. If the underlying cause is ignored, it is a wasted opportunity to help vulnerable patients.

First contact

As nurses form one of the largest employee groups in healthcare it is highly likely they will be the first contact a patient has when presenting with domestic abuse-related injuries.

Yet despite this, many nurses feel unable to approach the subject, describing it as a Pandora’s Box where they are unsure what could be uncovered and what support the patient would require (Williston and Lafreniere 2013).

Reluctance to approach the subject alongside a gap in knowledge, an inappropriate assessment area with unavoidably close proximity to other patients, or the abuser presenting with the patient and refusing to leave, all exacerbate the difficulty in completing appropriate assessment and identifying domestic abuse.

What can be done?

How can we improve identification rates? By continued research focusing on all relationships (not just heterosexual relationships with the male being the perpetrator), increased awareness among nursing staff of domestic abuse, and specifically focused domestic abuse guidance from professional bodies such as the NMC and RCN, which currently doesn’t exist.

A change in the way treatment is provided to domestic abuse survivors is necessary and fundamental to protect a vulnerable group of patients in great need of support.


References


Kelly Robson is a nursing student at Northumbria University, Newcastle Upon Tyne

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