Less safe in lockdown: how nurses can help people at risk of an escalation of domestic violence and abuse in COVID-19 pandemic

Advice on spotting when someone is at greater risk, and what to do about it

Domestic violence and abuse is an under-reported issue but it is estimated that almost one third (30%) of all women who have been in a relationship have experienced physical and/or sexual violence by their intimate partner.

While it should be acknowledged that men, women, transgender people and those in straight, gay or lesbian relationships can all perpetrate and be victims of domestic violence and abuse, it is experienced disproportionately by women and perpetrated predominantly by men.

Lockdown presents opportunities for perpetrators of domestic abuse

Measures to control COVID-19, such as confinement and social distancing, may result in perpetrators having more opportunity to abuse or to change the way they abuse. Reports indicate that calls to domestic violence helplines, police and shelters have increased during the pandemic, while other victims find themselves unable to leave the house or access help. The number of killings has also increased.

View our COVID-19 resource centre

Nurses in all settings can play a crucial role in the identification, prevention of domestic abuse and the management of the effects of it. Although nursing staff are busy providing COVID-19-related services, it is important to consider how you can support those affected.

We suggest you use the 4Rs – Recognise, Respond, Refer and Record – to guide your approach.

Physical injuries as a result of domestic violence or abuse

A patient may present with multiple injuries at different stages of healing, all with ambiguous or implausible explanations. They may provide an inconsistent explanation of the cause of injury in an attempt to hide or minimise its extent.

As well as cuts, bruises and burns, broken teeth, bite or grip marks and marks/injuries on wrists or ankle joints, other manifestations not as easily attributable to domestic violence and abuse include:

• Headaches.
• Hearing loss.
• Unexplained and long-term gastrointestinal symptoms.
• Genitourinary symptoms such as urinary tract infections.
• Vaginal or anal bleeding.
• Unexplained reproductive symptoms, including pelvic pain, sexual dysfunction and sexually transmitted infections.
• Ways of behaving and communicating.

Victims can provide subtle and implicit hints to alert the professional but may not feel ready to disclose they are subject to violence or abuse at home. Their behaviour and communication should encourage professionals to use judgement. Such implicit hints include low confidence and self-esteem, and the person may seem withdrawn, fearful, depressed or anxious. The individual may have a history of alcohol or substance misuse or there could be signs and symptoms of self-harm.

• RELATED: Older people who experience domestic abuse need support

All these manifestations on their own do not necessarily indicate domestic violence and abuse and further exploration would be needed, but they should alert you to the possibility.

Parveen Ali, senior lecturer in the Health Sciences School, University of Sheffield, and lead, Sheffield University Interpersonal Violence Research Group

Julie McGarry, associate professor, School of Health Sciences, University of Nottingham and safeguarding research lead for domestic violence and abuse, Nottinghamshire Healthcare NHS Foundation Trust

Julie Hitchen, domestic violence practitioner, trustwide safeguarding team Nottinghamshire Healthcare NHS Foundation Trust

Helen Pritchett, specialist practitioner safeguarding and domestic Violence, trustwide safeguarding team Nottinghamshire Healthcare NHS Foundation Trust