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.
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.
The 4Rs – a framework for supporting the individual
- Self-isolation may make it harder to recognise signs of domestic violence and abuse. There will be less possibility of face-to-face contact with individuals so picking up on mood changes, injuries and withdrawal from services will be more difficult.
- In each contact with the patient, ask about domestic violence and abuse related experiences. In case of virtual or telephone contact, ensure to check if the patient is alone and cannot overheard by someone else. This is essential to ensure their safety.
- Routine enquiry can be direct questioning or more subtle approaches, for example asking how everyone is coping with social distancing or self-isolation, and exploring any indication of conflict.
- It is important to recognise that those we work alongside may also be experiencing domestic violence and abuse so be alert to this and aware of organisational support structures.
- RELATED: The board game that helps you identify domestic violence and abuse
- Contact opportunities may be more limited at this time. It may not be possible to meet up, and phone contact can be difficult if the perpetrator is home much more than usual. Nurses should think about any risks to the victim, children or any other vulnerable adults. Use risk-assessment tools and think about how self-isolation influences any risks. Even if someone is self-isolating, call 999 if there appears to be an immediate danger.
- Try to agree a method of safe contact. Could contact be made when either the victim or perpetrator is undertaking permitted daily exercise?
- Currently, children are more isolated. If there are children involved, how will the situation be affecting them? Is anyone else working with the family who may be able to provide additional information that can help you assess risk and offer support?
- Ensure the victim knows that the need to escape violence or abuse at home overrides any instructions to stay there and that they can leave for a place of safety.
Refer and record
- Find out about local, regional and national agencies to which people can be referred and ensure records are clear so other practitioners can take over any planned care.
- Record all disclosures in the service user’s record, and ensure all information-sharing and supervision is recorded. Explain why you chose to take an action or why you chose not to.
- RELATED: The provision of emergency healthcare for women who experience intimate partner violence: part 1. An integrative review
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:
- 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.
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