Urgent training in domestic abuse is needed to open closed doors

Healthcare staff admit they lack knowledge of how to refer patients on for help following domestic violence

More than one quarter of nursing staff regularly encounter patients who have experienced domestic abuse, a Nursing Standard survey reveals.

While more than 50% of respondents encounter abused patients ‘once in a while’, just 16.5% never encounter them in their work.

Yet only 557 respondents (38.3%) said they have received training in the past year in how to treat survivors of domestic abuse and refer them on for support. Of the 898 (61.7%) who said they had not recently received training, most had never been trained.

Almost one third of the 1,455 nurses, midwives, healthcare assistants and nursing students said they would not know how to refer such a patient on for help.

Despite the prevalence of domestic abuse, a Nursing Standard survey of 94 trusts and boards across the UK revealed that almost one fifth do not have a policy for supporting staff affected by domestic abuse, while 17 (18.1%) do not have policies on supporting such patients. Nine organisations said they are currently introducing such policies.

Just 39 (41.5%) of organisations have a domestic abuse service, but even within this figure the provision of the service is patchy and variable.

Hidden problem

RCN professional lead for midwifery and women’s health Carmel Bagness explains: ‘Domestic abuse does not get the attention it needs because it is something that happens behind closed doors and is hidden.’

She says there needs to be a shift away from thinking of the stereotypical victim, such as the ‘battered housewife’.

‘We need to recognise that it can affect a whole range of people, including teenagers, men, the lesbian, gay, bisexual and transgender community, and understand that same-sex partners have the same issues as those in heterosexual relationships.

‘People still feel embarrassed and frightened about sharing the fact they are having problems at home.’

Ms Bagness says the lack of training staff receive is disappointing. Without it, she says, it will be difficult to shed stereotypical views.

‘It is important to ensure that every nurse and midwife understands what domestic abuse is and what to do when they come into contact with a patient who is experiencing it,’ she says.

In April, the RCN launched a two-year project to develop online resources on domestic abuse to help nurses and midwives recognise the signs and refer people safely to other services.

Domestic abuse statistics

In Nursing Standard’s survey of 1,455 nurses, midwives, healthcare assistants and nursing students:

51% of respondents said that a partner or family member has been verbally abusive or acted towards them in a controlling manner that has caused them psychological or emotional distress.

44% of the respondents have at some point in their lives had a partner or family member who has hit, shoved or pushed them, or made them feel frightened or threatened.

28% of nurses and midwives said they lacked confidence or had no confidence in supporting domestic abuse victims.

22% of nurses, midwives, students and HCAs have been forced by a partner into sexual activity.

Good practice

Responding to the survey findings, NHS Employers assistant director, development and employment, Ruth Warden said: ‘It is critical that anyone who suffers from domestic violence has the support they need.’ She emphasised the importance of employers having policies and practices to support staff and patients who experience domestic abuse so that they can feel confident and safe in raising issues that affect them.

Some examples of good practice in the NHS include Betsi Cadwaladr University Health Board in north Wales. It has clear policies and procedures for staff and patients affected by domestic abuse, and all new employees are inducted in the policy. All managers and clinical staff are expected to undertake training in domestic abuse every three years.

Policies are regularly updated in line with emerging legislation and, following a recent review, GPs will be informed when their patients have made a disclosure of abuse, subject to the individual’s consent.

In some departments, such as maternity, staff routinely ask patients questions to determine whether they are at risk of domestic abuse.

In 2014/15, 275 referrals were made to the multi-agency risk assessment conference for cases considered high-risk.

Voices of nursing staff who have experienced domestic abuse

A nursing student in England said: ‘My ex-partner controlled everything I did. I became a shadow of the person I had been when I first met him… I attempted suicide twice and self-harmed. I drank heavily and took drugs in order to cope. No one saw him for what he really was. He made me feel guilty about literally everything.’

A mental health nursing student said: ‘My ex-husband would grab my arm or squeeze my face, spit in my face and pull my hair. I left one day when he grabbed me by the throat and my toddler saw this and asked what he was doing. We rented a private place with money I’d been saving in a separate account – my running-away fund.’

In her response to the survey, one band 5 community nurse from England said: ‘My ex-husband would smash up the house and attack me. I had no confidence in myself… He just chipped away at me until I believed that everything was my doing and that I was the problem.’

Staff awareness

Clinical nurse specialist working in domestic abuse, harm and sexual violence Ann Jones says: ‘We know there are lots of people out there who have not been getting the support they need. Hopefully, making our staff aware of the signs and symptoms and what to do will help. We know that at the time of disclosure, the risk of domestic abuse is greater, so it is important staff know how to refer safely.’

RCN members will vote next week (June 18) at their annual congress on a resolution calling on RCN council to lobby for mandatory domestic abuse awareness training for all healthcare workers. The resolution was submitted by Nursing Standard nurse of the year 2015 Amanda Burston, who was recognised for setting up a domestic abuse service in the emergency department at Royal Stoke University Hospital.

She told Nursing Standard that national standardisation of nurse education in domestic abuse is needed to provide annual updates.

Ms Burston added: ‘Unless education keeps up to date and recognises the importance of early engagement with victims, health care will never deliver effective and efficient help’.

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