Opinion

Domestic abuse is everyone's responsibility

As the US author Napoleon Hill put it: ‘The starting point of all achievement is desire’.

I am an ordinary nurse, who is now on an extraordinary journey.  My nursing career has spanned three regions, Derby, Nottingham and Stoke on Trent, with the emphasis always on emergency medicine. My commitment to lifelong education began in 1990, looking for challenges, a lifetime of education, motivating life experience, new friendships and to be part of a new generation of nurses.

I soon developed special interest in education, competencies, and supporting junior colleagues at the beginning of their nursing adventure. Emergency Care is dynamic, with great diversity in the skills required. In May 2012 I met with ARCH (the domestic abuse charity) to discuss developing a project focusing on early recognition and engagement with presentations secondary to domestic abuse through emergency care. This was just six weeks after the brand new emergency centre and Major Trauma Unit opened at the Royal Stoke Hospital.

A total of 12% of attendances through emergency care are thought to be linked to domestic abuse. This is not just cuts, burns, bruising and fractures. It is also unexplained headaches, anxiety, depression, recurring attendances with no diagnosis as patients simply feel “lost”.

In September 2012 The Department of Health redefined domestic abuse to include behaviour and personality influences as well as actual physical violence.

It now covers: Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members, regardless of gender or sexuality. This can encompass, but is not limited to, the following types of abuse: psychological, physical, sexual, financial, and emotional.

Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.

Over the last three years our project has grown beyond our expectations. Initial goals were met as ARCH provided staff training, establishing an easy referral system, and we openly invite a domestic abuse conversation from all health care colleagues as well as patient's and visitors. Unexpected outcomes included the number of staff disclosures we received, and also the need to extend our training to include sexual exploitation, honour based violence and female genital mutilation.

NICE published guidelines in February 2014 on the approach to domestic abuse. The emphasis is on collaborative working with professional organisations, offering help with disclosure of domestic abuse, engagement and referral to safety. Our project was already successful and established above the recommendations NICE suggested.

The College of Emergency medicine produced their guidelines on Domestic Abuse in March 2015. The emphasis is places on multi professional approach, recognising emergency departments as key portal areas to engage with people suffering domestic abuse.

Recognition

Our innovation in practice was recognised by the Royal Stoke Hospital, who awarded us "Team of the Month" in 2014. This award put us into an annual final award ceremony hosted by RSUH at Keele Hall  where we were runners up in two categories.

When I became aware of the Nursing Standard annual awards, I entered the team. This process was simple and well supported. Presenting to the judges in London was not as overwhelming as it may sound. I know this project, I am proud of this project, I want to share it and replicate excellence with other emergency departments.

Being invited to attend the ceremony at the Savoy Hotel in London in May was fantastic for our team. Being amongst fellow nurses, all with innovative ideas, buzzing with energy and enthusiasm for patient care and a desire to improve all areas of the patient life was humbling.

Our team won in our category - Innovations in speciality care. We were so thrilled. However, we did not enter this process for self-gratification - this was for every victim of domestic abuse.

At the end of the evening, I was awarded the Nurse of the Year 2015 honour. Supported by RCN and Nursing Standard, I now have the opportunity to increase the conversations about domestic abuse. 

On reflection, I don't know why they chose me as the winner. Maybe it's because I have a desire to achieve - but don't we all?

About the author

Amanda BurstonAmanda Burston is the RCN Nurse of the Year 2015 and major trauma co-ordinator at Royal Stoke University Hospital

Photo gallery: Amanda Burston and the Safer Steps Team
Feature: Dedication to tackling domestic violence