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Bringing domestic violence out of the shadows

Domestic violence is an invisible issue. PHE's Justin Varney and Colleen Dockerty explain how nurses can help

Across England and Wales, 30 per cent of women and 16 per cent of men have experienced domestic abuse at some point. Two women die a week as a result of domestic violence, and many more suffer long term emotional, physical and psychological damage.1
The very nature of what healthcare professionals do, in particular nurses, puts them in a strong position to offer support to both victims and perpetrators of domestic violence. Nurses are often the first point of contact for patients. They are also one of very few trusted people who might find themselves alone with a patient, away from their partners, creating an opportunity for individuals to disclose personal information. In their day-to-day work nurses get a unique insight into patients' lives. Health visitors and district nurses in particular are able to witness evidence that most others can't through visits to the home.
People who experience domestic abuse seek healthcare more regularly than the general population because of the physical and mental health effects it causes. A study showed that in East London general practices 41 per cent of women attending had experienced domestic abuse at some point and 17 per cent had experienced violence within the past year.2 Another survey showed that among psychiatric care in-patients, 18 per cent of women had experienced physical violence in the past year.5 Nurses practicing in certain areas are especially likely to care for patients and families experiencing domestic abuse, particularly health visitors, specialist community nurses, and clinicians working in mental health, antenatal care, schools, A&E and general practice.
As clinicians, we have a duty to take action when patients reach out for help, to look out for signs and offer support when needed. Often this is neither easy nor straight forward. Domestic violence is not just physical violence, but encompasses control, coercion and threats, emotional, sexual, financial or psychological abuse. It is important that healthcare professionals maintain a high level of awareness for the possibility of domestic abuse among their patients. Studies show that with more health professionals' alert to the signs, disclosure among victims improves.3 Taking simple steps can save lives:

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