The relationship between a nurse and their patient is unique, often developing into an unparalleled bond between the two. 

As a result, patients may turn to nurses for support in areas beyond their medical requirements, and similarly, nurses' concern for their patients often goes further than their core duties of care.

A growing understanding of this relationship has prompted an expansion of the nursing role, in particular with regards to identifying and intervening in situations where domestic violence is suspected, or reported.

"Until recently, proactive identification of DV has been poor for a variety of reasons," says Dr Kathleen Baird, Director of Midwifery and Nursing Education, Women's and  Newborn and Children's Services/Gold Coast University Hospital.

Dr Baird says nurses have previously been reluctant to approach patients with their suspicions due to a belief that domestic violence enquiry is not within their professional remit.

Other reasons include fear of offending the patient, as well as anxiety and nervousness about dealing with a positive disclosure.

"And importantly, a lack of training and education," Dr Baird says. 

In contrast, women experiencing domestic abuse consistently identify health professionals, including nurses and midwives, as a potential source of support.

"It is known that women are not offended by being asked about a history of domestic violence, when the question is asked by a caring and knowledgeable nurse or midwife," Dr Baird says.

"Indeed, evidence now suggests that women experiencing violence can feel let down if they are not given an opportunity to disclose about their experiences of violence.

"More recently there has been an increase in research from Australia around the efficacy and value of the healthcare professional’s response to domestic violence.

"There has been an overwhelming drive for healthcare professionals to acknowledge the reality of domestic violence and the effect domestic violence can have on health."

With healthcare services now acknowledging the consequences and costs of domestic violence, many healthcare professionals are beginning to recognise and discuss domestic violence within their workload.

"There is a strong message and expectation that health will work with and alongside statutory and community organistions to recognise, respond to domestic and family violence,” says Dr Baird

As a result, nurses and midwives must be made aware of the close links between domestic violence and child abuse.

“And whilst the child protection role is not without its challenges, acceptance of this role means the health care professionals involved with working with children must accept their professional responsibilities in addressing domestic violence within their practice,” says Dr Baird.

With health services often the first point of contact for many domestic violence victims, it’s crucial to their long term health and safety that nurses are able to effectively offer support and guidance. 

“Without a doubt, within some sectors of the health service such as maternity and emergency departments, there has been a growing awareness of health professionals becoming more pro-active around domestic violence with an enhanced knowledge and understanding around its consequences and impact on health,” says Dr Baird.

Unfortunately, there is still some reluctance among health workers to engage in this sensitive area, most likely due to a lack of confidence, knowledge and support within health organisations.

“It is thought that clinicians remain unclear about their role in addressing domestic violence; many may find it difficult to listen or understand a woman’s disclosure from a fear of knowing what to do when a woman discloses about a history of partner or family violence. 

“Domestic violence is a very sensitive issue and to be able to deal with it effectively staff require the tools to do so.”

Although many government and professional bodies are now promoting routine enquiry in many clinical areas, Dr Baird says this cannot be safely and effectively carried out without an effective training programme for staff, and relevant multi- agency policies and guidelines in place. 

“Ongoing staff support is also fundamental in order to sustain this work.”

If a nurse suspects domestic violence, there are several important steps they should follow.

“Sensitive questioning should take place in a safe and private environment, without the presence of a partner or a child who could repeat the conversation to another person.

When a nurse receives a positive disclosure, they must be aware of the appropriate referral pathways, which Dr Baird says should to be multi-agency and developed in collaboration with nongovernment organisations (NGOs), such as local women’s support groups.

Nurses should also be aware of their local hospital guidelines and protocols, and the referral pathways to community domestic violence agencies.

Unfortunately, for a variety of reasons, some women may choose not be honest in their first response.

“A woman may decide to withhold the information as they often feel stigmatised and fear that they won’t be believed,” says Dr Baird.

“Some women will also be reluctant to disclose because opening up and telling someone about the violence can pose a threat to the woman.

“Indeed, it is important to remember that when they leave or attempt to leave a violent partner that most women who will be, are murdered at this time.”

As a result, women should never be encouraged to leave a violent relationship until a full risk assessment has been performed and a robust safety plan put in place to protect both her and her children.

“Unless there are child protection concerns, women should not be forced to make any decisions about their future until they feel ready and it is safe for them to do so.”

Health care professionals should work in collaboration with other agencies to ensure women’s safety. Nurses should also ensure that information is provided regarding local women’s support agencies and, if a patient is in immediate danger, call the police.