For many victim-survivors of domestic and family violence, contact with a nurse or midwife is often their first opportunity for positive disclosure. But with many nursing and midwifery departments understaffed and managing high workloads, encouraging take up of specialised DFV training can be challenging.

“DFV remains a highly gendered issue, disproportionately affecting women and children,” explains Griffith University’s Professor Silke Meyer.

“For some survivors it begins during pregnancy, for others it escalates during pregnancy. The women’s health and pre-natal healthcare space therefore offers critical opportunities for the identification of DFV.

“But beyond this, nurses have other opportunities. Victim-survivors of DFV have a disproportionately higher risk of injuries, chronic illnesses and mental health problems. This increased risk is associated with their experiences of DFV and the impact of trauma.”

While women may not disclose DFV as the underlying cause of their contact with healthcare, the contact itself offers a unique opportunity for routine screening.

“Nurses have an opportunity to screen for and identify signs of DFV and related risk in a safe, non-threatening and non-stigmatising environment, whereas disclosing DFV to police or child protection services for example creates a range of flow on effects that victim-survivors may not be prepared for, at least not initially,” says Professor Meyer.

What to look out for?

Professor Meyer says there are several red flags nurses should look out for, which is why training is imperative.

“To start with, whether a female service user is constantly accompanied by her male partner. Nurses should create opportunities to speak to female service users alone to get a sense of whether (her partner) is being supportive (or) whether his behaviour is a reflection of coercive control,” she says.

“It’s critical to consider translator services for female service users from non-English speaking backgrounds to avoid the scenario where an abusive partner acts as the translator and uses this opportunity to silence the victim-survivor and her support needs.”

If physical and/or sexual violence is present, nurses should pay attention to physical injuries and again create opportunities to examine and talk to the female service user alone to create opportunities for disclosure.

“It’s important to note here that many victim-survivors may not feel comfortable disclosing experiences of DFV, especially experiences of sexual violence, without having some rapport with the healthcare provider.

“Continuity of care plays a critical role in creating a safe and trusting environment for disclosures although isn’t always feasible within our healthcare system or when patients present to the system as a one-off or in case of an emergency. “

What can nurses and midwives do?

While it’s important to follow policies and procedures, nurses should establish whether the patient feels safe to go home and whether she would like a referral to a specialist service provider.

“At the very minimum, nurses should be familiar with their local service landscape – ie. have relevant state and national helplines ready to provide to the service user.

“Nurses can ask questions around safety (if) no formal screening and risk assessment tools are being used. Where these are in place, those tools usually guide nurses and other practitioners through the process of what to say and what to offer.“

It’s particularly important that nurses advise victim-survivors not to discuss any safety plans or plans to leave the abusive relationship with the abuser to avoid risk of escalating violence.

“Nurses need to be aware of their mandatory reporting requirements … depending on the level of risk involved.”

What training is available?

This depends on the setting. Public healthcare settings tend to have mandatory training that’s available to all healthcare practitioners. These settings also often have additional, voluntary modules, but for these to be undertaken by all staff, the healthcare service needs to provide an environment where nurses have time to pursue it.

“In settings where workloads are high and staff shortages are an issue, additional, voluntary training receives little uptake,” explains Professor Meyer.

“For those working in clinical settings that don’t provide minimum mandatory DFV training, there are free DFV training modules available online.

For example, the Recognise Respond Refer training is available to all frontline practitioners and organisations across Australia. Some of the government funded/public healthcare settings across jurisdictions also provide free access to basic training modules and information.

“The healthcare space offers an excellent platform to recognise, respond and refer. Frontline practitioners should therefore be equipped with the knowledge and skills required to do this safely,” says Professor Meyer.

“And this needs to go beyond organisations and services offering basic training during induction into the role. It needs to be refreshed regularly and it needs to be given the priority and space required for practitioners to engage with the training in a meaningful way.

“In other words, healthcare services must recognise DFV as core business given its high prevalence rate and the frequent contact of victim-survivors with the healthcare system. And they must create an authorising environment for nurses and other healthcare practitioners to treat the identification of and responses to as a priority that requires sufficient time allocations per service user to do this in a safe and meaningful way.”