护士在识别和应对暴力侵害妇女行为方面的依赖性

1 BACKGROUND

Violence against women (VAW) is the threat of or actual harm by physical, sexual or psychological abuse. Male violence, the most prevalent and dangerous form, is the leading contributor towards death, disease and disability amongst women aged 18–44 globally (Ellsberg et al., 2008). This type of abuse is extremely common; a recent survey of over 22,000 UK women found that as many as 99.7% report hing been repeatedly subjected to rape, harassment and physical violence over the course of their lifetime (Taylor Simon Shrive, 2021), far higher than previously thought. The Femicide Census, which tracks the murders of women by male perpetrators, also consistently reports over 100 deaths per year; rougly one woman every 3 days (Ingala Smith, 2018). Violence against women is a clear and serious public health concern with significant implications for the health, well-being and mortality of women around the world. However, violence should not be an inescapable aspect of women's lives; it can be prevented.

Victims, also commonly referred to as survivors, are likely to require care and treatment from healthcare services (Hooker et al., 2020). Despite this, the nursing response to this issue has been inadequate to date. Nurses and other healthcare professionals can play a vital role in recognising and responding to violence against women and its common expressions; domestic abuse and sexual violence (Bradbury-Jones, 2015).

How this issue is framed is central to how it is perceived or understood and reflects wider social issues in the UK and around the world. Violence against women is a common term and used throughout this discussion to highlight the health and well-being needs of women. However, this tends to obscure the source of the violence: men. When considering these issues, it is therefore important to remember that they do not occur in a vacuum and instead take place against a backdrop of misogyny, male dominance and women's subsequent inequality. Moreover, the ongoing failure to adequately address this issue within nursing and health care is intrinsically linked to medical paternalism and the dominance of medicine over the healthcare hierarchy.

2 WOMEN’S PROBLEMS

In the not-too-distant past, efforts to address violence against women within health care he been described by medical colleagues as ‘ill-considered professional interference’ and that it is ‘doubtful’ women would benefit from support (Fitzpatrick, 2001). This reluctance echoes broader social attitudes that he historically regarded domestic abuse as a private matter and has contributed to the hidden nature of abuse, stigma and ongoing normalisation of male violence.

Within the constructs of a patriarchal society, where male violence is intrinsically linked to male dominance, women remain subjugated, and their experiences hidden. Typically, women's problems are regarded as being a personal problem for women to fix. This obscures the perpetrator of violence and places the blame and responsibility upon victims to keep themselves safe, rather than addressing the source of the problem.

However, whilst perpetrators are solely responsible for violence and abuse, literature on perpetrator recidivism is severely lacking. A community approach to this issue has been shown to be the most effective prevention and intervention strategy (Hague and Bridge, 2008) and forms the rationale for the ongoing implementation of multi-agency risk assessment conferences (MARAC) across local authorities. Nurses, as the largest healthcare professional group, must therefore form an active component of this response, identifying and responding to risk, co-ordinating care and safeguarding women.

3 DEVELOPING KNOWLEDGE

Women who he experienced male violence repeatedly express the importance of supportive, empathic staff and psychologically safe environments (Bradbury-Jones, 2015). In order to achieve this, staff must be knowledgeable and competent in recognising and responding to signs of abuse and disclosures.

Whilst individual nurses may choose to develop their knowledge and understanding in this area, a small number of nurses scattered across services, boards and trusts are not able to lead care on a large scale nor are they able effect the kind of change necessary. A systemic approach is therefore needed that prioritises learning and development and ensures sustainability.

Investing in training and staff development is vital to ensuring staff knowledge and competence. However, training deficits are consistently noted in research. Nurses frequently report lacking the knowledge, confidence, and training to recognise and respond effectively to domestic abuse and sexual violence (Alshammari et al., 2018). As a result, nurses oid asking about abuse since they are unsure how to ask sensitively and how to respond to a disclosure.

The ongoing lack of development in this area is, no doubt, due to the lack of importance placed upon women's lives, health and well-being. Training is not prioritised in undergraduate curricula or CPD, and specialist nursing staff, capable of delivering such training, are vanishingly rare. But this is nothing new, health care, an historically paternalistic institution, has presided over women's health inequalities for hundreds of years.

4 PATERNALISM AND GENDER ROLES

Within healthcare systems, patriarchy and male dominance find expression in medical paternalism. The traditional dominance of medicine, which once excluded women entirely, remains present to some extent within modern health care. Medical staff, afforded the highest degree of autonomy within healthcare systems, continue to lead in research, policy development and service design and delivery the majority of the time. As such, doctors, nurses and patients exist within an operational hierarchy with medicine dominating from above. This dynamic is inherently gendered, with medical staff acting in the masculine role as dominant protectors and patients as passive, feminine and dependent recipients. Within this system abused women are doubly subordinate, to both their abusive partners and to healthcare staff, and very often must relinquish their autonomy in order to receive the care and treatment of health professionals.

Despite a focus on patient centred care, nursing can often be guilty of participation within these structurally oppressive and misogynistic practices where the patient remains subordinate. The nurse's role is typically one of concern and advocacy; however, even this should be acknowledged as taking place from a position of superiority, control and dominance.

A cursory glance of online patient feedback site Care Opinion reveals many poor experiences for women who disclose abuse to healthcare staff, including nurses of both sexes. This feedback often reflects a lack of staff knowledge and sensitivity, whilst patients nigate retraumatising practices and procedures. Despite being a majority female workforce and being more likely to he experienced male violence than their non-nursing peers (Cell Nursing Trust, 2016), experience alone is not sufficient to guide high standards of nursing care or eradicate the possibility of internalised misogyny within the profession.

However, nurses, as the largest patient facing workforce and who frequently lead on the development of models of care, should be well placed to not only identify and respond to violence against women; they are also well placed to lead strategic development in this area. This is not without its challenges since nurses, too, are subordinate to the dominant medical hierarchy. This unique position of being both the dominator and the dominated presents a tension that is not possible to resolve entirely without addressing the structural oppression of women within health care, at every level.

Healthcare leaders, managers and educators must therefore prioritise education, development and training on the issue of violence against women in order to improve knowledge, standards of care and ultimately women's health and well-being outcomes. However, they must also recognise and challenge the structural barriers, misogyny and oppression that has prevented or restricted development for women as patients and practitioners thus far. The influence of nurse leadership has profound implications for patient outcomes (Francis, 2013), and this is particularly true for the role of health care in addressing violence against women. Whilst the gendered nature of this issue is recognised, nursing leaders, organisations, unions and institutions he a role in challenging the status quo with clear implications for patient care.

5 CONCLUSION

Male violence is a significant public health concern affecting a high percentage of women. Nurses and other healthcare professionals he a responsibility to recognise and respond to the signs of domestic abuse and sexual violence in order to address ongoing health inequalities, safeguard women and ultimately se lives.

Ending violence against women cannot be achieved by individual nurses, however, and ultimately requires systemic change and investment in training, development and research. If nurses are to address the significant risks facing women, then nurse educators, leaders and managers must prioritise and invest in the development of knowledge and care to ensure that registrants are confident and competent to address this issue.

Importantly, they must also recognise and challenge the oppressive and structurally patriarchal systems that present barriers to advancing practice and understanding in this area. Ultimately, it is women who will continue to suffer the burden of inaction.

ACKNOWLEDGMENT

Both authors contributed equally to this editorial.

CONFLICT OF INTEREST

The authors declare that they he no Conflict of interest.

百字翻译（各集）

对女童的过激 (VAW) 是躯体、官能或人格酷刑的危险或实际损伤。年长过激是最众所周知和最致命的形式，是致使全球 18-44 岁异官能恋被害、疾病和残疾的主要原因（Ellsberg 等，2008）。这种类型的不当甚为众所周知；最近对最多 22,000 名英国异官能恋进行的一项深入调查断定，多达 99.7% 的异官能恋研究报告称作，她们毫无疑问多次致使、扰和躯体过激（Taylor Simon Shrive，2021 年），远高于当年的预期。年长嫌犯谋杀女童的杀戮异官能恋人口统计也长时间研究报告每年最多 100 人被害；左右每 3 天就有一个女人（Ingala Smith，2018）。过激侵犯女童道德上是一个一致而轻微的卫生毛病，对世界各地女童的肥胖、生活品质和被害率产生重大顾虑。然而，过激不应成为女童孤独中都不可避免的一个不足之处；这是可以预防的。

犯人，常常也称作做幸存者，很或许只能卫生保健增值私人机构的医护和治疗（Hooker 等人，2020 年）。尽管如此，当今世界，助产士对这个毛病的反应还不够不够好。医护部门和其他卫生保健管理学部门可以在鉴别和应付过激侵犯女童道德上及其类似解读不足之处造就甚为重要作用；父母亲酷刑和官能过激（Bradbury-Jones，2015 年）。

这个毛病的构建是如何当成或解读出来它的核心，它反映了英国和世界各地不够最常的社会毛病。对女童的过激是一个类似专有名词，在整个讨论中都用于以强调女童的肥胖和生活品质需求。然而，这常常暗示了过激的来源：年长。因此，在重新考虑这些毛病时，甚为重要的是要记住，它们不是在密闭中都发生的，而是在厌女症、年长为首和异官能恋随后不对等的取材下发生的。此外，在医护和卫生保健应用领域一直未能不够好彻底解决这个毛病，这与卫生家长作风和卫生在卫生保健等级中都的为首独立官能具有内在的紧密联系。

在不久的过去，彻底解决卫生保健中都针对异官能恋的过激道德上的努力被医学上司刻画为“重新考虑不周的管理学阻挠”，并且“怀疑”异官能恋确实会从支持中都不受益（Fitzpatrick，2001 年）。这种不情愿与不够最常的社会态度彼此之间交叠，这些态度当今世界将父母亲酷刑普遍认为私事，并致使酷刑、污名和年长过激长时间正常转化成的黑影官能质。

在男权社会的结构中都，年长过激与年长支配具有内在的紧密联系，异官能恋基本上被征服，她们的个人经历被黑影起来。常常，异官能恋的毛病被认为是异官能恋只能彻底解决的个人毛病。这暗示了过激的嫌犯，并将义务和义务推卸了犯人以尽可能自己的前提，而不是彻底解决毛病的根源。

然而，虽然嫌犯应付过激和酷刑负全部义务，但轻微不够关于嫌犯的文献。彻底解决这个毛病的社区内工具已被证明是最有效的预防和阻挠彻底解决方案（阿姆斯特丹和莱尔，2008 年），并看成了衔接地方当地政府长时间实施多私人机构不考虑到性评估会议 (MARAC) 的基本原理。因此，医护部门作为仅有的卫生保健管理学小团体，才会成为这一应付措施的积极必不可少，鉴别和应付不考虑到性、协调医护和庇护所异官能恋。

个人经历过年长过激的异官能恋反复解读了支持、善解人意的公司员工和人格前提环境的甚为重要官能（Bradbury-Jones，2015）。为实现这一期望，公司员工才会经验渊博且有灵活性鉴别和应付不当和披露的迹象。

虽然个别医护部门或许会选择其发展他们在该应用领域的经验和解读出来，但分散在增值、董事会和信托中都的少数医护部门只能大规模领导医护，也只能进行前提的变革。因此，只能一种系统会官能工具，应重新考虑学习和其发展并尽可能可长时间官能。

投资于招聘和公司员工其发展对于尽可能公司员工的经验和灵活性至关甚为重要。然而，在学术研究中都一直察觉到招聘毛病。医护部门平常研究报告不够接触和有效应付父母亲酷刑和官能过激的经验、热忱和招聘（Alshammari 等人，2018 年）。因此，医护部门避免查问酷刑，因为他们不考虑到如何敏感地查问以及如何回应披露。

毫无疑问，该应用领域长时间不够其发展的原因是不够对女童孤独、肥胖和生活品质的重视。商科或 CPD 并未应重新考虑招聘，并且能够提供此类招聘的管理学助产士甚为相像。但这并不是什么新鲜事，卫生保健是一个上曾上家长式的私人机构，数百年来一直在为首着异官能恋的肥胖不对等。

在卫生保健系统会中都，父权制和年长为首权在卫生家长作风中都得到体现。曾在完全排斥异官能恋的传统医学为首独立官能在现代卫生保健中都基本上存在。医务部门在卫生保健系统会中都占有有最高层面的自主权，他们在大多数情况下在此之后领导学术研究、政策拟订以及增值其设计和投入生产。因此，医师、医护部门和病征存在于一个操作层次结构中都，医学一组占有为首独立官能。这种动态本质上是官能别转化成的，医务部门作为主要庇护所者扮演年长角色，而病征则是被动、异官能恋和依赖的接不受者。在这个系统会中都，不受酷刑的女童对施虐的伴侣和医护部门都具备双重宗主独立官能，

尽管热衷于于以病征为中都心的医护，但助产士常常会因投身于这些结构官能暴政和厌恶异官能恋的做法而感到内疚，而病征基本上属于宗主独立官能。医护部门的角色常常是关注和首倡的角一；然而，依然，也应当拒绝接不受这是在优越、控制和支配独立官能上发生的。

粗略浏览一下在线病征该系统会博客 Care Opinion，就会断定向医护部门（仅限于男女医护部门）披露酷刑道德上的异官能恋有许多难不受的个人经历。这种该系统会常常反映了公司员工不够经验和敏感官能，而病征则在应付再行创伤实践和程序来。尽管异官能恋劳动力占有多数，并且比非医护班里不够有或许致使年长过激（Cell Nursing Trust，2016 年），但仅凭经验难于指导高标准的医护或消除概念转化成厌女症的或许官能。职业技能。

然而，医护部门作为仅有的病征面对的劳动力并且平常领导医护模式的其发展，不仅应当能够鉴别和应付针对女童的过激道德上；他们也有灵活性领导该应用领域的战略其发展。这并非没有终究，因为医护部门也从总称作占有为首独立官能的卫生等级。这种既是支配者又是被支配者的独特独立官能呈现出一种流血冲突，如果不彻底解决各级卫生保健中都对女童的结构官能暴政，就不或许完全彻底解决这种流血冲突。

因此，卫生保健领导、企业主和教育工作者才会应重新考虑关于过激侵犯女童毛病的教育、其发展和招聘，以不够高经验、医护标准并最终不够高女童的肥胖和生活品质。然而，他们还才会接触到并终究当今世界顾虑或放宽异官能恋作为病征和各行各业其发展的结构官能障碍、厌女症和暴政。医护部门主动性的顾虑对病征的病因具有深远的顾虑（Francis，2013)，众所周知是卫生保健在彻底解决过激侵犯女童道德上不足之处的作用。虽然该毛病的官能别官能质已得到认可，但医护领导、组织、工会和私人机构在终究现状不足之处造就着作用，对病征医护有一致的顾虑。

年长过激是一个甚为重要的卫生毛病，顾虑到很高比例的异官能恋。医护部门和其他卫生保健管理学部门有义务鉴别和应付父母亲酷刑和官能过激的迹象，以彻底解决长时间的肥胖不对等毛病，庇护所女童并最终挽救生命。

然而，终止对女童的过激道德上只能由个别医护部门实现，最终只能系统会官能变革以及对招聘、其发展和学术研究的投资。如果医护部门要彻底解决异官能恋造成了的重大不考虑到性，那么医护部门教育者、领导和管理部门才会应重新考虑并投资于经验和医护的其发展，以尽可能特许者有热忱并有灵活性彻底解决这个毛病。

甚为重要的是，他们还才会拒绝接不受并终究暴政官能和结构上的父权法制，这些法制对推进该应用领域的实践和解读出来看成了障碍。最终，异官能恋将在此之后承不受不作为的负担。