护士在识别和应对暴力侵害性工作者行为方面的作用

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 Wild 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.

全文中文翻译（仅供参考）

对女权的使用暴力 (VAW) 是双脚、持续性或心理施暴的威胁或仅仅伤害。男中产阶级使用暴力是最普遍和最可怕的形式，是随之而来全球 18-44 岁成年人死亡、疾病和老年人的主要原因（Ellsberg 等，2008）。这种类型的不作为颇为普遍；值得注意对超过 22,000 名英美成年人进行的一项调查推测，据统计 99.7% 的成年人简报称，她们一生中都多次致使、扰和双脚使用暴力（Taylor Wild Shrive，2021 年），远高于在此之后的预想。未成年嫌疑人谋杀案女权的无情成年人人口普查也不间断简报每年超过 100 人死亡；差不多每 3 天就有一个女人（Ingala Smith，2018）。使用暴力践踏女权行为是一个确切而相当严重的公共卫生妥善解决办法，对世界性女权的身体健康、冀望和死亡率产生重大阻碍。然而，使用暴力不不应带入女权日常生活中都不可避开的一个总体；这是可以公共卫生的。

受害人，举例来说也专指幸存者，很确实无需保健服务于私人机构的照护和化疗（Hooker 等人，2020 年）。尽管如此，迄今，照护人员对这个妥善解决办法的反不应还不够合理。药剂师和其他保健专业人士人员可以在定位和妥善解决妥善解决办法使用暴力践踏女权行为及其常见表达出来总体发挥起着最重要起着；中产阶级施暴和中产阶级使用暴力（Bradbury-Jones，2015 年）。

这个妥善解决办法的软件系统是如何看待或阐释它的核心，它解读了英美和世界性格外普遍的价值观妥善解决办法。对女权的使用暴力是一个常见术语，在整个争辩中都使用以强调女权的身体健康和冀望需求。然而，这并不一定掩盖了使用暴力的缺少：未成年。因此，在慎重考虑这些妥善解决办法时，最重要的是要记得，它们不是在电介质中都牵涉到的，而是在厌女症、未成年催生和成年人随后不公平的背景下牵涉到的。此外，在照护和保健科技领域一直未能合理妥善解决这个妥善解决办法，这与医疗卫生家长作风和医疗卫生在保健层级中都的催生独立性特别是在内在的连系。

在没多久的过去，妥善解决保健中都针对成年人的使用使用暴力的努力工作被病理学同事描述为“慎重考虑不周的专业人士介入”，并且“声称”成年人到底会从全力支持中都正因如此（Fitzpatrick，2001 年）。这种不情愿与格外普遍的价值观态度相呼不应，这些态度历来将中产阶级施暴视为私事，并随之而来施暴、长久以来和男中产阶级使用暴力不间断正常化的隐密特殊持续性。

在男权价值观的结构中都，男中产阶级使用暴力与未成年统治特别是在内在的连系，成年人一直被征服者，她们的经历被隐密出去。举例来说，成年人的妥善解决办法被认为是成年人无需妥善解决的个人妥善解决办法。这掩盖了使用暴力的嫌疑人，并将负起和负起推给了受害人以维护自己的安全，而不是妥善解决妥善解决办法的深层次。

然而，虽然嫌疑人妥善解决妥善解决办法使用暴力和施暴负全部负起，但相当严重忽视关于嫌疑人的文献。妥善解决这个妥善解决办法的社区原理已被断定是最有效的公共卫生和介入策略（海牙和布里奇，2008 年），并组成了区域性地方当局不间断实施多私人机构危险持续性评估内阁会议 (MARAC) 的基本原理。因此，药剂师作为小得多的保健专业人士个体，不能带入这一妥善解决妥善解决办法举措的积极组成部分，定位和妥善解决妥善解决办法危险持续性、协调照护和庇护所成年人。

经历过男中产阶级使用暴力的成年人每一次表达出来了全力支持、善解人意的公司员工和心理安全状况的最重要持续性（Bradbury-Jones，2015）。为发挥作用这一前提，公司员工不能专业知识学识渊博且有技能定位和妥善解决妥善解决办法不作为和谈及的有可能。

虽然个别药剂师确实会选择拓展他们在该科技领域的专业知识和阐释，但分散在服务于、董事会和信托中都的少数药剂师不能大规模催生照护，也不能进行必要持续性的转变。因此，无需一种该系统持续性原理，必需慎重考虑学习和拓展并维护可不间断持续性。

投资于招聘和公司员工拓展对于维护公司员工的专业知识和技能至关最重要。然而，在研究中都一直留意到招聘缺陷。药剂师经常简报忽视认识和有效妥善解决妥善解决办法中产阶级施暴和中产阶级使用暴力的专业知识、自信和招聘（Alshammari 等人，2018 年）。因此，药剂师避开询问施暴，因为他们不确定如何敏感地询问以及如何回不应谈及。

却是，该科技领域不间断忽视拓展的原因是忽视对女权日常生活、身体健康和冀望的注重。本科课程或 CPD 仍未必需慎重考虑招聘，并且尽确实提供此类招聘的专业人士照护人员颇为罕见。但这并不是什么新鲜事，保健是一个文化史上家长式的私人机构，数百年来一直在催生着成年人的身体健康不公平。

在保健该系统中都，宰制制和未成年催生权在医疗卫生家长作风中都得到突显。曾多次完全排斥成年人的传统病理学催生独立性在当代保健中都一直仅仅上。医务人员在保健该系统中都享有三高程度的权利，他们在大多数情况下之后催生研究、政策制定以及服务于设计和下单。因此，医生、药剂师和病征仅仅上于一个操作层次结构中都，病理学自上而下分之一催生独立性。这种静态某种程度上是持续性别化的，医务人员作为主要庇护所者担纲未成年角色，而病征则是同样、成年人和依赖的接受者。在这个该系统中都，受施暴的女权对施虐的配偶和消防员都有着双重等同独立性，

尽管个人兴趣于以病征为中都心的照护，但照护人员并不一定会因参与这些结构持续性压抑和厌恶成年人的只不过而感到痛心，而病征一直处于等同独立性。药剂师的角色举例来说是关注和倡导的角一；然而，以致于，也不某种程度宣称这是在优越、控制和支配独立性上牵涉到的。

相吻合上传一下网络病征反馈网站 Care Opinion，就会推测向消防员（包括男学生药剂师）谈及施暴行为的成年人有许多令人震惊的经历。这种反馈举例来说解读了公司员工忽视专业知识和诱发，而病征则在妥善解决妥善解决办法再创伤倡导和服务于器端。尽管成年人劳工分之一多数，并且比非照护同龄人格外有确实致使男中产阶级使用暴力（Cell Nursing Trust，2016 年），但仅凭经验不足以指导高标准的照护或抵消----厌女症的确实持续性。棒球员。

然而，药剂师作为小得多的病征面对的劳工并且经常催生照护模式的拓展，不仅不某种程度尽确实定位和妥善解决妥善解决办法针对女权的使用使用暴力；他们也有技能催生该科技领域的军事拓展。这并非没有下一场，因为药剂师也从归属于分之一催生独立性的医疗卫生层级。这种既是等同又是被等同的独有独立性呈现出一种关系恶化，如果不妥善解决各级保健中都对女权的结构持续性压抑，就不确实完全妥善解决这种关系恶化。

因此，保健催生者、管理者和文化教育工作者不能必需慎重考虑关于使用暴力践踏女权妥善解决办法的文化教育、拓展和招聘，以大幅提高专业知识、照护标准并再度大幅提高女权的身体健康和冀望。然而，他们还不能认识到并下一场迄今阻碍或约束成年人作为病征和大众传媒拓展的结构持续性障碍、厌女症和压抑。药剂师催生力的阻碍对病征的预后特别是在颇为最重要的阻碍（Francis，2013)，特别是保健在妥善解决使用暴力践踏女权行为总体的起着。虽然该妥善解决办法的持续性别特殊持续性已得到肯定，但照护催生者、组织、工会和私人机构在下一场长期以来总体发挥起着着起着，对病征照护有确切的阻碍。

男中产阶级使用暴力是一个最重要的公共卫生妥善解决办法，阻碍到很高比例的成年人。药剂师和其他保健专业人士人员有负起定位和妥善解决妥善解决办法中产阶级施暴和中产阶级使用暴力的有可能，以妥善解决不间断的身体健康不公平妥善解决办法，庇护所女权并再度保住一个人。

然而，延后对女权的使用使用暴力不能由个别药剂师发挥作用，再度无需该系统持续性转变以及对招聘、拓展和研究的投资。如果药剂师要妥善解决成年人面临的重大危险持续性，那么药剂师文化教育者、催生者和管理人员不能必需慎重考虑并投资于专业知识和照护的拓展，以维护注册者有自信并有技能妥善解决这个妥善解决办法。

最重要的是，他们还不能宣称并下一场压抑持续性和结构上的宰制制度，这些制度对前推该科技领域的倡导和阐释组成了障碍。再度，成年人将之后承受不作为的负担。