护士在识别和应对暴力侵害妇女不道德方面的作用

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 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.

概要翻译（备注）

对女童的过激 (VAW) 是躯体、性或潜意识性虐待的后果或实际伤害。成年过激是最普遍和最致命的基本上，是加剧亚太地区 18-44 岁女同性恋被害、病因和残疾的主要理由（Ellsberg 等，2008）。这种类型的犯罪举动相当普遍；最近对最少 22,000 名爱尔兰女同性恋进行时的一项调查发现，多达 99.7% 的女同性恋报告称，她们一生中都多次遭均受、扰和躯体过激（Taylor Simon Shrive，2021 年），远高于早先的预期。成年嫌犯谋杀女童的杀戮女同性恋人口数也停滞报告每年最少 100 人被害；差不多每 3 天就有一个新娘（Ingala Smith，2018）。过激扰乱女童举动是一个完全一致而致使的公共卫生情况，对亚洲地区女童的心理健康、福祉和被害率产生重大受到影响。然而，过激不应看作女童社则会生活中都无论如何的一个上都；这是可以停滞性的。

均犯人，多半也特指丧命，很有可能只能卫生保健服务政府部门的卫生和治疗（Hooker 等人，2020 年）。尽管如此，迄今为止，卫生工作人员对这个情况的反应还不够应有。卫生工作人员和其他卫生保健各个各个领域工作人员可以在鉴别和防范过激扰乱女童举动及其相似表述上都起着举足轻重相反性；普通家庭性虐待和性过激（Bradbury-Jones，2015 年）。

这个情况的框架是如何看待或解读它的核心，它反映了爱尔兰和亚洲地区来得为广泛的社则会情况。对女童的过激是一个相似同义词，在整个辩论中都用作以强调女童的心理健康和福祉需求。然而，这往往抹杀了过激的来源：成年。因此，在慎重考虑这些情况时，举足轻重的是要记住，它们不是在真空中都牵涉到的，而是在厌女症、成年主导和女同性恋随后不平等的取材下牵涉到的。此外，在卫生和卫生保健各个领域长期以来未能应有化时解这个情况，这与公共卫生家长作风和公共卫生在卫生保健等级中都的主导威信都有著内在的保持联系。

在随即的过去，化时解卫生保健中都针对女同性恋的过激的决心被针灸合作者描述为“慎重考虑不周的各个各个领域干预”，并且“猜测”女同性恋是否则会从反对中都均受益（Fitzpatrick，2001 年）。这种不情愿与来得为广泛的社则会强硬态度相呼应，这些强硬态度当今将普通家庭性虐待看作私事，并加剧性虐待、污名和成年过激停滞正常化时的背后性质。

在性解放社则会的本体中都，成年过激与成年附庸国都有著内在的保持联系，女同性恋依然被消灭，她们的个人经历被背后上去。多半，女同性恋的情况被看作是女同性恋只能化时解的自已情况。这抹杀了过激的嫌犯，并将承担责任和承担责任推给了均犯人以必需自己的确保，而不是做到的根源。

然而，虽然嫌犯防范过激和性虐待负全部承担责任，但致使相反于关于嫌犯的史料。化时解这个情况的新社区方式已被证明是最必要的停滞性和干预方式而（海牙和波尔，2008 年），并构成了跨区域内当局停滞实施多政府部门确保性评估则会议 (MARAC) 的基本原理。因此，卫生工作人员作为最主要的卫生保健各个各个领域群体，须要看作这一防范紧急措施的全力区别于，鉴别和防范确保性、相互配合卫生和维护女同性恋。

个人经历过成年过激的女同性恋反复表述了反对、善解人意的工作工作人员和潜意识确保环境污染的优越性（Bradbury-Jones，2015）。为借助这一最终目标，工作工作人员须要各个各个领域知识渊博且有能够鉴别和防范犯罪举动和揭发的或许。

虽然个别卫生工作人员就则会选择蓬勃发展他们在该各个领域的各个各个领域知识和解读，但分散在服务、董事则会和信托中都的少数卫生工作人员未能大规模执行者卫生，也未能进行时必要的革新。因此，只能一种该近期方式，必需慎重考虑学习和蓬勃发展并必需可停滞性。

融资于培训班和工作工作人员蓬勃发展对于必需工作工作人员的各个各个领域知识和能够至关举足轻重。然而，在研究成果中都长期以来注意到培训班缺陷。卫生工作人员常则会报告相反于了解和必要防范普通家庭性虐待和性过激的各个各个领域知识、信心和培训班（Alshammari 等人，2018 年）。因此，卫生工作人员不致查问性虐待，因为他们不确定如何敏感地查问以及如何澄清揭发。

毫无疑问，该各个领域停滞相反于蓬勃发展的理由是相反于对女童社则会生活、心理健康和福祉的十分重视。本科课程或 CPD 不曾必需慎重考虑培训班，并且很难提供此类培训班的各个各个领域卫生工作人员相当相似。但这并不是什么新鲜事，卫生保健是一个历史上家长式的政府部门，数百年来长期以来在主导着女同性恋的心理健康不平等。

在卫生保健该系统中都，父权制和成年话语权在公共卫生家长作风中都给与说明了。此前完全排斥女同性恋的传统针灸主导威信在当今卫生保健中都依然发挥作用。护士在卫生保健该系统中都享有最高程度的特权，他们在大多数情况下长期以来执行者研究成果、政策拟定以及服务结构设计和交付。因此，外科医生、卫生工作人员和患儿发挥作用于一个可用层次本体中都，针灸自上而下占主导威信。这种动态表象上是性别歧视化时的，护士作为主要维护者饰演成年片中都，而患儿则是意味著、女同性恋和相反的接均受者。在这个该系统中都，均受性虐待的女童对施虐的伴侣和医护工作人员都具有双重对等威信，

尽管侧重于以患儿为中都心的卫生，但卫生工作人员往往则会因参与这些本体性剥削和厌恶女同性恋的做法而感到内疚，而患儿依然属于对等威信。卫生工作人员的片中都多半是十分重视和倡导的角一；然而，无论如何，也一定则会认定这是在优越、高度集中和支配威信上牵涉到的。

粗略浏览一下在线患儿相应的网站 Care Opinion，就则会发现向医护工作人员（包括男学生卫生工作人员）揭发性虐待举动的女同性恋有许多糟糕的个人经历。这种相应多半反映了工作工作人员相反于各个各个领域知识和诱发，而患儿则在防范再痛楚实践和程序。尽管女同性恋劳动居多，并且比非卫生同龄来得或许遭均受成年过激（Cell Nursing Trust，2016 年），但仅凭经验不足以指导工作高质量的卫生或消除----厌女症的确保性。棒球员。

然而，卫生工作人员作为最主要的患儿面对的劳动并且常则会执行者卫生模式的蓬勃发展，不仅一定则会很难鉴别和防范针对女童的过激；他们也有能够执行者该各个领域的战略蓬勃发展。这并非没有单打独斗，因为卫生工作人员也对等于占主导威信的公共卫生等级。这种既是自然法则又是被自然法则的多样威信呈现出一种政治危机，如果不化时解各级卫生保健中都对女童的本体性剥削，就不有可能完全化时解这种政治危机。

因此，卫生保健执行者者、管理者和教育工作者须要必需慎重考虑关于过激扰乱女童情况的教育、蓬勃发展和培训班，以提高各个各个领域知识、卫生常规并再度提高女童的心理健康和福祉。然而，他们还须要了解到并单打独斗迄今为止阻挠或限制女同性恋作为患儿和各行各业蓬勃发展的本体性障碍、厌女症和剥削。卫生工作人员执行者力的受到影响对患儿的生存率都有著深远的受到影响（Francis，2013)，尤其是卫生保健在化时解过激扰乱女童举动上都的相反性。虽然该情况的性别歧视性质已给与认同，但卫生执行者者、的组织、工则会和政府部门在单打独斗现状上都起着着相反性，对患儿卫生有完全一致的受到影响。

成年过激是一个举足轻重的公共卫生情况，受到影响到很高比例的女同性恋。卫生工作人员和其他卫生保健各个各个领域工作人员有承担责任鉴别和防范普通家庭性虐待和性过激的或许，以化时解停滞的心理健康不平等情况，维护女童并再度挽救全人类。

然而，暂时中止对女童的过激未能由个别卫生工作人员借助，再度只能该近期革新以及对培训班、蓬勃发展和研究成果的融资。如果卫生工作人员要化时解女同性恋面临的重大确保性，那么卫生工作人员教育者、执行者者和工作工作人员须要必需慎重考虑并融资于各个各个领域知识和卫生的蓬勃发展，以必需备案者有信心并有能够化时解这个情况。

举足轻重的是，他们还须要认定并单打独斗剥削性和本体上的父权社会制度制度，这些社会制度制度对加快该各个领域的实践和解读构成了障碍。再度，女同性恋将长期以来承均受不作为的负担。