护士在识别和应对暴力侵害女性行为方面的作用 | J Clin Nurs

p 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 have 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 have 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 have 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 avoid 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 navigate retraumatising practices and procedures. Despite being a majority female workforce and being more likely to have experienced male violence than their non-nursing peers (Cavell 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 have 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 have 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 save 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.

全文翻译（所列）

1 取材

极端主义扰乱女童使用暴力 (VAW) 是对身体、大多性或病态施暴的小心或实际妨碍。成年极端主义是最大多和最小心的基本概念，是全球 18-44 岁女同大多性恋失踪、疾病和残障的主要原因（Ellsberg 等人，2008 年）。这种滥用十分大多；都只对 22,000 多名英国女同大多性恋进行的一项调查见到，多达 99.7% 的女同大多性恋表示在其一生里多次遭受过强奸、恫吓和身体极端主义（Taylor & Shrive，2021 年），远高于年末的预期。追踪成年犯罪者误杀女同大多性恋的女同大多性恋误杀人口普查也长时间报告每年有 100 多人失踪；每 3 天大约有一名女同大多性恋（Ingala Smith，2018）。极端主义扰乱女童使用暴力是一个明确而严重的流行病学缺陷，对世山海各地女童的病态健康、生活品质和失踪率具重大事件严重影响。然而，极端主义不应成为女童生活里不可避开的特别；这是可以预防的。

受害者，不一定也称为幸存者，可能并不需要医疗卫生服务政府机构的照护和化疗（Hooker 等人，2020 年）。尽管如此，纵观，对该缺陷的照护催化一直不足。药剂师和其他医疗卫生保健机械工程人员可以在识别和补救极端主义扰乱女童使用暴力及其常见表现特别发挥最重要作用；家庭施暴和大多性极端主义（Bradbury-Jones，2015 年）。

这个缺陷的框架是如何看成或了解它的核心，它突显了英国和世山海各地更广泛的观念缺陷。对女童的极端主义是一个常用术语，在整个探讨里都采用它来强调女童的病态健康和生活品质生产力。然而，这往往掩藏了极端主义的举例：成年。因此，在再考虑这些缺陷时，最重要的是要记得，它们不是在真空里引发的，而是在厌女症、成年为首和女同大多性恋随后的不公平取材下引发的。此外，在照护和医疗卫生保健里没法充分解决缺陷这一缺陷与医疗卫生家长制和外科在医疗卫生保健等级政治制度里的为首独立大多性特别是在内在的建立联系。

2 女同大多性恋的缺陷

在刚的过去，外科助手将解决缺陷医疗卫生保健里针对女同大多性恋的极端主义缺陷描述为“再考虑不周的机械工程打压”，并且“坚称”女同大多性恋会从支持里得益（Fitzpatrick，2001）。这种不情愿与更广泛的观念态度相呼应，这些态度当今将家庭施暴看作私事，并导致施暴、污名和成年极端主义长时间缓和的背后大多性质。

在伪善观念的内部结构里，成年极端主义与成年统治者特别是在内在的建立联系，女同大多性恋一直被收复失地，她们的境遇被背后起来。不一定，女同大多性恋的缺陷被认为是女同大多性恋并不需要解决缺陷的个人身份缺陷。这掩藏了极端主义的行凶，并将义务和义务招致受害者，以必需自己的安全大多性，而不是解决缺陷缺陷的乃是。

然而，虽然施暴者补救极端主义和施暴倒数第全部义务，但严重缺失关于施暴者刑满的文献。解决缺陷这个缺陷的社区方法已被证明是最理论上的预防和打压方针（Hague 和 Bridge，2008 年），并构成了在人口众多当局彼此间长时间拟定多政府机构高风险评估决议 (MARAC) 的基本概念。因此，药剂师作为第二大的医疗卫生保健机械工程群体，不能成为这种催化的积极区别于，识别和补救高风险，协调照护并管控女同大多性恋。

3 转型基础知识

境遇过成年极端主义的女同大多性恋反复表达了支持、善解人意的雇员和病态安全大多性环境的最重要大多性（Bradbury-Jones，2015 年）。为了做到这一要能，雇员不能具备识别和补救滥用和引述迹象的基础知识和技能。

虽然个别药剂师则会选择转型他们在这一行业的基础知识和了解，但分散在服务、董事会和信托政府机构的少数药剂师难以大规模领袖照护，也难以做到必要的变革。因此，并不需要一种子系统的方法，优先再考虑学习和转型并必需可长时间大多性。

入股于实习和雇员转型对于必需雇员的基础知识和技能至关最重要。然而，研究工作里一直注意到特训不足。药剂师往往报告缺失识别和理论上补救家庭施暴和大多性极端主义的基础知识、信心和实习（Alshammari 等人，2018 年）。结果，药剂师避免询问施暴，因为他们不确定如何敏感地询问以及如何回应引述。

毫无疑问，这一行业长时间缺失转型是由于缺失对女童永生、病态健康和生活品质的重视。大学本科或 CPD 不优先再考虑实习，能够备有此类实习的机械工程照护人员十分相像。但这并不是什么新鲜事，医疗卫生保健，一个当今家长式一贯的政府机构，数百年来一直为首着女同大多性恋的病态健康不公平。

4 家长制和大多男女彼此间

在医疗卫生保健子系统里，父权制和成年统治者在医疗卫生家长制里得不到反映。曾一度完全敌视女同大多性恋的传统外科为首独立大多性在现代医疗卫生保健里一直存在一定程度。医务人员在医疗卫生保健子系统里享有最高程度的自主权，部分时间都在研究工作、政策制定、服务设计和签订合同特别所处领先独立大多性。因此，医生、药剂师和病人存在于一个操创作者级别里，外科从上到下%为首独立大多性。这种动态本质上是大多性别歧视化的，医务人员反派成年角色，作为主要的管控者，而病人则反派主动、女同大多性恋和依赖的须先。在这个子系统里，受施暴的女同大多性恋是双重的从属，既服从于施虐的伴侣，也服从于消防员，

尽管高度重视以病人为里心的照护，但照护不一定会因参与这些内部结构上的敌视和厌恶女同大多性恋的做法而不已内疚，而病人一直所处从属独立大多性。药剂师的角色不一定是高度重视和倡议之一；然而，即使是这种情况，也应该坚称是在优越、操控和支配独立大多性的情况下引发的。

粗略浏览一下在线病人对子系统博客 Care Opinion 可以见到，向以外男女药剂师在内的消防员引述施暴使用暴力的女同大多性恋有许多引人注目的境遇。这种对子系统不一定突显了雇员缺失基础知识和敏感大多性，而病人则在进行再外伤实证和程序。尽管女同大多性恋劳动%优势，并且比非照护同龄人更有可能遭受成年极端主义（Cavell Nursing Trust，2016 年），但仅凭经验不足以指导高标准规范的照护或扫除实质上厌女症的可能大多性职业。

然而，药剂师作为第二大的病人面对劳动并往往领袖照护模式的转型，不仅应所处识别和补救极端主义扰乱女童使用暴力的有利位置；他们还可以很好地领袖该行业的大战略转型。这并非从未同样，因为药剂师也从分属%为首独立大多性的医疗卫生等级政治制度。这种既是支配又是被支配的独特独立大多性提出异议了一种关系紧张，如果不解决缺陷各个层面的医疗卫生保健行业对女童的内部结构大多性敌视，就不可能完全解决缺陷这种关系紧张。

因此，医疗卫生保健领袖者、雇员和观念工创作者不能优先再考虑极端主义扰乱女童缺陷的教育、转型和实习，以提高基础知识、照护标准规范并之后提高女童的病态健康和生活品质。然而，他们还不能坚称并同样纵观顾虑或限制女同大多性恋作为病人和各个领域转型的内部结构大多性障碍、厌女症和敌视。药剂师领袖的严重影响对病人的临床表现特别是在不可忽视的严重影响（弗朗西斯，2013)，对于医疗卫生保健在解决缺陷极端主义扰乱女童使用暴力特别的作用相比之下如此。虽然这个缺陷的大多性别歧视大多性质得不到坚称，但照护领袖者、组织、罢工和政府机构在同样现状特别发挥着作用，对病人照护有明显的严重影响。

5 结论

成年极端主义是一个重大事件的流行病学缺陷，严重影响到不大比例的女同大多性恋。药剂师和其他医疗卫生保健机械工程人员有义务识别和补救家庭施暴和大多性极端主义的迹象，以解决缺陷长时间的病态健康不公平缺陷，管控女童并之后挽救永生。

然而，个体药剂师难以扫除对女童的极端主义使用暴力，之后并不需要子系统大多性的变革和对实习、转型和研究工作的入股。如果药剂师要解决缺陷女同大多性恋面对的重大事件高风险，那么药剂师学学、领袖者和雇员不能优先再考虑并入股于基础知识和照护的转型，以必需注册者有信心和有技能解决缺陷这个缺陷。

最重要的是，他们还不能坚称并同样敌视大多性和内部结构大多性父权制，这些政治制度顾虑了该行业的实证和了解。之后，女同大多性恋将继续承受无所作为的倒数第担。

THE

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