护士在识别和应对暴力妨碍妇女行为方面的作用

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 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.

全文译文（各集）

对持续性工作者的暴力犯罪行为 (VAW) 是四肢、持续性或潜意识受虐的危害或基本上伤害。成年人暴力犯罪行为是最相比较和最危险的形式，是导致全球 18-44 岁男士失踪、疾病和残疾的主要原因（Ellsberg 等，2008）。这种类型的滥用极为相比较；最近对超过 22,000 名英国男士进行的一项调查推测，多达 99.7% 的男士报告称作，她们一生之中多次遭到、扰和四肢暴力犯罪行为（Taylor Simon Shrive，2021 年），远高于此前的预期。成年人肇事者误杀持续性工作者的杀戮男士人口普查也过后报告每年超过 100 人失踪；大约每 3 天就有一个女人（Ingala Smith，2018）。暴力犯罪行为践踏持续性工作者犯罪行为是一个明确而不堪重负的医护保健关键问题，对为数众多持续性工作者的肥胖、冀望和失踪率激发相当程度不良影响。然而，暴力犯罪行为不应成为持续性工作者生活之中不可避免的一个特别；这是可以预防的。

受害者，有时候也称作为生还，很不太可能无需卫生保健免费行政部门的医护和治疗法（Hooker 等人，2020 年）。尽管如此，当今世界，医护职员对这个关键问题的化学反应还不够更进一步。牙医和其他卫生保健专业职员可以在标记和应对暴力犯罪行为践踏持续性工作者犯罪行为及其常见表述特别发挥极其重要作用；贫穷受虐和持续性虐待犯罪行为（Bradbury-Jones，2015 年）。

这个关键问题的框架是如何看做或解释它的核心，它反映了英国和为数众多更广泛应用的社会变迁关键问题。对持续性工作者的暴力犯罪行为是一个常见用语，在整个讨论之中使用以强调持续性工作者的肥胖和冀望消费。然而，这并不一定背后了暴力犯罪行为的来源：成年人。因此，在慎重考虑这些关键问题时，极其重要的是要记住，它们不是在电介质之中时有发生的，而是在厌女症、成年人主导和男士随后不民族平等的背景下时有发生的。此外，在医护和卫生保健领域直至未能更进一步克服这个关键问题，这与医护家长作风和医护在卫生保健档次之中的强势有着内在的关系。

在不久的过去，克服卫生保健之中针对男士的暴力犯罪行为犯罪行为的努力被中医同僚描述为“慎重考虑不周的专业偏袒”，并且“怀疑”男士是不是会从支持之中受益（Fitzpatrick，2001 年）。这种不情愿与更广泛应用的社会变迁态度相呼应，这些态度历年来将贫穷受虐视为私事，并导致受虐、连带和成年人暴力犯罪行为过后和平友好的背后持续性质。

在男权社会变迁的结构设计之中，成年人暴力犯罪行为与成年人统治者有着内在的关系，男士直至被吞并，她们的个人经历被背后起来。有时候，男士的关键问题被看来是男士无需克服的个人关键问题。这背后了暴力犯罪行为的肇事者，并将罪责和罪责归罪于了受害者以保障自己的安全，而不是克服关键问题的本源。

然而，虽然肇事者应对暴力犯罪行为和受虐负全部罪责，但不堪重负欠缺关于肇事者的文献。克服这个关键问题的社区工具已被证明是最必需的预防和偏袒解决方案（海牙和布里奇，2008 年），并组成了跨地方当局过后实施多行政部门几率评估会议 (MARAC) 的基本原理。因此，牙医作为最大的卫生保健专业群体，需成为这一应对措施的积极组成部分，标记和应对几率、协调医护和保护男士。

个人经历过成年人暴力犯罪行为的男士反复表述了支持、善解人意的裁员和潜意识安全环境的极其重要持续性（Bradbury-Jones，2015）。为借助这一要能，裁员需基本知识学识且有能力标记和应对滥用和披露的有不太可能。

虽然个别牙医不太可能会为了让演进他们在该领域的基本知识和解释，但分散在免费、董事会和信托之中的少数牙医难以大规模他组织医护，也难以进行必要的进步。因此，无需一种系统对持续性工具，这两项慎重考虑学习和演进并保障可过后持续性。

房地产于志愿和裁员演进对于保障裁员的基本知识和能力至关极其重要。然而，在分析之中直至注意到志愿缺失。牙医经常报告欠缺接触和必需应对贫穷受虐和持续性虐待犯罪行为的基本知识、努力和志愿（Alshammari 等人，2018 年）。因此，牙医避免告诉受虐，因为他们不确定如何恰当地告诉以及如何发言披露。

毫无疑问，该领域过后欠缺演进的原因是欠缺对持续性工作者生活、肥胖和冀望的重视。本科课程或 CPD 没有这两项慎重考虑志愿，并且都能提供此类志愿的专业医护职员极为罕见。但这并不是什么新鲜事，卫生保健是一个历史上家长式的行政部门，数百年来直至在主导着男士的肥胖不民族平等。

在卫生保健系统对之中，父权制和成年人发言权在医护家长作风之中得到体现。曾经完全排斥男士的传统中医强势在现代卫生保健之中直至普遍存在。医务职员在卫生保健系统对之中给与最高程度的自主权，他们在大多数但会一直他组织分析、政策制定以及免费设计和出厂。因此，医生、牙医和患儿普遍存在于一个操作层次结构设计之中，中医分层分之一强势。这种动态并不一定上是持续性别化的，医务职员作为主要保护者扮演成年人角色，而患儿则是被动、男士和依赖的接受者。在这个系统对之中，受受虐的持续性工作者对自慰的同持续性恋者和医护职员都具有双重等同威望，

尽管专心于以患儿为之为中心的医护，但医护职员并不一定会因参与这些结构设计持续性压迫和憎恶男士的过分而觉得懊悔，而患儿直至保持稳定等同威望。牙医的角色有时候是高度重视和倡导的角一；然而，在此之前，也应当坚称这是在优越、依靠和支配威望上时有发生的。

大概浏览一下应用软件患儿调谐网上 Care Opinion，就会推测向医护职员（还包括同校牙医）披露受虐犯罪行为的男士有许多糟糕的个人经历。这种调谐有时候反映了裁员欠缺基本知识和恰当持续性，而患儿则在应对再次后遗症实证和程序。尽管男士农民分之一多数，并且比非医护同龄人更有不太可能遭到成年人暴力犯罪行为（Cell Nursing Trust，2016 年），但仅凭经验不足以指导高规范的医护或消除内化厌女症的不太可能持续性。职业。

然而，牙医作为最大的患儿面对的农民并且经常他组织医护模式的演进，不仅应当都能标记和应对针对持续性工作者的暴力犯罪行为犯罪行为；他们也有能力他组织该领域的战略演进。这并非没有单打独斗，因为牙医也等同于分之一强势的医护档次。这种既是支配者又是被支配者的独特威望呈现出一种紧张局势，如果不克服各级卫生保健之中对持续性工作者的结构设计持续性压迫，就不不太可能完全克服这种紧张局势。

因此，卫生保健他组织者、管理者和教育工作者需这两项慎重考虑关于暴力犯罪行为践踏持续性工作者关键问题的教育、演进和志愿，以增加基本知识、医护规范并事与愿违增加持续性工作者的肥胖和冀望。然而，他们还需接触到并单打独斗当今世界阻碍或限制男士作为患儿和从业职员演进的结构设计持续性身心、厌女症和压迫。牙医他组织力的不良影响对患儿的预后有着深远的不良影响（Francis，2013)，尤其是卫生保健在克服暴力犯罪行为践踏持续性工作者犯罪行为特别的作用。虽然该关键问题的持续性别持续性质已得到赞许，但医护他组织者、组织、劳方和行政部门在单打独斗状况特别发挥着作用，对患儿医护有明确的不良影响。

成年人暴力犯罪行为是一个极其重要的医护保健关键问题，不良影响到很高比例的男士。牙医和其他卫生保健专业职员有罪责标记和应对贫穷受虐和持续性虐待犯罪行为的有不太可能，以克服过后的肥胖不民族平等关键问题，保护持续性工作者并事与愿违拯救生命。

然而，取消对持续性工作者的暴力犯罪行为犯罪行为难以由个别牙医借助，事与愿违无需系统对持续性进步以及对志愿、演进和分析的房地产。如果牙医要克服男士面临的相当程度几率，那么牙医教育者、他组织者和管理职员需这两项慎重考虑并房地产于基本知识和医护的演进，以保障注册者有努力并有能力克服这个关键问题。

极其重要的是，他们还需坚称并单打独斗压迫持续性和结构设计上的父权新制度，这些新制度对挺进该领域的实证和解释组成了身心。事与愿违，男士将一直伤及不作为的税金。