护士在鉴别和应对暴力侵害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 Bell 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.

全文翻译成（仅供参考）

对男士的犯罪行为 (VAW) 是眼睛、性或人格强暴的危险或也就是说伤害。男受虐是最相比较和最危险的形式，是导致全球 18-44 岁男士被害、疾病和残障的主要原因（Ellsberg 等，2008）。这种类型的误用极为相比较；最近对超过 22,000 名苏格兰男士开展的一项追查发现，有数 99.7% 的男士份文件称，她们一生里多次遭遇、变和眼睛犯罪行为（Taylor Bell Shrive，2021 年），远高于此前的预期。异性恋受害人暗杀男士的杀戮男士人口普查也停滞份文件每年超过 100 人被害；大约每 3 天就有一个女人（Ingala Smith，2018）。犯罪行为侵害男士蓄意是一个具体而致使的公共卫生难题，对世界各地男士的人格健康、生活品质和被害率诱发实质性致使影响。然而，犯罪行为不应成为男士生活里不可会的一个多方面；这是可以卫生保健的。

受害者，举例来说也称之为幸存者，很确实所需公共服务项目服务项目独立机构的诊疗和外科手术（Hooker 等人，2020 年）。尽管如此，在此之前，诊疗其他部门对这个难题的中间体还不够充分。药剂师和其他公共服务项目从业者其他部门可以在辨别和补救犯罪行为侵害男士蓄意及其类似于表达出来多方面造就最重要依赖性；父母亲强暴和受虐（Bradbury-Jones，2015 年）。

这个难题的框架是如何看待或理解它的核心，它再现了苏格兰和世界各地更是相比较的社就会难题。对男士的犯罪行为是一个类似于该词，在整个讨论里可用以阐释男士的人格健康和生活品质所需。然而，这一般来说抹去了犯罪行为的来源：异性恋。因此，在慎重考虑这些难题时，最重要的是要记住，它们不是在真空里暴发的，而是在秽女症、异性恋主导和男士随后不应有的取材下暴发的。此外，在诊疗和公共服务项目信息技术直至并未充分补救这个难题，这与照护家长作风和照护在公共服务项目级别里的强势看作内在的联系。

在不久的只不过，补救公共服务项目里针对男士的犯罪行为蓄意的努力被病理学同事描述为“慎重考虑不周的从业者阻挠”，并且“不以为然”男士是否就会从支持里受益（Fitzpatrick，2001 年）。这种不执意与更是相比较的社就会看法相合呼应，这些看法历来将父母亲强暴视为私事，并导致强暴、污名和男受虐停滞正常转化成的隐藏形式。

在专制主义社就会的形态里，男受虐与异性恋支配看作内在的联系，男士仍然被征服，她们的漫长被隐藏起来。举例来说，男士的难题被确信是男士所需补救的个人身份难题。这抹去了犯罪行为的受害人，并将罪责和罪责推给了受害者以保障自己的确保，而不是补救难题的根源。

然而，虽然受害人补救犯罪行为和强暴负全部罪责，但致使依赖于关于受害人的文献。补救这个难题的社区工具已被证明是最有效的卫生保健和阻挠策略（海牙和威尔，2008 年），并构成了跨地方伊朗政府停滞拟定多独立机构风险评估就决议 (MARAC) 的分析工具。因此，药剂师作为最主要的公共服务项目从业者群体，须要成为这一补救措施的全力组成部分，辨别和补救风险、协调诊疗和保护男士。

漫长过男受虐的男士每一次表达出来了支持、善解人意的管理层和人格确保环境污染的最重要性（Bradbury-Jones，2015）。为构建这一目标，管理层须要基本知识广博且有意志力辨别和补救误用和引述的精神状态。

虽然个别药剂师确实就会选择其发展他们在该信息技术的基本知识和理解，但分散在服务项目、董事就会和信托里的少数药剂师未能大规模拥护诊疗，也未能开展充分的变革。因此，所需一种系统会性工具，适当慎重考虑进修和其发展并保障可停滞性。

投资者于实习和管理层其发展对于保障管理层的基本知识和意志力至关最重要。然而，在学术研究里直至显然实习缺陷。药剂师特别份文件依赖于认识和有波动对父母亲强暴和受虐的基本知识、努力和实习（Alshammari 等人，2018 年）。因此，药剂师会询问强暴，因为他们不确切如何引人注目地询问以及如何发言引述。

毫无疑问，该信息技术停滞依赖于其发展的原因是依赖于对男士生活、人格健康和生活品质的十分重视。法学院或 CPD 并未适当慎重考虑实习，并且并不所需提供此类实习的从业者诊疗其他部门极为相像。但这并不是什么新鲜事，公共服务项目是一个历史上家长式的独立机构，数百年来直至在主导着男士的人格健康不应有。

在公共服务项目系统会里，父权制和异性恋主导权在照护家长作风里得不到体现。曾经显然排斥男士的传统病理学强势在当代公共服务项目里仍然相比较存在。医务其他部门在公共服务项目系统会里享有最高素质的自主权，他们在大多数情况下暂时拥护学术研究、措施订立以及服务项目新设计和交付。因此，医生、药剂师和病患相比较存在于一个系统新设计层次形态里，病理学自上而下占总强势。这种快照某种程度上是性别歧视转化成的，医务其他部门作为主要保护者塑造成异性恋主角，而病患则是被动、男士和倚赖的接受者。在这个系统会里，受强暴的男士对施虐的伴侣和医护其他部门都具有双重实质上话语权，

尽管专注于以病患为里心的诊疗，但诊疗其他部门一般来说就会因参与这些形态上反抗和轻视男士的做法而沮丧内疚，而病患仍然处于实质上话语权。药剂师的主角举例来说是关注和提倡的角一；然而，即便如此，也应该承认这是在优越、掌控和支配话语权上暴发的。

粗略浏览一下在线病患测试者网站 Care Opinion，就就会发现向医护其他部门（包括女生药剂师）引述强暴蓄意的男士有许多可悲的漫长。这种测试者举例来说再现了管理层依赖于基本知识和引人注目性，而病患则在补救再创伤实践和程序。尽管男士劳工占总多数，并且比非诊疗同龄人更是有确实遭遇男受虐（Cell Nursing Trust，2016 年），但仅凭经验不足以范本高标准规范的诊疗或减轻内转化成秽女症的确实性。拳击手。

然而，药剂师作为最主要的病患眼见的劳工并且特别拥护诊疗模式的其发展，不仅应该并不所需辨别和补救针对男士的犯罪行为蓄意；他们也有意志力拥护该信息技术的战略其发展。这并非没有同样，因为药剂师也实质上于占总强势的照护级别。这种既是半神又是被半神的独特话语权描绘出一种关系恶转化成，如果不补救各级公共服务项目里对男士的形态上反抗，就不确实显然补救这种关系恶转化成。

因此，公共服务项目执行者、管理者和基础社会工作者须要适当慎重考虑关于犯罪行为侵害男士难题的基础教育、其发展和实习，以降低基本知识、诊疗标准规范并终于降低男士的人格健康和生活品质。然而，他们还须要认清并同样在此之前冲击或限制男士作为病患和大众传媒其发展的形态上妨碍、秽女症和反抗。药剂师拥护力的致使影响对病患的预后看作深远的致使影响（Francis，2013)，尤为是公共服务项目在补救犯罪行为侵害男士蓄意多方面的依赖性。虽然该难题的性别歧视形式已得不到接纳，但诊疗执行者、组织、工就会和独立机构在同样状况多方面造就着依赖性，对病患诊疗有具体的致使影响。

男受虐是一个最重要的公共卫生难题，致使影响到很高比例的男士。药剂师和其他公共服务项目从业者其他部门有罪责辨别和补救父母亲强暴和受虐的精神状态，以补救停滞的人格健康不应有难题，保护男士并终于挽救灵魂。

然而，终止对男士的犯罪行为蓄意未能由个别药剂师构建，终于所需系统会性变革以及对实习、其发展和学术研究的投资者。如果药剂师要补救男士面临的实质性风险，那么药剂师基础社会工作者、执行者和管理其他部门须要适当慎重考虑并投资者于基本知识和诊疗的其发展，以保障注册者有努力并有意志力补救这个难题。

最重要的是，他们还须要承认并同样反抗性和形态上的父权政治体制，这些政治体制对前推该信息技术的实践和理解构成了妨碍。终于，男士将暂时承受不作为的开销。