Health care professionals have a huge responsibility to provide care, support and protect the patients and victims of abuse in order to improve their health conditions. Health care providers are often the first one to recognize the signs of the abuse and the patients get medical help from them. It is important for patients to get appropriate, accurate, empowering and sensitive care and support from the health professionals.
This allows health worker to offer help in case they see any kind of abusive problem and suggest appropriate way to prevent violence or abuse. They should provide support and offer counselling services that can have positive impact on the victim’s health. They can refer such cases to social worker in the hospital to make plans or policy that ensures safety of the victims. Mostly women, younger children and older people are the victim of violence and abuse from their own family members, friends, care giver etc. Abuse means any deliberate behaviour or action by an individual in a position of trust like friends and family that causes distress or harm to the people. This type of violence causes physical, mental or emotional harm and also may cause material and financial abuse, neglect, abandonment, serious loss of respect and dignity. Elderly abuse, child abuse and domestic violence are the major societal issues.
Legal and professional issues
There are many legal and professional that health care worker has to face when they come in contact with the victim of domestic violence and other abuse. Health care providers can play important part in helping and assisting victims to combat issues related to abuses. When nurses get to know about the violence they need to discuss with their seniors and then report it to police or concerned department. Along with the victim health professionals have to go through many legal procedures. Many victims do not contact any advocacy organizations, police, shelters or prosecutors. In this case health care providers assist them to take further action against the people who has caused them distress. Health practitioners have to go through many legal formalities like assessment, documentation and other reports according to the law and policies of organization. They might face cultural issues, language barriers when the victims are from different community. Many nurses are underprepared so they might lack the knowledge which is required while dealing with these violence or victim issues. They might not have all information about the law codes and legislation against such violence.
Child abuse is a behaviour, inaction or action by an adult towards a young person or child that harms the child. It is considered as one of the most serious public health problems. It can be a single or number of incidents that takes place. It can result from emotional, physical and sexual harm (Schols, et al., 2013).
According to Child Protection Act 1999, if child is suffering harm or has suffered harm, or is at risk of suffering harm and their parents are not willing or able to protect them from harm is considered as child abuse. There are four types of child abuse which involves emotion, sexual, physical and neglect (Anon., 2017).
Health care professionals like nurses and doctors encounter almost every child due to nature of their job and play an important role in the detection of child abuse and reporting it (Phillips, 2009). However, they only report few cases of abuse to child protective agencies. All health professionals should be aware of their responsibilities which are related to the legal frame work i.e. The child Protection Act 1999 and the child protection (Anon., 2015).
According to research women who are victims of domestic violence do not seek help from professional directly. There are several barriers or issues for victims to not disclose violence they suffer (Anon., 2017). These barriers are as follows:
- Commitment to the relationship
- Fear for children, family and own safety
- Shame and embarrassment
- Stress and depression
- Emotional attachment with their partner or spouse
- Belief in the value of independence and self-reliance
- Lack of faith in ability of other people to help.
All health professions should have the information about the child protection and to report against the suspected child abuse and neglect. They should have important knowledge about the relevant legislation for child protection:
- Child Protection Regulation (2011)
- Child Protection Act (1999)
It provides the framework for the children protection in Queensland territory. Its main principle is the safety, wellbeing of child.
Any kind of abusive behaviour in a domestic setting like marriage by one individual against another is known as domestic violence. According to the data released by Australian Bureau of Statistics in 2017, 16% of Australian women are victims of domestic violence. It is emerging as a significant issue nationally and internationally. Nurses being a group of health workers considers domestic violence as a major health issue and play important role to assist the victims (woman and their children) of domestic violence in their work in community settings and hospitals. Domestic violence can cause many problems like psychological trauma, depression substance use, disability, migraine headaches, suicidal tendency. It is also called as Intimate Partner Violence and is a strictly punishable act in Australia. Nurses are only allowed to disclose any information with consent of patient or when there is legal or ethical obligation. It is important to use professional judgement while deciding to report such issues. Nurses should consult with their supervisors or any experienced colleagues. In Australia every state has particular public policies to deal with domestic violence.
The law related to family or domestic violence varies from state to state in Australia.
In Western Australia, the law related to domestic and family violence is the Restraining orders act, 1977. There is a provision of both civil and criminal law to protect the victims of domestic and family violence.
An order given by the court to ensure the safety of the victim by planning restriction on the person whose action or behaviour can pose a threat or risk of future harm is known as Restraining orders act. The type of condition imposed on the respondents may vary depending upon circumstances and need of the victim including restriction on communicating or making contacts, lawful vacation of a place or premises, prohibition on the use of fire arms. There is another law, which is Domestic and violence protection act 1989 also known as Queensland act. The main objective of this act is to provide safety and protection to the victim in case is related to: relationship between spouse, intimate relationship or personal relationship, relationship between family members, unhealthy care relationship. Similarly, New South Wales: Domestic & Personal Violence Act, South Australia Domestic Violence Act, Tasmania: Family Violence Act, Victoria Family Violence Act, Northern Territory Domestic Violence Act, Australian Capital Territory: Violence and Protection Act are the various act in respective states which ensures the women safety and protection against various abuses against them (Anon., 2009).
Clear accurate, full legible and timely records should be documented as it is important to submit these to court (Anon., 2007). In order to provide them with clear information experience and history regarding patients abuse.
The information that should be relayed to victims in relation to the records are as follows
each contacts of victim with the health professional are will documented
patient’s records are kept in safe place and are confidential
under the freedom of Information, victim have full right to access his or her personal health records.
Documents that are important and should be recorded are as follows
- Time and date of contact with patient
- Time and date when the entry was done in the file
- The name of health worker along with signature
- History provided by patient
- Indicators of FDV, outcome of assessment and high-risk factors
- Medical history of patient relevant for the case
- Injuries suffered by the patient along with the detailed information about treatment provided
- Suspected or stated cause of abnormalities or injuries and time of occurrence or injuries and time of occurrence
- Brief details of family members
- How the injuries were imposed and information about the weapon if it was used
- The name of alleged perpetrators and relationship to the victim if known
- Patient behaviour towards family member and partner
- Name of the police along with contact details if they are involved
Patient record of patient should be factual i.e. correct and objective recording of information, issues, action and observation (Etheridge, et al., 2014). Similarly, professional opinion is also recorded which are limited to their area of expertise. Document of physical examination is required that consist of body map with detailed sketch of physical injury. Medical photography is highly recommended along with written description about the injury and body maps.
Implications for the healthcare worker and delivery of patient care:
If anyone discloses abuse that has occurred or is occurring, health professionals should make them comfortable first to make them trust health care providers. They should reassure that the victims that they are sharing with them was right thing to do. Proper IPV screening should be provided to o victim by health care providers (Walton, et al., 2015). Educations about IPV should be included in healthcare curriculum so that they can address issue properly and can support and help victims effectively. Healthcare providers should respectfully address the abuse. They should address victims of confidentiality regarding the disclosed data. They should ensure patient safety and provide choices for actions. Health care provider should also support them emotionally.
The delivery of patient care should be effective and efficient. Health care delivery system should provide culture-based care so that victims feel more attached and assure about the service. They should provide proper counselling to vulnerable group of people who are more susceptible to the abuse.
Sufficient guidance to the victims may lead positive impact in their life. According to a study by Chang et al (2010). By the help of proper guidance women are able to change their IPV situation and helped them move on. So, these changes lead to increased awareness of options to resource and support, protecting other from abuse, etc. health care providers should provide interventions by providing routine screening, and recognition of abuse, can be sympathetic listeners for them.
From the above paper it is evident that domestic violence, child abuse is the one of the major issues in Australia and other countries. Health care providers play important role in helping these victims and help them to take appropriate actions. Health worker should ensure victims confidentiality, safety and motivate them to think positively. They should also try to help them by providing counselling & organize awareness programs for the women’s & child.
It is also mandatory according to the law that they should report the issue whenever they encounter victims. They might face many obligations and barriers while doing so, as in most of the case victims are not ready to file any kind of report due to fear, attachment with their spouse or family member. So, they should encourage them to share their issue and take legal action against the abuser. Though health care providers have been improved from fast few years, there’s still some issues that needs to be considered to improve the quality of health service provider. They must provide culture based, need based health service that is more efficient. They should provide screening and interventions and guide victim to make positive changes in life.
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Anon., 2009. Domestic Violence Laws in Australia, s.l.: s.n.
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Anon., 2017. An Introduction to the Child Protection Act 1999 (updated December 2017). [Online] Available at: 20 April 2018].
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Schols, M. W., Ruiter, C. & ?ry, F. G., 2013. How do public child healthcare professionals and primary school teachers identify and handle child abuse cases? A qualitative study. NCBI, 13(807).
Walton, L. M. et al., 2015. Intimate Partner Violence Screening and Implications for Health Care Providers. Online Journal of Health Ethics, 11(1).