Foreword

No Longer 'A Private Matter': Collective action against the manifestations of violence

Moira Carmody
Associate Professor, Social Sciences & Criminology, University of Western Sydney, NSW

PP: iii - iv

Article Text

Interpersonal violence is an insidious social problem that manifests itself in many different forms - including physical, sexual and emotional abuse as well as neglect. The personal, social and economic costs are enormous not only for individuals directly affected by it but their related family and our communities as a whole. While male children are at greatest risk of sexual assault under 10 years of age, females consistently record higher rates of sexual assault irrespective of age (Australian Institute of Criminology 2006). One in five women report being subjected to violence at some time in their adult lives (ABS 1996a). Interpersonal violence remains a highly gendered crime with women and men most at risk from men. A recent Victorian study into the health costs of violence found that intimate partner violence has wide ranging and persistent effects on women's physical and mental health (VicHealth 2004). The study concluded that intimate partner violence is responsible for more ill health and premature death in Victorian women under the age of 45 than any other of the well-known risk factors - including high blood pressure, obesity and smoking (VicHealth 2004). It is therefore very timely that this special issue of Contemporary Nurse (volume 21/2, May 2006) presents the latest research on the multiple ways in which nurses confront violence in their practice and some of the challenges in responding effectively to women. To facilitate its separate distribution to libraries and use as a course reader the publisher has also released this issue - Advances in Nursing and Interpersonal Violence - as a book (ISBN 0-9757422-1-3).

The articles in the first section draw our attention to the development of routine screening for domestic violence as a preventative strategy and how the impact of an abnormal pap result can trigger existing feelings of fear in women who have experienced violence. Understanding the complexities of intimate partner violence is aided by gaining a clear understanding of women's investment in romantic relationships and there is a need to move beyond categorizing women's experiences into a series of categories of physical and psychological ailments. Instead, it is argued that health care systems need to develop a more woman-centered underpinning for effective delivery of health care. A further article explores the informal support needs of women leaving abusive relationships and how knowledge of their journey towards healing can inform best nursing practice.

Violence is not something that happens just to patients but as the second theme explores, it is a frightening all too common experience for nurses in their workplaces. Increasingly, there is some awareness of violence as an occupational hazard for nurses by patients and relatives. As one author highlights 'assaults not only inflict physical and emotional injury, but undermine morale, create a climate of fear and subvert the quality of care'. The inadequacy of current responses to violence in the workplace are considered, as are calls for extending our understanding of the potential for violence beyond acute care and mental health settings to include the growing aged care sector. Also found wanting are the current explanatory discourses of violence and aggression that serve to maintain the status quo. Violence by patients creates an unsafe work environment but this is made even worse when the aggressor or bully is a colleague.

Psychological and emotional abuse of nurses by other nurses results in profound harm for those targeted. There is a pressing need for colleagues and senior staff to model non-violent behaviour and to openly challenge and prevent bullying practices in the workplace and in university settings where nurses are prepared for professional practice. As the French philosopher Michel Foucault reminds us, it is in our actions that our relationship to ourselves as ethical subjects is revealed. There is also a need to research this phenomenon further and explore how workplace violence develops in a profession that remains predominately female. Moving to a more global perspective, the impact of the politics of fear about terrorism and the anxieties it produces is also explored. It is argued that this rhetoric undermines our intellects and sensibilities. We need to be mindful of how these discourses serve to isolate us from each other and our common humanity and how we can resist their impact.

The closing selection of articles provides some additional insights into the important role that maternal and child health nurses can play in assisting families to develop positive outcomes for children exposed to violence. An understanding of how Japanese and Australian nurses both need ongoing education and clear policies and protocols to assist women who have been abused, challenges all health workers to be mindful of cultural differences and the global nature of interpersonal violence. An emerging area that has to date been poorly researched is violence directed from child to mother. This very interesting new work adds another dimension to the complexity of understanding interpersonal violence and reminds us that there is still much work to be done.

There is a broad consensus internationally that intimate partner violence is best addressed in the context of a human rights, legal and health framework - and through the development of multilevel strategies across sectors (WHO 2002; OWP 2002). Nurses play a crucial role as front line workers in attempting to achieve these goals. To be effective in the complex area of interpersonal violence, nurses and many other workers need comprehensive education that challenges assumptions about gendered violence being a 'private matter'. There is not only a need for our health systems to recognize the multiple ways in which violence manifests itself for patients, but also how inadequate policies and procedures can cause further harm to health clients and the staff charged with providing quality nursing care. Ultimately, the challenge facing us all professionally and personally is to resist the manifestations of violence in all its forms and to work collectively to build non-violent communities.

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