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Domestic violence in nursing curricula

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VOL: 98, ISSUE: 48, PAGE NO: 36

June Keeling, RGN, RMN, is domestic violence coordinator and assistant researcher, at Arrowe Park Hospital, Upton, Merseyside

Linda Birch, MSc, BSc, RGN, RM, is senior lecturer practitioner, practice development and research unit, at Arrowe Park Hospital, Upton, Merseyside

Domestic violence occurs throughout society and knows no social boundaries. The impact of domestic violence on an individual's mental and physical health is profound. The effect on the mental health of an individual following prolonged domestic violence may result in significant psychological morbidity. Common effects include low self-esteem, loss of self-confidence and people blaming themselves for the violence.

Domestic violence occurs throughout society and knows no social boundaries. The impact of domestic violence on an individual's mental and physical health is profound. The effect on the mental health of an individual following prolonged domestic violence may result in significant psychological morbidity. Common effects include low self-esteem, loss of self-confidence and people blaming themselves for the violence.

Psychological violence can also manifest as depression, anxiety, post-traumatic stress disorder or suicide (British Medical Association, 1998). According to the Department of Health: 'Domestic violence has considerable implications for the NHS ... The health costs incurred are considerable, personal costs even more so.

'All health professionals should be given basic information and taught about the nature and prevalence of domestic violence and the steps which need to be taken to support disclosure and prevent further violence' (DoH, 2000).

The health service is a unique entity in that everyone will access it at some point in his or her life. Health professionals are uniquely and ideally placed to detect women who experience domestic abuse and may be crucial in assisting them to escape their violent relationship. However, research has demonstrated that only a minority of health professionals ask directly about domestic violence (Foy et al, 2000).

Health professionals have a vital role in identification, assessment and response to domestic violence. The British Medical Association (1998) advocates that teachers should model nonabusive behaviour in all aspects of training and provide a safe and supportive environment for students who may themselves have been abused.

The RCM (1997) states that midwives are ideally placed to detect domestic abuse. It recommends that all midwives try to detect domestic violence because of the devastating impact it has on pregnancy.

Midwives have a responsibility to women to support, care and provide information on the agencies available to women who are subjected to violence to meet their needs and wishes without taking away their control.

Aim of study
The primary aim of this research was to ascertain whether domestic violence is included in the nursing and midwifery curricula. The time these courses allocated to teaching about the impact of domestic violence was examined, as was the reason or reasons for excluding the subject matter from the syllabus.

The personal attitude of the tutors was examined as well. They were asked whether they considered it appropriate to include domestic violence in the curricula. It was ascertained whether they themselves had received any formal education on the effects and impact of domestic violence on the health of individuals.

Method
Chester College of Higher Education provides nursing and midwifery students to four district general hospitals, one of which was the base for the researchers. All the tutors involved in the provision of nursing and midwifery curricula at these sites were invited to participate. Ethical approval was granted from both Chester College of Higher Education and from Arrowe Park Hospital, Upton, the hospital where the researchers work.

Professional opinion was sought on the appropriateness of the questionnaire from a senior lecturer in midwifery and from an anthropologist.

All tutors who are department heads for the four educational centres were contacted. The heads of department distributed the questionnaire to each tutor involved in nursing and midwifery curricula. An anonymous questionnaire, with preset and closed questions, was used for data collection. The envelopes were coded with the centre for education and batch number to allow for follow-up if the response was poor. Completed questionnaires were returned directly to a data input technician in order to maintain confidentiality and anonymity.

The quantitative data was analysed using the 'Statistical Package for the Social Sciences' (SPSS) - a statistical tool that is designed specifically to score and analyse this type of data.

Results
A response rate of 30 out of a possible of 59 (50.8 per cent) was recorded. Of the tutors who replied, 25 (83.3 per cent) were women and five (16.7 per cent) were men. The results should be viewed with regard to the fairly low response rate. However, the key points highlighted by this study remain relevant.

The number of years' experience the respondents had in tutoring varied as follows:

- 20 per cent of tutors had 0-5 years' experience; 6.7 per cent of tutors had 6-10 years' experience;

- 30 per cent of tutors had 11-15 years' experience; 43.3 per cent had more than 16 years' experience.

The majority of tutors (86.7 per cent) said that they believe it is appropriate to include the impact of domestic violence on health in the curriculum (see Fig 1). Almost all respondents agreed that domestic violence has an impact on an individual's health and believe it should be taught. However, even though tutors are aware of the impact of domestic abuse on health they are not all including it in the curriculum.

The reasons given for not including domestic violence in the curriculum were inadequate teaching time (43 per cent), inappropriate subject (28 per cent) and insufficient knowledge base (28 per cent). Only female tutors responded to this question (see Fig 2).

Domestic violence education was included in the curricula of 43 per cent of tutors and all of the tutors who said they included this subject matter in the curriculum were women (see Fig 3). The tutors who had more years of experience appeared more likely to include domestic violence in the curricula they taught.

Of the group of tutors who responded, 76 per cent of women and 40 per cent of men were aware that the incidence of domestic violence increased during pregnancy.

Tutors who had 11-15 years of experience had also received the most formal education about domestic violence. These tutors allocated the largest amount of time to domestic violence in their curricula.

This is contrary to the expected view that those tutors who had qualified the most recently would have received more education on this subject because of the priority it has been given by the government, nursing and midwifery agendas in recent years. Even without formal training it would have been expected that as the government and health agendas have made this subject a priority, the tutors would have endeavoured to include it in their teaching.

Conclusion
All health professionals should have the opportunity to examine and discuss their fears and apprehensions about domestic violence prior to qualification. This will encourage a non-judgmental attitude and a supportive response to identified victims of domestic abuse (Royal College of Obstetricians and Gynaecologists, 2001).

Tutors are ideally placed to support nursing and midwifery students to examine their own fears and experiences within a nurturing environment. The tutors require the knowledge and skills themselves to be able to support their students (see Box 1).

The research suggests that male tutors do not include domestic violence in the curricula they teach. Further research is needed to examine the question of gender in designing curriculum content.

Chambliss et al (1995) state: 'Failure to train ... in domestic violence may be the result of the common lack of faculty interest ... or the frequently reported attitude that domestic violence does not fall within the domain'.

This survey found that fewer than half of the respondents include domestic violence in the curricula they teach. This may be due to a lack of knowledge on the part of the tutors, or other subjects being viewed as a higher priority.

Although the tutors understood the impact that domestic violence has on health they did not include it in their curricula. The inclusion of domestic violence in the nursing and midwifery curricula should become an institutional priority and should not be left to the motivation of the individual tutor.

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