护士在识别和应对暴力侵害妇女行为之外的作用 | J Clin Nurs

op 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 have 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 have 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 have 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 avoid 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 navigate retraumatising practices and procedures. Despite being a majority female workforce and being more likely to have experienced male violence than their non-nursing peers (Cavell 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 have 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 have 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 save 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.

全文译者（仅供参考）

1 时代背景

极端主义损害妇人暴力行为 (VAW) 是对身体、性或心理性侵犯的威胁或实际毒害。男人极端主义是最广泛和最危险的方式，是全球 18-44 岁男人死亡、疾病和残疾的主要情况（Ellsberg 等人，2008 年）。这种滥用更是为广泛；早先对 22,000 多名法国男人同步进行的一项调查发现，多达 99.7% 的男人表示在其一生里面多次造成过强奸、挑衅和身体极端主义（Taylor Bell Shrive，2021 年），远高于此前的预期。锁定男人逃亡者谋杀男人的男人谋杀常住人口也持续报告每年有 100 近千人死亡；每 3 天有约有一名男人（Ingala Smith，2018）。极端主义损害妇人暴力行为是一个明确而严重的公共卫生疑问，对各种类型妇人的心理健康、冀望和死亡率具有关键性影响。然而，极端主义不应踏入妇人生活里面不应回避的多方面；这是可以预防的。

受害者，有时候也专指幸存者，可能需要医护维修服务政府机构的医护和疗法（Hooker 等人，2020 年）。尽管如此，纵观，对该疑问的医护反应会即使如此不足以。医务人员和其他医护保健机械工程人员可以在标识和促使极端主义损害妇人暴力行为及其类似表现多方面把握关键抑制作用；中产阶级性侵犯和性极端主义（Bradbury-Jones，2015 年）。

这个疑问的框架是如何看待或解读它的核心，它凸显了法国和各种类型更是较广的全球化疑问。对妇人的极端主义是一个常用术语，在整个讨论里面都采用它来阐释妇人的心理健康和冀望需求。然而，这往往掩盖了极端主义的；也：男人。因此，在考量这些疑问时，关键的是要记住，它们不是在真空里面遭遇的，而是在厌女症、男人相互竞争和男人随后的不平等时代背景下遭遇的。此外，在医护和医护保健里面无法前提彻底解决这一疑问与医护家长制和传统意义医学在医护保健等级社会制度里面的相互竞争独立性都有著内在的密切联系。

2 男人的疑问

在旋即的过去，传统意义医学同事将彻底解决医护保健里面针对男人的极端主义疑问描述为“考量不周的机械工程介入”，并且“声称”男人会从支持里面受益（Fitzpatrick，2001）。这种不愿意与更是较广的全球化态度相呼应，这些态度历来将中产阶级性侵犯视之为私事，并致使性侵犯、污名和男人极端主义持续正常化的隐秘特性。

在男权全球化的结构里面，男人极端主义与男人统治都有著内在的密切联系，男人即使如此被入侵，她们的参与者经历被隐秘出去。有时候，男人的疑问被认为是男人需要彻底解决的参与者疑问。这掩盖了极端主义的肇事者，并将承担责任和承担责任归咎于受害者，以必需自己的必要，而不是彻底为了让的所谓。

然而，虽然施暴者促使极端主义和性侵犯负全部承担责任，但严重依赖关于施暴者判罪的古文献。彻底解决这个疑问的社区法则已被验证是最有效率的预防和介入意图（Hague 和 Bridge，2008 年），并相关联了在地方当局之间持续拟定多政府机构风险评估全体会议 (MARAC) 的基本原理。因此，医务人员作为远超过的医护保健机械工程群体，需要踏入这种反应会的积极必不应少，标识和促使风险，协同医护并必要措施男人。

3 工业发展常识

参与者经历过男人极端主义的男人反复表达了支持、善解人意的工作人员和心理必要环境的关键性（Bradbury-Jones，2015 年）。为了实现这一目标，工作人员需要具备标识和促使滥用和公开发表有可能的常识和能力。

虽然个别医务人员可能会选择工业发展他们在这一行业的常识和解读，但分散在维修服务、董事会和信托政府机构的少数医务人员无法大规模积极支持医护，也无法实现必要的变革。因此，需要一种系统对的法则，必要考量学习和工业发展并必需可持续性。

投资额于培训和工作人员工业发展对于必需工作人员的常识和能力至关关键。然而，学术研究里面长期以来察觉到训练不足以。医务人员经常报告依赖标识和有效率促使中产阶级性侵犯和性极端主义的常识、自信和培训（Alshammari 等人，2018 年）。结果，医务人员避免追问性侵犯，因为他们不考虑到如何恰当地追问以及如何回应公开发表。

无论如何，这一行业持续依赖工业发展是由于依赖对妇人生命、心理健康和冀望的重视。本科课程或 CPD 不必要考量培训，必须提供此类培训的机械工程消防员更是为少见。但这并不是什么新鲜事，医护保健，一个历来家长式作风的政府机构，数百年来长期以来相互竞争着男人的心理健康不平等。

4 家长制和性别角色

在医护保健系统对里面，父权制和男人统治在医护家长制里面给与体现。曾经只不过排斥男人的传统传统意义医学相互竞争独立性在传统意义医护保健里面即使如此共存一定程度。医务人员在医护保健系统对里面享有最高程度的决定权，多数时间都在学术研究、政策制定、维修服务设计者和下线多方面始终保持领先独立性。因此，眼科医生、医务人员和病患者共存于一个操作层级里面，传统意义医学从上到下占总相互竞争独立性。这种动态本质上是性别化的，医务人员客串男人角色，作为主要的必要措施者，而病患者则客串被动、男人和依靠的理应。在这个系统对里面，受性侵犯的男人是双重的从属，既服从于施虐的同性恋者，也服从于消防员，

尽管关注以病患者为里面心的医护，但医护有时候会因参与这些结构上的暴政和厌恶男人的做法而感到内疚，而病患者即使如此始终保持从属独立性。医务人员的角色有时候是关注和倡导之一；然而，即使是这种可能，也应当申明是在优越、控制和支配独立性的可能下遭遇的。

大概上网一下在线病患者反馈该网站 Care Opinion 可以发现，向包括男同志医务人员在内的消防员公开发表性侵犯暴力行为的男人有许多糟糕的参与者经历。这种反馈有时候凸显了工作人员依赖常识和恰当性，而病患者则在同步进行再心理障碍倡导和程序。尽管男人劳动力占总多数，并且比非医护同龄人更是有可能造成男人极端主义（Cavell Nursing Trust，2016 年），但仅凭经验根本无法指导高规范的医护或抑制之下厌女症的可能性职业。

然而，医务人员作为远超过的病患者面临劳动力并经常积极支持医护模式的工业发展，不仅应始终保持标识和促使极端主义损害妇人暴力行为的不利于后方；他们还可以更好地积极支持该行业的战略工业发展。这并非没有单打独斗，因为医务人员也从仅指占总相互竞争独立性的医护等级社会制度。这种既是支配者又是被支配者的独特独立性提出了一种武装冲突，如果不彻底解决各个层面的医护保健行业对妇人的持续性暴政，就不应能只不过彻底解决这种武装冲突。

因此，医护保健积极支持者、管理人员和教育工著者需要必要考量极端主义损害妇人疑问的教育、工业发展和培训，以大幅提高常识、医护规范并最终大幅提高妇人的心理健康和冀望。然而，他们还需要申明并单打独斗纵观阻碍或限制男人作为病患者和从业者工业发展的持续性障碍、厌女症和暴政。医务人员积极支持的影响对病患者的预后都有著深远的影响（弗朗西斯，2013)，对于医护保健在彻底解决极端主义损害妇人暴力行为多方面的抑制作用尤其如此。虽然这个疑问的性别特性给与申明，但医护积极支持者、组织、工会和政府机构在单打独斗从根本上多方面把握着抑制作用，对病患者医护有明显的影响。

5 结论

男人极端主义是一个关键性的公共卫生疑问，影响到很大人口比例的男人。医务人员和其他医护保健机械工程人员有承担责任标识和促使中产阶级性侵犯和性极端主义的有可能，以彻底解决持续的心理健康不平等疑问，必要措施妇人并最终保住生命。

然而，个体医务人员无法抑制对妇人的极端主义暴力行为，最终需要系统对性的变革和对培训、工业发展和学术研究的投资额。如果医务人员要彻底解决男人面临的关键性风险，那么医务人员学学、积极支持者和管理人员需要必要考量并投资额于常识和医护的工业发展，以必需持有人者有自信和有能力彻底解决这个疑问。

关键的是，他们还需要申明并单打独斗暴政性和持续性父权制，这些社会制度阻碍了该行业的倡导和解读。最终，男人将继续承受以致于的负担。

THE

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