Domestic abuse: nursing’s silent epidemic

During the COVID-19 lockdowns, reports of domestic abuse rose significantly across the UK, and the latest figures show there’s been little improvement.  

All nursing staff should understand and feel confident to respond when they have a concern about domestic abuse, but it’s a complex issue. And one that many nursing staff might be dealing with in their personal lives too. 

We talked to nursing staff about their experiences and the many ways you can support your patients and colleagues dealing with abuse.   

What is domestic abuse?

The domestic abuse charity Women's Aid defines domestic abuse as: as an incident or pattern of incidents of controlling, coercive, threatening, degrading and violent behaviour, including sexual violence. 

Domestic abuse can take different forms, including: 

• physical abuse  
• psychological or emotional abuse, including gaslighting    
• sexual abuse 
• financial abuse  
• coercive and controlling behaviour
• digital/online abuse  
• harassment or stalking 
• ‘honour’-based abuse  
• forced marriage  
• female genital mutilation (FGM).  

Who can be affected? 

Domestic abuse can often go unnoticed, sometimes because there are misconceptions about who can be affected.

Abuse is not restricted to a specific gender, race, sexual orientation, ability/disability, religion, culture or age group – it can happen to anyone.

Every ward, unit, and community nursing team will have at least one member of nursing staff who is experiencing domestic abuse

And it’s not only a partner who can be abusive, other family members can be perpetrators too – including a child, sibling, parent or carer. 

Although women are more likely to experience abuse, research from the Crime Survey for England and Wales estimated that between March 2022 and March 2023, 1.4 million women and 751,000 men experienced a form of domestic abuse.  

But it’s nursing staff who may be most at risk. In 2016, the Cavell Nurses Trust found that nursing staff are 3 times more likely to experience domestic abuse than the average person.

Sadly, those findings still ring true – the nursing staff we spoke to all expressed their despair at how prevalent domestic abuse is among nursing professionals.

• Read next: How to have difficult conversations about domestic abuse.

We spoke to a safeguarding adults lead at an acute general hospital, who wished to remain anonymous, they said:

“Domestic abuse is a silent epidemic in nursing. In some areas the prevalence amongst the general population is 1 in 3 – so statistically, every ward, unit, and community nursing team will have at least one member of nursing staff who is experiencing domestic abuse.”

How to spot the signs

Nursing staff working in the community and in GP practices are more likely to discover patients dealing with domestic abuse, but everyone should be aware of what to look out for – whether that’s in our patients or our colleagues. 

Sarah Murphy, a counsellor for the RCN Counselling Service, says: “Domestic abuse is everyone’s responsibility, and everyone has a part to play – whether you’re an employer, a rep, a colleague or a friend.”
 
Keeping alert for the signs of domestic abuse in those around you is one way you can play your part. Although domestic abuse takes many forms, there are some common factors.  
 
Look out for:

• Physical injuries. 
• Clothing or heavy make-up worn to cover injuries. Someone may cover up even in hot weather or wear sunglasses inside or when it’s cloudy. 
• Someone who is afraid or anxious to please their partner. 
• Someone who can’t access their own money. They might not being able to pay by card, or try to use a card in their partner's name. 
• Someone who is withdrawn and unwilling to engage in friendly conversation. 
• Someone who is meek, fearful or extremely apologetic.

How to start a conversation

Someone experiencing domestic abuse is likely to be very hesitant to talk at first.  

If you have concerns about a patient or a colleague, Sally Wilson, the RCN UK Professional Lead for Older People, People with Dementia and Safeguarding Adults, suggests being patient and making every contact count. She says: 

• Talking about domestic abuse for the first time can be difficult for many survivors, who may be experiencing feelings of guilt, doubt and or shame.  
• As nursing staff, it’s important to understand this and try to create opportunities for people to talk — in clinics, the emergency department and on routine visits.  
• Asking about personal safety and whether people feel safe where they live is a useful opening question and should be incorporated into as many assessment proformas as possible — make every contact count.   
• Patients might confide in you when you are providing one- on- one care, or if you have been caring for them for a while and have built up mutual trust and respect. While workplaces can provide a safe space for colleagues experiencing domestic abuse. 
• The more we talk about domestic abuse, the easier it is to talk about. It enables both nursing staff and their patients to have a more ‘normalised’ view of domestic abuse. In time, survivors will feel empowered to disclose their story and ask for help. 

Counsellor Sarah also advises to keep the conversation open: “Sometimes, people will come to us to talk through a different issue, not recognising that they are experiencing domestic abuse until we alert them to it, especially if it’s more subtle.” 

Maria’s story 

Maria fled an abusive and controlling marriage and rebuilt her life and career. She now works in mental health nursing but has found that restraining patients can trigger her past trauma.  
 
Despite being made exempt from attending restraints, she’s found that some colleagues can be unsupportive of her not participating. “I’ve been made to feel like I’m avoiding my duties, or that I’m lazy,” says Maria.

In contrast, when Maria was exempt from restraints due to a physical injury, she noticed her colleagues were far more accommodating. Maria says we need more awareness of how survivors of domestic abuse may present at work. “It’s not pity I want, I just need understanding,” she says.

“Having to explain to every colleague that I’m exempt on psychological grounds, and why I need personal space around aggressive patients would be incredibly upsetting.” 

Although Maria struggles with restraints, her lived experience means patients connect and respond positively to her. After years of abuse, she struggled with her own mental health and understands the complexities of rebuilding yourself. This has given her an affinity with her patients and a first-hand appreciation of the issues they are facing.

Maria was eventually able to leave her marriage with the help of an older colleague who also survived domestic abuse. Her experiences remind us that looking out for signs of current domestic abuse and staying mindful of how we can continually support survivors can help rebuild lives.