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Purpose
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This guideline has been developed to assist medical, nursing and allied health staff develop a practice sensitive to the needs of women who have experienced violence.
At least one in two women in Australia have experienced some form of physical or sexual violence, yet few will disclose that to a health practitioner.
Good practice means recognising the impact of violence on women's health and their access to health care, whether or not there are any indicators of violence.
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Guiding principle
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A central element of the experience of violence is a loss of control and feeling of powerlessness, therefore the governing principle is to give all women as much sense of control over their health care as possible.
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Definition of violence against women
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The UN definition of violence includes physical, sexual and psychological violence by an intimate partner or other, child sexual assault, female genital mutilation, sexual harassment and intimidation, trafficking in women and forced prostitution.
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Impacts
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Health impacts of violence
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The health impacts of violence can include physical injury, gastrointestinal disorders, chronic pain syndromes, depression, anxiety and suicidal behaviour, gynaecological disorders, increased rates of HPV and cervical cancer, unwanted pregnancy, premature labour and birth, and sexually transmitted diseases and HIV/AIDS, increased rates of smoking, alcohol intake and other drug use including during pregnancy, negative impacts on reproductive health, low birth weights and anaemia.
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Impacts on women's access to health care may include late presentations for antenatal care, reluctance to undertake certain procedures such as internal vaginal examinations or Pap tests, and declining assistance with breast feeding, feeling uncomfortable or distressed with a male doctor.
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Impact on staff
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Staff may have been affected by violence or trauma either directly or indirectly. All staff are encouraged to seek support for trauma or distress relating to that experience, either through consultation and debriefing with Women's Social Support Services, CASA House, the Sexual Assault Crisis Line or through staff support.
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Management
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Creating a safe and supportive environment
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Communication
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- actively listen to what a woman is telling you
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- use language that is easily understood, i.e. avoid medical jargon
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- check that the woman understands what you are saying
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- always use qualified interpreters if required
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- ask if she has any concerns or questions about procedures or treatments
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- constantly check that the women is comfortable with any procedure, particularly if it involves touch or invasive examination or treatment
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- obtain CONSENT prior to making a referral.
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Suspected injuries, indicators of risk and disclosures of violence
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If there are visible or suspected injuries and/or indicators of risk to the women's safety, ensure you can sensitively ask her directly about this in private.
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If the woman tells you that she has experienced any form of violence, check on her immediate safety, and offer her appropriate referrals. If she indicates she has been sexually assaulted within the last two weeks offer her an immediate referral to CASA House.
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Document in the medical record any evidence of injuries, treatment provided because of injuries, referrals made and any information the woman provides. Do not record information about disclosures of violence in the hand held record without the women's permission.
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Refer to: Appendix 1: Management and Referral Options: Algorithm.
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If you have any concerns about risks to children, refer to the Women's: Child Protection Policy (intranet-only).
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Respect
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- Respect decisions and choices the woman makes. View the woman as the expert in her own life. It is important that she has as much control as possible over her care and her body. Recognise and respect that cultural background may have an influence on her decisions.
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- At all times convey a non-judgemental attitude.
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- Take the time to respond appropriately to the woman's needs.
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- Discuss confidentiality, and the limits of this, with women. Accept the woman's choice to continue talking about her experiences or not.
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- Ensure a woman's privacy when discussing personal details.
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Refer to the Women's: Privacy Policy (intranet-only).
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Information
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- provide and discuss care and treatment options with women
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- always introduce yourself and explain your role
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- advise women of the details of the service to be provided including information regarding waiting times
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- prior to undertaking any procedure, provide the reasons why to the woman - this includes taking blood pressure, or assisting with breast feeding
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- provide referral information to women, if requested
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Consultation and referral options
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Intimate partner violence
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Women's Social Support Services (WSSS) intake/crisis worker Tel: (03) 8345 3050 during business hours or access on-call social worker via the after-hours manager on weekends (Saturday and Sunday 9am to 5pm). Where no social worker is available and there are urgent concerns about safety, offer contact with police Tel: 000 or Women's Domestic Violence Crisis Service Tel: (03) 9322 3555
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After hours consultation for staff is available through the CASA on-call counsellor, who may be contacted through the Sexual Assault Crisis line on Tel: 1800 806 292 (24 hours).
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Sexual violence including rape, sexual harassment, past sexual assault, trafficking and forced prostitution:
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- CASA House duty worker Tel: (03) 9635 3610 (business hours).
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- Sexual assault crisis line Tel: 1800 806 292 (24 hours).
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Both provide counselling, information and support and can arrange access to immediate support and care for women who have been sexually assaulted in the past two weeks.
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Female genital mutilation:
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- FARREP Tel: (03) 8345 3058 during business hours
For after hours consultations, refer to senior medical registrar.
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Aboriginal Women's Health Business Unit (AWHBU)
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- Tel: (03) 8345 3047 / 3048: this referral should be offered for all women who identify as Aboriginal and Torres Strait Islander.
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Consumer information, contact details and resources
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The Royal Women's Hospital
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| Women's Social Support Service intake/crisis worker
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| Women's Domestic Violence Crisis Service of Victoria
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| t: (03) 9322 3555, toll free 1800 015 188
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| Sexual Assault Crisis Line
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| t: 1800 806 292 (24hours)
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| Centre Against Sexual Assault (CASA)
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| t: (03) 9635 3610 (24hrs)
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| Female genital mutilation (FARREP)
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| Aboriginal women's health (AWHBU)
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| t: (03) 8345 3047 (BH) or (03) 8345 3048 (BH)
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| | Information and resources
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Appendices
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Appendix 1: Management and Referral Options: Algorithm
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| Violence Against Women: Management and Referral Options: Algorithm
| Click on thumbnail to view full size image of algorithm (pdf 35kb)
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Appendix 2: Resources for staff working with women experiencing violence
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| Resources for staff working with women experiencing violence
| Click on thumbnail to view full size image (pdf 29kb)
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References
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Carson, K, Barriers to Cervical Screening Experienced by Victim/survivors of Sexual Assault - Pilot Study, CASA House, 2002
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McCarthy T. Public Health, Mental Health and Violence Against Women, Report Produced for Vic Health, 2003
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Mouzos, J and Makkai, T. Women's Experiences of Male Violence: Findings from the Australian Component of the International Violence Against Women Survey, Australian Institute of Criminology, Research and Public Policy Series No. 56. 2004
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United Nations Declaration on The Elimination of Violence Against Women, UN Resolution 48/104 (444), proceedings of the 85th Plenary Meeting, United Nations General Assembly, Geneva, 1993
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Vic Health, The Health Costs of Violence: Measuring the Burden Of Disease Caused By Intimate Partner Violence, A Summary of Findings, Victorian Health Promotion Foundation, 2004
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Walsh D, Weeks W. What A Smile Can Hide: A Report on the Study of Violence Against Women During Pregnancy, the Women's, 2004
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World Health Organisation. Violence Against Women: A Priority Health Issue, Geneva, 1997
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World Health Organisation, WHO Multi-country Study on Women's Health and Domestic Violence against Women, 2005.
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http://www.who.int/gender/violence/who_multicountry_study/summary_report/en/index.html
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World Health Organisation. World Report on Violence and Health, Geneva, 2002
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Revised and updated: 22 July 2009
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Edited: 4 February 2010
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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