NURSING CARE IN RELATION TO WOMEN VICTIM OF DOMEST=
IC
VIOLENCE IN PRIMARY HEALTH CARE
CUIDADOS DE ENFERMAGEM EM RELAÇÃO A MU=
LHER
VÍTIMA DE VIOLÊNCIA DOMÉSTICA NA ATENÇÃO PRIMÁRIA À SAÚDE
Jhuliano Silva Ramos de Souza[1]
* Patrícia Lemos Magalhães[2]
* Sueli de Carvalho Vilella[3]
* Zélia Marilda Rodrigues Resck[4]
Abstract:
Keywords:
Resumo: Objetivo:
Refletir
sobre cuidados de enfermagem em relação à mulher vítima de violência domést=
ica
na Atenção Primária à Saúde. Método: Trata-se de um estudo teórico-r=
eflexivo
com a coleta de dados em março de 2021, por meio das bases de dados: Litera=
tura
Latino-Americana e do Caribe em Ciências da Saúde (LILACS), National Lib=
rary
of Medicine (PUBMED) e Scientific Electronic Library Online
(SCIELO). Foram selecionados seis estudos dos últimos dez anos (2010-2020),
utilizando a análise de conteúdo para a categorização dos artigos. Resul=
tados:
Emergiram duas categorias sobre o cuidado de
enfermagem a mulher vítima de violência na atenção básica e capacitação dos
profissionais de enfermagem frente no reconhecimento da violência doméstica=
.
Considerações finais: As dificuldades que os profissionais de enferm=
agem
têm ao cuidado a mulheres em situações de violência estão relacionadas à fa=
lta
de formação qualificada, treinamento e capacitação, trazendo sentimento de
impotência e despreparo perante as situações vivenciadas na prática clínica,
como o encaminhamento aos serviços de referência e a familiaridade com a fi=
cha
de notificação compulsória.
Palavras-chave: Equipe de Enfermagem; Atenção Primária à Saúde;
Violência contra a Mulher.
.<=
span
lang=3DEN-US style=3D'font-size:12.0pt;font-family:"Times New Roman",serif;
mso-ansi-language:EN-US'>INTRODUCTION
The World Health Organization defines violence as =
the
intentional use of physical force, power or threat against one another, to
another, to a group or even to their peers, resulting in damage not only of=
a
physical nature (bodily injuries), but also psychological and even death
In 2018, 4,519 women died because of violence agai=
nst
women in Brazil, most of them black people living in the north and northeast
regions, highlighting the cause of death from feminicide in which the
perpetrators of this crime were their partners/partners who lived in their
family life (3).
According to Law nº 11,340, from August 7, 2006, k=
nown
as the Maria da Penha Law, that protects women who suffer/suffered any type=
of
violence in Brazil, it defines that violence to women is "any action or
omission that causes death, injury, physical, sexual or psychological suffe=
ring
and moral or patrimonial damage" bringing various classifications as to
the typologies of violence, such as domestic violence and intrafamily viole=
nce (4).
About violence in the domestic sphere, it is every
environment of coexistence of people who live in the same place without hav=
ing
a biological family bond. In relation to the intrafamily, it is understood =
as a
group of people who have some kinship, whether biological or not that are
interconnected for some reason, affinity or will (4). The terms =
of
both domestic and intrafamilial violence show similarities between their co=
ncepts
but presenting small distinctions between their definitions (5).=
In view of this phenomenon of a criminal nature, it
has become a serious public health problem. In this sense, health
professionals, especially nursing professionals, should be prepared to care=
for
these women in situations of violence in health services, such as Primary H=
ealth
Care (PHC) since this type of service is the gateway to the care of women in
situations of violence (6).
The role of the nursing team in PHC in the care of
women victims of domestic violence is related to welcoming, empathy,
therapeutic listening, creating bonds and trust between nurse-patients to
create a good interpersonal relationship, because many women have resistanc=
e to
share about the violence they suffer in their family life (7).
Health professionals who are going to assist these=
victims
must have the skills and skills to combat violence. However, there are still
disagreements about identifying what roles they should have in identifying
physical signs of violence and referral to public security, justice and soc=
ial
services. The performance of the professionals shows that they ignore certa=
in
characteristics of the epidemiology of violence against women, especially w=
ith
prenatal service (8).
As for nursing professionals, there is still a lac=
k of
training in the care of people in situations of violence, being one of the =
main
gaps is the lack of training, training and training of the same, bringing a
feeling of helplessness in the face of the situations experienced and the
nursing processes that should be applied in clinical practice, as well as in
the referral to reference services (7).
Perhaps due to the lack of training for women's ca=
re,
nursing professionals understand that domestic violence is only identified =
by
physical signs, discarding other indicators that are extremely present in v=
ictims
of violence against women (9), may be inserted in several contex=
ts
of life, including private, domestic and family, making it necessary that t=
he
reception and care of these victims be effective, proactive, humanized and
ethical in the face of the challenges and problems that the health sector e=
nds
up facing in their daily lives (10).
In view of this contextualization, the objective of
this study was to reflect on nursing care in relation to women victims of
domestic violence in PHC.
METHOD
This is a theoretical-reflexive study on nursing c=
are
in relation to women as victims of domestic violence in PHC. Data collection
occurred in March 2021, through the electronic databases/portals of the Vir=
tual
Health Library (VHL): Latin American and Caribbean Literature on Health
Sciences (LILACS), and Medical Literature and Retrieval System Online (MEDL=
INE)
and Scientific Electronic Library Online (SCIELO).
The Descriptors in Health Sciences (DeCS) and the
Medical Subject Headings of the U.S. National Library of Medicine (Mesh):
Nursing Team AND Violence against Women were used; Primary Health Care AND
Violence against Women; Group of Enfermería AND Violencia contra la Mujer;
Atención Primaria de Salud AND Violencia contra la Mujer, in the Portuguese,
English and Spanish languages in the last ten years (2010-2020).
The inclusion criteria were studies that relate the
role of nursing in the care of women who suffer violence in PHC. Exclusion
criteria were studies that address violence against women without nursing p=
articipation
in care and/or related to other types of violence, such as against children,
adolescents and the elderly.
For the analysis of the included studies, the cont=
ent
analysis of Bardin (11) was used following the three phases
indicated by it 1) pre-analysis, 2) exploration of the material and 3)
treatment of the results, inference and interpretation. They were categoriz=
ed
for the reflexive discussion on the theme addressed.
RESULTS
The bibliographic search resulted in 703 studies in
the first selection made by reading titles and abstracts, which excluded
duplicate articles (14) and those that did not meet the inclusion criteria
(668) and studies related to a multiprofessional approach on domestic viole=
nce
and/or related to other types of violence.
Through the first selection of studies, 21 studies
were pre-selected, among which were read in full, 15 found in MEDLINE, 5 in
LILACS and 1 in SCIELO, did not meet the study objective because they were
related to the approach of victims of violence in the hospital, forensic,
palliative, psychiatric and mental health and other languages. Thus, the sa=
mple
resulted in six articles.
In view of the analysis of the selected studies, t=
wo
categories emerged for the discussion on: I) Nursing care for women who are=
victims
of violence in primary care; and II) Training of nursing professionals in t=
he
recognition of domestic violence.
DISCUSSION
I)
Nursing care for women who are victims of violence in primary care
PHC is an environment that favors the identificati=
on of
women victims of domestic violence because they are assisted in these servi=
ces
and because it is considered a gateway service as well as because of the
structure of the same and its exchange with the family and with the habitat=
of
the population (12).
The characteristics that help in the identificatio=
n of
women victims of violence are related to economic and affective dependence =
on
the partner, fear of the aggressor, external judgment and even death due to
threats. As well as, due to physical injuries, signs of coercion, psycholog=
ical
and emotional aspects that can be perceived during the nursing consultation=
or
even at times of specific procedures and in home visits. Thus, it is notable
that different types of violence can be identified, as domestic violence
defined as violation of women's rights, and can be classified as physical,
verbal, moral and psychological, and physical, identified as one of the best
known (9).
The care of women who are victims of domestic viol=
ence
involves comprehensive care in the physical and biological, psychological,
social, legal aspects. Identifying and understanding the feelings experienc=
es
of victims of violence, in addition to physical injuries, allow interventio=
ns
to be resolutive. For this, communication and reflexive listening are
strategies that mark the efficiency in care, in which nurses report the
existence of problems between communication and listening to the care of th=
ese
women (13). Another aspect of care is to enable
support, encouragement, empowerment so that women feel protected, respected=
and
safe when seeking care in health services, thus preserving their mental hea=
lth (14).
On the other hand, the nurse who works in PHC can
identify the victims in relation to the consequences left by violence, since
they can generate marked trauma to these victims, such as, which will affect
their biopsychosocial state, which may be a precursor of depressive symptom=
s,
isolation, fear and inability to make decisions and others.
In the legal sphere, nurses must help victims to s=
eek
their rights and protection. In this sense, there is unpreparedness of the
nursing team regarding the knowledge of legislation and compulsory notifica=
tion,
which generates insecurity, fear and difficulties in providing correct
information in the care of people in situations of violence (13)=
.
Interpersonal relationships between nurses and wom=
en
victims of domestic violence must be based on the creation of bonds so that
they can encourage and empower their rights and their decisions in the face=
of
intimate partner violence, as well as favor the feeling of trust, belief in
secrecy, empathy, trust in the professional. On the other hand, it favors t=
he
professional the emancipation of technical-scientific knowledge, skills and
competencies to assist women in violent situations (10).
In view of this, nursing care for women victims of
domestic violence should be based on promotion, safety, reception, respect,
planning of strategic actions, public policies and legislation in force for=
the
protection and prevention of the consequences that violence has on the live=
s of
these women. As well as welcoming, qualified listening, bonding, encouragin=
g to
report, detailed physical examination and psychoemotional approach, in which
primary care services should be prepared to receive/assist these women in
situations of violence (9).
In addition, there are still failures in care beca=
use
they are not familiar with the compulsory notification form, in the recepti=
on,
in the referral to the psychologist, to the social worker and public safety,
with no return and close monitoring by the nurse who works in primary care =
(12).
As for the knowledge of PHC nurses about violence against women, it =
is
observed that there is a need for an interdisciplinary approach in public,
social, legal and education services (15).
The knowledge of professionals about the care of women victims of
violence, is deficient since they do not have qualified training, do not kn=
ow
the epidemiological characteristics of violence, do not know what correct
conduct to take against cases, as well as the lack of an instrument that gu=
ide
this type of specific care, which hinders care, decreases sensitivity in
welcoming the victim and hinders referral to public safety (16).=
It is important that nurses know how to ident=
ify
the appropriate behaviors, but due to the complexity of the problem of
violence, a broad and interdisciplinary approach is necessary, covering
prevention and protection actions against violence (16).
In addition to the systematization of nurs=
ing
care for women victims of domestic violence, nurses who work in PHC have the
function of training their team (12). For this, specific skills and skills ha=
ve
been developed so that they can train others, which is not evident in some
studies (6,7,8,9,10,12). In this sense, it is perceived that it is important that the nursing
professional seeks qualification strategies for this.
II) Training of nursing professionals in the recogniti=
on
of domestic violence
The recognition of PHC nurses includes what domest=
ic
violence is and its important role in care in the face of it, whether in
anamnesis, physical examination and qualified listening, still presents
difficulties caused by fear and insecurity in caring for victims of domestic
violence, lack of specific training and professional training (12). As
for unpreparedness, it still exists due to the academic training of health
professionals in relation to the identification and care of people in
situations of violence, generating a feeling of insecurity (17).=
Moreover, PHC nurses have knowledge and interest on
the theme of violence against women, presenting knowledge about women's
protection policy, compulsory notification and identifying this phenomenon =
as a
public, social, judicial, economic and cultural health problem (18).
Although some nurses include in their professional practice a planning of
actions related to the care of women victims of violence, they reported tha=
t they
did not take training courses to work in the area. there is disqualificatio=
n in
the laws and decrees that support these women and the need to strengthen the
health networks that receive this public (18).
As for the knowledge of primary care nurses about
violence against women, there is a good result of the participants' violenc=
e,
epidemiological profile, care for the victims, as well as identifying the
characteristics of the aggressor (15). Moreover, when
courses are offered that train these professionals on the care of victims of
violence, it demonstrates a satisfactory point to the results after its con=
clusion
that they feel more prepared and qualified to serve this public (17).
The challenges that primary care services face regarding violence against women shows that nurses who are on the front lin= e of care should be trained to perform humanized, educational and ethical functi= ons and conducts. However, it is still observed within PHC services the scarcit= y of their preparation in biopsychosocial recognition, requiring continued educa= tion to improve and fulfill the gaps in interdisciplinary care (12).<= o:p>
The limitations that many professionals present are
the lack of preparation and training regarding the approach of violence aga=
inst
women, presenting failures since their training process consequently with a
deficiency not only in the care in the face of cases of violence, but the
development of professional skills and skills (19).
It is notorious that nursing professionals who have
been inserted in primary care services are familiar with the theme so that =
they
can play their role before women in critical situations regarding violence,=
as
well as develop necessary conducts to feel supported and supported in relat=
ion
to referring specialized networks and notification as a tool to identify ca=
ses
of domestic violence.
FINAL NOTES
It was evidenced that the difficulties that nursing
professionals have in the care of women in situations of violence are relat=
ed
to lack of qualified training, being identified feeling of helplessness and
unpreparedness in the face of situations experienced in clinical practice, =
such
as referral to reference services and familiarity with the compulsory
notification form.
It should be reflected what difficulties this basic
health care is facing, providing professionals with training, through
continuing education, instrumentalizing them to identify and understand the
feelings and experiences of the victims, so that it is easier to receive and
quality care.
Future studies on the role of the nursing team in =
PHC
on victims of violence against children and adolescents and the elderly are
suggested, whose approach is completely different, and these professionals
should be aware of these types of signs of violence.
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Autor correspondente:
Jhuli=
ano
Silva Ramos de Souza, Rua da Liberdade, nº72, Vila Betânia, CEP: 37-137-090,
(35) 991299524. E-mail: jhulianoramoz@hotmail.com
2021-04-29
Approval: 2021-05-29
[1]=
Enfermeiro, Mestr=
e e
Doutorando em Enfermagem pelo Programa de Pós-Graduação em Enfermagem da
Universidade Federal de Alfenas (UNIFAL-MG). E-mail: jhulianoramoz@hotmail.com ORCID: https://orcid.org/0000-0002-4338=
-4433
[2]=
Enfermeira, Mestr=
ando
em Enfermagem pelo Programa de Pós-Graduação em Enfermagem da Universidade
Federal de Alfenas (UNIFAL-MG). E-mail: patilemos37@gmail.com
ORCID: https://orcid.org/0000-0001-5974-5451
[3]=
Enfermeira, Douto=
ra
em Ciências pela Escola de Enfermagem de Ribeirão Preto da Universidade de =
São Paulo
(EERP/USP). Docente do Programa de Pós-Graduação em Enfermagem da Universid=
ade
Federal de Alfenas (UNIFAL-MG). E-mail: suelicvilela@gmail.com ORCID: https://orcid.org/0000-0003-3034=
-3904
[4]=
Enfermeira, Pós-d=
outorado
em Ciências pela Escola de Enfermagem de Ribeirão Preto da Universidade de =
São
Paulo (EERP/USP). Docente do Programa de Pós-Graduação em Enfermagem da
Universidade Federal de Alfenas (UNIFAL-MG). E-mail: zmrresck57@gmail.com ORCID:
https://orcid.org/0000-0002-3752-8381
=