Domestic abuse as a transgressive practice: understanding nurses' responses through the lens of abjection

Abstract

Domestic abuse is a worldwide public health issue with long-term health and social consequences. Nurses play a key role in recognizing and responding to domestic abuse. Yet there is considerable evidence that their responses are often inappropriate and unhelpful, such as trivializing or ignoring the abuse. Empirical studies have identified several reasons why nurses' responses are sometimes wanting. These include organizational constraints, e.g. lack of time and privacy; and interpersonal factors such as fear of offending women and lack of confidence. We propose, however, that these factors present only a partial explanation. Drawing on the work of Julia Kristeva, we suggest that alternative understandings may be derived through applying the concept of abjection. Abjection is a psychological defence against any threat (the abject) to the clean and proper self that results in rejection of the abject. Using examples from our own domestic abuse research, we contend that exposure of nurses to the horror of domestic abuse evokes a state of abjection. Domestic abuse (the abject) transgresses established social boundaries of clean and proper. Thus when exposed to patients' and clients' experiences of it, some nurses subconsciously reject domestic abuse as a possibility (abjection). They do this to protect themselves from the horror of the act, but in so doing, render themselves unable to formulate appropriate responses. Rather than understanding the practice of some nurses as wilfully neglectful or ignorant, we argue that through a state of abjection, they are powerless to act. This does not refute existing evidence about nurses' responses to domestic abuse. Rather, as a relatively unknown concept in nursing, abjection provides an additional explanatory layer that accounts for why some nurses respond the way they do. Crucially, it elucidates the need for nurses to be supported emotionally when faced with the transgressive practice of abuse.

To ask, or not to ask: the hesitation process described by district nurses encountering women exposed to intimate partner violence

“…). Encountering women who have been exposed to IPV has been associated with repression of feelings in nurses (Bradbury‐Jones & Taylor ), fear of the answers they might receive and fear of getting too involved (Robinson ). This phenomenon is known as the fear of ‘opening Pandora's box’ (McCauley et al .…”

Opinions and Experiences of Primary Healthcare Providers Regarding Violence against Women: a Systematic Review of Qualitative Studies

“…It's the scary feeling of not being in control of what you're going to be able to do for that woman" (Taylor et al 2013, p.495). According to some PCPs these feelings could be explained by the conflict that they felt between their skills to solve problems, the absence of procedures, and their sense of loss control over women's decision-making processes and outcomes (Williston and Lafreniere 2013;Bradbury-Jones and Taylor 2013;Cox et al 2001;Papadakaki et al 2014). It seems to be more frequent between PCPs with less experience working with female victims of violence (Webster et al 2006).…”

“…A minority of PCPs used different coping strategies to face the personal emotional impact and remove their subjectivity from the interaction with women and effectively engage with women them. These strategies ranged from mentoring to writing, going for a walk or gardening (Cox et al 2001;Bradbury-Jones and Taylor 2013;Webster et al 2006).…”

“…Because of the bond with their patients, the majority of PCPs played a supportive and counseling role, undertaking identification of the VAW and assessing its impact on women's health (Bradbury-Jones and Taylor 2013;Cocco da Costa et al 2015;Cox et al 2001;Djikanovic et al 2010;Hesler et al 2013;Hughes 2010;Iverson et al 2013;Kohler et al 2013;McCall-Hosenfeld et al 2014;De Oliveira and Godoy Serpa 2007;Papadakaki et al 2014;Signorelli et al 2013;Vieira et al 2013;Visentin et al 2015;Webster et al 2006;Williston and Lafreniere 2013;Taynan Sousa Porto et al 2014; Nunes Guedes and Godoy Serpa da Fonseca 2011; Salgado Diez 2012; Taylor et al 2013): "As a doctor, I think I am the one who should give orientation…I should warn the person about the risk she has…and which actions she should take…I think we play the role of detectors and counselors but the real action is up to her" (Vieira et al 2013, p.686); "The women are ashamed of coming to the health center, of coming to the doctors, any assistant or nurse, and saying that they were hurt by their husband or partner. This taboo really needs to be broken.…”

“Put bluntly, they are targeted by the worst creeps society has to offer”: Police and professionals' views and actions relating to domestic violence and women with intellectual disabilities

“…Domestic violence is a distressing topic and disclosure can be unsettling for student nurses (Bradbury‐Jones & Broadhurst, ). Bradbury‐Jones and Taylor () argued that some nurses may fail to respond appropriately to domestic violence due to feelings of horror, resulting in distancing or trivializing to avoid anxiety and that they experience an emotional toll when dealing with domestic violence. Health professionals appeared to lack confidence in handling domestic violence situations (Lazenbatt et al., ).…”