Domestic violence: HAS publishes guidance on identifying women victims

The French Health Authority (HAS) published in September 2019 guidance on good practice dedicated to identifying women victims of domestic violence. Nurses are directly concerned.

The objectives of the guidance

• Strengthening the involvement of healthcare professionals in combating violence against women.
• Promoting the identification of women victims of domestic violence.
• Facilitating coordination between the professionals involved.

Who is it aimed at?

All healthcare professionals are concerned, particularly those working in primary care or prevention: doctors, midwives, emergency and private practice nurses, health visitor nurses, dentists, physiotherapists. Psychologists, pharmacists, relationship counsellors, social workers, healthcare assistants and medical secretaries are also involved.

The figures cited by HAS

• On average, 219,000 women aged 18 to 75 are victims each year of physical or sexual violence by their partner or former partner.
• Only 19% of them report having filed a complaint.
• In 2018, 121 women were killed in a context of domestic violence, and 21 minor children died in the context of marital conflict.
• All women can be affected, regardless of their age, social background, state of health or disability. Men can also be victims.

The key messages

• Demonstrate commitment: posters and leaflets available in the waiting room.
• Ask systematically, even without warning signs: violence escalates and accelerates over time.
• Pay particular attention during pregnancy and the postpartum period, with an empathetic and non-judgmental attitude.
• Protect children in the household: any domestic violence constitutes maltreatment for children exposed to it.
• Explain the mechanism of violence (psychological, verbal, physical, sexual, economic), which evolves through cycles that become increasingly frequent and intense, to relieve the patient of guilt.
• Assess signs of severity and put protective measures in place if necessary.
• Draw up a certificate or attestation, which allows the victim to assert her rights.
• Make a report if necessary: with the victim's consent, inform the public prosecutor of the facts observed, without naming the perpetrator. This consent is not required if the victim is a minor or vulnerable.
• Inform and refer: the victim has the right to file a complaint; refer her to associative, judicial and healthcare structures.
• Build a multidisciplinary network.

HAS documents

• Practical guide: how to identify and assess
• Practical guide: how to act
• Text of the guidance
• Supporting evidence
• Guidance page on the HAS website

The role of the nurse according to the National Nursing Council

A woman victim of violence often confides first in a nurse, who may also detect signs of violence during their practice. The code of ethics sets out the conduct to be followed:

"When a nurse becomes aware that a person with whom they are called upon to intervene is a victim of abuse, deprivation, ill-treatment or sexual assault, they must implement, exercising prudence and discretion, the most appropriate means to protect them. If it is a minor or a person who is unable to protect themselves because of their age, illness or physical or mental condition, the nurse must, except in particular circumstances which they assess in conscience, alert the judicial, medical or administrative authorities." (article R. 4312-18 of the French Public Health Code)

When vulnerability is not established, the nurse encourages the woman to file a complaint. At the victim's request, she may draw up a nursing clinical attestation: the victim's consent lifts professional confidentiality. This attestation remains strictly objective and faithfully reports the victim's account.

Council documents

• "Nursing clinical attestation" guide (PDF)
• Notice for the "Nursing clinical attestation" guide (PDF)

For further information:ANFIIDE guide on violence and nurse safety.