Introduction
The domestic violence against women continues to attract the attention of medical professionals and public administrators. according to Ahmed (2009), “domestic violence is a global phenomenon occurring among people of all races, ages, socioeconomic status, educational and religious backgrounds” (p. 1).
Such cases are particularly widespread in South Asian communities. This paper will be discussing the causes and magnitude of this problem from socio-environmental perspective. More importantly, it is aimed at developing a specific plan that would help the victims of home abuse and minimize the occurrence of such cases. Overall, nurses can greatly contribute to the resolution of this problem.
Domestic violence as a socio-environmental health issue
Statistical data indicate that the magnitude of this problem is really alarming. For instance, according to the study conducted by Adam Najma and Paul Schewe, more than 77 percent of immigrant Pakistani and Indian women experienced some form of domestic violence (2007, p. 13).
Furthermore, this study relies primarily on the reported case of spousal abuse. Many of these cases could go undocumented. As it has been identified in the study by Aisha Gill (2004), many victims fail report family abuse because they believe that their male partners are virtually “all-powerful” or “immune” to any intervention even from the police (p. 475).
Thus, they may simply fear to share their experiences with social workers or nurses (Izzidian, 2008). This issue can become even more urgent if we consider that Indian immigrants are one of the fastest growing populations in many developed countries such as the United States (Liao, 2006, p. 24).
There are various theories which strive to explain the causes of domestic violence. One of them is the resource theory developed by William Goode (Goode as cited in Cane & Kritzer, 2010, p. 228).
According to this approach, the victims are primarily those women, who are financially dependent on their partners. Hence, they might be afraid of living their husbands even if they abuse them. This theory may not explain the actual cause of violence but it helps to identify some factors which contribute to it (Sokoloff & Pratt, 2005, p. 166). In part, this hypothesis is confirmed by the statistical findings.
To elaborate this theory, one should look at educational background of the victims and determine if they act as breadwinners. The research carried out by Bowlus & Seitz (2006) suggests that employment can significantly reduce the likelihood of domestic violence (p. 1120). In particular, only 8.9 percent of those women, who reported spousal abuse, were employed on a full time basis (Bowlus & Seitz, 2006, 1120). Hence, one can say that this hypothesis is supported by empirical findings.
However, the resource theory may not be sufficient for complete explanation of this problem. One should also take into consideration in some communities, domestic violence can be tolerated. To a great extent, such tolerance is based on a racist premise that women must submit to the will of their husbands. In this regard, violence becomes one of the public health concerns, as it is stated in Lundy & Janes (2009, p. 509).
Thus, one should not overlook cultural background of families. For example, the surveys of many Asian Indian women show that from victims’ perspective, an ideal wife should “unquestioningly sacrifice to the demands of the husband” (Liao, 2006, p. 26). As a rule, such families are patriarchal and the husband acts as a main decision-maker. This is circumstance which is usually associated with domestic violence.
Besides, one should not forget that in many Asian communities top priority is given to “family honor” which means that the victims can find it shameful to disclose domestic violence. They may not report spousal abuse for approximately seven years (Liao, 2006, p. 27). Another issue that should be taken into account is that the victims are often separated from their closest relatives, especially parents. In part, their high tolerance of domestic violence can be explained by the fact they have nowhere else to go.
Finally, one should not disregard such factor as the loss of social status. The problem is that many immigrants coming from Asian countries cannot secure a job that would fit their professional education. Some of them have to do menial jobs, and these men believe that they occupy an undeservedly low place in the social hierarchy (Liao 2006, p 27; Stretch, 2003, p. 141).
Therefore, they attempt to raise their self-esteem by means of force and violence (Lawrence, 1994, p. 48). Thus, while speaking about the propensity to violence, one should determine the extent to which the family assimilated into a foreign society.
On the whole, this discussion shows that there are several conditions which can lead to domestic violence: 1) women’s unemployment and lack of financial resources; 2) high tolerance of violence within the family and the community; 3) loss of social status, and 4) patriarchic structure of the family. These factors are extremely important for the identification of those women who are likely to suffer from domestic violence.
Intervention plan
In this case, nursing intervention has to be based on the population health model. The main advantage of this approach is that it takes into account economic and social environment of a person, namely education, income, employment, culture, and social support (Kovner, Knockman, & Weisfeld, 2011, p. 86). As it has been shown in the previous section these environmental factors are closely related to domestic abuse.
Nurses and other healthcare professionals should overcome several obstacles which prevent victims of domestic abuse from looking for help. The first barrier is lack of knowledge about those institutions which can protect women from abuse (Hamberger, 2004, p. 179). In other words, many women do not know who can help them and how. This is the reasons why they do not tell about the instances of domestic abuse to nurses, social workers or physicians.
The second barrier is the fear of retribution. The thing is that many victims do not even to consult nurses, physicians, or consultants because they believe that the disclosure of abuse will result in retaliation (Hamberger, 2004, p. 179). In addition, lack of trust toward healthcare providers can prevent the victims from telling about their experiences. These are the main obstacles that nurses and social workers should overcome.
The plan proposed in this paper seeks to build health public policy and strengthen community actions against domestic abuse. One of its tasks is to create an environment in which South Asian women or any other victims of violence will not feel helpless and alienated. Finally, it is vital that these women acquire or develop personal and coping skills.
Overall, there are several important things that can be done by public administrators in order to protect women from abuse. First, nurses and counselors must carefully study the reports and criminal records related to spousal abuse. On the basis of this information they will be able to single out at-risk families or communities, for example, South Asian communities.
The second important stage is screening intervention. At this point, nurses begin to play the most crucial role. They must be able to assess psychological and physical state of women. In part, it can be done by the use of various questionnaires which help to evaluate the relations between the partners.
Moreover, nurses must determine whether the physical symptoms of a woman can be related to domestic abuse. Provided that there is some evidence indicating at domestic violence, for example, bruises or depressed state of the patient, the nurse tell the victim what kind of organizations can help her (Humphrey & Campbell, 2010, p. 61). Nurses must properly document the results of their assessment since this evidence will important for legal protection of the victim.
Another important intervention is safeguarding. It is essentially aimed at limiting the contacts of an alleged victim with the perpetrator. If there is an explicit threat to her health or life, she must be isolated from her husband. In some cases, she and her children must be providing with temporary accommodation (Humphrey & Campbell, 2010 p 61). The third stage consists of two important interventions namely counseling and legal protection.
The victim of abuse must acquire the skills for coping with traumatic experiences. She should be able to talk to her extended family or peers in order to recover at least particularly. This person must receive counseling from nurses at the initial stages of intervention. It is of crucial importance that nurses encourage the victims to voice their complaints (Timby, 2009, p. 15). At later stages, group counseling services must be provided by certified therapists.
It should be noted that these interventions must be accompanied by a set of preventive measures. In particular, it is necessary to raise the community awareness about domestic abuse. In part, it can be done by issuing educational leaflets (Shipway, 2004, p. 108). Those women, who live in the at-risk communities, must know that they will not be left to their own devices. These leaflets can be distributed by community nurses as well the workers of non-governmental organizations.
One must not disregard financial aspects of spousal abuse. As it has been shown in the previous part of the paper, many of these women are financially dependent on their husbands. Thus, the government should help them with employment and offer some vocational training.
Only in this way, the victims will become more self-sufficient. These are the main interventions that can resolve the problem of physical abuse. They have to attain three important objectives: 1) the protection of women; 2) the prevention of abuse; and 3) recovery of victims.
Required Health nursing roles and ideas
Thus, it is possible to argue that nurses can significantly contribute to the implementation of this plan. Under circumstances, he/she should act as an assessor of patient’s mental or physical health, counselor, and coordinator. These are the roles which nurses often perform (Forster, 2001, p. 22). However, one should take into consideration that they will be dealing with people whose cultural background can be different.
This is why many authors stress the importance of cultural competence (Nagelclerkm, 2000, p. 200; Liao, 2006). This term can be explained as the ability to recognize and respect cultural distinctions of the patient. In particular, the nurse must know how South Asian women view family, gender roles, equality of sexes and so forth. Another important issue is the language barrier. In many cases, the victims of abuse may not be proficient in the English language; thus, a nurse should be able to communicate in this language.
Furthermore, this healthcare professional must understand non-verbal communication of these women. The thing is that gestures, posture, personal appearance, facial expressions can tell very much about mental health of a patient (Aquino, 2008, p. 165). This skill is of vital importance for screening.
As a counselor, he/she must be able to establish rapport with this patient. Therefore, one can argue a nurse must have in-depth knowledge of socio-cultural environment of South Asian women in order to detect or prevent the instances of spousal abuse. Hence, the roles and skills of nurses are very diverse.
The Strengths and weaknesses of the plan
The main strength of this plan is that it takes into account social and cultural environment of women suffering from domestic abuse, because, as it is stated by Yolanda R. Davila, ” domestic violence is recognized as a priority women’s health issue” (2005, p. 1). Secondly, it is based on cooperation of nurses, counselors, public administrators, and non-governmental organizations. Such cooperation can be essential for the success. Furthermore, this plan may not only protect the victims, but prevent the occurrence of domestic violence.
Finally, the implementation of these strategies can make women suffering from spousal abuse more self-sufficient. This argument is particularly important when we speak about employment assistance that will be offered to these victims. Again, this strategy is premised on the idea that domestic violence can be explained by the financial dependence of women in these communities.
Yet, there is some limitation or weakness, namely, this plan requires considerable financial support of the government. In order to offer psychological and legal counseling to these South Asian women, the government will require have to make significant expenditures. However, this weakness can be minimized by attracting non-governmental organizations. Moreover, this problem can be resolved by partnering with those institutions which provide vocational training to unemployed people.
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