Family violence: What health workers can do

Abstract

Nasilje u obitelji je skup ponašanja čiji je cilj kontrola nad članovima obiteljske zajednice uporabom sile, zastrašivanja i manipuliranja. Oblici nasilja su psihičko, fizičko, seksualno i ekonomsko. Najčešće žrtve nasilja su djeca, žene, starije osobe i osobe s posebnim potrebama. Zdravstveni djelatnici mogu imati ključnu ulogu u ranom prepoznavanju i prevenciji nasilja u obitelji jer su oni jedini stručnjaci s kojima svi ljudi kontaktiraju tijekom života i koji mogu stvoriti povjerljivo okruženje za razgovor. Žrtve redovito umanjuju i prikrivaju obiteljsko nasilje u strahu da će njihova sigurnost biti još više ugrožena ako se nekome povjere, zbog srama što žive u takvoj obitelji i zbog specifične dinamike nasilnog odnosa koji žrtvu čini bespomoćnom i lojalnom nasilniku. Liječnici i sestre nerado započinju razgovor o problemu nasilja u obitelji, a samo oko četvrtina žena žrtava tjelesnog nasilja o tome razgovara s obiteljskim liječnikom, uglavnom zato što ih liječnik o tome nije pitao. Stoga je bitno da su zdravstveni djelatnici osposobljeni prepoznati znakove nasilja, da znaju što učiniti s takvom osobom i da su spremni pomoći da se nasilje zaustavi. Zakonska je obveza zdravstvenih djelatnika prijaviti nasilje u obitelji policiji i državnom odvjetništvu. To je u skladu s etičkim načelima struke jer uzrok tegoba bolesnika treba prepoznati i onda kada je nemedicinske naravi; zdravstveni djelatnici svojom intervencijom pomažu žrtvi da izbjegne i smanji svoju izloženost nasilju, što dovodi do smanjenja štetnih zdravstvenih posljedica, a može sačuvati ljudski život i zdravlje jer se nasilje u obitelji ponavlja i eskalira.Family violence is a set of behaviors aimed to control family members by force, intimidation and manipulation. Different forms of violence and abuse are psychological, physical, sexual and economic. Most common victims are children, women, elderly and people with special needs. Health workers have a major role in early recognition and prevention of family violence because they are the professionals with who most people get in contact during their life time and who have an opportunity to create a confidential environment. The victims typically deny family violence because they fear their safety may be compromised, feel shame of having a violent family, and due to the specific dynamics of violent relationship that leaves the victim powerless and loyal to the perpetrator. Physicians and nurses often hesitate to discuss the family violence with their patients, so that only about one quarter of female victims of physical violence talk about it with their general practitioner, mostly because the physician did not ask about it. Therefore it is important to increase the capacity of health workers to recognize the signs of violence, know what to do and become willing to help stop the violence. They are legally mandated to report family violence cases to police and public prosecutor. This is consistent with the professional ethnic since the patients’ complaints need to be investigated even when they are of non-medical nature, health workers can help a victim avoid and decrease exposure to violence, thus contributing to decrease in poor health outcomes, and they can help save lives and health because family violence recurs and escalates

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