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Role of the community health nurse

Community health nurses are a large group of service

providers who have a central ethic of caring and an agenda of
early intervention and health promotion in their work to improve
the health status of communities. CHN are expected to perform a
variety of roles in the community to prevent and early detect of
domestic violence. The nurse can act as educator, counselor,
researcher, advocator, decision maker, coordinator, leader,
caregiver, communicator, change agent (McGarry & Nairn,
2015).

The role of the nurse as:-

1. Coordinator:-

CHN may be one of the first professionals domestic-abuse

victims talk to about the abuse. Like other health professionals
who see abuse victims for health issues often unrelated to abuse,
CHN have a special opportunity to identify, intervene, and
support victims of domestic violence. Professionals working in
health care will see abuse victims when they are living with their
abusers and do not know that abuse is abnormal, when they
attempt to leave their abusers, when they return to their abusers,
and when they ultimately separate. Justice system professionals
only see abuse victims when they have decided to try to leave. A
thorough knowledge about relief available in the legal system for

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abuse victims will allow CHN to help victims effectively

(McGarry, 2017).

Also the CHN role is broad and complex: its remit may
include child protection issues as well as mental health issues.
Domestic abuse against a female partner is often accompanied by
physical and/or sexual abuse of the child and the community
health nurse duty is to to report any concerns about a child's
safety to social services or the police. The community health
nurse is responsible for planning, organizing, developing,
implementing and evaluating programs that prevent and early
detect of domestic violence on cooperation with community
services (Natan, Khater, Ighbariyea, & Herbet, 2016).

2. Educator:-

Being a teacher is an important role for CHN. It is her duty

to give health education to all community. However, the nurse
must be able to assess the knowledge level, learning needs and
readiness of the clients, families and community to give
appropriate and necessary health care education they need to
prevent occurrence of domestic violence (Appleton, 2016).

CHN focus on presenting materials in a clear and

understandable format. They provide information to individuals,
families, and communities and also health professionals that
create a framework for preventing any type of domestic violence.
The educational priority should be to raise awareness amongst
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health professionals of the impact that domestic abuse has on

health, and to outline the appropriate referral procedures to follow
when abuse is encountered. Training can be undertaken with large
or small groups, or individually, depending on the organizational
structure. The CHN should teach community people how to
identify violence, what they should do and how they seek for help
or make a report (Al‐Natour, Qandil, & Gillespie, 2016).

3. Counselor:-

CHN may act as a counselor. She provides emotional,

intellectual and psychological support. She helps a client who
exposed to domestic violence to recognize with stressful
psychological or social problems, to develop and improved
interpersonal relationship (Ponte et al., 2019).

4. Researcher:-

Community health nurses collect and use evidence to

execute positive changes for better health and prevent domestic
violence. The CHN health nurse is responsible for doing
researches that concentrate on the causes, types, and consequence
of domestic violence and the way by which the community be
free as can as possible from domestic violence (Heard, Mutch, &
Fitzgerald, 2017).

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5. Advocate

A nurse may act as an advocator. An advocator is the one

who expresses and defends the cause of another or acts as
representative. People who exposed to domestic violence may be
too weak to do on his own and or even to know his rights to safe
life. Public health nurses advocate on the local and international
level to provide better access to health and safe life, protect
funding for public health programs, and reduce or eliminate all
type of violence (Gerber, 2018).

6. Caregiver:-

CHNs are expected to assist the client who exposed to

violence physically, psychologically, developmentally, cultural
and spiritual needs. It involves a full care to a completely
dependent client, partial care for the partially dependent client and
supportive-educative care, in order to attain the highest possible
level of health and wellness (Miller, McCaw, Humphreys, &
Mitchell, 2015).

Medical providers didn’t have a formal way to identify or

treat women who had been abused. The effects of that violence —
including mental-health issues, traumatic brain injuries, broken
bones and bruises — were often dismissed, ignored or treated
without acknowledging the underlying cause. The CHN should
identify the domestic violence and its perpetrators and victims,
control of the behavior and its harms, punishment and/or
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treatment for the perpetrators, and support for the victims.

Intensive collaboration and coordinated services across agencies
may be vital in tertiary prevention efforts to address chronic
domestic violence and to help prevent future generations of
batterers and victims. However, tertiary efforts can be very
expensive and often show only limited success in stopping
domestic violence, addressing long-term harms, and preventing
future acts of violence (Okada, et al, 2016).

The CHN should assess the victims completely, CHN

should be aware that some of the following physical signs of
injuries might be related to domestic violence (Jack et al., 2017):

 Bruising in the chest and abdomen;

 Multiple injuries;
 Minor lacerations;
 Ruptured eardrums;
 Delay in seeking medical attention; and
 Patterns of repeated injury.

However it is unlikely women will present with a physical injury.

They will more likely present with issues such as:

 A stress-related illness;
 Anxiety, panic attacks, stress and/or depression;
 Drug abuse including tranquilizers and alcohol;
 Chronic headaches, asthma, vague aches and pains;
 Abdominal pain, chronic diarrhea;

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 Sexual dysfunction, vaginal discharge;
 Joint pain, muscle pain;
 Sleeping and eating disorders;
 Suicide attempts, psychiatric illness; or
 Gynecological problems, miscarriages, chronic pelvic pain.

The woman may also:-

 Appear nervous, ashamed or evasive;

 Describe her partner as controlling or prone to anger;
 Seem uncomfortable or anxious in the presence of her
partner;
 Be accompanied by her partner, who does most of the
talking;
 Give an unconvincing explanation of the injuries;
 Be recently separated or divorced;
 Be reluctant to follow advice.

If nurses think a woman in their care may be experiencing

domestic violence, the detail of questioning will depend on how
well they know the woman and what indicators they have
observed. Nurses should begin with broad questions (Salmon,
Baird, & White, 2015), such as:

 'How are things at home?'

 'How are you and your partner relating?'
 'Is there anything else happening that may be affecting your
health?'
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Specific questions linked to clinical observations could include:

 'You seem very anxious and nervous. Is everything all right

at home?'
 'When I see injuries like this, I wonder if someone could
have hurt you?'
 'Is there anything else that we haven't talked about that
might be contributing to this condition?'

More direct questions could include:

 'Are there ever times when you are frightened of your

partner?'
 'Are you concerned about your safety or the safety of your
children?'
 'Does the way your partner treats you ever make you feel
unhappy or depressed?'
 'I think there may be a link between your illness and the
way your partner treats you. What do you think?'

It is also imperative to assist the woman by assessing her safety

and the safety of her children. To do so, speak to the woman
alone and ask her (Hooker, Small, & Taft, 2016):-

 Does she feel safe going home after the appointment?

 Are her children safe?
 Does she need an immediate place of safety?

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 Does she need to consider an alternative exit from your

building?
 If immediate safety is not an issue, what about her future
safety? Does she have a plan of action if she is at risk?
 Does she have emergency telephone numbers (i.e. police,
women's refuges)?
 Help make an emergency plan: Where would she go if she
had to leave? How would she get there? What would she
take with her? Who are the people she could contact for
support?
 Document these plans for future reference.

7. Communicator:-

Communication is very important in nursing roles. It is

vital to establish nurse-client relationship. Nurses who
communicate effectively get better information about the client’s
problem either from the client itself or from his family. With
better information nurses will be able to identify and implement
better interventions and or nursing care that promotes fast
recovery, health and wellness. The response of CHN to victims in
these circumstances can have a profound effect on their
willingness to open up or to seek help. Some responses to assist
successful communication in these circumstances could include
(MacLean, Kelly, Geddes, & Della, 2017):

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 Listening: Being listened to can be an empowering

experience for a woman or child who has been abused.
 Communicating belief: "That must have been very
frightening for you."
 Validating the decision to disclose: "It must have been
difficult for the CHN to say about this." "I'm glad you were
able to tell me about this today.'
 Emphasizing the unacceptability of violence: "You do not
deserve to be treated this way.

CHN should avoid responses that undermine the woman's actions,

such as:

 "Why do you stay with a person like that?"

 "What could you have done to avoid the situation?"
 "Why did he hit you?"

8. Change Agent:- 

As a change agent, oftentimes a nurse change or modify

nursing care plan based on her assessment on the client’s health
condition. This change and modification will only happen when
the intervention/s does not help and improve a client’s health
(Salmon, Baird, & White, 2015).

9. Leader:- 

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CHN often assumes the role of leader. Not all nurses have
the ability and capacity to become a leader. CHN can participate
in and guide teams that assess the effectiveness of intervention
program, implement-based practices, and construct process
improvement strategies that aim to reduce and prevent any type
domestic violence (Hooker, Small, & Taft, 2016).

10.Change Agent:-

  As a change agent, oftentimes a nurse change or modify

nursing care plan based on her assessment on the client who
exposed to domestic violence when the intervention/s does not
help and improve a client’s health (McGarry & Nairn, 2015).

Reference

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Al‐Natour, A., Qandil, A., & Gillespie, G. (2016). Nurses' roles in screening for
intimate partner violence: a phenomenological study. International
nursing review, 63(3), 422-428.
Appleton, J. V. (2016). Recognising and responding to domestic violence and
abuse: the role of public health nurses. Community practitioner, 89(3), 24.
Gerber, L. (2018). Understanding the nurse's role as a patient advocate.
Nursing2018, 48(4), 55-58.
Heard, E., Mutch, A., & Fitzgerald, L. (2017). Using applied theater in primary,
secondary, and tertiary prevention of intimate partner violence: A
systematic review. Trauma, Violence, & Abuse, 1524838017750157.
Hooker, L., Small, R., & Taft, A. (2016). Understanding sustained domestic violence
identification in maternal and child health nurse care: process evaluation
from a 2‐year follow‐up of the MOVE trial. Journal of advanced nursing,
72(3), 533-544.
Jack, S. M., Ford‐Gilboe, M., Davidov, D., MacMillan, H. L., Team, N. I. R., O'Brien,
R., . . . Coben, J. (2017). Identification and assessment of intimate partner
violence in nurse home visitation. Journal of clinical nursing, 26(15-16),
2215-2228.
MacLean, S., Kelly, M., Geddes, F., & Della, P. (2017). Use of simulated patients to
develop communication skills in nursing education: An integrative review.
Nurse Education Today, 48, 90-98.
McGarry, J. (2017). Domestic violence and abuse: an exploration and evaluation of
a domestic abuse nurse specialist role in acute health care services.
Journal of clinical nursing, 26(15-16), 2266-2273.
McGarry, J., & Nairn, S. (2015). An exploration of the perceptions of emergency
department nursing staff towards the role of a domestic abuse nurse
specialist: a qualitative study. International emergency nursing, 23(2), 65-
70.
Miller, E., McCaw, B., Humphreys, B. L., & Mitchell, C. (2015). Integrating intimate
partner violence assessment and intervention into healthcare in the
United States: a systems approach. Journal of Women's Health, 24(1), 92-
99.
Natan, M. B., Khater, M., Ighbariyea, R., & Herbet, H. (2016). Readiness of nursing
students to screen women for domestic violence. Nurse Education Today,
44, 98-102.
Ponte, H. M. S. d., Silva, A. V. J. G., Pinto, F. R. M., Aguiar, F. A. R., Aviz, A. L. M. d.,
Aires, S. F., . . . Gomes, F. M. A. (2019). Being a nurse, being a counselor:
awakening to social control and public health. Revista Brasileira de
Enfermagem, 72(1), 134-139.

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Salmon, D., Baird, K. M., & White, P. (2015). Women's views and experiences of
antenatal enquiry for domestic abuse during pregnancy. Health
Expectations, 18(5), 867-878.

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