CONJUGAL VIOLENCE AND HEALTH CARE PRACTICE THROUGH LEVELS OF HEALTH CARE: NURSES´ SPEECHES

Sousa, Anderson Reis de; Estrela, Fernanda Matheus; Silva, Andrey Ferreira da; Oliveira, Milena Arão da Silva; Loureiro, Adriana Karlla Neves da Silva; Gomes, Valquíria Rodrigues

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ORIGINAL ARTICLE • Cogitare Enferm. 26 • 2021 • https://doi.org/10.5380/ce.v26i0.74083 copy

CONJUGAL VIOLENCE AND HEALTH CARE PRACTICE THROUGH LEVELS OF HEALTH CARE: NURSES´ SPEECHES

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to describe the nurse’s care practice in the face of cases of marital violence in the three levels of health care.

Method:

qualitative study conducted with 47 nurses working in a large city in the Northeast of Brazil. The data were collected between September and November 2018, systematized through NVIVO11® software, and analyzed through the Discourse of the Collective Subject.

Results:

the research revealed that, in the identification of cases of violence, there is a need to investigate the daily marital life and establish a bond with the user. Regarding referrals, articulation with other professionals is necessary.

Final considerations:

the research offers subsidies to guide the care of women in conjugal violence situation in the three levels of attention.

DESCRIPTORS
Domestic Violence; Health Care Levels; Nursing; Public Health; Women’s Health

Levels of attention	Recognition of conjugal violence	Case Management
Basic Attention	Most of the time, it is the Community Health Agents who bring to the team meetings the situations of conjugal violence that occur in the community [...] When these women seek care, I welcome and listen to them. It is at this moment that I perceive the demands not only physical but also psychological [...] Before, the user came to the basic unit with a smile on her face, then we noticed in her countenance a deep sadness. During the nursing consultations, I also notice traces of physical and sexual violence [...] There are signs that are classic, such as bruises, scratches and stains [....] Some of them report absence of libido, however, during the physical examination of the perianal region I notice vaginal and/or anal lacerations. (DSC, Nurses who worked in Basic Health Care - USF, UBS, CAPS)	I do not have an action protocol for situations of violence against women. I provide the necessary assistance, such as dressings and medication. Cases of greater complexity we share with NASF and, when we do not have conditions to handle the case, we refer it to other services [...] (DSC, Nurses who worked in Basic Health Care - USF, UBS, CAPS)
Medium complexity	During the screening, we already noticed something different [...] Most of the time, the woman who suffers violence presents very characteristic lesions such as bruises on her face, arms and legs [...] Sometimes they arrive accompanied by another woman, being the mother, sister or a friend. In others they are accompanied by a police vehicle [...] this already left us in alert. During the anamnesis, the victims always keep their heads down, cry a lot and cannot give us the information. Usually, I ask the questions to his/her companion, who	In situations of physical violence, we restrict ourselves to physical care, such as the administration of medication, evaluation of vital signs and, in the face of a more serious injury, we perform dressings or assist the doctor in suturing [...] In cases of sexual violence, we follow a flow of care. If the act had occurred within 72 hours, we welcomed, performed emergency conception, conducted laboratory tests, HIV and STI prophylaxis and for expert examination. If this
	reports to me what happened. [...] When it was a situation of sexual violence, she would arrive crying a lot, placing her hand on the genital area. If the person on duty was a male nurse, they did not want to be seen by him. (DSC, nurses who worked in Emergency Units, Outpatient Clinics (Policlinics) and Mobile Emergency Service - SAMU)	after 72 hours, we welcomed and forwarded it to laboratory tests. In both cases, we made the compulsory notification of the violence and referred to the social assistance and psychologist. (DSC, nurses who worked in units of Emergency Care, Outpatient Clinics (Policlinics) and Mobile Emergency Care Service - SAMU)
High complexity	Here at the hospital, we receive extreme situations of physical violence against women, such as gunshot wounds and firearms requiring surgical interventions. [...] When women arrive with signs of burning in certain parts of the body such as the head and limbs, we already understand that it was violence (DSC, Nurses who worked in the hospital network - Obstetrics, Emergency, Intensive Care, Epidemiological Surveillance, Surgical Center and Hospitalization Units)	I try to approach with respect, without being invasive and without asking embarrassing questions, seeking to establish a bond with her [...] After that, I give the assistance that I am supposed to give based on what was found during the anamnesis and physical examination [...] Soon, I build the care plan so that this woman can be assisted in the best possible way, not only in the physical field, but also in the psychological field. (DSC, Nurses who worked in the hospital network - Obstetrics, Emergency, Intensive Care, Epidemiological Surveillance, Surgical Center and Hospitalization Units)

Universidade Federal do Paraná Av. Prefeito Lothário Meissner, 632, Cep: 80210-170, Brasil - Paraná / Curitiba, Tel: +55 (41) 3361-3755 - Curitiba - PR - Brazil
E-mail: cogitare@ufpr.br

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[1] Corresponding author:
Fernanda Matheus Estrela Universidade Estadual de Feira de Santana – Feira de Santana, BA, Brasil E-mail: nanmatheus@yahoo.com.br