The care for the persistent family aggressor in the perception of nursing students

Objective: to analyze the perception of nursing students about the care given to the persistent family aggressor. Method: a descriptive study, with a qualitative approach. Madeleine Leininger’s Theory of Diversity and Universality of Care was used as a theoretical reference. The data collection took place with 37 in the last year of at a public university in Southeast Brazil. We used the technique of Projective Design with a Topic and semi-structured interview. The data were analyzed with the content analysis. Results: the examination of the narratives underpinned the construction of four categories: The care of the aggressor with the family, Recognition of family values and culture, The search for knowledge to care for the aggressor and family, Multidisciplinary and intersectoral care to confront violence. Conclusion: there is an acknowledgment that the care for the aggressor should not only be individual but should involve all those affected. For this, multidisciplinary work is important, and the search for knowledge on the subject is essential for culturally significant care.


Introduction
Violence, despite its quite complex nature, can be understood as the use of power (physical, psychic or social) for threat or practice, against others or oneself, resulting in injury, deprivation, trauma, harm, and even death (1)(2) . Among the types of violence is that of family members, characterized as aggression, negligence or omissive acts, of an intentional nature, committed by individuals with family ties to the victim (natural, civil, social or substitute kinship) with the objective of coercion, offense, advantage, demoralization, oppression, or causing pain and suffering to those whom the aggressor judges inferior (2)(3) .
The isolated concept of violence may not have a coherent meaning if there are no reflections from the perspective of the society that produces it, because there is direct influence of economic, political, social, religious and cultural aspects on daily relationships and peace constructs (3)(4)(5) . Thus, family violence should be treated as a broad phenomenon, triggered by multiple factors and should be seen in the context, social environment and historical moment that happens, including the perceptions of the individuals involved (victims, aggressors, and witnesses) (4)(5) .
Nurses involved in the issue tend to sympathize with the victim, providing zealous assistance and adopting the appropriate measures recommended in flows or lines of care to the person in a violence situation (5)(6) . However, aggressors tend to be rejected and may even be poorly assisted by professionals, as a movement of reproducing common sense behavior, impulsive and with predefined judgment, especially in cases of frequent offenders, that is, those who practice violent acts eventually or often (4)(5)(6) .
Recent studies (7)(8) indicate that caring for only the victim may not be successful, since the offender may perpetuate his or her violent actions if he or she sees them as natural or does not have his or her needs and feelings accepted and cared for. Besides, offenders may not necessarily be safely removed from the victims, as stated by professional recommendations (6)(7) .
Another relevant point is that there is a scarcity of studies on nursing care for the persistent family aggressor, i.e., the one that constantly harms one or more members of his or her family nucleus. This can lead professionals and students to persist in conditions of distance and prejudice. There is a particular shortage of publications in developing countries (8) .
The issue of family violence is not usually present in the graduation of nurses and may cause the organization of not very resolute or inefficient care practices (7)(8)(9) . Thus, the authors of this study ask the  In order to analyze the interviews, the content analysis steps developed by Bardin were followed, which were pre-analysis, exploration of the material and processing of the results (13) . In the pre-analysis, two authors read, line by line, the transcribed material from the interviews with the students and they search for the elements that could compose the analysis
Regarding the drawings, it was evidenced that all families were heterosexual, nuclear, with one or more children, with members drawn with black or dark lines. In five cases none of the characters had a face. In ten cases, the aggressors were presented  it would be professionals more focused on their mental health.
You need more people together to take care, even outside the health care area (E14); There must be a judicial intervention in the case, to turn to someone in the legal department to help us (E15); In some cases, it is even understandable to accept that is not only us who will be able to do this and request social services, support centers and more drastic measures to be able to intervene (E29).

Discussion
The phenomenon of intrafamily violence needs to be deepened in several areas of action, including health, which only a few years ago became more family (14)(15) . Far from it, however, is the care directed to the family aggressor. Almost always hasty judgments are made, condemning the aggressors to a position of carelessness, because they are not understood as vulnerable in this context (15)(16) .
But the data obtained from the analysis of the material in this study showed that a special look should be she realizes that in some societies there are power logics that produce mechanisms for the functioning of that nucleus and that make sense to it (11)(12)25) . One of these aspects is still relevant: sexism in cultures such as Latin, where women are undervalued, seen as fragile and potentially subject to the men's will, who in turn are violent and power grantees (26) .
As in the unconscious of those researched, man is the main perpetrator of family violence, especially sexual and physical violence. A study conducted in the United States of America has shown that such thinking also occurs in jurists in simulated domestic violence scenarios, even affecting decision making and imposing more severe penalties on men than on women (26) . But it is up to health professionals to seek to understand what makes a man a potential aggressor, identifying values, beliefs, and behaviors in order to expand the possibility of culturally correct care planning. Studies indicate that men who commit violent acts in their families reproduce models passed down from previous generations. In other words, the harmful act is a trans-generational message that has been understood as correct or assertive. Within this logic, the family aggressor can also form new aggressors (27) .
In addition, it is interesting that in care planning nurses reflect that the violent drive is not necessarily a constant in the life of the aggressor. Perhaps their harmful behavior occurs as a final mechanism of conflict resolution, whose otherwise unsuccessful attempts at resolution have caused atrocious impulses (22)(23)(24)(25)(26)(27) .
Care for the persistent family abuser has presented itself as a challenge for nursing, especially given the few discussions on this topic during professional training. Therefore, the search for knowledge is a necessary practice for everyone who, directly or indirectly, is involved with the topic. assistance provided to the aggressor, in the most varied places and situations, from those of deprivation of liberty to within the home (28)(29) .
Understanding the worldview proposed by TDUC may become more timely when nurses dealing with the subject seek the specialty cited, as it reduces the distance between the professional and the one who needs the care (11)(12)25) , here, the aggressor. The approach of nursing to the subject, from the perspective of the TDUC, can provide a more naturalized service to the health-disease context from the perspective of the actors involved, which allows for the creation of links between those who care and those who are cared for. Also, we can promote human and empathetic care, committed to the other in their values, limits, and culture.
Studies on the topic of domestic violence safely state that the search for knowledge by nurses is a necessity for better care for the victims, witnesses, and aggressors. In addition, such studies cite that the qualification of these professionals can be crucial for decision making, referrals, and outcomes, not only clinical but also psychic and social (14)(15)30) .
However, the care for the aggressor should not be a solitary assignment. The multidisciplinary action allows for different conceptual perceptions of the facts, which allows for enriching discussions and collectively planning interventions. The multiple training courses in joint action collaborate to find risks, limits, potentialities and possible paths to follow (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) , as evidenced by the participants of this study. Actions to prevent violence and promote a Culture of Peace, such as conflict mediation, restorative practices and the use of nonviolent communication are also measures to be taken by the multidisciplinary health team. These actions reduce the incidence of violence, as well as they can generate medium-term reflexes on harmful cultural aspects, such as machismo (22)(23)(24) .
Complementing care, intersectoral actions allow the articulation of support networks that foster assertive practices (31) . Areas such as justice and citizenship, education, public security, social assistance, and even culture can together add up to efforts that lead Therefore, the care of the family offender must take into account that it is not only social conditioning and health determinants that must be improved, such as access to services and treatment but multiple factors that influence satisfaction and quality of life. In addition to the preventive measures adopted by these sectors, collaborative action allows for greater agility in problemsolving, as in cases that require for segregation of the aggressor from the victims.

Conclusion
The study revealed that the care given to the family aggressor does not appear to be simple. It requires the one who gives the care the recognition of the context and the values of the family, to re-signify cultural aspects that permeate the relationships and that can answer the questions about the mechanisms of violence. Furthermore, this research has shown that care should be given to the perpetrator, but in harmony with the family. That is, for practices to be culturally meaningful, offender, victim, and witness must be cared for as a unit, avoiding prior trials and unilateral practices.
The students affirmed their technical and formative unpreparedness for the exercise of care with security, however, they recognized the need to search for knowledge that has not been offered at college. Moreover, it is inferred that the subject requires a multidisciplinary www.eerp.usp.br/rlae 7 Fernandes H, Brandão MB, Castilho-Júnior RA, Hino P, Ohara CVS. and intersectoral approach, given the limitations of nursing and other professions in responding alone to complex situations such as the care to the aggressor and their family. This networked care allows cycles of violence to be broken and beneficial results for the aggressor to be achieved, thus seeking to meet the premises of the culture of peace.
Finally, the authors point out that perhaps the offer of educational activities on the subject in the modality of university extension can contribute to continuing professional formation.