Positions constructed in specialist health care for patients experiencing intimate partner violence

Abstract

The aim of this study was to examine the positions that health personnel in specialist health care construct for patients experiencing intimate partner violence. It was also studied whether these constructed positions were challenged by other health care professionals and if so, how. The method of analysis chosen was discourse analysis.

The data in this study was part of a larger development and research project Violence Intervention in Specialist Health Care (VISH), which was funded by the EU Daphne III Program in 2009–2010. The data consisted of six focus group interviews collected in 2006 in Jyväskylä, Finland. In these interviews specialist health care personnel discussed how they encounter and intervene in intimate partner violence. There were 30 participants altogether: physicians, nurses, social workers and psychologists. The health care professionals worked in VISH pilot departments in specialist health care in Central Finland Health Care District: the maternity, psychiatric ward and emergency department.

The patients experiencing intimate partner violence were positioned in diverse ways. The positions were constructed in three dimensions, each of them having three to four subcategories. The patient was positioned as a visible and easily recognisable “victim”; latently damaged by the violence; and participating in and supporting the violence. The patient was perceived as possessing the classic characteristics of a “victim”: physical injuries, visible emotional expressions and obvious relationship problems. The patient was also perceived as damaged or disturbed in a way that their victimisation becomes hidden behind some secondary symptoms, such as psychological problems, substance abuse, becoming violent oneself or turning into a “time bomb”. The patients were perceived as participating in and supporting the violence when they were positioned responsible for ending the violence. It was thought that the patients did not leave the relationship because of their weakness, participation as an accomplice or guilt for the violence. Almost all the constructed positions were challenged by the other health care professionals, although most often in a very discreet way, through tones and gestures.

The results of this study support the common notion that health personnel often have stereotypical and even distorted perceptions about people experiencing intimate partner violence. This is why a mere suspicion of abuse based on a health care professional’s intuition is unable to detect most of these patients. The health personnel’s perception of intimate partner violence as a rare phenomenon that only relates to certain types of people can be considered a valid argument for universal screening of violence. The education of health personnel is imperative in order to implement screening policies and change the attitudes about patients experiencing intimate partner violence.