CONTENT WARNING: THIS STORY DISCUSSES FAMILY AND INTIMATE PARTNER VIOLENCE.
After moving to Australia from the United States, obstetric nurse Tatiana Zecher switched her focus to midwifery. Settling in Melbourne, she spent a few years on the floor at the Royal Women’s Hospital and has recently completed her Masters in General Practice with research.
‘My research was on the experiences of nurses and midwives caring for women who experienced miscarriages during the COVID pandemic lockdowns in Melbourne. I was drawn to the work because I was seeing a lot of my fellow nurses and midwives suffering vicarious trauma when caring for loss and grief and I wanted to be able to report back and have their struggles recognised.’
Recognising trauma and supporting those who’ve experienced it is part of the reason why Tatiana recently joined the Strengthening Hospital Responses to Family Violence (SHRFV) team. ‘Family violence is a health issue,’ she says. ‘It is a predominant determinant of health. We have people who come to us for so many other issues – from developmental to gastro-intestinal – but every part of it comes down to how safe they are at home, and whether or not they’re living their lives in fear. So addressing the violence is very much a health issue.’
‘We’re so good at the physical procedures, but it’s sometimes hard to see someone suffering in a way that isn’t physical.’
The SHRFV model provides evidence-based training and resources to help support clinicians to screen for and identify people who might be experiencing family violence. It is vital work: the healthcare sector is often a critical entry point to assistance for many victim survivors, if not the only pathway for some. But healthcare workers including nurses and midwives may not have appropriate training or experience to identify and support them.
‘We’re so good at the physical procedures, but it’s sometimes hard to see someone suffering in a way that isn’t physical,’ Tatiana notes. The training provided by the SHRFV team helps healthcare workers with the skills – ‘I hate the term soft skills’ – required when ‘healing isn’t necessarily a physical thing.’
The model was developed by the Women’s in collaboration with Bendigo Health and the state government in response to recommendation 95 of the Royal Commission into Family Violence, which called for a system-wide, whole-of-hospital approach when responding to family violence experienced by patients.
But it can also be used ‘to help our colleagues who might be experiencing family violence themselves,’ Tatiana adds. ‘The nursing and midwifery professions have a high percentage of very compassionate, beautiful people who unfortunately can find themselves in domestic violence situations.’
A voice for nurses
As a system-wide model, the SHRFV team includes clinicians from all fields, but Tatiana is one of the only nurses and midwives. ‘Part of why I joined the SHRFV team,’ she says, ‘was because if we’re doing training for clinicians, there needed to be a clinician on the team representing nurses and midwives. Someone to say: these are the things we’re going to struggle with; these are the things that are going to work for us; this is how we think; this is how we work; these are the struggles that we have. I wanted to be that voice in pre-training and creating curriculums.’
‘Everyone has a role to play. It’s not any one clinician’s responsibility to be screening for family violence; it is everyone’s responsibility.’
While being a voice for nurses and midwives, Tatiana’s work benefits all healthcare workers – and their patients and clients. ‘Ideally, I would like to be able to train everyone who has any interaction with our patients and women and their families,’ she says, ‘because everyone has a role to play. It’s not any one clinician’s responsibility to be screening for family violence; it is everyone’s responsibility.’
Among those already trained are SHRFV Clinical Champions, volunteers from disciplines across the Women’s who support and assist clinical staff to be able to access evidence-based information about family violence. They assist staff to recognise the signs of family violence, to sensitively inquire and respond to patients experiencing family violence, to enhance safety, and to provide appropriate support and referral options to both patients experiencing family violence, as well as staff working with them.
‘We have about 30 Clinical Champions at Royal Women’s who’ve gone through training and have a community of practice together. For anyone else on the floor who’s thinking “I’m seeing some signs of family violence but I’m not sure what to do with these pieces” the Clinical Champions are able to answer questions, get resources, direct to secondary consultations if needed etc.’
Trauma-informed care resources
Tatiana and the team are currently working on 5th edition of the SHRFV Toolkit, which includes specialist content and resources that are aligned to the Victorian government’s family violence Multi-Agency Risk Assessment and Management (MARAM) framework – another royal commission recommendation.
They offer training and resources on sensitive practice, information sharing, intersectionality, the role that gender stereotyping plays in violence, holistic approaches to family violence and more. ‘There’s a lot of very easily accessible pieces for anyone who is interested in expanding their knowledge to be more informed about family violence.’
The Women’s is also exploring a trauma-informed care model that, like SHRFV, will be a whole of hospital response, largely supported by the SHRFV Clinical Champions in their respective divisions. This model will operate on ‘the idea that it’s the norm, rather than the exception, that people have experienced traumatic events,’ Tatiana says. ‘It will help guide our interactions with each other when there is always a possibility that people have experienced some level of trauma, and help us to be compassionate and kind when we’re working through that.’
It’s also vital to be compassionate and kind to yourself, Tatiana notes. To look after her own wellbeing while engaging in this vital work, she engages in clinical supervision ‘where you can talk about these things with other people who know the situation’ and is diligent about distinguishing between work time and non-work time. ‘I think it’s also important to make friends outside of the medical field while also keeping friendships within the medical field: not only do nurses have the best sense of humour – and they can eat a meal in like five minutes! – but we’re beautiful, generous, kind, loving people in general: nurses make the best friends.’
16 days of activism
Every year in November and December there are 16 days of activism against gender-based violence running from 25 November, the International Day for the Elimination of Violence against Women, until Human Rights Day, 10 December.
In Victoria, the annual Walk Against Violence march on Friday 24 November marks the beginning of the 16 days of activism. Members are invited to join the ANMF and unions contingent for the walk. Wear your red t-shirt and meet us 10.45am at Parliament Gardens for the start of the march.