Commentary: ‘I never knew it was so prevalent’: Experiences and perceptions of student health visitors recognising and responding to domestic abuse in practice placement settings

This paper bravely highlights the significant challenges shared by student health visitors in asking about domestic abuse (DA) as part of the routine enquiry of health visiting practice. I say ‘bravely’ as the intrinsic feelings of what I would describe as ‘eekyness’, or discomfort in broaching the subject of DA, is not always openly discussed, let alone routinely explored in the health visiting profession. I can still remember the nerve-wracking feelings about this first foray as a health professional into routine enquiry and the awkwardness, embarrassment and discomfort I felt at having to ‘intrude’ into the private and personal life of my unsuspecting client, I felt unprepared and unskilled as a novice practitioner.

As a Student Health Visitor in 2000, this front and centre approach to identifying families at risk of the impact of DA, had just started to gain traction in the profession as part of routine health needs assessment (Wright et al., 1998) recognising that addressing DA was an essential element of healthcare provision (Sivarajasingam, 2021). I can still recall working in a middle-class area and needing to enquire about DA at a routine antenatal visit to a second-time mother. Although there has been documented reporting of the challenges some healthcare professional experience in making routine enquiry about Adverse Childhood Events, which would include DA (Pearce et al., 2019), there is here little about the feelings of student health visitors in broaching the issue with their clients.

Demonstrating the use of interpretive phenomenological analysis (IPA) to provide an idiographic focus this paper provides insight for understanding the complex, subjective experiences of student health visitors in recognising and responding to DA. Although the number of participants in the study is limited at only five (n = 5), the idiographic nature of IPA enables the detailed study of individual cases or events, rather than seeking to establish general laws or principles that apply to all cases. As such this paper provides a grounding for further larger-scale research in establishing and understanding how best to provide learning and teaching that is supportive to an individual’s unique knowledge and skills (Thornton, 2008).

Superordinate theme two highlights student health visitors’ challenges and confused appreciation of the male of the family unit as a potential victim of DA, and the participants’ perception of ‘normal’ practice was ‘generally we don’t ask dads. . ..’ (p. 12). Since the 20 plus years, since routine enquiry started as an essential element of health needs assessment, the contemporary notion of ‘family’ is normalised to include recognition of the lesbian, gay, bisexual and transgender/transsexual people (LGBT+).

As a practitioner, one of the most traumatic incidents of DA I was involved with was between a lesbian couple. An experience that required accessing sound and effective supervision to enable me to understand my professional actions and explore personal thoughts and feelings about the situation. In their systematic review of the literature, O’Neil et al. (2022) identified that clinical supervision is an important aspect of providing consistent and quality care and safe practice, and supervisors require specific training and interpersonal skills to be effective in their role.

This paper already highlights that using reflective practice in talking through experiences was beneficial to those in the study and further understanding and evaluation of the effectiveness of a range of learning experiences that instil the confidence to undertake routine enquiry of DA would be of benefit. Nonetheless reflection on its own may not be sufficient.

The identification of the ‘normalisation’ of DA as ‘part and parcel of health visiting practice’ as superordinate theme one suggests is worrying. Normalisation in practice is associated with significant risks, including:

Importantly this paper also highlights that the expert knowledge associated with health visiting is at risk as the numbers of qualified practitioners in the profession, again, decline. Carper’s (1978) ‘fundamental ways of knowing’, the empirical, personal, ethical and aesthetic that are a significant element of proficient health visiting practice, passed from qualified practitioner to student, to facilitate the challenging aspects of the profession such as routine enquiry into DA will be lost.