DOMESTI C VI OLENCE: FROM THE VI SI BLE TO THE I NVI SI BLE
Mar t a Angélica I ossi Silv a1 Mar ia das Gr aças Car v alho Fer r iani2
Silva MAI , Ferriani MGC. Dom est ic violence: from t he visible t o t he invisible. Rev Lat ino- am Enferm agem 2007
m ar ço- abr il; 1 5 ( 2 ) : 2 7 5 - 8 1 .
This st udy aim ed t o ident ify and analy ze not ificat ions of dom est ic v iolence against childr en r egist er ed at t he Regional Healt h Services in Guarulhos, São Paulo, Brazil; t he lim it at ions im posed t o healt h professionals’ act ions and t he m eaning of dom est ic violence against children in t he healt h professionals’ rout ine. The not ificat ions r egist er ed bet w een 2001 and 2002 w er e char act er ized in or der t o bet t er under st and t his r ealit y and also t o support t he collect ed dat a t hrough t he qualit at ive approach. There is a predom inance of negligence cases 45% , while 26% of t he not ificat ions relat ed t o physical violence and 14% t o suspect ed sexual violence. Social workers r egist er ed t he highest num ber of not ificat ions, 46% . Based on t he social agent s’ discour se, w e ident ified t w o em pir ical cat egor ies: “ int er faces of t he v iolence” and “ fear ” .
DESCRI PTORS: healt h; dom est ic v iolence; child; m andat or y r epor t ing
VI OLENCI A DOMÉSTI CA: DE LO VI SI BLE A LO I NVI SI BLE
Est e est udio t uvo por finalidad ident ificar y analizar las not ificaciones realizadas en las sedes de salud del m unicipio de Guar ulhos, los lím it es en las acciones r ealizados por los pr ofesionales y el significado de la v iolencia dom est ica en su cot idiano de t r abaj o. Fue descr it o el escenar io de las not ificaciones r ealizadas en 2 0 0 1 y 2 0 0 2 con el obj et iv o de obt en er u n a m ej or com pr en sión de la r ealidad y apoy ar el diálogo con las infor m aciones r ecolect adas a t r av és de la inv est igación cualit at iv a. De los casos not ificados const at am os un pr edom in io de casos de n egligen cia en 4 5 % de las n ot ificacion es, así m ism o, 2 6 % fu er on n ot ificacion es de v i ol en ci a f ísi ca y 1 4 % d e l as n ot i f i caci on es f u er on sosp ech a d e v i ol en ci a sex u al . Qu i én m ás r eal i zó l as not ificaciones fue el asist ent e social, siendo r esponsable por 46% de las m ism as. A par t ir de las discusiones con los agent es sociales, ident ificam os dos cat egor ías em pír icas: “ int er fases de la v iolencia” y “ m iedo” .
DESCRI PTORES: salud; v iolencia dom ést ica; niño; not ificación obligat or ia
VI OLÊNCI A DOMÉSTI CA: DO VI SÍ VEL AO I NVI SÍ VEL
Est e est u do obj et iv ou iden t if icar e an alisar as n ot if icações de v iolên cia dom ést ica con t r a cr ian ças, r ealizad as j u n t o às Reg ion ais d e Saú d e Gu ar u lh os, os lim it es d a at u ação d os p r of ission ais d a saú d e e o significado da v iolência dom ést ica cont r a a cr iança no cot idiano do seu t r abalho. Car act er iza- se o cenár io das not ificações realizadas nos anos 2001 e 2002, no m unicípio, com o int uit o de m elhor com preender a realidade e subsidiar o diálogo com os dados colhidos at r av és da abor dagem qualit at iv a. Const at ou- se pr edom inância dos casos de negligência 45% das not ificações, 26% de violência física e 14% de suspeit a de violência sexual. Quem m ais not ificou for am os assist ent es sociais, sendo r esponsáveis por 46% das not ificações. Por m eio das falas dos at or es sociais, ident ificou- se duas cat egor ias em pír icas: “ int er faces da v iolência” e “ m edo” .
DESCRI TORES: saúde; v iolência dom ést ica; cr iança; not ificação de abuso
1
PhD Professor, e- m ail: m aiossi@eerp.usp.br; 2 Full Professor, e- m ail: caroline@eerp.usp.br. Universit y of São Paulo at Ribeirão Pret o College of Nursing WHO Collaborat ing Cent er for Nursing Research Developm ent
I NTRODUCTI ON
A
cr o ss h u m a n i t y, t a l k i n g a b o u t v i o l e n ce ag ain st ch ild r en h as b een a com p lex issu e, t o t h eex t en t t h at it im p oses ap p oin t in g alt er n at iv es an d
ex pect at ions t o fight against t he social v ulner abilit y
of childhood, bot h globally and locally. I t also im plies
ad d r essin g f am ily con f lict s, a ch or e t h at h ad b een
consider ed a place of pr ot ect ion against t he child.
Alt hough violence has exist ed since Ant iquit y,
i t i s o n l y f r o m t h e 1 9 6 0 ’ s o n w a r d s t h a t h e a l t h
r esear ch er s h av e w idely st u died an d d iscu ssed t h e
t hem e( 1 ).
Many problem s have t urned t he dim ensioning
of dom est ic v iolence against childr en in Br azil m or e
d i f f i cu l t , su ch a s t h e d i f f e r e n t d e f i n i t i o n s o f t h e
pr oblem , t h e r an ge of in f or m at ion sou r ces an d t h e
inex ist ence of nat ional populat ion inquir ies. How ever,
t he result s of som e nat ional st udies indicat e t hat int
ra-fam ily v iolence in Br azil is ex pr essiv e and should be
consider ed a pr ior it y on t he social policy agenda( 2).
Th i s s t u d y l o o k e d a t t h e v i o l e n c e
p h en om en on , esp ecially it s f or m s an d ex pr ession s,
considering it s com plexit y, polysem y and subj ect ivit y,
b e s i d e s a c k n o w l e d g i n g t h e m u l t i f a c e t e d a n d
m u lt id im en sion al n at u r e of t h is p r ob lem . Dif f er en t
t ypes of violence t end t o be expressed in com binat ion,
co n st i t u t i n g a n et w o r k i n w h i ch t h o se ex p r essi n g
conflict s in t he social syst em art iculat e at int erpersonal
lev els( 3 ).
Despit e t h e legal ch an ge br ou gh t abou t by
t he issuing of t he Child and Adolescent St at ut e ( CAS)
in 1990( 4) and t he acknowledgm ent of t his populat ion’s
social right s, t he problem of children and adolescent s
in social and personal risk sit uat ions was pot ent ialized
in ur ban cent er s and inside t heir hom es.
Am ong t he public policies for m anaging t his
pr oblem( 5- 7), t hose aim ed at r educing m or bidit y and
m or t alit y cau sed b y v iolen ce st an d ou t , as w ell as
t hose direct ed at guiding and im proving t he qualit y of
n o t i f i c a t i o n s , a t s t r u c t u r i n g a n a t i o n a l v i o l e n c e
p r e v e n t i o n a n d h e a l t h p r o m o t i o n n e t w o r k , a t
i m p l a n t i n g a n d i m p l em en t i n g v i o l en ce p r ev en t i o n
cen t er s in st at es an d cit ies an d at est ablish in g t h e
Epidem iological Surveillance Syst em for Accident s and
Violence ( SEVI V) , specifically in São Paulo St at e( 8).
I n t he cit y of Guar ulhos, in t he last decade,
im por t ant pr oj ect s, pr ogr am s and act ions hav e been
im p lan t ed an d im p lem en t ed in t h e sp ecif ic ar ea of
c h i l d a n d a d o l e s c e n t v i c t i m p r o t e c t i o n , w h i c h
em phasize not ificat ion and healt h care delivery t o t he
populat ion liv ing in v iolence sit uat ions, as w ell as a
m u n icipal com m it t ee f or dealin g w it h dom est ic an d
sexual violence against childr en and adolescent s( 9- 10).
Based on ou r p r of ession al ex p er ien ce an d
su p p o r t ed b y t h e o b j ect i v es o f t h i s r esea r ch , w e
at t em pt ed t o answ er quest ions lik e: What difficult ies
a n d f a ci l i t i e s h a v e h e a l t h p r o f e ssi o n a l s f a ce d t o
welcom e and deliver care t o child vict im s or suspect ed
vict im s of dom est ic violence? What are t he lim it s and
bar r ier s felt by healt h pr ofessionals t hat m ak e t hem
adopt at t it udes of m inim izat ion or om ission t ow ar ds
v iolen ce? Wh at sect or an d in t eg r at ed p olicies an d
a ct i o n s h a v e b e e n a d o p t e d w i t h r e sp e ct t o t h i s
p r ob lem ?
I n view of t hese considerat ions, t his research
aim ed t o ident ify and analyze not ificat ions of dom est ic
v iolen ce again st ch ildr en at t h e Gu ar u lh os Region al
H e a l t h D i v i s i o n s , t h e l i m i t s a n d g a p s i n h e a l t h
pr of ession als’ act ion s an d t h e m ean in g of dom est ic
v iolence against childr en in t heir daily w or k .
METHODS
We car r ied out a descr ipt ive and explor at or y
r e s e a r c h w i t h a q u a l i t a t i v e a p p r o a c h . Th i s
m et h odological alt er n at iv e h elped u s t o u n der st an d
t h e r ealit y ex pr essed by h ealt h pr of ession als abou t
t h e i r p e r s p e c t i v e o n d o m e s t i c v i o l e n c e a g a i n s t
ch ild r en .
Th e pr oj ect w as an aly zed an d appr ov ed by
t he Resear ch Et hics Com m it t ee of t he Ribeir ão Pr et o
Co l l e g e o f Nu r si n g – USP a n d b y t h e Gu a r u l h o s
Municipal Healt h Secret ary. Aft er t he research subj ect s
h a d g i v en t h ei r co n sen t b y si g n i n g t h e Fr ee a n d
I nfor m ed Consent Ter m , dat a w er e collect ed t hr ough
s e m i - s t r u c t u r e d i n t e r v i e w s a n d t h e a n a l y s i s o f
docu m en t s an d r ecor ds, bet w een Au gu st 2 0 0 3 an d
Apr il 2004.
I n order t o bet t er underst and t he st udy obj ect ,
enlar ge our aw ar eness of t he pr oblem and descr ibe
it s m agnit ude, t his r esear ch aim ed t o quant it at iv ely
i d e n t i f y t h e sce n a r i o o f n o t i f i ca t i o n s o f d o m e st i c
v iolen ce again st ch ildr en at t h e Gu ar u lh os Region al
Healt h Divisions in 2001 and 2002.
Therefore, we consult ed 35 not ificat ion form s
Em er g en cy Healt h Un it s sen t t o t h e f ou r Reg ion al
Healt h Div isions in Guar ulhos, w it h a v iew t o a fir st
cr it ical look on t he st udy pr oblem .
Based o n t h i s p r el i m i n ar y an al y si s o f t h e
not ificat ions, w e est ablished Regional Healt h Div ision
I I I as t h e st u dy ar ea an d r ealit y f or u n der st an din g
and invest igat ion, t hrough t he Fam ily Healt h Unit ( FHU)
Jd. Fort aleza and t he Basic Healt h Unit ( BHU) Carm ela,
which present ed relevant not ificat ion indices according
t o t he surveyed dat a. Next , we consult ed t he files of
t h e ch ildr en r elat ed t o t h e n ot if icat ion s at Region al
I I I , in order t o charact erize t he sit uat ions t hat indicat ed
t h e co n f i r m a t i o n a n d / o r su sp i ci o n t h a t d o m e st i c
v iolen ce h ad occu r r ed.
Th e r esea r ch su b j ect s w er e p r o f essi o n a l s
act ive in care delivery t o children who were pot ent ial
v ict im s of dom est ic v iolence and/ or t heir fam ilies in
t h eir daily w or k . We in t er v iew ed t w o psy ch ologist s,
t wo nurses, t wo com m unit y healt h agent s, t wo nursing
aids and t w o pediat r icians.
The int er v iew scr ipt consist ed of t hr ee open
gu idin g qu est ion s: Wh at is y ou r ex per ien ce in car e
d e l i v e r y t o c a s e s o f d o m e s t i c v i o l e n c e a g a i n s t
ch ild r en ? Wh at h av e y ou d on e ab ou t t h e p ossib le
cases? What is your opinion on t he work, t he resources
m ade available in t he cit y for care t o t hese children?
Ba se d o n t h e co l l e ct e d m a t e r i a l a n d t h e
t h eor et ical f r am ew or k , w e an aly zed dat a accor din g
t o M i n a y o ’ s( 1 1 ) p r o p o s a l , u s i n g t h e d i a l e c t i c
h er m en eu t ical m et h od , w h ich m ak es it p ossib le t o
confront different posit ions in dat a int erpret at ion and,
according t o t he aut hor, is “ t he m ost capable of giving
an approxim at e int erpret at ion of realit y. I t places t he
discour se in it s cont ex t in or der t o under st and it on
t he basis of it s int erior and in t he field of t he hist orical
and t ot alizing specificit y it is pr oduced in”.
The qualit at ive analysis of t he int erview s led
t o dat a or der ing and classificat ion by r egist r y unit s,
r e f e r e n c e d b y t h e m e s a n d r e f i n e d i n s y n t h e t i c
e x p r e s s i o n s , i . e . t h e e m p i r i c a l c a t e g o r i e s t h a t
ex pr essed r ealit y accor ding t o t he int er v iew ees.
RESULTS
Figur e 1 show s t hat t he highest not ificat ion
r at io of v iolence against childr en in 2 0 0 1 and 2 0 0 2
corresponds t o t he region of Regional Healt h Division
I I I , r esponsible for 40% of not ified cases.
0% 5% 10% 15% 20% 25%
Regional I Regional II Regional III Regional IV Physical V. Sexual V. Negligence PhV/SV/Neg. Suspected PhV Suspected SV
Fig u r e 1 - Dist r ib u t ion of n ot if icat ion s of d om est ic
v iolence against childr en and adolescent s r egist er ed
in Reg ion al Healt h Div ision s, accor d in g t o v iolen ce
t ype, Guar ulhos, SP, 2001 and 2002
As t o t he t ypes of violence t he vict im s w er e
su b m i t t ed t o , Fi g u r e 2 sh o w s a p r ed o m i n a n ce o f
n e g l i g e n c e c a s e s , c o r r e s p o n d i n g t o 4 5 % o f
n o t i f i c a t i o n s , 2 6 % p h y s i c a l v i o l e n c e a n d 1 4 %
su spect ed sex u al v iolen ce.
asd
26%
3%
45% 6%
6%
14%
Physical V. Sexual V. Negligence PhV/SV/Neg. Suspected PhV Suspected SV
Fig u r e 2 - Dist r ib u t ion of n ot if icat ion s of d om est ic
v iolence against childr en and adolescent s r egist er ed
in Reg ion al Healt h Div ision s, accor d in g t o v iolen ce t ype, Guar ulhos, SP, 2001 and 2002.
Figur e 3 show s t he dist r ibut ion accor ding t o t h e p r o f e s s i o n a l c a t e g o r y r e s p o n s i b l e f o r t h e
not ificat ion and r ev ealed t hat social assist ant s w er e
r esp o n si b l e f o r 4 6 % o f n o t i f i ca t i o n s, f o l l o w ed b y psychologist s ( 12% ) . Nurses were responsible for only
3% of not ificat ions. A significant par t ( 21% ) did not
inform t he professional cat egory t hat not ified t he case.
46%
6% 3% 12% 9% 3%
21%
Social Worker Physician Nurse Psychologist Nursing Aid Dental Aid Not informed
Figure 3 - Distribution of notifications of dom estic violence
against children and adolescent s regist ered in Regional
Health Divisions, according to professional category that
According t o Figure 4, 31% of t he cases were
only sent t o t he Tut elary Council, 28% t o t he Tut elary
Council and ot her social pr ogr am s at t he sam e t im e
and 23% for out pat ient t r eat m ent only.
31%
28% 3%
23%
6% 3%
6%
Tutelary Council Council and other resources
Home Visit Outpatient Treatment
Council and Juvenile Court Out. Treat and Juvenile Court
Not informed
Fig u r e 4 - Dist r ib u t ion of n ot if icat ion s of d om est ic
v iolence against childr en and adolescent s r egist er ed
in Regional Healt h Div isions, accor ding t o follow - up,
Guar ulhos, SP, 2001 and 2002
EMPI RI CAL CATEGORI ES
A f t e r o r g a n i z i n g t h e m a t e r i a l c o l l e c t e d
t h r o u g h t h e i n t er v i ew s, d i f f er en t r ead i n g s o f t h i s
m at erial and it s qualit at ive analysis, w e apprehended
t w o e m p i r i ca l ca t e g o r i e s f r o m t h e p r o f e ssi o n a l s’
st at em ent s: “ int er faces of v iolence” and “ fear ”.
I n t er faces of v iolen ce
Th i s c a t e g o r y e v i d e n c e d t h e a b s e n c e o f
p o l i t i ca l p o l i ci e s t o m a n a g e t h e p h e n o m e n o n o f
dom est ic v iolence against childr en and t he subj ect s’
difficult y t o ident ify and deliver care t o cases in t heir
daily act iv it y. The pr ofessionals also appoint ed ot her
aspect s relat ed t o t he problem ’s lack of visibilit y and
p r of ession als’ lack of p r ep ar at ion t o d eal w it h t h is
issu e. Th ey h igh ligh t t h e n eed t o in t egr at e act ion s
w it h differ ent ar eas and ser v ices.
Yes, a care net work, it would be very good if we could
work, or even have a space t o discuss if not all, at least t he m ain
cases in a m ore int egrat ed way. ( E8)
I would really like t he Secret ary t o im plem ent and creat e
a space inside t he care program , where we could be t rained and
advised t o work wit h t his problem , as well as t o allow for a m ore
official int egrat ion wit h ot her services and secret aries. ( E9)
Th e p er cep t i o n o f d o m est i c v i o l en ce as a
m u l t i f a c e t e d p h e n o m e n o n w i t h c o m p l e x m a c r o
-s t r u c t u r a l r o o t -s i -s -s i g n i f i c a n t l y p r e -s e n t i n t h e
st at em ent s, as follow s:
[ ...] I ’d say t hat t he violence I det ect is st rongly relat ed
t o living condit ions... ( E1)
I have several cases of alcoholic m ot hers who go out at
night and leave t heir children alone, I have several cases like
t hat . ( E8)
We k n ow ab ou t t h e im p or t an ce of n ot if y in g an d
r egist er ing t he cases w e r eceiv e, but som et im es it becom es
difficult t o define if it really is or not , as m any cases are social ...
So who are t he m ain vict im s? The children. ( E10)
An o t h e r q u e st i o n t h e su b j e ct s a p p o i n t i s
healt h professionals’ lack of educat ion and t raining t o
act on t his problem .
Many pr ofessionals ar e not pr epar ed t o assess and
perceive violence sit uat ions... I t hink it ’s t he professionals’ lack
of t raining and supervision, accom panim ent . ( E6)
I t hink it would have t o be dissem inat ed m ore am ong
professionals, what t o do and how t o do it , m any of t hem do not
know how t o act or do not feel support ed... ( E8)
Ju st lik e m e, m an y colleagu es f ace dif f icu lt ies t o
ident ify what violence is, and what ot her reference have we got
besides t he Council. ( E9)
Fear
Th is em p ir ical cat eg or y ev id en ced t h e f ear
t hat em er ges in social act or s’ im aginar y, daily r ealit y
and act ion t owards dom est ic violence cases. I t is one
o f t h e f a ct o r s d e t e r m i n i n g t h e su b j e ct s’ a ct i o n ,
influencing what t hey do or what t hey t hink t hey can
or cannot do.
Because I have cases like t hat . There were cases in
which t he fam ily t ells m e what happens, everybody knows, t hen
it goes t hrough an em ergency unit and nobody perceives or does
som et hing, t hey oft en do not perceive it out of fear” . ( E4)
I m yself, I had j ust put down t he phone and I got
scared. I said: oh dear what have I done? I got concerned, I
couldn’t sleep well. ( E5)
The pr ofessionals’ st at em ent s highlight t heir
fear of being chased by t he r elat iv es of t he not ified
v ict im s.
Because ot her people have done t his for m e, you see, it
didn’t have t o be people from here, because aft erwards we’re
badly consider ed by t he neighbor hood. Hav e y ou im agined,
denouncing a fam ily and being obliged t o go t here one m ont h
lat er! ( E5)
Yes... dist r ust ful, I found out t hat she had alr eady
been called and t hat , very angry, she said she would find out who
had filed t he com plaint ... I was happy t o see t hat t hey didn’t say
DI SCUSSI ON
Co n s i d e r i n g t h e d a t a r e g i s t e r e d a t t h e
Regional Healt h Divisions, cases of dom est ic violence ag ai n st ch i l d r en i n t h e ci t y o f Gu ar u l h o s ar e st i l l
significant ly under not ified. This has m ade it difficult t o est ablish new and int egr at ed policies and act ions,
as “ t he act of not ifying is a crucial elem ent in punct ual act ion against v iolence, in global polit ical act ion and
in t he under st anding of t he phenom enon”( 12). Un d er n ot if icat ion is f r eq u en t ly r elat ed w it h
h ealt h p r of ession als’ lack of k n ow led g e ab ou t t h e
i m p o r t a n c e o f a n d p r o c e d u r e s n e e d e d f o r t h e n ot if icat ion ; lack of adh er en ce t o n ot if icat ion ; t h eir
concer n w it h t he br each of infor m at ion secr ecy and, finally, t heir lack of percept ion about t he relevance of
t his t eam for public healt h( 13).
The st udy showed t hat t he region of Regional
Healt h Div ision I I I display ed t he highest not ificat ion i n d e x . Th i s a r e a c o r r e s p o n d s t o c o u n t l e s s
neighbor hoods w it h a high concent r at ion of pov er t y and m iserable sit uat ions, t errit orial invasion areas and
s l u m s , h e t e r o g e n e i t y, h i g h p o p u l a t i o n o v e r t u r n overpopulat ed houses, besides a lack of social capit al.
Th ese f act or s h av e b een m ain t ain in g t h e lev els of
econom ic, cult ural and social inequalit y in t he region. I n t h i s r eg i o n , 0 6 Ba si c Hea l t h Un i t s a r e
inst alled, wit h 12 Fam ily Healt h Team s, 03 Em ergency Car e Unit s and 01 Dent al Car e Cent r al.
Accor d in g t o d at a b y t h e Mu n icip al Healt h Secr et a r y( 1 4 ), b a sed o n d a t a f r o m t h e Ba si c Ca r e
I nform at ion Syst em ( SI AB) , t he est im at ed populat ion
of t his r egion is 2 8 7 , 9 0 2 inhabit ant s, cor r esponding t o 20.97% of t he cit y’s t ot al populat ion. Of t his group,
71,198 ( 24.73% ) are bet w een 0 and 09 years old. The Map of Social Exclusion and I nclusion of
Guar ulhos( 15) show s t hat differ ent neighbor hoods t hat a r e p a r t o f Re g i o n a l H e a l t h D i v i si o n I I I d i sp l a y
significant lev els of social ex clusion, unem ploy m ent , low qualit y of life and hum an dev elopm ent .
An o t h e r r e l e v a n t a sp e ct o b se r v e d i n t h e result analysis refers t o t he high percent age of not ified
cases of negligence and t he care healt h professionals
t ak e in t he ident ificat ion of negligence cases in t heir daily work. This ident ificat ion is com plex and dem ands
a crit ical look from professionals, so as t o dist inguish t he exist ence of int ent ionalit y in not at t ending t o t he
child’s needs, in t he privat ions and lacks deriving from pov er t y sit u at ion s.
I t was also observed t hat t he low not ificat ion
l e v e l s b y n u r se s se e m t o e v i d e n ce t h e n e e d f o r
great er involvem ent by t his cat egory, which is peculiar
not only due t o it s specific knowledge, but also due t o
it s capacit y t o act , list en and relat e, as an agent wit h
t he pow er t o act and t r ansfor m .
Mo r eov er, n u r si n g , co n si d er ed as a so ci al
pr act ice and com m it t ed t o em ancipat ion and hum an
d e v e l o p m e n t , c a n n o t b e p e r f o r m e d o u t s i d e t h e
per spect iv e of t h e com plex it y of t r an sf or m at ion s in
t he cont em por ar y social cont ex t , w hich includes t he
in t egr al an d m u lt idisciplin ar y appr oach of dom est ic
v iolence against childr en.
Despit e know ing t hat not ificat ion for m s have
t o be filled out correct ly, 21% of t he not ificat ions did
not infor m t he not ify ing pr ofessional cat egor y, w hich
co n f i r m s t h e f act t h at p r o f essi o n al s m i n i m i ze t h e
com plet ion an d im por t an ce of t h is for m . I n v iew of
t his aspect , anot her fact t hat should be addr essed is
t he possibilit y t hat not filling out t he funct ion and t he
consequent signat ure indicat e t hat m any professionals
ar e af r aid of legal an d r elat ion al pr oblem s der iv in g
fr om t he not ificat ion.
I n ou r st u dy, alt h ou gh t h e m ost sign if ican t
r e su l t s sh o w t h a t ca se s a r e se n t t o t h e Tu t el a r y
Co u n c i l s , a s d e t e r m i n e d b y t h e CA S , i t w a s
rem arkable t hat 23% of t he not ificat ions only result ed
in t he v ict im s’ out pat ient t r eat m ent , w it hout pr oper
n o t i f i c a t i o n t o t h e Tu t e l a r y Co u n c i l , d e s p i t e i t s
ob lig at or in ess.
Th e i n t e r v i e w e e s r e v e a l e d t h e s u b j e c t s ’
difficult y t o ident ify cases ex act ly and pr ofessionals’
lack of pr epar at ion t o deal w it h t h is issu e as gr eat
difficult ies in care delivery t o child vict im s of dom est ic
v iolen ce.
Th e st at em en t s dem on st r at ed t h e t ech n ical
d i f f i cu l t y o f t h e n o t i f i ca t i o n p r o ce ss. D e sp i t e t h e
o b l i g a t o r y n a t u r e o f n o t i f i c a t i o n s , p r o f e s s i o n a l s
ex p er i en ce d i f f i cu l t i es t o ad o p t t h em as st an d ar d
b eh av ior, a b eh av ior t h at is st ill load ed w it h m an y
uncer t aint ies and doubt s.
This difficult y m ay be relat ed t o t he fact t hat
t he quest ion of dom est ic violence against children has
not been t r eat ed in a syst em at ic and int egr at ed w ay
in p r of ession al t r ain in g , t h at is, in u n d er g r ad u at e
curricula, and is absent from t he perm anent educat ion
p r o g r a m s h e a l t h s e r v i c e s o f f e r. H e n c e , m a n y
pr ofession als do n ot h av e basic in for m at ion n eeded
t o diagnose v iolence ex act ly( 12).
I n t h e i r s t a t e m e n t s , t h e p r o f e s s i o n a l s
d e m o n s t r a t e d t h a t t h e y c l e a r l y p e r c e i v e t h e
for care delivery t o child vict im s of dom est ic violence.
This ar t iculat ion is necessar y t o r eor der m or e v isible
and sust ainable public policies.
I n t h is sen se, pu blic h ealt h “ n eeds t o t u r n
t ow ar ds t he dev elopm ent of j oint act ions w it h ot her
s e c t o r s , n o t r e m a i n i n g l i m i t e d t o t h e s p a c e s i t
t r adit ionally occupies”( 16).
A s t o d e t e r m i n a n t f a c t o r s o f d o m e s t i c
v iolence against childr en, it w as per ceiv ed fr om t he
p r of ession als’ d iscou r se t h at t h ey ar t icu lat e t h ese
f act or s w it h t h e st r u ct u r al an d social v iolen ce t h e
ch ildr en , t h eir f am ilies an d t h e societ y t h ey liv e in
ar e ex posed t o.
Th e st at em en t s an d t h eor et ical p r od u ct ion
pr esent ed her e m ak e us r eflect on t he v iolence t hat
occurs in t he st ruct ural sphere, which ends up out lining
violence in t he privat e space of fam ilies. The violence
pat t ern m any fam ilies im pose on t heir children cannot
b e seen i so l a t ed l y f r o m b r o a d er i ssu es o f p o w er,
frust rat ion, reduced social right s and privat ion caused
b y u n e m p l o y m e n t , s o c i a l i n j u s t i c e , i n e f f i c i e n t
econom ic policies and t he absence of t he St at e fr om
play in g it s r ole as a cr eat or an d m an ager of social
p olicies.
The econom ic aspect is not t he only point t o
be t ak en int o account in t he hist or ical det er m inat ion
of v iolence. Educat ional, cult ur al, social and polit ical
f a ct o r s n e e d t o b e co n si d e r e d , w h i ch i n t e r r e l a t e
dialect ically in t he disput e for power, for t he possession
of t he ot her, for aut horit y.
Children’s and adolescent s’ qualit y of life will
becom e real when t he fight against violence bet ween
social classes ( st r uct ural violence, of w hich childhood
m ar k ed b y p ov er t y, p r ost it u t ion an d ex p lorat ion at
w or k ar e som e fr uit s) and t he fight against v iolence
inside social classes ( of which childhood vict im ized at
h o m e i s o n e c o n s e q u e n c e ) a r e f o u g h t
sim ult aneously( 1 7 ).
Wit h respect t o t he em pirical cat egory “ fear ”,
it w as obser v ed t hat , w hen ex pr essing t he sit uat ion
of fear, t he pr ofessionals em phasize it as som et hing
r eal, der iv ing fr om t hr eat ening ex per iences t hey liv e
w it h in t h eir d aily lif e, f eelin g t h r eat en ed in t h eir
physical int egrit y and in t he perform ance of t heir work,
charact erizing one of t he resist ances against realizing
t h e n o t i f i cat i o n , b ecau se t h ey f eel ch ased b y t h e
r elat ives of t he not ified vict im s( 12).
I n o r d er t o u n d er st an d t h e d y n am i cs an d
m anifest at ion of t he fear t he subj ect s report , it needs
t o be appr ehended as a com plex social phenom enon
t hat involves t he relat ions am ong social, cult ural and
p ol i t i cal f or ces i n soci et y. Th er ef or e, i t can n ot b e
st udied out side t he societ y t hat produces it , as it feeds
on social fact s, such as ur ban v iolence for ex am ple,
a s w e l l a s i m a g i n a r y a n d cu l t u r a l f a ct s t h a t a r e
t r anslat ed in daily r elat ions( 18).
FI NAL CONSI DERATI ONS
Th r ou gh t h is r esear ch , it can be r eaffir m ed
t hat dom est ic violence against children and it s nuances
im pose t hem selv es as an ex er cise t o under st and t he
current dynam ics of t he fam ily and societ y. The t hem e
is com plex and, given it s com plexit y, knowledge about
it is st ill under const ruct ion.
I n order t o im pede t he ( re) product ion of t he
int r a- fam ily v iolence cy cle, sociopolit ical init iat iv es in
t he ar ea should at t em pt t o answ er t he challenges of
w it hdr aw ing dom est ic v iolence against childr en fr om
secrecy; get a bet t er underst anding of t he product ion
p r o c e s s o f t h i s p h e n o m e n o n , t r a i n c o m p e t e n t
pr ofessionals w ho ar e socially com m it t ed t o fight ing
t his v iolence m ode.
How ever, it is em phasized t hat t his v isibilit y
p r ocess d oes n ot occu r h om og en eou sly. Th er e ar e
adv an ces an d back lash es, su ccesses an d obst acles,
r equ ir in g per sev er an ce an d com m it m en t .
Get t ing t o k now t he m eaning and int er faces
of d om est ic v iolen ce ag ain st ch ild r en accor d in g t o
h ealt h pr ofession als allow ed u s t o v er ify t h at t h ese
professionals lack educat ion and support and t hat t he
w or k pr ocess needs t o be r econsider ed w it h a v iew
t o a bet t er art iculat ion of t he social policies t hat need
t o be est ablished am ong differ ent ar eas.
This st udy is considered a cont ribut ion t o t he
h e a l t h a n d n u r s i n g a r e a , t h r o u g h a d e e p e r
underst anding of t he st udy obj ect , indicat ing t hat t he
nurses’ role, as elem ent s in t he healt h t eam , im plies
a m or e act iv e at t it u de, appr opr iat in g t h em selv es of
new k now ledge and pr act ices.
I n con clu sion , w e h op e t h at t h e p r esen t ed
r e s u l t s i n s t r u m e n t a l i z e t r a n s f o r m a t i o n s i n c a r e
pract ice and st im ulat e furt her research, as t his st udy
d o e s n o t cl o se o f f t h e u n d e r st a n d i n g a b o u t t h e
m eaning of dom est ic v iolence against childr en.
S t u d i e s a i m e d a t a s s e s s i n g i n f o r m a t i o n
syst em s t o accom pany t he m agnit ude of t he problem ,
t h a t a t t e m p t t o i m p r o v e a t h e o r e t i c a l - a n a l y t i c
u n d e r s t a n d i n g o f t h e s p e c i f i c n a t u r e o f t h i s
ph en om en on t oday, t h e v u ln erabilit y an d pr ot ect ion
fact or s w hich differ ent cult ur es and societ ies hav e in
com m on, or t he ext ent t o which t he t hem e is insert ed
int o t he school cur r icula at differ ent t r aining lev els,
can lead t ow ar d s n ew k n ow led g e an d cou r ses t h at
m ake it possible t o prom ot e t he right s, prot ect ion and
cit izenship of t his populat ion.
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