However, what about women presenting without obvious signs and symptoms of domesticviolence—such as a woman who comes to the clinic for assessment of an upper respiratory tract infection? Should such women be prompted to disclose whether they are being abused? The woman who is not being abused will answer to that effect, and the appointment can carry on. But for the woman who is experiencing violence, who has not volunteered this information, several factors must be considered. An important issue is whether she is ready—both psychologically and in terms of taking specifi c actions—to confront the issue. A number of excellent qualitative studies have examined the process that women undertake in acknowledging that they are “victims” of “abuse” and embarking on the often long and diffi cult journey to avoid, reduce, and ultimately stop the violence in their lives [16,17]. Given the enormousness of that task, the key question becomes the extent to which prompting disclosures of abuse through universal screening will actually help women in this process, and help them in a way that they fi nd meaningful.
Thus, more studies on the subject are neces- sary so that healthcare providers have a holistic and empathetic view. This view allows for under- standing experiences and problems lived, which may be present and appear veiled or not in the everyday healthcare routine. It is worth noting the limitations of the study because, although covering the experiences of women victims of domestic vio- lence, this is not an absolute reality for all of those who are living with violence. The unpredictability of the course of violence can bring other charges and conlicts, which should be considered and evaluated by healthcare professionals when assist- ing women victims and their families, in directing the actions to be implemented and support to overcome the situation and restructure the family.
Given this view of violence against women, the practices of these professionals in caring for victims take an essentially clinical focus, priori- tizing the treatment of physical injuries while overlooking or failing to sufficiently contem- plate the subjectivity and complexity of these situations. They do not always approach or are oriented to act with the individuals involved in these situations: the woman, the children, and much less the aggressor. Aggressors are rarely approached, and even then with a police view, taking a punitive approach to the case, showing that the healthprofessionals mainly associate domesticviolence with law enforcement in the belief that the police and courts should solve the issue. In short, in the view of the interviewees, intimate partner violence is only a matter for the social worker and psychologist, as well as the po- lice and courts. In fact, the study showed that the psychologists were more sensitized than their colleagues from other health specialties to take a more appropriate approach to women in situa- tions of intimate partner violence.
Therefore, it is possible to realize that ensuring care for people in situations of domesticviolence goes beyond the ield of health. This is because the experience of violence for social relations was also pointed out as a repercussion of the phenomenon, both for women and for children. For children and adolescents, schools, including the Programa Saúde na Escola (PSE - School Health Program), should be alert for signs that suggest family conlict such as: aggressiveness, introspection, poor school performance and drug use. In the case of women, it is fundamental that healthprofessionals seek to know their domestic contexts, because when they are in a situation of violence, they become more vulnerable to social isolation and annulment in the professional sphere. Such situations point to
Objective: to analyze the representations about domesticviolence against women, among healthprofessionals of Family Health Units. Method: qualitative study based on the Theory of Social Representations. Data were collected by means of evocations and interviews, treating them in the Ensemble de Programmes Pemettant L’Analyse des Evocations software - EVOC and content analysis. Results: nurses, physicians, nursing technicians and community health agents participated. The evocations were answered by 201 professionals and, of these, 64 were interviewed. The central core of this representation, comprised by the terms “aggression”, “physical-aggression”, “cowardice” and “lack of respect”, which have negative connotations and were cited by interviewees. In the contrast zone, comprised by the terms “abuse”, “abuse-power”, “pain”, “humiliation”, “impunity”, “suffering”, “sadness” and “violence”, two subgroups were identified. The first periphery contains the terms “fear”, evoked most often, followed by “revolt”, “low self-esteem” and “submission”, and in the second periphery “acceptance” and “professional support”. Conclusion: this is a structured representation since it contains conceptual, imagetic and attitudinal elements. The subgroups were comprised by professionals working in the rural area and by those who had completed their professional training course in or after 2004. These presented a representation of violence different from the representation of the general group, although all demonstrated a negative connotation of this phenomenon.
Why did you hit her? She must have “pissed” him too much, until he got to the point of hitting her. Are you thinking that women are all good persons, just got bit up? When it comes to getting bitten up, it is because the situation is already “ugly.” But, there are women who are difficult to deal with (I2FG5)! Now, there are women that I am going to tell you, she wants for the man to beating her to sleep well. I have seen many women like that. She goes “attacking” the man, doing wrong thing, implying and jumping over him. And you want the man to “stay” there, just as a saint? No man is going to be just as a saint (I7FG8).
Although this was not the focus of the study, it was an important inding since other studies could be developed from this perspective. Taken all together, this study enabled a more extensive view of domesticviolence which has been an issue of great importance in women’s health care, it also enabled knowledge and understanding of the working processes of medical and nursing professionals who are part of the Family Health Strategy and who still focus their practice in the biological aspects of it; and inally this study gave evidence of invisibility of violence in this vulnerable age group.
It is important to emphasize that in this work, we do not be- lieve that violence is a personality trait related to male or female sex, much less that genetic traits determine that men are more violent and women more fragile and submissive, as this would reinforce a very common stereotype, still used to justify the current situation of domesticviolence against women. Instead, what we want with this relection, that is to defend the violent streak will form with the construction of gender, which in turn is linked to the way of living and surviving in each society. As already mentioned, the violence is socially and historically constructed. Naturalizing it, therefore, is to deny that there are eicient ways of intervention. In the ield of public health, which is based on the theory of social determination of health-disease process, health and disease are two sides of the same coin. One does not deny the biological ballast that each individual brings, but every social group has the potential of detrition or consequential protection from the forms of production and social reproduction, in which he lives. So we chose to work within the line of reasoning of the concept of vulnerability.
The length of time from the abuse suffered to the com- plaint and later withdrawal is trespassed by the tension be- tween defending herself and exerting her autonomy and accepting the situation of violence and maintaining the fam- ily values. From the aggression perpetrated by the intimate partner until the complaint, the feelings of pain, shame and anger were predominant. Turning their aggressors in made them experience an unknown situation, where they did not know what to expect. Few abandoned the aggressor. Sev- eral women explain and justify the choice to go back to their partner: because of their children, the feelings towards their husband. But it was a choice. Maybe they are not aware that it was a legitimate choice: they are exerting their right. Maybe this perception can help them to develop in the sense of assuming their own life. Intentionality directed towards living. Therefore, they should assume their choices. We think that the essential meaning of their testimonies lies there: in the possibility of discovering their own au- tonomy, as something internal, regardless of external pres- sures. It is about making choices by themselves and for themselves. The for the other will only be authentic as a consequence of faithful choices for themselves.
Data was inserted and analyzed in the software Excel 2007, considering the simple frequency of each variable, and the stratification according to time of work and trai- ning in the service for variables regarding the attention. To analyze the knowledge and the conduct of the professio- nals, scores were elaborated, according to correct, incorrect, or do not know answers. Regarding the correct answers, the following was adopted: < 50% right answers - low kno- wledge; from 50% to 60% right answers - reasonable kno- wledge; 61% - 70% - good knowledge; 71% to 80% - very good knowledge; 81% to 90% - great; and >91% - excellent knowledge. Regarding the incorrect: < 50% wrong answers - low knowledge; from 50% to 60% - reasonable knowled- ge; 61% - 70% - little knowledge; 71% to 80% - very little knowledge; 81% to 90% - extremely little knowledge; and >91% - almost no knowledge. And concerning the do not know answers: < 50% - low knowledge; 50% to 60% - reaso- nable knowledge; 61% to 70% does not know - little know- ledge; 71% to 80% - very little knowledge; 81% to 90% - ex- tremely little knowledge; and >91% - almost no knowledge. The study respected the norms of the Resolution nº 466/2012 of the National Health Council, and was appro-
This method consists of decision rules that perform successive divisions throughout all of the data, in a way that makes it more and more homogenous with respect to a depen- dent variable. The decision tree utilizes a graph that begins with a root node, in which all of the observations from the sample are presented. The nodes produced in sequence rep- resent the subdivisions of the data in groups that become more and more homogeneous, denominated as children nodes. When there is no more possibility for division, the nodes are called terminal nodes or leaves. 15
Thus, the female figure needs to stand out, because only in this way, we know their real needs and will aim to create functional adjustments in an attempt to resolve such a situation. The woman with its relations of violence do not remain more hidden, invisible as they were for a long time, the media has cooperated for this, that is a good thing, because only by knowing the history of life, the scenery, the wishes and desires of those women who can think of effective aid and possible solutions. 13
Women who report having suffered domesticviolence show com- bined forms of physical aggressions – black stains, fractures, bur- nings, marks of strangling attempts, bruises provoked by sharp instruments etc – as well as psychological aggressions which have as sequels: fear, affective isolation, emotional dependence, fee- lings of guilt and depressive pictures.
These data indicate an urgent need of creation and/or enlarge- ment of psychiatric residence in the Center-Western region, where there is a lack of mental health services, in such a large and at the same time promising area for new colleagues, with the opening of new sources of job opportunities and without the saturation of professionals, a phenomenon which is already a reality at almost all big cities of the Southern and Southeastern regions.
professionals also revealed their responsibility in reproducing gender inequalities. In addition to recognizing cases, the pro- fessionals should be trained to work on issues of gender and the construction of autonomy, aiding in the prevention of new cases of violence, and in disseminating the results of their daily practice. The scarcity of studies from professionals in the ser- vice or in partnership with academia points to a needed change in this framework. The increase of scientific articles derived from partnership between academia and the public health care service, and the expansion of means of dissemination of pub- lications resulting from experiential reports and other modali- ties, can contribute to the unveiling of strategies, limitations and potential to reduce gender inequalities and violence against women. In this sense, it is also necessary to incorporate the category of gender by health care institutions, towards an ex- panded perspective of women’s health in situations of violence, constituting a privileged space for overcoming violence against girl children and adolescents and adult women.
The “community violence” variable was con- structed from five items selected from the origi- nal list of six. One of the six items was excluded, since the subject was asked whether she or he had been beaten or injured with a firearm or knife, but the perpetrator was not identified and thus could have been a family member, in which case the act would be classified as domestic rather than community violence. The score for exposure to community violence was structured, assigning 0 to items with negative answers and 1 for positive answers. The sum of the items comprised a score varying from zero exposure (absence of violence) to an exposure of 4 to 5 (maximum exposure to violence), with various intermediate degrees, namely: minimal (level 1), moderate (level 2), and high (level 3). The score’s composition in five degrees follows the model adopted in two North American studies 10,20 .
characterise violence: physical, psychological, sexual and neglect. The article 136 of this law specifies a penalty for exposing someone who is under his or her authority/responsibility to life or health hazard. Such obligation extends to custody or supervision for the purpose of education, treatment or custody, and may be defined by deprivation of food or indispensable care of the person, by subjecting the person to excessive or inadequate work, or by abusing the means of correction or discipline. The penalty consists of detention from two months to one year, or fine 15,16 .
In this study it was found that there was a high ra- te of errors in the questionnaire answered before the course: 45.2% in the 10h course and 41,6% in the 30h course , considering that most of the questions addres- sed the social aspects of violence, as well as the atti- tudes that should be taken in face of the victims. This leads to the conclusion that universities are forming professionals little sensitized to the issue, who prioriti- ze the legal aspects over the assistance aspects, which was noticed in this study. The majority of participants – 60% of the 10h course and 48% of the 30h course in the category Before - wrongly believed that the first assistance to sexual violence victims should be their referral to a police station to file a police report and subsequently have medical attention. There was signifi- cant improvement in this aspect, as in the 30h course in the category After (p=0.0009) all the students gave the correct answer for this question.