Behind closed doors: new guidance helps nurses spot and open conversations about domestic abuse

(L-R) Sonya McMullan, Women’s Aid Federation; Maureen Ritchie, DoH; Catherine Magennis, PHA; Health Minister Mike Nesbitt; Amanda Mairs, NHSCT; Justice Minister Naomi Long; Sonia Glendinning, DoH; Amber McCloughlin, PHA; Martina Moore, DoH.

New regional guidance designed to help nurses and midwives identify and respond to domestic abuse has been launched across Northern Ireland, aiming to strengthen early intervention and ensure victims receive the support they need sooner.

The Routine Enquiry into Domestic Abuse Guidance was jointly launched ahead of International Women’s Day on 8 March by Health Minister Mike Nesbitt and Justice Minister Naomi Long.

The guidance is intended to support midwives, health visitors, school nurses and family nurses in safely asking women about domestic abuse and responding appropriately where concerns arise.

Routine Enquiry (RE) involves asking all women about domestic abuse regardless of whether warning signs are present. The practice has been offered by healthcare practitioners during pregnancy and in the postnatal period since 2006, providing opportunities to identify women who may be experiencing domestic violence and abuse.

Those identified can then be offered supportive interventions such as information, safety planning and referrals to specialist support services.

Strengthening early identification

The new regional guidance follows a review led by the Public Health Agency (PHA), which examined how the Routine Enquiry process could be strengthened and applied more consistently.

The review included a service evaluation and engagement with survivors of domestic abuse, facilitated and supported by organisations including Women’s Aid, the Rowan Centre and the Department of Health.

Health Minister Mike Nesbitt said the guidance reflects a wider commitment by government departments to tackle domestic and sexual abuse more effectively.

“The Domestic and Sexual Abuse Strategy (DSA), jointly launched by my Department and the Department of Justice in 2024, provides a vision for Northern Ireland as a place where domestic and/or sexual abuse is not tolerated, and everyone can be safe and free from fear,” he said.

“A key deliverable is that domestic and/or sexual abuse is identified and responded to earlier. This guidance document aligns with that commitment as it aims to improve and standardise care provided to families who may be experiencing domestic abuse through early identification and intervention.

“The guidance was developed in consultation with key stakeholders across the five geographic Health & Social Care Trusts, reflects the findings of the PHA review and crucially, is informed by the recommendations of those with lived experience of domestic abuse.”

Supporting victims to come forward

Justice Minister Naomi Long said healthcare professionals often play a vital role as first responders who can help victims access safety and justice.

“I wholeheartedly welcome the publication of this guidance for nurses.

“The nature of domestic abuse requires a unique approach, as it is associated with fear and control, and I recognise the important role that nurses, midwives and other health and social care professionals, as first responders, can play in identifying abuse and supporting victims.

“Opportunities for victims to safely share information on what they are experiencing can open a door to help and to justice. This guidance will support the nursing profession by providing the information needed to help them respond appropriately and bring more victims into safety.

“We must all work to ensure that when anyone comes forward to report abuse they receive the right response; have access to guidance, protection and support; and are clear about their options.

“I am delighted that this guidance has been developed through collaboration including by listening to victims about their experiences.”

A consistent approach across Northern Ireland

The guidance sets out a consistent regional approach for healthcare professionals when asking about and responding to suspected domestic abuse.

Its key aims include reducing the impact of domestic abuse on those experiencing it, including children, through earlier identification and appropriate intervention. It also focuses on increasing the knowledge, skills and confidence of nurses and midwives to recognise and manage domestic abuse issues.

Emily Roberts, Interim Director of Nursing at the Public Health Agency, said domestic abuse continues to affect people in every community across Northern Ireland.

“Domestic abuse has a damaging and lasting impact on the lives of adults, children and young people right across Northern Ireland. It is prevalent in every community and can affect people of all ages, socioeconomic status, sexual orientation, gender identity, race or religion.

“This guidance will help equip organisations, midwives, health visitors and family nurses with the understanding, awareness and training to ask the right questions and respond appropriately to help address domestic abuse.”

When routine enquiry takes place

The guidance states that Routine Enquiry should be completed by midwives and health visitors at every core Healthy Child, Healthy Future contact where it is safe to do so.

This includes situations involving same-sex couples and foster carers.

School nurses are advised to carry out routine enquiry during targeted home visits and whenever the Family Health Assessment is updated, including during the Primary 1 health appraisal if a parent is present.

Family nurses should also complete the Family Nurse Partnership Intimate Partner Violence pathway with each of their clients.

To support implementation, awareness sessions for relevant staff will take place throughout March. Existing training programmes are also being revised and are scheduled to run between April and September 2026.

The guidance builds on a Department of Health directive introduced in 2006 requiring routine enquiry to be carried out for all pregnant women, including those who have experienced miscarriage or stillbirth.

At a glance

• New regional guidance has been published to help nurses and midwives identify and respond to domestic abuse across Northern Ireland.

• The guidance supports the Routine Enquiry process, where healthcare professionals ask women about domestic abuse even if there are no visible indicators.

• Routine enquiry has been offered during pregnancy and postnatal care since 2006 to help identify victims and offer support.

• The updated guidance follows a Public Health Agency review that included survivor engagement and collaboration with organisations such as Women’s Aid.

• Healthcare professionals including midwives, health visitors, school nurses and family nurses will apply the guidance during key health contacts with families.

• Awareness sessions for staff will run during March, with revised training programmes scheduled between April and September 2026.