Emergency Nurses’ Barriers to Intervention of Domestic Violence in Turkey: A Qualitative Study

Patient and Provider Emergency Care Experiences Related to Intimate Partner Violence: A Systematic Review of the Existing Evidence

Intimate partner violence (IPV) is a public health problem that has devastating physical, psychological, and economic consequences. The emergency department (ED) is an important point of contact for individuals experiencing IPV. However, there are few studies synthesizing interactions between patients experiencing IPV and providers. We aimed to summarize the existing evidence regarding (1) ED care experiences of patients with a history of IPV and (2) experiences of ED providers interacting with them. The secondary aim of this review was to evaluate high-quality care barriers and facilitators and to elucidate common causes of care avoidance. A literature search of peer-reviewed electronic databases was undertaken. Inclusion criteria consisted of studies detailing IPV-related patient or provider experiences surrounding ED visits. Articles published before 2000 or unavailable in English/French were excluded. A total of 772 studies were screened, yielding a final number of 41 studies. Negative patient experiences arose from individual-, institutional-, and system-level issues, commonly including adverse provider behavior. Negative provider experiences stemmed from individual-, institutional-, and system-level issues, such as a lack of knowledge and lack of infrastructure. Facilitators to positive patient experiences included interacting with empathetic providers, having privacy, and receiving timely specialized care. Facilitators to positive provider experiences included feeling well-equipped to manage IPV and having policies leading to appropriate care. Negative ED care experiences reveal inadequate care quality, ultimately leading to secondary victimization of individuals experiencing IPV. This review also uncovered important literature gaps regarding experiences of those who identify as equity-deserving.

The Effect of an Intimate Partner Violence Against Women Training Program Based on the Theory of Planned Behavior on the Approaches of Nurses and Midwives: A Randomized Controlled Study

The aim of this study was to analyze the effect of intimate partner violence against women training program based on the theory of planned behavior on nurses' and midwives' approaches of violence. A randomized controlled trial was performed at nurses and midwives in Turkey, between December 2016 and August 2017. The participants were separated into an intervention group (n = 50) and control group (n = 49). According to the result of study, training given to the intervention group was more effective in increasing the intimate partner violence attitudes, practices, and reporting compared to the control group. These results show that this training program effectively developed the nurses' and midwives' approaches about intimate partner violence against women.

Health practitioners' perceptions of structural barriers to the identification of intimate partner abuse: a qualitative meta-synthesis

BACKGROUND

Health care practitioners (HCPs) play a critical role in identifying and responding to intimate partner abuse (IPA). Despite this, studies consistently demonstrate a range of barriers that prevent HCPs from effectively identifying and responding to IPA. These barriers can occur at the individual level or at a broader systems or organisational level. In this article, we report the findings of a meta-synthesis of qualitative studies focused on HCPs' perceptions of the structural or organisational barriers to IPA identification.

METHODS

Seven databases were searched to identify English-language studies published between 2012 and 2020 that used qualitative methods to explore the perspectives of HCPs in relation to structural or organisational barriers to identifying IPA. Two reviewers independently screened the articles. Findings from the included studies were analysed using Thomas and Hardin's method of using a thematic synthesis and critiqued using the Critical Appraisal Skills Program tool for qualitative studies and the methodological component of the GRADE-CERQual.

RESULTS

Forty-three studies conducted in 22 countries informed the review. Eleven HCP settings were represented. Three themes were developed that described the structural barriers experienced by HCPs: The environment works against us (limited time with patients, lack of privacy); Trying to tackle the problem on my own (lack of management support and a health system that fails to provide adequate training, policies and response protocols and resources), Societal beliefs enable us to blame the victim (normalisation of IPA, only presents in certain types of women, women will lie or are not reliable).

CONCLUSION

This meta-synthesis highlights the need for structural change to address these barriers. These include changing health systems to enable more time and to improve privacy, training, policies, and referral protocols. On a broader level IPA in health systems is currently not seen as a priority in terms of global burden of disease, mortality and morbidity and community attitudes need to address blaming the victim.

Emergency department nurses experiences of female domestic violence presentations: A review of the qualitative literature

Domestic violence (DV) is a prominent social problem involving upwards of 30% of women and in most cases, it is often the emergency department (ED) that is the first point of call. This qualitative review aimed to explore and describe ED nurses experiences of DV presentations. A search of the qualitative literature was undertaken between 2000 and 2019. This review was performed using a three-stage process of thematic synthesis. For papers to be included each paper must have described a qualitative account of ED nurses' experiences of DV presentations. Ten papers met the inclusion criteria. Three themes emerged from the papers reviewed-feeling devastated in a world of helplessness and hopelessness; the anger of indifference; and grieving the pain and suffering. These included feelings of anger, rage, depression, guilt, helplessness, sadness, hopelessness, and cynicism. In conclusion, the emotional burden of care in supporting and protecting victims of DV can be immense for the nurses involved. This can lead to ED nurses distancing themselves from the patient as a means of emotional self-protection as well as increasing compassion fatigue as a result of secondary vicarious trauma.

Personal barriers to addressing intimate partner abuse: a qualitative meta-synthesis of healthcare practitioners' experiences

BACKGROUND

Healthcare practitioners (HCPs) play a crucial role in recognising, responding to, and supporting female patients experiencing intimate partner abuse (IPA). However, research consistently identifies barriers they perceive prevent them from doing this work effectively. These barriers can be system-based (e.g. lack of time or training) or personal/individual. This review of qualitative evidence aims to synthesise the personal barriers that impact HCPs' responses to IPA.

METHODS

Five databases were searched in March 2020. Studies needed to utilise qualitative methods for both data collection and analysis and be published between 2010 and 2020 in order to qualify for inclusion; however, we considered any type of healthcare setting in any country. Article screening, data extraction and methodological appraisal using a modified version of the Critical Appraisal Skills Program checklist for qualitative studies were undertaken by at least two independent reviewers. Data analysis drew on Thomas and Harden's thematic synthesis approach.

RESULTS

Twenty-nine studies conducted in 20 countries informed the final review. A variety of HCPs and settings were represented. Three themes were developed that describe the personal barriers experienced by HCPs: I can't interfere (which describes the belief that IPA is a "private matter" and HCPs' fears of causing harm by intervening); I don't have control (highlighting HCPs' frustration when women do not follow their advice); and I won't take responsibility (which illuminates beliefs that addressing IPA should be someone else's job).

CONCLUSION

This review highlights the need for training to address personal issues in addition to structural or organisational barriers. Education and training for HCPs needs to: encourage reflection on their own values to reinforce their commitment to addressing IPA; teach HCPs to relinquish the need to control outcomes so that they can adopt an advocacy approach; and support HCPs' trust in the critical role they can play in responding. Future research should explore effective ways to do this within the context of complex healthcare organisations.

The provision of emergency healthcare for women who experience intimate partner violence: part 1. An integrative review

This integrative review is the first of a two-part series about intimate partner violence (IPV). Part 2 will explore strategies to address barriers to the care of women who experience IPV in the emergency department (ED). IPV has become a major concern globally and specifically in Australia. Healthcare professionals in the ED are often the first point of contact for women experiencing IPV and therefore the provision of a comprehensive healthcare response to these vulnerable patients remains a priority. The review evaluated healthcare professionals' approaches to the care of women who present to the ED with injuries related to IPV. A systematic search of studies was undertaken using four databases. After the selection process, a total of 24 articles was identified. Six themes emerged: IPV care protocols, physical care provision, psychosocial care provision, provision of safety, role of referrals and barriers to appropriate care provision. There is a lack of evidence supporting healthcare approaches in the ED to address IPV. ED healthcare professionals experience numerous barriers that hinder their ability to provide patient-centred care, which suggests that patients presenting with IPV-related concerns may not be receiving adequate or appropriate healthcare in ED settings.

Assessing the psychometric properties of the Turkish version of attitudes and practice of health care providers regarding intimate partner violence survey scale

This study was planned to assess the psychometric properties of the Turkish version of the "attitudes and practices of health care providers regarding intimate partner violence" (APHCPs-IPV) survey scale. The sample consisted of 355 primary health care providers. A Likert-type scale composed of eight subfactors, and 43 items were used. Means and standard deviations were calculated for interval-level data. Ap value of less than .05 was considered statistically significant. The Turkish version consisted of eight factor groups. The Cronbach's alpha of the general scale was .66, and the Cronbach's alpha of the factor groups ranged from .29 to .81. It was determined that the APHCPs-IPV scale was a valid and reliable scale to be used in Turkish society, on the condition that item number 33 be removed.