Maternal and Child Health nurse's preparedness to respond to women and children experiencing intimate partner violence: A cross sectional study

Women escaping domestic violence to achieve safe housing: an integrative review

BACKGROUND

This integrative review summarises original research that explores women's experiences of escaping domestic violence to achieve safe housing.

METHODS

Integrative review. A robust search strategy was conducted using the following databases: Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane, Medline and PubMed. All articles were assessed for quality using the Mixed Methods Appraisal Tools (MMAT) scoring. Whittemore and Knafl's (2005) five stage approach was used to analyse the primary literature related to women's and stakeholders' experiences of escaping domestic violence to achieve safe housing.

RESULTS

A total of 41 articles were retrieved and 12 papers were included in this review (six qualitative, one quantitative and five mixed methods) that fulfilled the inclusion criteria. Four overarching themes were identified: 'Experiences of leaving domestic violence', 'Barriers to achieving safe housing', 'Facilitators to achieving safe housing' and 'The road to recovery'. The 'Experiences of leaving domestic violence' theme included two subthemes: 'the losses' and 'ongoing contact with the perpetrator'. The 'Barriers to achieving safe housing' theme included three subthemes: 'financial insecurity', 'being judged by others for leaving and service availability'. The 'Facilitators to achieving safe housing' theme included two sub-themes: 'support, partnership, and collaboration between women and service providers' and 'feeling respected and heard'. The 'Road to recovery' theme included two sub-themes: 'being a good mother' and 'empowerment after leaving domestic violence'.

CONCLUSIONS

This review has highlighted the need for service and health care providers to work together and collaborate effectively with the woman experiencing and escaping domestic violence, especially in rural and remote areas. This means giving women access to the most suitable educational resources and services that are appropriate for their unique situation. Tailoring support for women is crucial to enable women to achieve safe housing and to be able to live a safe life with their children, away from the perpetrator of the domestic violence.

Nurses' preparedness, opinions, barriers, and facilitators in responding to intimate partner violence: A mixed-methods study

INTRODUCTION

Intimate partner violence (IPV) is associated with multiple adverse health consequences. Nurses (including midwives) are well positioned to identify patients subjected to IPV, and provide care, support, and referrals. However, studies about nursing response to IPV are limited especially in low- and middle-income countries (LMICs). The study aimed to examine nurses' perceived preparedness and opinions toward IPV and to identify barriers and facilitators in responding to IPV.

DESIGN

An explanatory sequential mixed-methods study was conducted by collecting quantitative data first and explaining the quantitative findings with qualitative data.

METHODS

The study was conducted in two tertiary general hospitals in northeastern (Shenyang city) and southwestern (Chengdu city) China with 1500 and 1800 beds, respectively. A total of 1071 survey respondents (1039 female [97.0%]) and 43 interview participants (34 female [79.1%]) were included in the study. An online survey was administered from September 3 to 23, 2020, using two validated scales from the Physician Readiness to Manage Intimate Partner Violence Survey. In-depth, semistructured interviews were conducted from September 15 to December 23, 2020, guided by the Consolidated Framework for Implementation Research.

RESULTS

The survey respondents largely agreed with feeling prepared to manage IPV, e.g., respond to discourses (544 [50.8%] of 1071) and report to police (704 [65.7%] of 1071). The findings of surveyed opinions (i.e., Response competencies; Routine practice; Actual activities; Professionals; Victims; Alcohol/drugs) were mixed and intertwined with social desirability bias. The quantitative and qualitative data were consistent, contradicted, and supplemented. Key qualitative findings were revealed that may explain the quantitative results, including lack of actual preparedness, absence of IPV-related education, training, or practice, and socially desirable responses (especially those pertaining to China's Anti-domestic Violence Law). Commonly reported barriers (e.g., patients' reluctance to disclose; time constraints) and facilitators (e.g., patients' strong need for help; female nurses' gender advantage), as well as previously unreported barriers (e.g., IPV may become a workplace taboo if there are healthcare professionals known as victims/perpetrators of IPV) and facilitators (e.g., nurses' responses can largely meet the first-line support requirements even without formal education or training on IPV) were identified.

CONCLUSIONS

Nurses may play a unique and important role in responding to IPV in LMICs where recognition is limited, education and training are absent, policies are lacking, and resources are scarce. Our findings support World Health Organization recommendations for selective screening.

CLINICAL RELEVANCE

The study highlights the great potential of nurses for IPV prevention and intervention especially in LMICs. The identified barriers and facilitators are important evidence for developing multifaceted interventions to address IPV in the health sector.

An Integrative Review of Response Rates in Nursing Research Utilizing Online Surveys

BACKGROUND

Online surveys in nursing research have both advantages and disadvantages. Reaching a sample and attaining an appropriate response rate is an ongoing challenge and necessitates careful consideration when designing a nursing research study using an online survey approach.

OBJECTIVE

In this study, we aimed to explore response rates and survey characteristics of studies by nurse researchers that used online methodologies to survey nurses, nursing students, and nursing faculty.

METHODS

We conducted an integrative review of research studies that used online surveys for data collection published from 2011 to 2021. We examined response rates and survey characteristics such as recruitment method, use of incentives, question type, length of survey, time to complete the survey, and use of reminders.

RESULTS

Our review included 51 studies published by nurses with target samples of nurses, nursing students, or nursing faculty. Study sample sizes ranged from 48 to 29,283, the number of respondents ranged from 29 to 3,607, and the response rates ranged from 3.4% to 98%, with an average of 42.46%. Few patterns emerged regarding recruitment or other factors to enhance response rates; only five studies used incentives.

CONCLUSION

Response rates to online surveys are unlikely to reach the rates seen in older mailed surveys. Researchers need to design online survey studies to be easily accessible, concise, and appealing to participants.

Engagement and Retention of Families in Universal Australian Nurse-Home-Visiting Services: A Mixed-Methods Study

Family support is offered to Australian parents of young children using a mix of targeted and universal child and family health services including nurse-home-visiting programmes. These rely on the voluntary engagement of families. In this study, the capacity to engage and retain families, including those at risk of becoming involved with child protection services, was examined. The broad objective was to identify nursing practices used at the interface of health and child protection services and to articulate those practices. Child and Family Health Nurses (CFHN) (n = 129) participated in a pragmatic, multilevel mixed-methods study. A questionnaire was used to identify nursing practices in the first phase of this study followed by focus groups in the second phase to describe these practices in more detail. Three practice themes were identified and described: enrolment, retention and conclusion of the nurse-family relationship. Universal child and family health services feature flexible, advanced, and multidimensional family support services including child protection practices. This paper focuses on practices employed by nurses to engage and retain families where child protection concerns are identified.

Implementing intimate partner violence (IPV) screening within emergency departments - Barriers, challenges and enablers experienced by intimate partner violence practice change champions

AIM

To identify the barriers, challenges, and enablers that clinical champions experience whilst implementing Intimate Partner Violence (IPV) screening within Emergency Departments (EDs).

BACKGROUND

Champions support the introduction of IPV screening within EDs. This paper shares new knowledge about IPV practice change champions: barriers, challenges and enablers they experienced in their efforts.

DESIGN

Between 2017-2019, semi structured qualitative interviews were conducted with 23 individuals who identified as champions, working to introduce routine IPV in two rural tertiary hospital Emergency Departments. An interpretive framework and process of constant comparison was used to thematically analyse data from transcribed interviews.

RESULTS

Champions identified barriers, challenges, and enablers that they experienced. Enablers included: support for the work of champions; champion leadership and collegiality; and training for the champion role. Challenges and Barriers included: resistance to a change in the focus of practice; and workflow and workload.

CONCLUSIONS AND IMPLICATIONS

Nurse champions can effectively support IPV practice change but face certain barriers, challenges and enablers. Nurse managers can use this information to support champions to undertake their role effectively in order to better meet the needs of individuals experiencing IPV.

Natural disasters and perinatal mental health: what are the impacts on perinatal women and the service system?

Aim

The perinatal period is characterised by radical change across multiple domains. When it coincides with natural disasters, women and families need targeted support to mitigate the impacts on their birthing and early parenting experiences. Disaster planning in Australia has paid scant attention to the needs of this group. This study aimed to explore rural maternal and child health nurses' perceptions of how women receiving postnatal care during times of disaster manage mental health and wellbeing issues.

Subject and methods

Eight female maternal and child health nurses (MCHNs) were recruited through purposive sampling across two rural regions of Victoria, Australia. A qualitative design using an online survey followed by in-depth interviews, was underpinned by intersectional feminist theory. Thematic analysis was applied to qualitative data.

Results

Three overarching themes: context of practice, impact of disasters on mothers, and impact of disasters on services were identified. Isolation for mothers was highlighted, necessitating increased provision of emotional support, at a time when service providers themselves were under strain.

Conclusion

Natural disasters exacerbate stressors on perinatal rural women and can impede their access to formal and informal supports, jeopardizing mental health outcomes. Targeted investment in rural perinatal services to enable proactive planning and implementation of disaster strategies is urgently needed to reduce the impact of natural disasters on rural perinatal women and their families.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01855-y.

Barriers and enablers to postpartum depression and anxiety screening: A qualitative study of Victorian maternal and child health nurses' practices

In Victoria, Australia, Maternal and Child Health nurses (MCHNs) play a key role in facilitating the timely identification of Postnatal Depression and Anxiety (PNDA). Understanding MCHNs' screening practices, and the factors which impact them, is central to ensuring that future screening policy agendas are evidence-based and able to support MCHNs in carrying out this critical work. Yet, little is known about this subject. The purpose of this study was to gain an in-depth understanding of MCHNs' screening practices, and the factors which impact them. Qualitative descriptive design with semi-structured interviews were used. Participants were MCHNs who had been practicing for a minimum of 6 months and regularly saw new mothers. Purposeful sampling was used to facilitate diversity across participant characteristics. Twelve MCHNs were interviewed between March and May 2021. Thematic analysis was conducted to identify patterns across our data. Qualitative content analysis was then used to identify issues which were most emphasised by MCHNs. Two themes were identified. Theme one, 'variations in screening practices', pertained to MCHNs' various screening practices (i.e., who, when, how) and the factors which influence them. Theme two, 'systemic barriers hinder equitable screening', pertained to factors which hindered equitable screening practices. Results indicate that systemic barriers contribute to inconsistent and inequitable screening practices, with women from culturally and linguistically diverse backgrounds less likely to be screened in line with best practice. Our findings emphasise an urgent need for MCHNs to be allocated with the resources required to screen all women equally, regardless of their cultural background.

Chinese nurses' preparedness and opinions in responding to intimate partner violence: An adaptation and validation study

AIM

To adapt and psychometrically test two scales from The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) for measuring nurses' preparedness to manage intimate partner violence (IPV) and opinions on IPV in China.

DESIGN

A cross-sectional study for cross-cultural adaptation and validation of instruments.

METHODS

The study was conducted in two tertiary hospitals in northeastern and southwestern China in 2020: (Step 1) translation and back-translation by four translators; (Step 2) expert consultation to assess content validity by a five-person panel; (Step 3) cognitive debriefing to evaluate the online survey with six nurses; (Step 4) pilot testing to finalize the survey with 79 nurses; and (Step 5) psychometric evaluation of construct validity and internal consistency reliability including post hoc analysis with 1071 nurses.

RESULTS

The Chinese scales of Perceived Preparation and Opinions demonstrated generally acceptable content validity, construct validity and internal consistency reliability; some factor analysis results were uninterpretable, and socially desirable responses existed. A post hoc inspection of item and score distributions assisted the item classification into Confident, Cautious and Concerned regarding the authenticity of nurses' responses.

CONCLUSION

Reliability and construct validity of the Chinese versions of Perceived Preparation and Opinions were supported in this sample. The instrument measures nurses' preparedness and opinions towards IPV. Item classification into Confident, Cautious and Concerned categories is a pragmatic way to interpret the results.

IMPACT

The Chinese scales can be used to measure nurses' preparedness and opinions towards IPV in China. The study also provides an approach for interpretation of results and identification of socially desirable responses in validation and survey studies in other contexts. The adaptation and use of the Chinese scales serve as a primary step in responding to IPV in China's health sector and can be used as a template for adapting the instrument in other low- and middle-income countries.

Measuring Nurses' and Physicians' Attitudes and Perceptions of the Appropriate Interventions towards Intimate Partner Violence in Saudi Arabia

Background: Intimate partner violence (IPV) is considered the most common form of violence against women worldwide, concerning public health, safety, and human rights. However, little to no studies in Saudi Arabia have explored the attitude and perception of health care providers working in emergency departments toward IPV. This study aimed to measure the attitude and perception of Emergency Room (ER) health care providers towards the appropriate intervention for IPV. Methods: This is a cross-sectional quantitative study. Data was collected from a convenient sample of nurses (n = 88) and physicians (n = 18) working in ER, using Readiness to Manage Intimate Partner Violence Survey (PREMIS). Data was collected from two hospitals in Riyadh, Saudi Arabia, and descriptive analysis was used to analyze the data. Results: The majority of the respondents were aged 18−40 (n = 106, 78%), while 22% were 41−60 years old, 69% were female, and 31% were male. Eighty-five percent were nurses and 15% were physicians. The majority of the respondents did not have any training on IPV and had gained knowledge or skills mostly during their medical/nursing classroom and clinical training. The analysis revealed that the participants had moderate levels of overall preparedness, knowledge about IPV, and perceived knowledge, with a mean score of 2.30, 18.62, and 2.18, respectively. The respondents had low scores in practice issues in new diagnosis (0.91), current screening (1.69), and actions when IPV is identified (0.91). The perceived preparedness and knowledge have a significant positive correlation, as shown by an r value of 0.8476 and a p-value of <0.05. Conclusion: The study shows that participants stated minimal previous IPV knowledge and training. It is necessary to put in place adequate resources and specific training programs to overcome this issue for both ER nurses and physicians.

Disparities in postnatal depression and anxiety screening: Results from a cross sectional survey of Maternal and Child health nurses in Victoria, Australia

OBJECTIVES

To describe Maternal and Child Health nurses' self-reported knowledge of, and attitude toward screening for postnatal depression and anxiety, and identify factors which impact screening in line with recommended guidelines.

METHODS

A population-based, cross-sectional study of all Maternal and Child Health nurses in Victoria, Australia. Data were collected in 2019 through an online survey designed to fit a Knowledge, Attitude and Practice framework. Descriptive analyses were conducted to describe participant characteristics, self-reported knowledge, attitude, and practices. Bivariate and multivariate regression analysis were performed to evaluate associations between screening practices and nurses' attitude toward screening and a range of sociodemographic variables.

RESULTS

Two hundred and eighteen Maternal and Child Health nurses participated in the study. Participants viewed screening as an important part of their role and screened all mothers at least once in the first 12 month postpartum. <35% routinely did so more than once in the first 12 months postpartum, and 31% were able to adhere to the recommended use of psychosocial assessments as part of their screening practice. After adjusting for confounding factors, nurses practicing in communities with greater socio-economic advantage were significantly more likely to conduct psychosocial assessments (aOR 3.93, 95% CI 1.47-10.49) and screen more than once (aOR 2.91, 95% CI 1.18-7.13), compared to nurses who worked in disadvantaged communities.

CONCLUSION

Place-based inequities in nurses' screening practices serve to widen the gap in health outcomes between advantaged and disadvantages mothers. Policy and practice strategies must consider the systematic challenges that contribute to this phenomenon and embed place-based strategies which address them.

A qualitative content analysis of nurses' perceptions about readiness to manage intimate partner violence

AIMS

To explore the perceptions of nurses on the factors that influence their readiness to manage intimate partner violence (IPV) in Spain.

DESIGN

Qualitative content analysis based on data from six different regions in Spain (Murcia, Region of Valencia, Castile and Leon, Cantabria, Catalonia, Aragon) collected between 2014 and 2016.

METHODS

37 personal interviews were carried out with nurses from 27 primary health care (PHC) centres and 10 hospitals. We followed the consolidated criteria for reporting qualitative research guidelines. Qualitative content analysis was supported by Atlas.ti and OpenCode.

RESULTS

The results are organised into four categories corresponding to (1) acknowledging IPV as a health issue. An ongoing process; (2) the Spanish healthcare system and PHC service: a favourable space to address IPV although with some limitations; (3) nurses as a key figure for IPV in coordinated care and (4) factors involved in nurses' autonomy in their response to IPV, with their respective subcategories.

CONCLUSION

In practice, nurses perceive responding to IPV as a personal choice, despite the institutional mandate to address IPV as a health issue. There is a need to increase continuous training and ensure IPV is included in the curriculum in university nursing undergraduate degrees, by disseminating the existing IPV protocols. Furthermore, coordination between healthcare professionals needs to be improved in terms of all levels of care and with other institutions.

Threads of Practice: Enhanced Maternal and Child Health Nurses Working With Women Experiencing Family Violence

Family violence is a serious public health issue with significant health consequences for women and children. Enhanced Maternal and Child Health nurses (EMCH) in Victoria, Australia, work with women experiencing family violence; however, scholarly examination of the clinical work of nurses has not occurred. This qualitative study explored how EMCH nurses work with women experiencing abuse, describing the personal and professional challenges for nurses undertaking family violence work. Twenty-five nurses participated in semi-structured interviews. Using interpretive description methodology has enabled an insight into nurses' family violence work. Threads of practice identified included (1) Validating/Reframing; (2) Non-judgmental support/Safeguarding and (3) Following/Leading. The nurses highlighted the diversity of experience for women experiencing abuse and nurses' roles in family violence nurse practice. The research contributes to understanding how EMCH nurses traverse threads of practice to support women experiencing family violence.

Managing maternal and child health nurses undertaking family violence work in Australia: A qualitative study

AIM

To explore the experience of nurse managers managing maternal and child health nurses undertaking family violence work in Victoria, Australia.

BACKGROUND

Health care practitioners' ability to address violence against women is strengthened by health service systems that include effective staff management and leadership. Maternal and child health nurses work with women experiencing abuse; however, their support by the health system and their managers has not been examined.

METHOD

Semi-structured interviews with 12 nurse managers in 2019-2020 explored how they supervised and managed nurses. The data were analysed using reflexive thematic analysis.

RESULTS

We identified three themes-(a) managing the service: being resourceful; (b) supporting nurses' emotional safety; and (c) hitting the ground running: the demands on the manager.

CONCLUSION

Inadequate support for nurse managers undermines workplace well-being and role satisfaction, impacting the safety and supervision of nurses doing family violence work.

IMPLICATIONS FOR NURSING MANAGEMENT

An integrated family violence systems approach must include improved training and support for nurse managers to enable reflective practice and ensure effective support for nurses working with women experiencing abuse.

Nurse-Family Partnership nurses' attitudes and confidence in identifying and responding to intimate partner violence: An explanatory sequential mixed methods evaluation

AIMS

To evaluate the effect of an intimate partner violence intervention education component on nurses' attitudes in addressing intimate partner violence; complementary aims included understanding nurses' perceptions of the education and how it influenced their attitudes and confidence to address intimate partner violence in practice.

DESIGN

An explanatory sequential mixed methods design embedded within a 15-site cluster randomized clinical trial that evaluated an intimate partner violence intervention within the Nurse-Family Partnership programme.

METHODS

Data were collected between February 2011 and September 2016. Quantitative assessment of nurses' attitudes about addressing intimate partner violence was completed by nurses in the intervention (n = 77) and control groups (n = 101) at baseline, 12 months and at study closure using the Public Health Nurses' Responses to Women Who Are Abused Scale. Qualitative data were collected from nurses in the intervention group at two timepoints (n = 14 focus groups) and focused on their perceptions of the education component. Data were analysed using content analysis.

RESULTS

Nurses in the intervention group reported large improvements in their thoughts, feelings and perceived behaviours related to addressing intimate partner violence; a strong effect of the education was found from baseline to 12 months and baseline to study closure timepoints. Nurses reported that the education component was acceptable and increased their confidence to address intimate partner violence.

CONCLUSION

Nurses reported improved attitudes about and confidence in addressing intimate partner violence after receiving the education component. However, these findings need to be considered together with trial results showing no main effects for clients, and a low level of intervention fidelity.

IMPACT

These evaluation findings underscore that improvement in nurses' self-reported educational outcomes about addressing intimate partner violence cannot be assumed to result in adherence to intervention implementation or improvement in client outcomes. These are important considerations for developing nurse education on intimate partner violence.

Factors Related to Gender Violence and Sex Education in Adolescents: A Cross-Sectional Study

Background: For school medical services and the staff responsible for sex education for adolescents, it is important to understand the factors that may influence gender violence. The aim of this study is to determine whether the presence of sexist attitudes, double standards and/or romantic myths contributes to the risk of gender violence. Methods: This cross-sectional study was carried out at five secondary schools in the province of Malaga (Spain). In total, 879 adolescents aged 12–18 years were included, studying years 1–4 of compulsory secondary education. Their attitudes were measured on the following scales: Ambivalent Sexism Inventory (ASI), Double Standard Scale (DSS) and Romantic Love Myths Scale (EMA). Results: Significant differences were observed among the age/year groups for the mean scores obtained on each of the above scales (DSS, p < 0.01; EMA, p < 0.01; ASI, p < 0.01). By gender, the boys recorded higher scores for ASI and lower ones for DSS (p < 0.01). The Spearman’s rho value revealed significant relationships between the presence of sexual double standards and that of romantic myths and ambivalent attitudes (p < 0.01). Conclusions: Adolescents commonly express romantic love myths, sexist attitudes and sexual double standards. These three factors, which are significantly correlated, influence the presence of violence in dating relationships.