Cervical screening and the aftermath of childhood sexual abuse: are clinical staff trained to recognise and manage the effect this has on their patients?

Trauma and cervical cancer screening among women experiencing homelessness: A call for trauma-informed care

OBJECTIVE

Women experiencing homelessness are at increased risk of cervical cancer and have disproportionately low Pap screening behaviors compared to the general population. Prevalence of Pap refusals and multiple kinds of trauma, specifically sexual trauma, are high among homeless women. This qualitative study explored how trauma affects Pap screening experiences, behaviors, and provider practices in the context of homelessness.

METHODS

We conducted 29 in-depth interviews with patients and providers from multiple sites of a Federally Qualified Health Center as part of a study on barriers and facilitators to cervical cancer screening among urban women experiencing homelessness. The Health Belief Model and trauma-informed frameworks guided the analysis.

RESULTS

Trauma histories were common among the 18 patients we interviewed. Many women also had strong physical and psychological reactions to screening, which influenced current behaviors and future intentions. Although most women had screened at least once in their lifetime, many patients experienced anticipated anxiety and retraumatization which pushed them to delay or refuse Paps. We recruited 11 providers who identified strategies they used to encourage screening, including emphasizing safety and shared decision-making before and during the exam, building strong patient-provider trust and communication, and individually tailoring education and counseling to patients' needs. We outlined suggestions and implications from these findings as trauma-informed cervical cancer screening.

CONCLUSION

Discomfort with Pap screening was common among women experiencing homelessness, especially those with histories of sexual trauma. Applying a trauma-informed approach to cervical cancer screening may help address complex barriers among women experiencing homelessness, with histories of sexual trauma, or others who avoid, delay, or refuse the exam.

Describing the healthcare experiences and strategies of women survivors of violence

AIM AND OBJECTIVE

The purpose of this study was to develop knowledge on women survivors' healthcare experiences and strategies.

BACKGROUND

Survivors of traumatic life events are at an increased risk for an array of negative health consequences, which can be complicated when distressing healthcare experiences act as a barrier to accessing needed care. Implications for trauma-informed and sensitive practice are well established, but evidence to date on survivors' healthcare experiences and patient engagement is limited.

DESIGN

This study utilized individual interviews and qualitative description methods.

METHODS

Fourteen participants completed a demographic questionnaire and one semistructured interview focused on their exposure to violence, healthcare experiences and strategies for navigating health care. Thematic analysis in alignment with qualitative description methods was used to analyse interview transcripts and identify themes.

RESULTS

Participants in this study reported a variety of traumatic life experiences, ranging from childhood sexual abuse and intimate partner violence to severe car accidents. Experiencing a multiplicity of trauma sometimes complicated participants' later healthcare experiences. Although participants described ways in which providers helped them attain positive care experiences, they also acknowledged that limitations of the healthcare system could make trauma-informed practices difficult to implement. Participants described strategies they use to prepare for, navigate and recover after healthcare encounters including selecting providers, bringing support persons to appointments and engaging in relaxing activities after appointments.

CONCLUSIONS

Participants emphasised the importance of trusting and equitable provider-patient relationships and described several ways they prepare for, cope with and care for themselves after difficult healthcare experiences. Descriptive data on the patient engagement behaviours of survivors of violence is a unique contribution of this study to existing research.

RELEVANCE TO CLINICAL PRACTICE

Findings from this study indicate the importance of comprehensive trauma history screening during health assessments, development of trusting and mutually respectful provider-patient relationships and provider training programmes focused on trauma-informed care practices.

Development of a practice framework for improving nurses' responses to intimate partner violence

AIMS AND OBJECTIVES

The aim of this article is to discuss critically the theoretical concepts of awareness, recognition and empowerment as manifested in intimate partner violence and to show how these can be translated into a practice framework for improving nurses' response.

BACKGROUND

Intimate partner violence is a universal problem and is considered a significant public health issue. Nurses are in an ideal position to recognise and respond to intimate partner violence, but many lack confidence in this area of practice. In our previous empirical work, we identified three concepts through which nurses' responses to intimate partner violence can be understood: awareness, recognition and empowerment. In this article, we advance nursing knowledge by showing how these concepts can form a practice framework to improve nurses' responses to intimate partner violence.

DESIGN

A discussion paper and development of a practice framework to improve nurses' responses to intimate partner violence.

DISCUSSION

The framework comprises three principal needs of women and three related key requirements for nurses to meet these needs. Arising from these are a range of practice outcomes: enhanced understanding of intimate partner violence, increased confidence in recognising intimate partner violence, establishment of trusting relationships, increased likelihood of disclosure and optimised safety.

CONCLUSIONS

Nurses sometimes lack confidence in recognising and responding to intimate partner violence. Awareness, recognition and empowerment are important concepts that can form the basis of a framework to support them. When nurses feel empowered to respond to intimate partner violence, they can work together with women to optimise their safety.

RELEVANCE TO CLINICAL PRACTICE

Access to adequate and timely intimate partner violence education and training is important in improving nurses' responses to intimate partner violence. Getting this right can lead to enhanced safety planning and better health outcomes for women who experience intimate partner violence. Although difficult to measure as an outcome, nurses' improved responses can contribute to higher rates of referral for help and reduction in intimate partner violence rates.