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Wemrell M, Tegel E, Öberg J, Ivert AK. Assessing the use of clinical guidelines against domestic violence in southern Sweden: A mixed-methods study. Scand J Caring Sci 2023; 37:828-841. [PMID: 37002636 DOI: 10.1111/scs.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/09/2023] [Accepted: 03/18/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND AND AIM Domestic violence is a prevalent public health issue. While clinical guidelines and care programs for its identification and handling have been formulated in all administrative regions of Sweden, their degree of implementation is largely unknown. This study aims to assess the implementation of one administrative region's care program, including how it is seen to align with and function in clinical practice, and any perceived barriers to or facilitators of its use. METHODS A survey was distributed to first-line managers for healthcare units with patient contact in the region (n = 807). The responses were analysed using descriptive statistics. Open responses were analysed thematically. Group interviews (n = 5) were held with caregivers (n = 15) working primarily with young patients and analysed thematically. RESULTS 73% of the survey respondents reported previous awareness of the care program, and 27% reported knowledge of its content. The extent to which their staff knew about and followed the care program was assessed to be relatively low. The survey response rate was 19%. Among interview participants, knowledge of the care program was generally quite low. Survey responses and interview discussions pointed to the importance of developing routines, of collegial and managerial support and of training on domestic violence and the care program. CONCLUSION This study indicates that the knowledge and use of the regional care program is limited among healthcare staff, including among those working with young patients. This underscores the importance of information and training for furthering the implementation of clinical guidelines on domestic violence.
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Affiliation(s)
- Maria Wemrell
- Department of Gender Studies, Faculty of Social Sciences, Lund University, Lund, Sweden
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Emma Tegel
- Department of Criminology, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Johan Öberg
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Health and Medical Care Management, Region Skåne, Malmö, Sweden
| | - Anna-Karin Ivert
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Criminology, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Stensvehagen MT, Bronken BA, Lien L, Larsson G. Association of daily hassles, daily uplifts, coping styles and stress-related symptoms among women exposed to sexual abuse-A cross-sectional study. Scand J Caring Sci 2023; 37:117-130. [PMID: 35851719 DOI: 10.1111/scs.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 05/04/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women who experience physical or sexual violence report poor self-perceived health. Knowledge of daily hassles, daily uplifts and coping styles, as well as how these factors can affect health and well-being among survivors of sexual abuse, is important for healthcare professionals to understand and target their needs. AIM The aim of the current study was to explore the association of daily hassles, daily uplifts, coping strategies and stress-related symptoms among female survivors of sexual abuse. METHODS A group of women (n = 57), exposed to sexual abuse, were recruited from nine support centres in Norway. Participants completed a questionnaire that addressed demographics, socioeconomic conditions, trauma history, daily hassles, daily uplifts, coping styles and stress-related symptoms. Two groups of participants were compared: one group that had above-median scores on uplifts and adaptive coping styles and one group that had above-median scores on daily hassles and maladaptive coping styles. RESULTS Results indicate that women who experienced more daily hassles and used maladaptive coping styles reported significantly more stress-related symptoms, and particularly emotional symptoms, than women who experienced more daily uplifts and used adaptive coping styles. There were few differences between the two groups related to socioeconomic conditions and trauma history. CONCLUSION The results indicate that women in both groups struggle with stress-related physical, emotional, cognitive and target group-specific symptoms. However, high incidence of daily hassles and the use of maladaptive coping styles were associated with an increase in stress-related symptoms. Novell's findings indicate that despite severe traumatic experiences, adaptive coping styles and favourable perceptions of stress in everyday life were associated with a lower frequency of stress-related symptoms. It may therefore be helpful to focus on altering maladaptive coping styles to reduce stress-related symptoms among sexual abuse survivors.
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Affiliation(s)
| | | | - Lars Lien
- Inland Norway University of Applied Sciences, Elverum, Norway.,University of Oslo, Oslo, Norway.,Innlandet Hospital Trust, Brumunddal, Norway
| | - Gerry Larsson
- Inland Norway University of Applied Sciences, Elverum, Norway.,Swedish Defence University, Karlstad, Sweden
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Tarzia L, Bohren MA, Cameron J, Garcia-Moreno C, O'Doherty L, Fiolet R, Hooker L, Wellington M, Parker R, Koziol-McLain J, Feder G, Hegarty K. Women's experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis. BMJ Open 2020; 10:e041339. [PMID: 33247027 PMCID: PMC7703445 DOI: 10.1136/bmjopen-2020-041339] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/16/2020] [Accepted: 11/18/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP). METHODS The databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women's experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis. RESULTS Thirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women's experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women. CONCLUSIONS Our findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored.
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Affiliation(s)
- Laura Tarzia
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Meghan A Bohren
- Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqui Cameron
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lorna O'Doherty
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Research in Psychology, Behaviour and Achievement, Coventry University, Coventry, UK
| | - Renee Fiolet
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leesa Hooker
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Molly Wellington
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rhian Parker
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Koziol-McLain
- Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Auckland, New Zealand
| | - Gene Feder
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Family Violence Prevention, The Royal Women's Hospital, Parkville, Victoria, Australia
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Read J, Harper D, Tucker I, Kennedy A. How do mental health services respond when child abuse or neglect become known? A literature review. Int J Ment Health Nurs 2018; 27:1606-1617. [PMID: 29873169 DOI: 10.1111/inm.12498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
Child abuse and neglect are strongly associated with many subsequent mental health problems. This review summarizes the research on how adult mental health services respond when child abuse or neglect become known. MEDLINE, PsycINFO, and Scopus were searched for studies with rates of responding in various ways to child abuse and neglect by mental health professionals. Thirteen studies were identified: seven case note reviews, three surveys of staff, and three sets of interviews with service users. Rates of inclusion of abuse or neglect in treatment plans ranged from 12% to 44%. Rates of referral to abuse-related therapy ranged from 8% to 23%. Rates were lower for neglect than for abuse and were also lower for men and people with a diagnosis of psychosis. Two per cent or less of all cases were referred to legal authorities. The studies varied in focus and methodology, but all indicated inadequate clinical practice. The rates of abused or neglected people referred for therapy are actually lower than indicated by this review because most users of adult mental health services are not asked about abuse or neglect in the first place. The barriers to good practice, and the need for trauma-informed services, are discussed.
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Affiliation(s)
- John Read
- School of Psychology, University of East London, London, UK
| | - David Harper
- School of Psychology, University of East London, London, UK
| | - Ian Tucker
- School of Psychology, University of East London, London, UK
| | - Angela Kennedy
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
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Bradbury-Jones C, Clark M, Taylor J. Abused women's experiences of a primary care identification and referral intervention: a case study analysis. J Adv Nurs 2017; 73:3189-3199. [PMID: 28072474 DOI: 10.1111/jan.13250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
AIMS The aim of this study was to report the findings of a qualitative case study that investigated abused women's experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care. BACKGROUND Domestic violence and abuse is a significant public health issue globally but it is a hidden problem that is under-reported. In the UK, Identification and Referral to Improve Safety is a primary care-based intervention that has been found to increase referral rates of abused women to support and safety services. This paper reports on the findings of an evaluation study of two sites in England. DESIGN Qualitative study with a case study design. METHODS In line with case study design, the entire evaluation study employed multiple data collection methods. We report on the qualitative interviews with women referred through the programme. The aim was to elicit their experiences of the three aspects of the intervention: identification; referral; safety. Data collection took place March 2016. FINDINGS Ten women took part. Eight had exited the abusive relationship but two remained with the partner who had perpetrated the abuse. Women were overwhelmingly positive about the programme and irrespective of whether they had remained or exited the relationship all reported perceptions of increased safety and improved health. CONCLUSION Nurses have an important role to play in identifying domestic violence and abuse and in referral and safety planning. As part of a portfolio of domestic violence and abuse interventions, those that empower women to take control of their safety (such as Identification and Referral to Improve Safety) are important.
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Affiliation(s)
- Caroline Bradbury-Jones
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Maria Clark
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Julie Taylor
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK.,Birmingham Children's Hospital NHS Foundation Trust, Birmingham, B4 6NH, UK
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Örmon K, Hörberg U. Abused women's vulnerability in daily life and in contact with psychiatric care: In the light of a caring science perspective. J Clin Nurs 2016; 26:2384-2391. [PMID: 27349375 DOI: 10.1111/jocn.13306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2016] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study is to deepen the understanding of abused women's vulnerability in relation to how the abuse and encounters with health care professionals affect life. A further aim is to highlight abused women's vulnerability with a caring science perspective. BACKGROUND Experience of abuse has consequences for the mental health of women and girls. Abused women may experience health care as unsupportive, and as a result, often chose not to disclose their experiences of abuse. DESIGN AND METHODS The results of two qualitative empirical studies were analysed along with a phenomenological meaning analysis in accordance with the methodological principles of Reflective Lifeworld Research. FINDINGS Living one's life with experiences of abuse implies vulnerability, which can prevent abused women from achieving good health. This vulnerability results from insecurity regarding identity, along with the sense that one could have been a different individual if it were not for the abuse and thereby have a more fair chance in life. Being cared for within general psychiatric care could further increase this vulnerability. The healthcare professional's ability to care for the women who have experienced abuse leads to either an encounter of trust or else further suffering for the women. CONCLUSION A lifeworld-oriented caring science perspective as a foundation for care can contribute to care for abused women which reaches the existential dimensions of their vulnerability and vulnerable life situation. RELEVANCE TO CLINICAL PRACTICE It is evident that healthcare professionals should deepen their understanding of how abused women live, within a general psychiatric context. This study enables a deeper understanding of abused women's vulnerability in relation to how the abuse and encounters with healthcare professionals affect life.
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Affiliation(s)
- Karin Örmon
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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Bradbury-Jones C, Clark MT, Parry J, Taylor J. Development of a practice framework for improving nurses' responses to intimate partner violence. J Clin Nurs 2016; 26:2495-2502. [PMID: 27302748 DOI: 10.1111/jocn.13276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2016] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
| | - Maria T Clark
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Julie Taylor
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.,Edgbaston and Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
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Örmon K, Sunnqvist C, Bahtsevani C, Levander MT. Disclosure of abuse among female patients within general psychiatric care - a cross sectional study. BMC Psychiatry 2016; 16:79. [PMID: 27009054 PMCID: PMC4806428 DOI: 10.1186/s12888-016-0789-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/18/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Experiences of abuse are common among women in general psychiatric care. Even so, there are to our knowledge no previous national or international studies exploring disclosure in a general psychiatric setting of female patient's experiences of abuse to staff or to formal and informal networks. This study aimed to explore women's disclosure of experiencing physical, emotional and/or sexual abuse during their most recent contact with staff at a general psychiatric clinic. The study also aimed to determine whether the women have previously disclosed abuse to anyone. METHODS A consecutive sampling of eligible female patients at a general psychiatric clinic in an urban area of southern Sweden answered the NorVold Abuse Questionnaire, NorAQ, a self-administrated questionnaire. NorAQ has previously been used and further developed to compare the prevalence of abuse in women present in gynecological outpatient settings in the five Nordic countries. Seventy-seven women with experiences of abuse participated in the research. Descriptive statistics were used to analyse the data. RESULTS Most respondents did not disclose their experiences of abuse to staff at the general psychiatric clinic. Women with experiences of physical abuse (n = 40), emotional abuse (n = 37) and sexual abuse (n = 37) chose not to disclose their experiences. Respondents disclosed abuse more often to others than to staff. CONCLUSIONS Our findings indicated the importance of including routine questions concerning abuse experiences as a natural part of female patients' medical history.
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Affiliation(s)
- K. Örmon
- Department of Care Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
| | - C. Sunnqvist
- Department of Care Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
| | - C. Bahtsevani
- Department of Care Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden
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Örmon K, Torstensson-Levander M, Bahtsevani C, Sunnqvist C. The life course of women who have experienced abuse - a life chart study in general psychiatric care. J Psychiatr Ment Health Nurs 2015; 22:316-25. [PMID: 25311151 DOI: 10.1111/jpm.12177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2014] [Indexed: 12/01/2022]
Abstract
The life chart offers rich information that provides a broader picture of the lives of women who have experienced abuse. Life charts could be useful for nurses identifying women in general psychiatric care who have experienced abuse. Despite experiences of abuse and stressful events during childhood, there were only a few indications of them receiving support in the life charts. Many of the women had as adults been in contact with or received care at numerous healthcare services. Violence against women is a worldwide problem and has an impact on the lives of women and girls. The study aims to investigate the life course of women within psychiatric care who have experienced abuse. The women's resources, stressful events, experience of abuse, perpetrators, mental ill health, and care and support throughout the life course are also highlighted. Eleven women who had all sought general psychiatric care in an urban area in Sweden participated. A computer software program was used for constructing life charts for each participant, and manifest content analysis was used to analyse the data. The women's social status and resources differed, and some of them spoke of only experiencing few stressful events growing up, while others described a stressful childhood. All of the women had been abused sometime during their life course, and most of the perpetrators were known to the women. Even so, the women had seldom disclosed their childhood abuse. As adults, the women were diagnosed with psychiatric diagnoses, and suicidal behaviour increased. The life chart offers rich information and a broader picture of the life history of women who experienced abuse as well as constituting a tool useful for identifying women with experiences of abuse.
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Affiliation(s)
- K Örmon
- Department of Care Science, Faculty for Health and Society, Malmö University, Malmö, Sweden
| | - M Torstensson-Levander
- Department of Criminology, Faculty for Health and Society, Malmö University, Malmö, Sweden
| | - C Bahtsevani
- Department of Care Science, Faculty for Health and Society, Malmö University, Malmö, Sweden
| | - C Sunnqvist
- Department of Care Science, Faculty for Health and Society, Malmö University, Malmö, Sweden
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