Nurse and midwifery education and intimate partner violence: a scoping review

Educational training programs on intimate partner violence in pregnancy for midwives/student midwives: A scoping review

INTRODUCTION

Educational strategies for preventive screening and effective interventions in midwives are needed to improve clinical practice and outcomes for abused women and their families. This scoping review aimed to describe available educational training programs on intimate partner violence (IPV) in pregnancy for midwives/student midwives.

METHODS

A scoping review of the literature, which was published in English from January 2010 to March 2023, in PUBMED, EBSCO, and CINAHAL databases, was applied. The following keywords were used in the search: 'evaluation', 'educational training', 'course', 'midwives', 'student midwife', 'intimate partner violence', 'pregnancy', combined with AND and OR Boolean operators. The included studies focused on training programs/courses for midwives/student midwives regarding intimate partner violence.

RESULTS

A total of 9 studies were eligible for inclusion, describing six programs for midwives and 3 for student midwives. Educational interventions varied in length (e.g. a few hours to weeks) and educational approaches such as multidisciplinary sessions, lectures, theory, role-playing, practice in screening, group activities, watching videos, and case reports discussion. The programs had similar content, including raising awareness of violence, defining it, discussing gender roles, the impact of IPV on women's health, referral agencies, and the laws regarding violence in each country.

CONCLUSIONS

This scoping review highlighted a lack of educational programs on intimate partner violence during pregnancy, suggesting that new programs need to be developed based on contemporary clinical practices and recommendations for midwifery education.

Exercise Addiction and Intimate Partner Violence: The Role of Impulsivity, Self-Esteem, and Emotional Dependence

Given the scarcity of studies linking exercise addiction to intimate partner violence, the present study aims to analyze the relationship between these variables and examine the potential mediating roles of emotional dependence, impulsivity, and self-esteem. This is a non-experimental, cross-sectional correlational design study. The sample comprised 887 university students (86% women, mean age 20.82 years, SD = 3.63). Elevated levels of exercise addiction were associated with increased impulsivity, emotional dependence, and exerted violence, as well as decreased self-esteem and perceived violence. Mediation models were tested, explaining 7% of the variance in received violence, 13% of the variance in exerted violence, and 6% of the variance in perceived violence. Higher levels of exercise addiction were linked to increased received and exerted violence and decreased perceived violence, attributed to the positive impact of exercise addiction on emotional dependence. This study highlights the mediating roles of self-esteem and impulsivity in the relationship between exercise addiction and partner violence. Identifying risk or vulnerability factors such as emotional dependence, impulsivity, and self-esteem related to exercise addiction and interpersonal partner violence is especially relevant for designing and implementing preventive interventions in the general young population.

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.

Preparedness of Australian and British nurses and midwives about domestic violence and abuse

BACKGROUND

Domestic violence and abuse (DVA) is a major health problem that affects individuals across the world. Nurses, midwives and healthcare providers need to be confident and competent in identifying and responding to DVA.

AIMS

To measure current levels of knowledge, opinions and preparedness towards DVA and how it is managed by registered nurses and midwives residing in Australia and the UK.

METHODS

A cross-sectional study design was used. Data were collected using the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) measuring the perceived preparation and knowledge, actual knowledge, opinions and practice issues. Australian data were collected in 2018 and UK data were collected in 2017-2018. Descriptive and inferential statistics were used to analyse the data and differences in knowledge and attitudes of British and Australian nurses.

FINDINGS

Nurses and midwives (n = 368; 130 from Australia; 238 from the UK) responded to the survey. Minimal previous DVA training was reported by the participants. Participants had minimal knowledge about DVA, though had a positive attitude towards engaging with women experiencing DVA.

DISCUSSION

Most participants felt unprepared to ask relevant questions about DVA and had inadequate knowledge about available resources. Australian participants scored better than British participants; however, the mean difference in all aspects remained statistically insignificant.

CONCLUSION

Australian and British nurses and midwives have a positive attitude towards women experiencing DVA; however, the knowledge and skills to support women experiencing DVA are limited.

IMPLICATIONS FOR NURSING POLICY

Nursing institutions should develop strategic policies regarding mandatory preparation and training of nurses for domestic violence assessment and management.

Multifaceted training and readiness to respond to family violence: A prospective cohort evaluation

BACKGROUND

As frontline healthcare workers, there is a growing expectation that nurses should be able to respond to disclosures of family violence. However, the profession and hospital systems have been slow to respond with clear skills, knowledge and confidence deficits identified in existing research. There is limited research which has robustly evaluated the effectiveness of in-depth, multifaceted training on readiness to respond among nurses.

AIM

To longitudinally evaluate the effectiveness of an in-depth family violence training intervention on confidence, knowledge and clinical skills of nurses working in a large tertiary adult hospital.

DESIGN

Single-centre, longitudinal intervention study. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used.

METHODS

One hundred and ten nursing clinicians participated in this study to complete a comprehensive evidence-based model of healthcare workers response for assisting patients experiencing family violence. A mixed methods survey was used to assess change in knowledge, confidence and clinical skills among participants. Outcome assessment was electronically undertaken at baseline, 6-9 months and 12-15 months following intervention.

RESULTS

Statistically significant improvement was seen in self-reported knowledge, confidence and frequency of screening for family violence. Relative to baseline estimates, these improvements were identified 6-9 months and 12-15 months following intervention; albeit with consideration to the visually observed trend of skill reversion at follow-up. Quantitative findings were paralleled by qualitatively identified improvements in the recognition of the intersectional nature of violence, need for patient collaboration in screening and depth in considerations around how family violence is screened for.

CONCLUSIONS

Findings provide tentative support for the utility of a multidimensional training approach to improving nurses' readiness to respond to disclosures of family violence.

RELEVANCE TO CLINICAL PRACTICE

This study provides preliminary support for multidimensional, evidence-based training to effectively improve nurses' confidence, knowledge and clinical skills required for responding to family violence.

REPORTING METHOD

The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (SQUIRE) Statement: guidelines for reporting observational studies (see Table S1).

PATIENT CONTRIBUTION

Patients were involved in the initial design of the survey tool. This involvement came through the Allied Health Consumer panel and included input on the design and question wording of the survey items.

Domestic violence against women has increased during the COVID-19 pandemic: A perspective paper about the need for change to current and future practice

The COVID-19 outbreak led to widespread disruption and stress to people's lives. Concern about the escalation of domestic violence (DV) rates and related mental health issues soon emerged following the implementation of strategies aimed at curbing the spread of the virus. This perspective paper presents an overview of the issues, argues for greater recognition of the link between DV against women and serious emotional distress, and the need for greater awareness and knowledge about DV among mental health professionals. While we acknowledge that men also experience DV, their rates are much lower than for women and in this paper our focus is on women.

Detection of intimate partner aggression through dark personality and moral disengagement

Health professionals are often the first to detect abuse. Intimate partner aggression can be approached by studying the personality of the aggressor. From this perspective, dark personality and the use of moral disengagement mechanisms are two key variables. In this study, information was collected from 348 individuals, mostly women, and a questionnaire was applied to determine what their sexual behavior was like with their partner. The Short Dark Tetrad (SD4) test was used to identify dark personality and the Propensity to Moral Disengagement to identify moral disengagement. Data were collected via Google forms and multivariate decision tree analysis (CHAID growth method) was performed. Results show that men score higher on the variables of dark personality variables and use of moral disengagement mechanisms than on the three variables that, along with sex, increase the presence of dark personality and moral disengagement mechanisms: infidelity, pornography consumption, and maintaining homosexual relationships. Infidelity and pornography consumption are characteristics present in all dimensions of dark personality. Moreover, these three variables are defining characteristics of relationships with high sadism scores. Nursing staff are possibly able to detect the presence of these variables in aggressors and thus initiate a process of victim protection. Therefore, this study proposes that nursing staff should be trained to perform this detection.

Barriers Faced by Australian and New Zealand Women When Sharing Experiences of Family Violence with Primary Healthcare Providers: A Scoping Review

Despite the Australian Government's attempts to reduce domestic violence (DV) incidences, impediments within the social and health systems and current interventions designed to identify DV victims may be contributing to female victims' reluctance to disclose DV experiences to their primary healthcare providers. This scoping review aimed to provide the state of evidence regarding reluctance to disclose DV incidents, symptoms and comorbidities that patients present to healthcare providers, current detection systems and interventions in clinical settings, and recommendations to generate more effective responses to DV. Findings revealed that female victims are reluctant to disclose DV because they do not trust or believe that general practitioners can help them to solve their issues, and they do not acknowledge that they are in an abusive relationship, and are unaware that they are in one, or have been victims of DV. The most common symptoms and comorbidities victims present with are sleep difficulties, substance use and anxiety. Not all GPs are equipped with knowledge about comorbidities signalling cases of DV. These DV screening programs are the most prominent intervention types within Australian primary health services and are currently not sufficiently nuanced nor sensitive to screen with accuracy. Finally, this scoping review provides formative evidence that in order for more accurate and reliable data regarding disclosure in healthcare settings to be collected, gender power imbalances in the health workforce should be redressed, and advocacy of gender equality and the change of social structures in both Australia and New Zealand remain the focus for reducing DV in these countries.

Opinions of male nursing students about violence against women: A qualitative study

AIM

This study aims to explore the opinions of male nursing students on violence against women in Turkey.

INTRODUCTION

The prevalence of violence against women in the world is increasing every passing day. Although women try to deal with the changes their lives bring along, they are faced with physical, sexual, psychological, and economic violence for various reasons at the same time.

BACKGROUND

Inclusion of men in studies can have a strong impact on how strategies are developed and implemented. Tackling the issue of violence against women requires active engagement of men and, therefore, knowing the knowledge, attitudes, and understanding of male nursing students is important.

METHODS

In this qualitative study, 18 male nursing students participated. The participants were selected through purposive sampling, and data were collected through individual semi structured interviews. The data were analyzed using the thematic analysis method designed by Clarke and Braun.

FINDINGS

The findings of the study are presented in seven themes and these are definition of violence, causes of violence, reactions to witnessing violence, impacts of violence on society, solutions to violence, efforts regarding violence in Turkey, and being a male nurse. Among the striking results of the study were that students considered violence with its many dimensions, that they stated that violence could be prevented, that they found that efforts regarding the issue were insufficient in Turkey, and that they stated that important responsibilities for preventing violence against women lay with nurses.

CONCLUSION/IMPLICATIONS FOR PRACTICE

Students considered violence and its various dimensions. They felt that violence could be prevented, that the efforts regarding the issue were insufficient in Turkey, and that important responsibilities for preventing violence against women lay with nurses. The views of male nursing students on violence against women are promising as it encourages the empowerment of future nurse professionals, who are expected to be the pioneers of necessary changes in the field of health in order to defend women.

Influence of educational intervention on nurse-midwives' knowledge and management practices of Intimate Partner Violence (IPV) in healthcare Facilities in Ekiti-State, Nigeria

OBJECTIVE

To assess the influence of an educational intervention on midwives' knowledge, detection and management of intimate partner violence (IPV).

METHODS

A quasi-experimental study involving 158 midwives from two districts in Ekiti State, Nigeria. The sample was divided into experimental and control groups (79 midwives per group). Data were collected using a questionnaire and an observation checklist. A customized educational training program on IPV detection and management was conducted in the experimental group. Measurement was performed before the intervention, immediately after and 6 weeks later. Data were analyzed using descriptive and inferential statistics (Chi-square and binary logistic regression) with a level of significance set at p < 0.05.

RESULTS

Prior knowledge regarding IPV detection and management among midwives in both groups was poor, with only 16.5 % of the experimental group and 17.7 % of the control group having good knowledge in the pre-intervention phase. The experimental group had a significant improvement in knowledge of IPV screening and management, with 82.1 % having good knowledge immediately after the intervention and 92.0 % at 6 weeks after the intervention (p = 0.001). Observed practice of IPV detection and management improved significantly from 21.9 % satisfactory practice before the intervention to 63.5 % after the intervention (p = 0.001) in the experimental group, with no appreciable improvement in practice detected in the control group (21.9% versus 36.5%; p = 0.682).

CONCLUSION

The use of a customized educational training program improved midwives' knowledge and practice in the detection and management of intimate partner violence.

Victim-Centered Care Among College Women of Color: A Qualitative Study

AIMS

Women of color are disproportionally affected by intimate partner violence (IPV) and sexual assault (SA), and those on college campuses may have additional risk factors. The purpose of this study was to explore how college-affiliated women of color assign meaning to their interaction with individuals, authorities, and organizations tasked to help survivors of SA and IPV.

METHODS

Semistructured focus group interviews ( N = 87) were transcribed and analyzed using Charmaz's constructivist grounded theory methodology.

RESULTS

Three priority theoretical elements were identified: what hurts , namely, distrust, uncertain outcomes, and silencing of experiences; what helps , namely, support, autonomy, and safety; and desired outcomes , namely, academic progress, supportive social networks, and self-care.

CONCLUSION

Participants were concerned about uncertain outcomes of their interaction with organizations and authorities that are set to help victims. Results can inform forensic nurses and other professionals about the care priorities and needs of college-affiliated women of color in the context of IPV and SA.

Brotto L, Lyons J, Pederson A. The Experiences of Women and Healthcare Providers in Assessing the History of Gender-Based Violence During Perinatal Care

Despite its prevalence and consequences, perinatal healthcare providers' identification of gender-based violence (GBV) remains controversial in British Columbia. This study investigated women and healthcare providers' perspectives regarding their experiences with and views of inquiring about GBV during perinatal care. Twelve in-depth interviews were conducted with women with a history of GBV and 16 perinatal healthcare providers. Data were analyzed thematically. Three themes, including "barriers to disclosure," "healthcare providers hesitate to open Pandora's Box," and "how to ask in a culturally safe way," emerged from the data. Study participants support inquiry about GBV during perinatal healthcare.

Preparedness to Respond to Family Violence: A Cross-Sectional Study Across Clinical Areas

Introduction

Family violence (FV) is one of the most urgent health issues of our generation. While nurses play a vital role in identifying and supporting victim/survivors of violence, little is known about nursing readiness to respond across clinical areas.

Objective

This study aimed to compare and contrast the knowledge, confidence, clinical skills, and perceived barriers of nurses across three clinical areas of a tertiary trauma hospital in Melbourne, Australia, in responding to FV.

Method

A prospective, mixed methods design was used. The nursing staff at a large trauma hospital were approached to participate. Participants completed a brief online survey to quantify clinician-reported knowledge, clinical skills, and barriers to managing FV.

Results

Two hundred and forty-two nursing staff electronically completed a brief survey to capture self-reported confidence, knowledge, clinical skills, and barriers to working effectively in the area. The descriptive analysis reflected service-wide deficits in knowledge, confidence, and self-reported clinical skills, irrespective of the work area. Deficits were identified on a background of limited structured training for FV among this cohort. Significantly higher rates of FV confidence and knowledge were identified among emergency department nurses relative to acute and subacute clinical counterparts.

Conclusion

Nurse respondents overall reported low rates of confidence, knowledge, and clinical skills in responding to disclosures of FV. Findings reinforce the need for imbedded training programs to support frontline responses.

Curricular Limitations and Recommendations for Training Health Care Providers to Respond to Intimate Partner Violence: An Integrative Literature Review

BACKGROUND

Intimate partner violence (IPV) is a well-known public health problem occurring worldwide. With a multisectoral approach being emphasized in addressing IPV, the health sector has a key role to play due to many IPV victims who appear in health facilities without their needs being met. A well-designed and implemented IPV curriculum is necessary for effectively training health care professionals to provide quality IPV care and related services. This integrative review was conducted to establish evidence for existing curricular limitations and recommendations for training health care providers to respond to IPV.

METHODS

A systematic literature search was conducted for studies published from 2000 to 2020 in five databases (PubMed, Science Direct, Cochrane Library, Google, and Scholar). As a criterion, studies that reported curricular limitations in training health care providers/professionals to address IPV were included. A total of 198 studies were identified for screening, with 16 studies meeting the inclusion criteria and included in the review.

FINDINGS

Curricular limitations for IPV response training for health care providers were reported in the following areas (themes): time allocated for the training, amount of content in the existing curricula, institutional endorsement for the content, IPV response teachers/facilitators, teaching and learning strategies, and funding to support curricular implementation. Various recommendations to improving IPV response training were provided including guaranteeing the training in all courses, increasing academic capability to teach the content, allocation of funding to improve infrastructure for curriculum development and implementation, comprehensive approaches to teaching, and continuing education for health care providers.

More support, knowledge and awareness are needed to prepare emergency department nurses to approach potential intimate partner violence victims

BACKGROUND

Intimate partner violence is a global health issue. In the emergency department, patients seek help for health problems that may be related to exposure to physical, psychological or sexual violence, or controlling behaviour from a current or former partner. Of the many victims that seek care in an emergency department, few are identified, especially among those whose chief complaint is not clearly related to recent physical abuse. Not having all the facts about a patient can jeopardise patient safety and delay treatment. The aim of this study was to describe experiences of caring for adults, subjected to intimate partner violence, from an emergency nurse perspective.

METHODS

A qualitative semi-structured interview study of nine emergency care specialist nurses was conducted using content analysis.

FINDINGS

Two categories emerged: 'Subtle signs' and 'Not being enough'. The short encounters in emergency care do not allow for deep conversations. The informants highlighted the need for more knowledge about what and how to ask in that specific context. Some mentioned situations where the question had been avoided due to lack of time to handle the answer. The interviews revealed the importance of regular discussions to increase awareness of intimate partner violence and its prevalence among patients.

CONCLUSIONS

The organisation plays an important role in putting the question about intimate partner violence on the daily agenda and giving time to emergency nurses and other professions for training and reflection.

Development and Psychometric Assessment of a Questionnaire for the Detection of Invisible Violence against Women

BACKGROUND

Invisible violence against women (IVAW) can be understood as the set of attitudes, behaviors, and subtle beliefs that men use to subordinate women and that are culturally accepted. These behaviors can be a risk factor for intimate partner violence (IPV), so it is important to design tools that allow us to detect it early. The aim of this study was to design and psychometrically assess a questionnaire for the detection of invisible violence against women (Q-IVAW).

METHODOLOGY

A descriptive cross-sectional methodological study carried out in three phases: (1) development of the initial version; (2) pilot study (N = 51); and (3) final validation study (N = 990). The tool's reliability, validity, and legibility were assessed. To assess reliability, the internal consistency (Cronbach's α) was analyzed. The validity assessment included an analysis of content, criterion, and construct validity.

RESULTS

The EFA revealed that the Q-IVAW was comprised of five factors that explained 55.85% of the total variance found. The Q-IVAW showed very high reliability (α = 0.937), excellent content validity, and good construct validity. The criterion validity analysis showed a moderate correlation between A-IPVAW and Q-IVAW (r = 0.30; p < 0.001).

CONCLUSION

The psychometric assessment of the Q-IVAW yielded good results, which could support the tool's ability to assess how often women are subjected to inviable violent behaviors by their partners.

IPV nurse education: Scoping things out to see who's doing what?

Introducing best practice approaches to help nursing students identify and respond to patients who are/have been exposed to intimate partner violence (IPV) is instrumental to their professional development. The objectives of this study are to gather preliminary data from the American Association for the Colleges of Nursing (AACN) affiliated schools of nursing to determine 1) if they offer any training of students at the undergraduate or graduate level in identifying and responding to IPV; 2) if so, what are the components of that training, outcomes, and satisfaction with the existing approach; 3) if not, what are the individual and institutional level barriers to offering this training; and 4) if schools are interested in incorporating best practice, IPV training content into their curriculum.

DESIGN AND METHODS

A total of 836 AACN affiliated nursing schools across the US were surveyed using a 64-item electronic survey.

RESULTS

Of the 95 (11%) schools that completed at least 40% of the survey, approximately 60% offer IPV training once at the undergraduate level and only 30% offered such preparation at the graduate level. We found that most IPV education took place as embedded material within an existing course. Those nursing schools not providing any IPV education identified that they would like to at both levels and the 50% of nursing schools already providing this education said they wanted to provide more. The greatest barriers to offering IPV education were lack of faculty expertise and time constraints, yet about 70% of the participants stated that IPV education should be an essential part of undergraduate and graduate nursing school.

CONCLUSION

This study provides useful insights to inform IPV curriculum development by identifying common gaps in IPV education experienced by participating schools and strategies for addressing them.

A commentary on the challenges for nurses in identifying and responding to intimate partner violence amongst gay and bisexual men

AIM

This commentary elucidates the challenges for nurses in effectively identifying and supporting gay and bisexual men who experience intimate partner violence and offers guidance for education, training and practice to nurses when responding to patients who may be experiencing intimate partner violence.

DESIGN

The commentary highlights issues raised by Callan et al.'s (2020) scoping review, translating the experiences of male sexual minorities undergoing abuse to a nursing context, in particular, issues such as homophobic remarks and heteronormative practices in health care and nursing-led environments militate against the identification of individuals who may be experiencing coerced sexual risk-taking, homophobia and sexual orientation outing.

RESULTS

Intimate partner violence is a widespread issue that permeates across heterosexual and LGBTQ+ communities, while impressing on the everyday realities of nurses. The potential for discrimination against sexual minority patients may be offset by improving training, education and offering recommendations for nurses in how to identify IPV and how to assess risk.

CONCLUSIONS

Nurses possess essential training and transferable skills such as empathy, adaptability, active listening and diplomacy and are ideally placed to facilitate disclosure of intimate partner violence. Gaps in knowledge, training and organizational support for nurses may be effectively addressed through drawing on extant research and international best practice guidelines.

IMPACT

Suggestions for research, education and practice to identify gay and bisexual male survivors, intervene appropriately and avoid missed disclosure opportunities are made. We conclude with a table of recommendations with a view to enhancing the essential response of nurses in addressing intimate partner violence in marginalized communities.

Domestic violence: A cross-sectional study among pregnant and postpartum women

AIM

To assess the prevalence of domestic violence/intimate partner violence, aggressors, types of violence and associated factors in women who attend an antenatal and postnatal care service in a public hospital in Brazil.

DESIGN

Cross-sectional study.

METHODS

We interviewed women attending antenatal and postpartum care services in a Brazilian public tertiary woman's hospital in Campinas, São Paulo, between July 2019 and September 2021. Data were collected through interviewer-administered questionnaires previously used in healthcare settings: Abuse Assessment Screen (AAS); Woman Abuse Screening Tool (WAST); Hurt, Insulted, Threatened with Harm and Screamed (HITS). We evaluated the relationship between the sociodemographic characteristics of women and domestic/intimate violence using bivariate and multivariable logistic regression analyses.

RESULTS

Of the 600 pregnant and postpartum women interviewed, 138 (23%) had suffered any abuse. Some participants disclosed physical violence during pregnancy (2.3%) and during the last 12 months (5.3%). The partner was identified as the main aggressor in most of the cases (60%). When women had a partner, 3.5% reported domestic violence and 6.7% disclosed intimate partner violence during pregnancy or postpartum period. Women with non-white skin colour (OR = 1.53; 95% CI 1.01-2.34; p = .048), gestational age ≤ 13 weeks (OR = 3.41; 95% CI 1.03-11.25; p = .044) and in postpartum period (OR = 2.81; 95% CI 1.32-5.99; p = .008) were more likely to experience domestic violence at some time in their lives. Women interviewed before the COVID-19 pandemic were more likely to disclose that they had suffered any abuse.

CONCLUSION

Experience of violence during pregnancy and postpartum period was more frequent in women with non-white skin colour, in their first gestational trimester and in the postpartum period, and was more reported before the COVID-19 pandemic. Antenatal and postpartum care services could be safe places to support violence survivors.

IMPACT

Pregnant and postpartum women are a vulnerable group to experiencing domestic violence/intimate partner violence. Violence can negatively affect women's and children's health and well-being. Antenatal and postpartum care should be considered as a moment to routinely inquiry women about past and current violence experiences. Regular contact among healthcare professionals and women during this period offers a window of opportunities for implementing psychosocial interventions among women at risk of violence. Healthcare providers (i.e., physicians, psychologists, social workers, nurses and midwives) have an important role in identifying survivors, offering support and providing quality information to women.

Researching the Impact of Service provider Education (RISE) Project - a multiphase mixed methods protocol to evaluate implementation acceptability and feasibility

BACKGROUND

Health and social service providers receive limited education on recognizing and responding to family violence. With adequate education, providers could be prepared to identify individuals subjected to family violence and help reduce the risk of associated impairment. Informed by the Active Implementation Frameworks, our research will determine the scope of strategies needed for the uptake and sustainability of educational interventions focused on family violence for providers. It will also determine the acceptability, feasibility, and proof-of-concept for a new educational intervention, called VEGA (Violence, Evidence, Guidance, Action), for developing and improving primary care provider knowledge and skills in family violence.

METHODS

This paper details the protocol for the Researching the Impact of Service provider Education (RISE) Project. The RISE Project follows a sequential multiphase mixed method research design; qualitative and quantitative data are being collected and integrated over three conceptually and methodologically linked research phases. Activities primarily occur in Ontario, Alberta, and Quebec. Phase 1 uses a sequential exploratory mixed method research design to characterize the scope and salience of learning and implementation needs and preferences for family violence education. Phase 2 will use an embedded mixed method research design to determine whether VEGA technology supports providers to achieve their family violence learning goals with effectiveness, efficiency, and satisfaction. Phase 3 will use a concurrent mixed method research design to determine acceptability, feasibility, and proof-of-concept for evaluating whether VEGA improves primary care providers' knowledge and skills in family violence. This final phase will provide information on implementation strategies for family violence education in the "real world." It will also generate data on provider recruitment, retention, and data completeness, as well as exploratory estimates of the effect for provider outcome measures proposed for a randomized controlled trial.

DISCUSSION

The RISE Project comprehensively integrates an implementation approach to improve family violence education for the health and social service professions. It will provide important information about factors that could influence the uptake and effectiveness of a health profession's educational intervention into the real world, as well as provide foundational evidence concerning the tenability of using a randomized controlled trial to evaluate the impact of VEGA in primary care settings.

The Readiness of Australian Health Care Students to Encounter Patients Experiencing Partner Abuse

Partner abuse is a significant contributor to mortality and morbidity worldwide, and has been identified as a priority health care issue. Most health care students rarely receive education on partner abuse and report not feeling ready to encounter patients experiencing partner abuse. Analysis of the current readiness of health care students and can inform educational needs to address this gap. The READIness to encounter partner abuse patients Scale was delivered to a convenience sample of Australian prequalification health care students. Participant demographics and estimated hours of education were also reported. Mean readiness scores were calculated by discipline. The relationship between hours of education and readiness scores was calculated using linear regression. A total of 926 participants were included in the analysis. Approximately half of the participants (47.5%) reported less than two hours of education. Mean readiness of students was 4.99 out of 7 (SD 0.73, range 4.39-5.95). Linear regression revealed a significant association between hours of education and readiness, r(925) = .497, p < .000. Australian health care students receive little education about partner abuse, and do not report feeling ready to encounter patients experiencing partner abuse. An individual's confidence and belief in their abilities appear to be the key factor influencing overall readiness. Participants indicated a strong belief that responding to partner abuse was part of their professional role, which is a positive change from previous research. Higher hours of education is associated with higher readiness, though which educational methodologies are most impactful remains unclear.

The influence of an educational intervention on nursing students' domestic violence knowledge and attitudes: a pre and post intervention study

Background

Nurses, as the largest group of health professionals, have a key role in recognising, mitigating and preventing domestic violence. However, studies demonstrating effective undergraduate educational interventions are lacking. The research aim was to compare undergraduate nursing students’ knowledge and attitudes about domestic violence before and after an educational intervention on domestic violence and explore their views on the most useful teaching strategies.

Methods

A quasi-experimental pre and post design was used to determine the impact of an educational intervention. Australian nursing students enrolled in a first-year undergraduate subject were invited to participate. The educational intervention included a 40-min pre-recorded lecture on domestic violence, and a two-hour face-to-face workshop facilitated by an expert, supported by readings. Students completed a pre- and post-intervention online anonymous survey using a validated instrument, the Inventory on Beliefs and Attitudes towards Domestic Violence. Wilcoxon signed rank tests were used to compare pre and post intervention results.

Results

Approximately 400 students completed the voluntary workshop; 198 students completed the pre survey, 176 completed the post survey and 59 (13.1%) completed both. Post intervention, participants indicated stronger agreement on 15 of 22 items. The inventory score became significantly more positive (Z = -3.196, p = .001, CI -.206—-0.067) post intervention. Of the 173 students who indicated post intervention which forms of education they found useful, 38.2% considered face-to-face tutorials to be the most useful education modality.

Conclusions

This study demonstrates the effectiveness of even a small educational intervention in changing attitudes, and creating awareness and knowledge of the context, prevalence, perpetrators, and significant associated burden of illness related to domestic violence, and nurses’ responsibility to support victims.

Does the gender course have any effects on young people's gender equality perceptions, dating violence, and problem-solving behaviours in romantic relationships?: A mixed-method study

PURPOSE

This study aims to evaluate the effects of the gender course (GC) on nursing students' gender equality perceptions, dating violence attitudes, and problem-solving behaviors in romantic relationships.

DESIGN AND METHODS

Using a sequential explanatory mixed-methods design, this study utilized Sociodemographic Form, Gender Equality Scale (GES), Dating Violence Attitudes Scale (DVAS), Problem-solving in Romantic Relationships Scale (PSRRS), and students' written accounts to collect data.

FINDINGS

GES and PSRRS scores demonstrated no differences between the experimental and control groups; DVAS scores indicated differences. The quantitative findings were supported through the qualitative findings. The GC increased students' awareness about gender equality and dating violence and had positive effects problem-solving skills in romantic relationships.

PRACTICE IMPLICATIONS

GC could be utilized to raise awareness about gender-based violence.

Effects of a structured online educational program course on nursing students' attitudes toward gender roles and women and children's violence abuse reports: A quasi-experimental evaluation

BACKGROUND

It is important to know the rights of women and children while shaping attitudes toward gender roles, violence against women, and reporting child abuse. To shape attitudes toward reporting abuse, women's and children's rights courses should be integrated into undergraduate nursing curriculum. It is important to develop positive attitudes of nursing students toward gender roles, violence against women, and reporting child abuse.

OBJECTIVES

The aim of the study was to evaluate the effects of a "women's-children's rights" online-educational program in a nursing curricula.

DESIGN

A pretest-posttest follow-up with a control group quasi-experimental trial.

SETTINGS

Nursing department of the state university in Turkey.

PARTICIPANTS

Fourth-year students (N = 62) of a nursing department at the state university in Turkey constituted the study sample. The students were divided into two groups: education and control groups with each group comprising 31 fourth-year nursing students.

METHODS

The education group took the women's-children's rights online-course, whereas the control group did not. In both groups, baseline assessments were performed online using the "Gender Roles Attitude Scale," "Violence Against Women Attitude Scale," and "Healthcare Provider Attitudes Toward Child Maltreatment Reporting Scale." The posttest (T1) was conducted immediately after the 14-week course was completed. Follow-up was performed after 1 month (T2). Numbers, percentages, chi-square test, t-test, Kolmogorov-Smirnov test, Pearson's correlation, and Duncan's test were conducted using SPSS 20.00 software.

RESULTS

The education group's scores of attitudes toward gender roles, violence against women, and reporting child abuse/neglect were significantly higher than those of the control group (p < 0.05). After the online program, a significant difference between the groups and between the measurements was observed in the education group (p < 0.05).

CONCLUSIONS

The women's-children's rights online-course is an effective method in educating and enriching nursing students on women's and children's rights.

"One of the most important subjects for a healthcare worker": Cross-sectional student evaluation of family violence best practice response curriculum

Family violence can affect the health and well-being of victim-survivors. Nurses and other healthcare providers are well placed to respond to family violence, yet evidence shows that nurses have limited knowledge of family violence and students are unprepared for this work. The objective of this study was to evaluate a pilot of the subject Family Violence Best Practice Response for undergraduate nurses and other healthcare students at an Australian university. The study used a cross-sectional pre-posttest design. Survey instruments included a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool and the World Health Organization Curriculum evaluation tools. Sixty-four students enrolled in the pilot. Participants made significant improvements in their feelings of preparedness to complete family violence work and in their perceived knowledge across a range of clinical practices and knowledge domains. Qualitative data showed students enjoyed the subject and gained valuable knowledge of how to inquire and validate disclosures. Healthcare professionals should receive training and be ready and able to identify and sensitively respond to victim-survivors of family violence when they enter the workforce.

Nurses', midwives' and students' knowledge, attitudes and practices related to domestic violence: A cross-sectional survey

AIMS

To measure registered nurses', registered midwives', and nursing and midwifery students' current levels of knowledge, attitude and practices related to intimate partner violence.

BACKGROUND

Nurses and midwives whether registered or students need to be confident and competent in identifying and responding to intimate partner violence.

DESIGN

A cross-sectional survey.

METHODS

Data were collected through online surveys using the Physician Readiness to Manage Intimate Partner Violence Survey. Descriptive and inferential statistics were used to analyse the data.

RESULTS

Nursing and midwifery students were less knowledgeable and prepared than nurses and midwives. Midwives had more positive attitudes compared with nurses towards women experiencing intimate partner violence.

CONCLUSIONS

Heath care institutions and regulatory bodies should provide resources and support to nursing and midwifery professionals. Personal experiences of domestic abuse and professional experience of supporting victims of domestic abuse/intimate partner violence affected practitioner's abilities to identify and manage intimate partner violence.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse and midwifery managers can ensure that clinical and organisational policies and protocols are revisited and updated regularly and that interdisciplinary collaboration is promoted and emphasized for prompt identification and management of intimate partner violence.

Australian hospital staff perceptions of barriers and enablers of domestic and family violence screening and response

Background

Hospital presentations provide unique opportunities to detect DFV. However, up to 70% of women experiencing Domestic and Family Violence (DFV) go undetected by hospital staff. While routine DFV screening is internationally encouraged, there is still much debate surrounding its implementation. The aim of the study was to determine staff perceptions of barriers and enablers of DFV screening and response.

Methods

A cross-sectional survey was conducted at a tertiary level public hospital and health service. Health care staff in allied health, maternity and mental health divisions (n = 615) were invited to participate by email and through team meetings. 172 responses were analysed.

Results

Less than a third of respondents reported routinely asking patients about DFV, with 34.9% reporting they did not have sufficient training to assist with DFV. Increased levels of training were positively correlated with screening practices, preparedness and knowledge. Major barriers were presence of partner and language barriers, while written protocols and supportive work environment were the principal enablers of screening.

Conclusion

Staff generally believed that routine screening was important and should encompass all forms of abuse. Many felt ill-equipped to ask about or manage disclosure of DFV. More training improves staff capacity for DFV detection and response, and written guidelines should be made available to all staff.

Board Game Violetas: the perspective of professionals addressing violence against women

OBJECTIVE

To analyze the potentialities and limits of the board game Violetas to address violence against women, from the perspective of the professionals who work in assisting the victims.

METHOD

This is an interventional study with a qualitative approach. Thirty professionals from the Casas da Mulher Brasileira (Brazilian Women's Houses) in Brasília, Campo Grande and Curitiba participated. Data collection was carried out during Critical-Emancipatory Workshops. Data were subjected to thematic content analysis with the support of the software webQDA.

RESULTS

As potentialities, the professionals mentioned the game design, the collaborative participation, and the ludicity as learning facilitators, stimulating reflections on the visibility of violence, assistance to victimized women, and the articulation of the supportive network services. As limitations of the study, the lack of familiarity with games, the understanding of the rules, and some issues contained in the game were mentioned.

CONCLUSION

The game proved to be a powerful educational strategy for the training and qualification of the professionals involved in the supportive network.

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.

Training healthcare providers to respond to intimate partner violence against women

BACKGROUND

Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors.

OBJECTIVES

To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language.

SELECTION CRITERIA

All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach.

MAIN RESULTS

We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review.

AUTHORS' CONCLUSIONS

Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.

Which Violence Against Women Educational Strategies Are Effective for Prequalifying Health-Care Students?: A Systematic Review

Gender-based violence (GBV) is a global public health issue which disproportionately affects women. Health-care providers have an important role in recognizing and addressing GBV in practice, yet research suggests that the issue remains underrecognized, with many qualified professionals reporting lack of confidence and a sense of unpreparedness. Prequalifying GBV educational strategies are inconsistent in both quantity and quality worldwide, and to date, there has been no comprehensive review of those programs' effectiveness. This internationally focused literature review aimed to identify best educational practices in GBV for prequalifying health-care students. A systematic search of six databases yielded 17 studies meeting the inclusion criteria, with all studies examining one or more educational intervention. Quality appraisal was undertaken and data were tabulated to capture relevant information. Thematic findings suggest that interactive educational strategies yield better results than didactic approaches. Similarly, interventions with a focus on practical application of learning are generally preferred over strictly theoretical approaches. Courses of longer duration seem to be more effective in instilling attitudinal changes. Lastly, gendered differences were noted in a number of studies, with female students consistently outperforming males. However, more research is needed before conclusions can be drawn about the effectiveness of single- versus mixed-gender audiences. This review makes a useful contribution to the literature of health education, supporting many findings from previous studies and identifying knowledge gaps to be explored in future research. There are implications for both educators and practitioners in creating discernible change for women in their care.

The impact of violence against women courses on the attitudes of nursing students toward violence against women and their professional roles

This study determines whether the inclusion of violence against women (VAW) education in nursing curricula would improve attitudes and professional help toward victims of violence. Research was carried out as cross-sectional and comparative quasi-experimental study. The research included 524 students; 262 students were trained and 262 were untrained. Data were collected using the Sociodemographic and Personal Charaterics Form, Attitude toward Violence Scale (AVS), and Attitude toward Occupational Roles in Violence Scale (AORVS). The overall average AVS score of students was 30.81 ± 8.68 and overall average AORVS score was 25.50 ± 6.86. There were significant differences in AVS scores and AORVS scores between the experimental and control groups. The scale and sub-dimension mean scores of the students who received the course were significantly lower; it was determined that obtaining low scores reflected divergence from traditionalism and increase in modern opinions in the evaluation of the scales. It is clear that undergraduate courses are an ideal opportunity to initiate changes in attitudes toward intimate partner violence (IPV) and equip graduates with comprehensive knowledge of IPV. This study demonstrates that meeting professional and information needs about VAW by revising nursing curricula is important.

Victorian maternal and child health nurses' family violence practices and training needs: a cross-sectional analysis of routine data

This study investigated maternal and child health (MCH) nurse family violence clinical practices, practice gaps and future family violence training needs. Descriptive analysis was conducted of routine data collected as part of a larger MCH nurse family violence training project conducted in 2018. A purposive sample of routine data (2017-18) was analysed from six Victorian metropolitan and four regional and rural areas that were experiencing high rates of violence, as indicated by police reports. Descriptive statistics and regression analyses were used to identify rates of nurse family violence screening, safety planning and referral, with practice differences analysed across locations. MCH nurses ask only one in two clients about family violence at the mandated 4-week postnatal clinic visit. Overall, metropolitan nurses screen for family violence at higher rates than rural nurses. Safety planning rates were low (1.3%), suggesting that screening is not translating to disclosure rates equivalent to state-wide prevalence (~14-17%) or police data. Nurse referrals are even lower (<1%), with practice differences noted across reporting systems. Despite data collection limitations, analysis of routine data shows significant gaps in nurse family violence screening and response practices. This evidence reinforces the need for systems changes to address family violence and other maternal health and social issues.

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

BACKGROUND

Intimate partner violence victims regularly seek health care and support. Health care providers need to understand the complexities of partner violence and how to safely respond to clients. Policy guiding nurse identification and responses exist, yet practices and education are lagging. Maternal and Child Health nurses are required to address intimate partner violence, yet their knowledge and preparedness to undertake this work is under-explored. The most effective methods of provider training are unknown.

OBJECTIVES

1) To assess the level of Maternal and Child Health nurse intimate partner violence training and nurse preparedness to address partner violence and 2) compare group differences in preparedness by nurse location, role and level of training.

DESIGN

A cross sectional research design.

PARTICIPANTS

Australian community based Maternal and Child Health nursing workforce.

METHODS

Online survey conducted in June 2018. Survey questions explored nurse characteristics, knowledge and 'preparedness' to complete intimate partner violence work and previous violence training. Descriptive analysis involved reporting proportions within categories. Proportional group differences were analysed using Chi square test of independence. Statistical significance was set at p < 0.05.

RESULTS

Survey response rate was 65% (735/1125). Nurses feel well prepared to complete intimate partner violence practices, although differences were seen across groups. Rural nurses feel less prepared than metropolitan colleagues, especially conducting safety assessments and documentation. Nurse co-ordinators are the most prepared. A dose response relationship is seen between training and preparedness: nurses with greater (>10 h) and more recent training (within 5 years) report being more prepared for intimate partner violence work.

CONCLUSIONS

Greater systems supports are needed for sustainable nurse intimate partner violence work. In particular, opportunities are needed for rural nurse training, delivered locally and tailored to rural needs and context. Nurse co-ordinators are key leaders to achieving sustained nurse intimate partner violence practices.

Nurse Training in Gender-Based Violence Using Simulated Nursing Video Consultations during the COVID-19 Pandemic: A Qualitative Study

Gender-based violence (GBV) is a serious global public health problem that becomes aggravated during public health emergencies that involve quarantine measures. It is important to train nursing students on GBV, especially in vulnerable situations, such as the current COVID-19 pandemic. The purpose of our study is to explore the perceptions of third-year nursing students about simulated nursing video consultations for providing assistance to potential cases of GBV victims using a high-fidelity clinical simulation methodology. After all of the simulated scenarios were completed, 48 scripted interviews were carried out following a guide composed of four open-ended questions to facilitate in-depth discussion. A descriptive qualitative study based on the interpretative paradigm was conducted. The nursing students indicated that they improved their knowledge on GBV victim management (mainly their awareness of the problem, recognition of the role of nursing professionals, and performance of non-technical skills), although they also mentioned the need for continuous training (particularly in socio-emotional skills, interview techniques, a holistic nursing care approach, and not presupposing). This innovative high-fidelity simulation methodology allows nursing students to improve their awareness of the GBV problem, acquire a realistic view about their role in addressing GBV, and build their non-technical skills (such as active listening, communication skills, empathy, and generating confidence) required to adequately care for victims of GBV.

Intimate partner violence screening intention instrument for Thai nursing students: A principal component analysis

BACKGROUND

Identifying factors related to intimate partner violence (IPV) screening intentions of future nurses is critical, but no studies specific to this research area exist in Thailand; nor does any validated instrument currently exist to systematically evaluate Thai nursing students' IPV training or measure their readiness to address IPV. The purpose of this study was to develop the Intimate Partner Violence Screening Intention, Nursing Students (IPVSI-NS) for Thai nursing students and identify components explaining their intentions to screen for intimate partner violence (IPV).

METHOD

We designed a Thai-language, culturally appropriate 36-item instrument based on the theory of planned behavior (TPB), which describes intentions as the precursors of actual behaviour. We then conducted an anonymous cross-sectional online survey of female senior Thai nursing students (N = 594). Principal component analysis with varimax methods was used to examine the component structure of the instrument. The internal consistency reliability and convergent construct validity were evaluated. See Supporting File S1.

RESULTS

A six-component structure was evident which explained 59.56% of variance and identified: attitudes (advantages and disadvantages of screening), subjective norms (support from important people, and opinions of important people and policy) and perceived behavioural control (training experience, teamwork, facility resources and screening barriers).

CONCLUSION

The IPVSI-NS, based on the TPB, provides a psychometrically sound, reliable and valid tool for Thai nursing educators and researchers to advance nursing education, practice and research regarding IPV.

RELEVANCE TO CLINICAL PRACTICE

Provides support for the components of the TPB (attitude, subjective norm and perceived behavioural control) as an excellent fit to predict intention of IPV screening for future clinical nurses. Implications for future research and educational practice are discussed.

Knowledge, attitude, and preparedness toward IPV care provision among nurses and midwives in Tanzania

BACKGROUND

With increasing recognition of intimate partner violence (IPV) as a public health challenge, nurses and midwives are recognized for their crucial role in providing front-line healthcare services for IPV. This study aimed to evaluate knowledge, attitude, and preparedness related to IPV care provision in health facilities among nurses and midwives in Tanzania.

METHODS

A self-administered anonymous questionnaire survey was conducted among nurses and midwives working in health facilities in the Mbeya region between December 2018 and January 2019. The questionnaire consisted of questions on their perceived and actual knowledge, attitudes, and preparedness to provide care in relation to IPV.

RESULTS

A total of 662 (50.1%) of 1321 nurses and midwives who worked in hospitals and/or health centers in the Mbeya region participated in this study, and 461 (69.6%) completed questionnaires were included in the analysis. The proportion of nurses and midwives with high scores in IPV perceived knowledge, actual knowledge, attitude, and preparedness to provide care was 59.9%, 53.1%, 54.2%, and 54.0%, respectively. Regardless of the type of facility, gender, educational level, and work experience, the use of IPV guidelines was significantly associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.004), and preparedness to provide care (P < 0.001), but not attitude, which was negatively associated (P = 0.048). Regardless of the type of facility, gender, educational level, and work experience, receiving preservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.049), and preparedness to provide care (P = 0.002), but not attitude (P = 0.192). Regardless of the type of facility, gender, educational level, and work experience, in-service IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.043), and preparedness to provide care (P = 0.001), but not attitude (P = 0.063).

CONCLUSIONS

Although guidelines and training could improve nurses' and midwives' knowledge and preparedness to provide care regarding IPV, attitudes against IPV care are a challenge. To improve attitudes regarding IPV among front-line nurses and midwives, it is necessary to address concepts of IPV care and sympathy with potential and actual victims of IPV in pre- and in-service training in addition to providing recall-level knowledge.

Nurses' knowledge, attitudes and preparedness to manage women with intimate partner violence

AIM

To investigate nurses' knowledge, attitudes and practices related to intimate partner violence among women in Saudi Arabian healthcare settings.

BACKGROUND

There is a global focus on abuse experiences in clinical settings. However, nurses' practice in managing intimate partner violence patients in Saudi healthcare settings has not yet been examined.

INTRODUCTION

Intimate partner violence is a health issue that can lead to mortality and morbidity. It has recently received attention in an Arabian context. Thus, scrutinizing nurses' role in responding to intimate partner violence patients is needed to fill a current gap.

METHODS

A cross-sectional study was conducted with a convenience sample of 114 nurses from two hospitals in Saudi Arabia using a questionnaire.

RESULTS

Minimal previous intimate partner violence training was reported, as 63% of nurses had not received training related to intimate partner violence, and 52% believed that they did not receive adequate training to respond to intimate partner violence survivors. The results show that nurses had both low perceived knowledge and low preparedness in managing intimate partner violence, and only had basic intimate partner violence knowledge. Results indicated that nurses did not have appropriate attitudes towards intimate partner violence. The majority were not aware about intimate partner violence protocols or policies in their institutions. Only 2.6% had diagnosed intimate partner violence in the last six months.

CONCLUSION

There were gaps in nurses' perceived preparedness, knowledge, attitudes and behaviours. There was also limited training and preparation for nurses to assess and address intimate partner violence.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The study suggests the need for clear institutional health policies related to detecting, responding to, and preventing intimate partner violence. Guidelines about integrating intimate partner violence in nursing curricula and implementing in-service training should be developed and implemented. A multi-level intervention that enables nurses to respond to intimate partner violence is also needed.

Women's Experiences of Being Screened for Intimate Partner Violence in the Health Care Setting

OBJECTIVE

To qualitatively describe experiences of survivors of intimate partner violence (IPV) in being screened for IPV and to identify opportunities to improve screening and response by health care providers.

DESIGN

Qualitative descriptive study.

SETTING/LOCAL PROBLEM

Although it is recommended that nurses and other health care providers screen for IPV, a local needs assessment of IPV screening among health care practices in Houston, Texas, showed inconsistencies in IPV screening practices, a lack of understanding on how to screen for IPV, and low referral rates to IPV agencies.

PARTICIPANTS

Seventeen survivors of IPV from three agencies that provide services to survivors of IPV.

INTERVENTION/MEASUREMENTS

Three focus groups were conducted, and notes were coded and analyzed for content and themes using open coding from the observed data. The constant comparative method was used for the analysis.

RESULTS

Four themes emerged from the focus group data. The first three themes address concepts and dynamics of IPV that affect IPV screening and disclosure of abuse. The final theme addresses screening for IPV in health care settings.

CONCLUSION

Many survivors reported that they were not screened for IPV by health care professionals, and those who were screened were not screened effectively. Compassionate care is needed in these situations, and nurses and other health care providers should be aware that the responses of IPV survivors are dynamic and may change over time.

Differences in help-seeking behaviours and perceived helpfulness of services between abused and non-abused women: A cross-sectional survey of Australian postpartum women

New mothers may face substantial physical and mental health challenges during the postpartum period and are at a greater risk of intimate partner violence. Healthcare services provide support, however, acknowledging a problem and seeking help for it can be difficult. Research on where postpartum women seek help and how helpful they perceive it is limited. Additionally, little is known of how these help-seeking behaviours differ between abused and non-abused postpartum women. The aim of this study was to examine the help-seeking behaviour and perceived helpfulness of services in abused and non-abused postpartum women. Secondary analysis was undertaken of data collected during the MOVE (Improving Maternal and Child Health Care for Vulnerable Mothers) cluster randomised controlled trial of a nurse, intimate partner violence screening and supportive care intervention. MOVE was set in eight community-based nurse teams in Melbourne, Australia. The trial (2010-2013) included a survey of n = 2,621 postpartum Australian women who had given birth within the previous 8 months. Data were analysed using descriptive and interferential statistics. Findings indicate that abused women who had experienced partner violence sought informal family support less frequently (81.3% compared with 92.4%, p < .001) and were more frequent users of hospital emergency departments (p = .03), nurse home visiting programs (p = .02) and some breastfeeding services (p = .001), compared with non-abused women. They were also more frequent users of psychiatrists (p ≤ 0.001), early parenting centres (both day stay (p = .006) and residential (p = .008), child welfare services (p < .001), and were generally less satisfied with the help received. Postpartum women experiencing partner violence seek help from certain formal services more frequently and are less satisfied with the care received, compared with non-abused women. Access to potential protective supports from family and friends is limited. Further qualitative research is needed to gain a greater understanding of abused postpartum women's experiences and help-seeking behaviours.

Vocational training and sexual assault against women: challenges for graduation in nursing

Abstract Objectives: To understand the meanings of sexual assault against women in the point of view of students, professors and university managers of undergraduate nursing; and to understand how the contents on this subject are approached in undergraduate courses in Nursing in Higher Education Institutions. Method: A qualitative study, with data collection from March to November 2018, through interviews with ten students, ten teachers and seven managers from two private institutions. Data was treated by the modality of thematic content, with a theoretical-analytical reference of 'gender violence' and 'rape culture'. Results: The topic is approached in a fragmented way in different academic contexts, which leads to the reflection of the topic in the training of nurses, extending to their professional performance. Conclusion and implications for practice: The possibilities of incorporating the subject in the teaching-learning scenarios and practices converge to approach the content about the different types of violence in the undergraduate subjects, with educational actions with the population, potentializing the deconstruction of the culture of female subordination. In addition, the study is aligned with the appropriate time in which the reorientation of the curricular guidelines for the health courses is discussed.

A cross-sectional study of domestic violence instruction in nursing and midwifery programs: Out of step with community and student expectations

BACKGROUND

Domestic violence is a global health concern. Nurses and midwives must respond to those who experience domestic violence, although many are not prepared to do this. The World Health Organization recommend that domestic violence content be included in all pre-registration training as a matter of urgency.

OBJECTIVES

To examine self-reported undergraduate student perceptions of domestic violence content in their programs of study and student attitudes and beliefs about domestic violence.

DESIGN

A cross-sectional research design with online survey was employed from June to October 2017.

METHODS

Using convenience sampling, 1076 students were recruited to the study from a total population sample of just over 6000 undergraduate nursing and midwifery students; a response rate of 17.9%. Survey data reported the nature and frequency of teaching and learning along with student attitudes and beliefs about domestic violence. Open ended responses were examined via thematic analysis.

SETTINGS

Nine Australian universities offering undergraduate nursing and midwifery degrees.

PARTICIPANTS

Undergraduate university nursing and midwifery students.

RESULTS

Over half of students surveyed (53.7%, n = 578) reported that domestic violence was not addressed in their program of study. A direct correlation was found between students' perceived preparedness to assess and respond to domestic violence, and the amount of taught content in their program of study.

CONCLUSION

This major gap in curricula has significant implications for professional practice preparedness. Further research should focus on examining the reasons why quality domestic violence content is lacking in undergraduate nursing and midwifery programs and how prioritisation of domestic violence content can be improved.

Australian nursing and midwifery student beliefs and attitudes about domestic violence: A multi-site, cross-sectional study

Nurses and midwives have a professional responsibility to identify and provide effective care to those experiencing domestic violence. Pre-registration preparation may develop this capability. In order to inform curriculum development, this study explored Australian nursing and midwifery students' attitudes and beliefs about domestic violence. Data were collected between June and October 2017. Descriptive statistics were calculated and comparative analysis performed on independent variables. Thematic analysis was performed on open-ended qualitative responses. Participants included 1076 students from nine Australian universities. The majority were enrolled in nursing programs (88.4%), followed by midwifery (8.6%), and combined nursing/midwifery (2.4%) programs. There was no statistically significant difference in scores by year level across all subscales, suggesting there was no developmental change in beliefs and attitudes toward domestic violence over the course of study. Nursing students held views that were more violence-tolerant than midwifery students. Australian and Chinese-born males were more likely to refute that domestic violence is more common against women. Students had a limited understanding of domestic violence suggesting a critical need to address undergraduate nursing and midwifery curricula.