Research, education and capacity building priorities for violence, abuse and mental health in low- and middle-income countries: an international qualitative survey.

PURPOSE: Despite the World Health Organization and United Nations recognising violence, abuse and mental health as public health priorities, their intersection is under-studied in low- and middle-income countries (LMICs). International violence, abuse and mental health network (iVAMHN) members recognised the need to identify barriers and priorities to develop this field. METHODS: Informed by collaborative discussion between iVAMHN members, we conducted a pilot study using an online survey to identify research, education and capacity building priorities for violence, abuse and mental health in LMICs. We analysed free-text responses using thematic analysis. RESULTS: 35 senior (29%) and junior researchers (29%), non-government or voluntary sector staff (18%), health workers (11%), students (11%) and administrators (3%) completed the survey. Respondents worked in 24 LMICs, with 20% working in more than one country. Seventy-four percent of respondents worked in sub-Saharan Africa, 37% in Asia and smaller proportions in Latin America, Eastern Europe and the Middle East. Respondents described training, human resource, funding and sensitivity-related barriers to researching violence, abuse and mental health in LMICs and recommended a range of actions to build capacity, streamline research pathways, increase efficiency and foster collaborations and co-production. CONCLUSION: The intersection between violence, abuse and mental health in LMICs is a priority for individuals with a range of expertise across health, social care and the voluntary sector. There is interest in and support for building a strong network of parties engaged in research, service evaluation, training and education in this field. Networks like iVAMHN can act as hubs, bringing together diverse stakeholders for collaboration, co-production and mutually beneficial exchange of knowledge and skills.

Nurses' experiences of perceiving violence and abuse of women in Saudi Arabia: A phenomenological study.

AIM: To explore the practices, understanding, and experiences of nurses and nursing students about domestic violence and abuse in Saudi Arabia. BACKGROUND: Domestic violence and abuse is a well-known public health issue and a clear violation of human rights resulting in detrimental effects on women's health. INTRODUCTION: Societal and cultural barriers in Saudi Arabia limit women's rights and disclosure of violence within marriage and families, preventing access to health care and support. There are few reports of this phenomenon in Saudi Arabia. METHODS: We used a hermeneutic phenomenological approach to acquire in-depth insights into nurses' perceptions and experiences regarding domestic violence and abuse. Eighteen nurses and student nurses were recruited from Riyadh, Saudi Arabia, using convenience sampling. Data were gathered between October 2017 and February 2018 through in-depth semistructured interviews, organized using NVivo 12 and analyzed manually to identify consistent themes. This study adhered to the consolidated criteria for reporting qualitative research. FINDINGS: An overarching concept of "being disempowered" was identified, which was present at three levels: a lack of nurses' professional preparation, insufficient organizational structures and processes, and wider social and cultural components. CONCLUSION: This study provides an in-depth account of nurses' practices, understanding, and experiences of domestic violence and abuse, highlighting the sensitivity and difficulties of addressing the problem in hospitals across Saudi Arabia and potentially other similar countries. IMPLICATIONS: The study's findings will inform the development of nursing education and practice in Saudi Arabia, as well as pave the way toward formulating effective strategies with needed modifications in curriculum, organizations, policy, procedures, and laws.

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.

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.

Domestic violence and abuse: an exploration and evaluation of a domestic abuse nurse specialist role in acute health care services.

AIMS AND OBJECTIVES: The aim of this study was to explore the experiences of clinical staff in responding to disclosure of domestic violence and abuse, and to evaluate the effectiveness of training and support provided by a dedicated Domestic Abuse Nurse Specialist across one acute National Health Service Trust in the UK. BACKGROUND: The impact of domestic violence and abuse is well documented and is far reaching. Health care professionals have a key role to play in the effective identification and management of abuse across a range of settings. However, there is a paucity of evidence regarding the constituents of effective support for practitioners within wider nonemergency hospital-based services. DESIGN: A qualitative approach semi-structured interviews (n = 11) with clinical staff based in one acute care Trust in the UK. Interviews were informed by an interview guide and analysed using the Framework approach. FINDINGS: The organisation of the nurse specialist role facilitated a more cohesive approach to management at an organisational level with training and ongoing support identified as key facets of the role by practitioners. Time constraints were apparent in terms of staff training and this raises questions with regard to the status continuing professional development around domestic violence and abuse. CONCLUSIONS: Domestic violence and abuse continues to exert a significant and detrimental impact on the lives and health of those who encounter abuse. Health care services in the UK and globally are increasingly on the frontline in terms of identification and management of domestic violence and abuse. This is coupled with the growing recognition of the need for adequate support structures to be in place to facilitate practitioners in providing effective care for survivors of domestic violence and abuse. RELEVANCE TO CLINICAL PRACTICE: This study provides an approach to the expansion of existing models and one which has the potential for further exploration and application in similar settings.

Understanding management and support for domestic violence and abuse within emergency departments: A systematic literature review from 2000-2015.

AIMS AND OBJECTIVES: To identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of domestic violence and abuse who present at emergency department. BACKGROUND: Domestic violence and abuse is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. Emergency department is widely recognised as one healthcare facility where domestic violence and abuse survivors will often disclose domestic violence and abuse. In the UK, National Institute of Clinical Excellence produced guidelines in 2014 requiring all sectors of health care and those they work alongside to recognise support and manage survivors of domestic violence and abuse. Whilst there is an increasing body of research on domestic violence and abuse, limited synthesised work has been conducted in the context of domestic violence and abuse within emergency department. DESIGN: This review encompasses empirical studies conducted in emergency department for screening interventions, management and support for domestic violence and abuse patients including prevalence. This review included studies that included emergency department staff, emergency department service users and domestic violence and abuse survivors. METHODS: A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000-2015. RESULTS: From the 35 studies, four descriptive overarching themes were identified (i) prevalence of domestic violence and abuse in emergency department, (ii) use of domestic violence and abuse screening tools and emergency department interventions, (iii) current obstacles for staff working in emergency department and (iv) emergency department users and survivor perspectives. CONCLUSIONS: Having knowledgeable and supportive emergency department staff can have a positive benefit for the longer-term health of the domestic violence and abuse survivor who seeks help. The physical characteristics of domestic violence and abuse are often easier to identify and manage, but emotional and psychological aspects of domestic violence and abuse are often more complex and difficult for staff to identify. This therefore raises questions as to what approaches can be used, within these busy settings, when often survivors do not want to disclose. RELEVANCE TO CLINICAL PRACTICE: Domestic violence and abuse has been shown to have a direct impact on the health and well-being of survivors who will often access emergency department services with direct injuries and associated medical conditions. This article is relevant to those working in the emergency department in raising awareness in a number of areas of practice for example the prevalence of male intimate partner violence survivors. Furthermore, patients do not always disclose domestic violence and abuse even in cases where there is clear sustained injury thus requiring staff to be vigilant to repeat attendees and patient history. This requires a well-maintained and effective reporting system for instances of suspected and disclosed domestic violence and abuse in order that staff can provide the appropriate care and support. Emergency department staff often deal with complex cases, this includes different aspects of domestic violence and abuse including physical, emotional and psychological abuse. Continual support and guidance, including educational interventions, would assist emergency department clinical staff to manage and discuss instances of domestic violence and abuse in their workplace and their interactions with domestic violence and abuse patients. Whilst training for emergency department staff is welcomed, there also needs to be a greater awareness of the potential complexity of domestic violence and abuse presentations beyond physical injury in order for staff to remain observant throughout consultations. It is also suggested that clear domestic violence and abuse assessment and referral mechanisms should be embedded into clinical practice, including emergency department, as described in the UK National Institute of Clinical Excellence guidelines (2014). Overall improvements in reporting mechanisms in emergency department for the identification, management and support for domestic violence and abuse survivors would add to the collective and growing body of evidence surrounding domestic violence and abuse and their presentations within healthcare settings. Such measures would enable those working in emergency department to support disclosure of domestic violence and abuse more effectively.

Older women, intimate partner violence and mental health: a consideration of the particular issues for health and healthcare practice.

AIMS AND OBJECTIVES: To explore qualitative evidence in older women with a history of intimate partner violence and their accounts and experiences of mental health. BACKGROUND: Intimate partner violence significantly impacts the health and well-being of women who experience it. However, women who experience intimate partner violence do not form a homogenous group and the effect on older women has not been adequately distinguished. While there is a growing body of evidence to address this deficit, studies to date have tended to concentrate on older women's experiences of intimate partner violence in totality and as such mental health issues have been subsumed as a part of the whole. DESIGN: Meta-ethnographic synthesis of qualitative evidence. METHODS: A systematic search of PUBMED, Cumulative Index to Nursing and Allied Health Literature, COCHRANE, Medline and PsycInfo, Sci was completed. The search included articles published up until the end of December 2015. RESULTS: The review identified that intimate partner violence exerts a significant impact on the mental health of older women. Intimate partner violence for women in later life is inherently complex, especially where the boundaries of violence and vulnerability have been blurred historically both within the intimate partner violence discourse and through provision and practice. CONCLUSIONS: This study adds to the developing knowledge and understanding of intimate partner violence for older women as a part of the growing body of evidence of the impact of intimate partner violence on the health and well-being of those who experience abuse more generally. When age and gender intersect with intimate partner violence, there are specific implications and health professionals and service providers need to be aware of these. RELEVANCE TO CLINICAL PRACTICE: urses and healthcare professionals are professionally accountable for the effective management and support of women who have experienced abuse. It is therefore crucial that they are able to understand and identify the possible complexity of presentations of abuse and this includes older women.

Identifying signs of intimate partner violence.

Intimate partner violence is a major public health and social problem that affects people everywhere. Nurses can play an important role in identifying victims who present to healthcare settings with domestic abuse-related health issues. Evidence suggests that most women who present to emergency departments have experienced domestic abuse at some point in their lives, but that only 5% are identified by healthcare professionals. To identify and respond to victims effectively, emergency nurses must understand domestic abuse and its associated complexities. This article provides an overview of these issues, including the different types of abuse, and their prevalence, causes and effects on health. The article also explores how emergency nurses can identify and manage the effects of violence at work.

Exploring the effects of emergency department crowding on emergency nurses.

Although the phenomenon of crowding in emergency departments (EDs) is not new, it remains a significant problem for patients, ED staff and the wider healthcare system. Crowding in EDs, which is also called overcrowding, has been widely explored in the literature, but there are relatively few studies of the subject from an emergency nurse perspective. This article reports the findings of a literature review that aimed to explore the effects of crowding on nurses working in EDs. Four key themes were identified from a synthesis of 16 articles included in the review: staffing and skill mix; inadequate care and the effect on nurses' well-being and stress levels; violence in the ED; and hospital metrics and patient flow. Further research is required to explore in more depth the effects of ED crowding on emergency nurses and to address the multiple factors that perpetuate the phenomenon.

Corrigendum: Experiences of healthcare staff in forensic care facilities supporting sexual violence survivors, in Tshwane, South Africa.

No abstract available.

Corrigendum: Accessing care services after sexual violence: A systematic review exploring experiences of women in South Africa.

No abstract available.

Developing a new post for nurses to identify cases of domestic abuse.

Nurses working in emergency departments (EDs) need specialist training to identify and respond appropriately to patients who have experienced domestic abuse (Gibbons 2011). This article describes the development of a domestic abuse nurse specialist role in an ED, a training programme for new ED staff and relevant resources for patients. It also outlines the results of an evaluation of the role and makes recommendations for service development.

Experiences of healthcare staff in forensic care facilities supporting sexual violence survivors, in Tshwane, South Africa.

BACKGROUND:  Sexual violence is a persisting global epidemic that is constantly increasing on a large scale. The rate of sexual violence in South Africa is one of the highest in the world; and it has been reported to appear socially normalised and acceptable. OBJECTIVES:  The study aimed to explore and describe the experiences of healthcare staff working in forensic care centres (FCCs) in Tshwane, South Africa. METHOD:  A qualitative approach was followed incorporating focus group interviews with a range of healthcare staff based in the two FCCs. Non-probability purposive sampling was done. Data analysis was informed by the Analytic Hierarchy Model which comprised of three steps: data management, descriptive accounts and developing explanatory accounts. RESULTS:  Three main themes emerged as, (1) help them to do away with the idea of self-blame: everyday work; (2) barriers to the accessibility of care: seeking alternative traditional remedies (muti) from traditional healers and working in an unconducive environment and (3) compassionately sick at times: Emotional impact of forensic care work. CONCLUSION:  The findings revealed that the healthcare staff are often working in difficult circumstances and that both professional and societal factors mediate against the provision of care and support for survivors. Greater attention is needed both in terms of service development and wider challenges to pervading societal norms surrounding violence against women.Contribution: The study highlighted the need for training, improved management support and debriefing sessions.

Accessing care services after sexual violence: A systematic review exploring experiences of women in South Africa.

BACKGROUND:  Sexual violence against women is a global phenomenon. This is a particular issue in South Africa, where it is estimated with evidence provided that up to half of all women will encounter gender-based and/or sexual violence from a partner during their lifetime. Therefore, evidence suggests that addressing the needs of women in South Africa is a priority. OBJECTIVE:  This qualitative review aimed to explore the experiences of women seeking care from first contact healthcare facilities in South Africa after sexual violence and during follow-up care. METHOD:  This systematic review was conducted using the PRISMA checklist for systematic reviews and in line with a published protocol (PROSPERO, CRD42019121580) and searched six relevant databases in 2022. A total of 299 sources were screened, with 5 forming the overall synthesis. RESULTS:  Two synthesised themes of women's experiences emerged at the time of reporting and during attendance at follow-up healthcare services. CONCLUSION:  South Africa does have an established legal framework for prosecution and can provide support for survivors of sexual violence through established Thuthuzela Care Centres (TCCs). The review identifies that survivors' needs are not clearly established when seeking medical attention initially nor identifying support or appropriate pathways.Contribution: The review has the potential to characterise the support available for women, the type and nature of sexual violence and interventions that may be used by healthcare professionals to support survivors especially during follow-up care.

Reflexivity and habitus: opportunities and constraints on transformative learning.

This paper will explore the relationship between Mezirow's concept of reflexivity and Bourdieu's theory of habitus in order to develop a more robust framework within which critical reflection can take place. Nurse educators have sought to close the theory practice gap through the use of critical reflection. However, we are not convinced that this has produced the depth and quality of reflection required. Furthermore, the contexts in which critical reflection takes place is often sidelined or erased so that the whole impetus in the literature is to educate nurses in reflection rather than empower nurses to understand the complex circumstances and barriers that obstruct critical reflection. This paper argues that the reason for this position is that nurse education does not always acknowledge the role that personal and cultural values systems have on reflective practices. The literature search was undertaken using CINHAL and MEDLINE. Keywords included: values systems, habitus, and critical reflection. Inclusion criteria were determined by the theoretical approach and included seminal texts, from as far back as 1956, to identify key themes. Although critical reflection is a potentially powerful way of enhancing care it has often failed to do so. It is suggested that this is because nurse educators have frequently used models of reflection without considering the impact that student's personal values systems has on their perceptions of care and subsequently care delivery. The purpose of this paper is to promote deeper levels of reflection and is part of a programme of research aimed at developing a more robust approach to reflection in educational practice.

Improved safeguarding of older people through inter-agency learning.

Elder abuse remains a significant problem nationally and globally. Early definitions of abuse, however, oversimplified the phenomena and while the complexity of elder abuse, in nature and scale, has also been growing recently there remains some confusion conceptually and in practice in terms of what is meant by and can be identified as abusive practice. The lack of conceptual clarity is evident across professional and agency boundaries. The authors suggest that a potential way forward is through the development of interprofessional learning as an integral part of education and training in respect of safeguarding older adults. This article highlights a number of complexities in the context of safeguarding and raises areas for further reflection and possible debate.

Creativity and Connection: The Impact of inspirED with Secondary School Students.

The World Economic Forum predicts that the skills most highly valued by employers in 2025 will be problem-solving, self-management, working with people, and technology use and development. Educators are seeking ways in which to incorporate these skills into their daily instruction. Here, we offer one possible approach to bolster skills in each of these domains: the inspirED program. inspirED was designed for U.S. middle and high schools to support teams of students in completing projects or campaigns that they believe will make their school a better place for all. This study enrolled teams of students from 22 middle and high schools, and provided them with online training, coaching in the inspirED process, and resources to complete their project. Upon finishing their projects, students on the inspirED teams reported higher sense of purpose and self-awareness around the importance of emotions. The larger student bodies at schools in which inspirED projects took place also reported improvements in school climate including students' perceptions of teaching quality, sense of school pride, student relationships, and emotional safety. Implications and future directions for school-based social-emotional learning and student leadership opportunities are discussed.

Spousal Role Expectations and Marital Conflict: Perspectives of Men and Women.

Intimate partner violence (IPV) affects millions of people across the world and is associated with a significant impact on physical and mental health of the victim. IPV often takes place within the context of marriage, where gender role expectations can play an important part in shaping attitudes towards it. While there is much research carried out to understand the phenomenon of IPV, little relates to how a husband and wife's accounts of spousal role expectations of each other contribute to marital conflict. The issue of IPV within marriage is highly sensitive, particularly in a patriarchy such as Pakistan. The aim of this unique study was to explore the perspective of Pakistani men and women about a husband and wife's role expectations and how fulfillment of such spousal role expectations impacts on marital conflict, and thereby IPV. Using the community setting, data for this qualitative study were collected through 41 individual interviews, including 20 from Pakistan and 21 from the UK. The findings are presented in two main themes, each containing two subthemes. The theme "provider and protector" relates to the role expectations from a husband, whereas "caretaker and household manager" relates to the role expectations of a wife. Overall, husbands and wives have numerous expectations of each other, and these expectations are shaped by gender role attitudes alongside cultural and societal norms. Unmet expectations and deviation of behavior from the perceived norms can result in the development of marital conflict which can escalate to IPV. The significance of this study lies in understanding spousal role expectations from the perspectives of husbands and wives and how unmet expectations contribute to marital conflict and IPV is important for health care professionals within family health contexts. This article provides a detailed insight of this largely hidden phenomena.

Silent Voices: Exploring Narratives of Women's Experiences of Health Care Professional Responses to Domestic Violence and Abuse.

The impact of domestic violence and abuse (DVA) is far reaching not least in terms of both the immediate and longer term physical and mental wellbeing of those who have experienced abuse. DVA also exerts a considerable detrimental impact on the wider family including children. While professional perspectives of working with DVA survivors is increasingly well documented, there remains a paucity of accounts of encounters with healthcare services and/or healthcare professionals from survivors of DVA themselves. A central aim of this study was the exploration of women's experiences of healthcare encounters told purely as personal narrative rather than framed in more traditional research terms. The focus of this paper therefore is unedited personal stories of encounters with healthcare professionals. The position of narrative as research method and the presentation of narratives in this particular instance are also considered.