Confidence and connectedness: Indigenous Maori women's views on personal safety in the context of intimate partner violence.

Maori (New Zealand) women, similar to women belonging to Indigenous and minority groups globally, have high levels of lifetime abuse, assault, and homicide, and are over-represented in events that compromise their safety. We sought insights into how Maori women view safety. Twenty Maori women's narratives revealed safety as a holistic concept involving a number of different elements. We found women had developed an acute sense of the concept of safety. They had firm views and clear strategies to maintain their own safety and that of their female family and friends. These women also provided insights into their experiences of feeling unsafe.

Women's lived experiences of domestic violence during pregnancy (2).

This paper is a follow up paper to a study which explored women's experiences of domestic violence before, during and after pregnancy. Findings from this study suggested that women would like midwives to be able to recognise the signs of domestic violence and to be able to offer them an appropriate response and support. Midwives are well placed to recognise the signs of domestic violence and provide appropriate support. This paper addresses some of the challenges and dilemmas for midwives when identifying and supporting women who have experienced domestic violence and provides some key messages for midwifery practice.

Pay Now or Pay Later: An Economic Rationale for State-Funded Helping Services to Assist Women Leaving an Abusive Relationship.

There has been an increase in costing analysis of intimate partner violence in recent decades, including the monetary impact to government, society, and the individual. Using data collected in a Canadian longitudinal study, the empirical analysis in this article provides an economic rationale for mobilizing public resources that improve the well-being of women leaving an abusive relationship. I estimated six variants of a selection model and used a costing exercise to build an economic case for preventive and other helping services to support women over their healing journey. The removal of financial constraints suffered by abused women, in support of their training needs, as well as reduced barriers to preventive health care services, may potentially lead to fiscal resource savings in the long run.

Emotional distress and sense of coherence in women completing a motivational program in five countries. A prospective study.

PURPOSE: The purpose of this paper is to investigate changes in, and associations between, sense of coherence (SOC) and emotional distress in women who participated in an accredited motivational program (VINN) in correctional institutions in five countries. DESIGN/METHODOLOGY/APPROACH: A prospective study with a pre- and post-test design included 316 participants from Sweden, Estonia, Denmark, Russia and Norway. Global emotional distress was measured by the Hospital Anxiety and Depression Scale. SOC was measured using the 13-item Orientation to Life Questionnaire. One-way analysis of variance and multilevel regression models were used in the statistical analyses. FINDINGS: An increase in SOC was associated with a decrease in emotional distress. Emotional distress decreased significantly -3.80 points (95 percent CI (-4.61, -2.97)), and SOC significantly improved from pre- to post-measurement by 1.82 points (95 percent CI (0.72, 2.92)), regardless of country and correctional institution. Practical implications - The results add new knowledge regarding a coherent theoretical foundation of a motivational program for women. The ability of a program promoting health is important for researchers, health-care workers and facilitators delivering programs for women in correctional facilities. An increase in SOC can act as a protective factor in order to manage stressors and risk factors among women serving in correctional facilities. ORIGINALITY/VALUE: The present study indicates that enhancing women's coping resources and providing income alternatives to crime is fundamental to their capacity to desist from criminal behavior.

From Blue to Green: The Development and Implementation of a Therapeutic Horticulture Program for Residents of a Battered Women's Shelter.

The delivery of therapeutic services to clients is influenced by service providers' understanding of the "fit" of a specific program with their service mandate as well as their perceptions of the potential benefits of the program. This article discusses the development and implementation of a therapeutic horticulture (TH) program at a battered women's shelter that serves 17 counties in Central Kentucky. Through semistructured interviews, we gauge the shelter staff's perceptions of the relationship of the TH program to the shelter's overall mission; their sense of the program's benefits for residents, for the shelter as a community organization, and for themselves; and their concerns about the TH program. We consider how these findings may impact future programming at the shelter, and we discuss plans for further evaluation of the TH program in terms of its impact on shelter residents' long-term outcomes.

Promoting successful collaborations between domestic violence and substance abuse treatment service sectors: a review of the literature.

Women who experience intimate partner violence (IPV) victimization are more likely to struggle with substance abuse problems than are women who do not experience IPV. Given the connection between IPV victimization and substance abuse, recommended practices urge collaboration between domestic violence service agencies and substance abuse treatment agencies to provide comprehensive services for women with these co-occurring problems. However, domestic violence and substance abuse services have unique histories of development that have led to distinct ways of service delivery. To promote successful collaborations, service providers and researchers are developing strategies to foster relationships across the two service sectors. The authors conducted a review of this emerging body of knowledge with the aim of assembling recommendations for strategies to foster collaboration between domestic violence and substance abuse services. The authors identified 15 documents for review inclusion and our analysis established 5 categories of documents. Findings yield key collaboration strategies and recommended service models. In addition, the review determined the existence of considerable challenges to promoting collaborative relationships between domestic violence and substance abuse treatment service sectors.

Suicide attempts and overdoses among adults entering addictions treatment: comparing correlates in a U.S. National Study.

BACKGROUND: Suicide attempts and non-fatal overdoses are both associated with substance use. The aim of the present study was to examine correlates of suicide attempts and non-fatal overdoses simultaneously among individuals seeking addictions treatment. METHODS: A large U.S. national sample of individuals entering addictions treatment participated in a cross-sectional survey (n=5892). Multinomial logistic regression modeling tested the adjusted associations of violence, injection drug use, specific substances, and depressive symptoms with a four-category outcome variable based on prior histories of suicide attempt and non-fatal overdose (neither, suicide attempt only, overdose only, both), adjusting for demographic and treatment characteristics. RESULTS: Sexual and physical victimization was associated with suicide attempts with or without overdoses (ORs 1.25-2.84), while perpetrating violence was associated with having experienced either or both outcomes (ORs 1.25-1.56). Depressive symptoms had a stronger association with suicide attempts (OR=3.05) than overdoses (OR=1.29). Injection drug use was associated with overdoses with or without suicide attempts (ORs 2.65-3.22). Individuals seeking treatment for marijuana use were less likely have overdosed or attempted suicide (ORs 0.39-0.67), while individuals seeking treatment for heroin use were more likely to have overdosed (OR=1.46). Seeking treatment for use of more than one substance was associated with overdose and overdose and suicide attempt (ORs 1.58-2.51), but not suicide attempt alone. CONCLUSIONS: The present findings indicate that suicide and overdose are connected yet distinct problems. Individuals who have had a history of both may be a group with particularly poor psychological functioning as well as more severe drug-related problems.

The health care costs of violence against women.

The aim of this study is to analyze the health care costs of violence against women. For the study, we used a register-based approach where we identified victims of violence and assessed their actual health care costs at individual level in a bottom-up analysis. Furthermore, we identified a reference population. We computed the attributable costs, that is, the excess health care costs for victims compared to an identified reference population of nonvictims. Only costs within the health care sector were included, that is, somatic and psychiatric hospital costs, costs within the primary health care sector and costs of prescription pharmaceuticals. We estimated the attributable health care costs of violence against women in Denmark, using a generalized linear model where health care costs were modeled as a function of age, childbirth, and exposure to violence. In addition we tested whether socioeconomic status, multiple episodes of violence, and psychiatric contacts had any impact on health care costs. We found that the health care costs were about €1,800 higher for victims of violence than for nonvictims per year, driven mostly by higher psychiatric costs and multiple episodes of violence.

What causes domestic abuse and how can nurses effectively support abused women?

Domestic abuse is a significant public health problem in the UK, primarily perpetrated against women. Nurses can play a vital role in identifying patients who have experienced abuse, and in offering them emotional, psychological and practical support. This article explores the causes of domestic abuse, and nurses' role in caring for those affected. It emphasises the need for enhanced nurse education and awareness to enable nurses to provide holistic care for women.

Use of complementary and alternative medicines by a sample of Turkish women for infertility enhancement: a descriptive study.

BACKGROUND: Infertility patients are a vulnerable group that often seeks a non-medical solution for their failure to conceive. World-wide, women use CAM for productive health, but only a limited number of studies report on CAM use to enhance fertility. Little is known about traditional and religious forms of therapies that are used in relation to conventional medicine in Turkey. We investigated the prevalence and types of complementary and alternative medicine (CAM) used by infertile Turkish women for fertility enhancement. METHODS: A face-to-face questionnaire inquiring demographic information and types of CAM used for fertility enhancement were completed by hundred infertility patients admitted to a primary care family planning centre in Van, Turkey between January and July 2009. RESULTS: The vast majority of infertile women had used CAM at least once for infertility. CAM use included religious interventions, herbal products and recommendations of traditional "hodja's" (faith healers). Of these women, 87.8% were abused in the last 12 months, 36.6% felt not being supported by her partner and 80.5% had never spoken with a physician about CAM. CONCLUSIONS: Infertile Turkish women use complementary medicine frequently for fertility enhancement and are in need of information about CAM. Religious and traditional therapies are used as an adjunct to, rather than a substitute for, conventional medical therapy. Physicians need to approach fertility patients with sensitivity and should be able to council their patients about CAM accordingly.

Identifying abuse among women: use of clinical guidelines by nurses and midwives.

AIM: This aim of this study to identify the incidence of violence against women seeking healthcare services and evaluate the use of clinical guidelines to identify interpersonal violence. METHODS: A cross-sectional survey was carried out. Data were collected over a period of 7 months in 2005 and 2006. The samples consisted of 14 nurses, 10 midwives and 208 women in Iceland (101 women visiting the Emergency Department and 107 receiving prenatal care at the High Risk Prenatal Care Clinic). RESULTS: Twenty women (19.6%) who visited the Emergency Department and 21 women (19.8%) who came to the High Risk Prenatal Care Clinic had been sexually abused at some point in their lives by close family members. Within the preceding 12 months, 18 women at the Emergency Department (19.1%) and eight at the High Risk Prenatal Care Clinic (7.5%) reported physical abuse, and 22 women (22.2%) at the Emergency Department and 12 (11.5%) at the High Risk Prenatal Care Clinic reported emotional abuse. A majority of the nurses and midwives indicated that the guidelines were efficient for assessing/screening for gender violence in emergency and high risk clinical settings. CONCLUSION: Screening for abuse of women at emergency and high risk clinics is crucial, not only to offer the women the immediate interventions they might need, but also to ensure the future provision of appropriate healthcare services.

Substance abuse by men in partner abuse intervention programs: current issues and promising trends.

This article discusses key studies linking intervention for co-occurring substance abuse and partner abuse. Findings are grouped into three areas: (a) the effect of addictions treatment on partner violence; (b) application of transtheoretical, motivational, and culturally focused approaches to improve engagement and prevent attrition; and (c) assessment-based matching of services. Finally, the relative value of serial, coordinated, and integrated substance abuse programs and partner abuse intervention programs are considered. We reached three primary conclusions: (a) Addiction treatment alone reduces the risk for future domestic violence in a subset of men who batter, (b) screening and assessment for substance abuse by all men in partner abuse intervention programs is a standard of practice but needs to extend beyond "intake" and occur periodically, and (c) coordinated and integrated substance abuse and domestic violence programs probably offer more safety than traditional serial substance abuse treatment followed by partner abuse intervention.

Effects of coordinated services for drug-abusing women who are victims of intimate partner violence.

This article summarizes outcomes from a demonstration project on collaboration between substance abuse and domestic violence agencies. Researchers recruited women seeking services for substance abuse or intimate partner violence at 1 of 6 participating agencies. Admitted women were both victims of domestic violence and abusing alcohol or drugs. Following an initial screening, participants were interviewed at program entry (n = 255) and again 4 to 6 months later (n = 128, 50%). Key outcomes were the number of days substances were used in the past 30 days, women's perceptions of harm from battering, and domestic violence self-efficacy. Results suggest participants used substances less frequently and experienced themselves as more efficacious following services, but they were also more fearful of the consequences of domestic violence. Repeated-measures MANOVA found that substance abuse days and domestic violence self-efficacy significantly contributed to the multivariate function. Implications for services for women with co-occurring substance abuse and domestic violence victimization are discussed.

The importance of spirituality in the lives of domestic violence survivors.

Women with abusive partners utilize a variety of coping strategies to deal with and heal from the violence and sense of betrayal they have experienced. For many women, their trust in a higher power and the support they receive from their faith community is integral to their healing. Of 151 women interviewed for this study, the majority (97%) noted that spirituality or God was a source of strength or comfort for them. Extent of religious involvement predicted increased psychological well-being and decreased depression. For women of color, greater religious involvement was also related to increased social support. Implications for research and direct services are discussed.

Resiliencia, espiritualidad, aflicción y tácticas de resolución de conflictos en mujeres Maltratadas / Resilience, spirituality, distress and tactics for battered women's conflict resolution

OBJETIVO: Determinar relación de resiliencia y espiritualidad en mujeres maltratadas, con la aflicción, la frecuencia e intensidad del maltrato y la severidad de las lesiones recibidas. MATERIAL Y MÉTODOS: Muestra de 199 mujeres consultantes en Comisarías de Familia de Medellín, Colombia. Se utilizan escalas de Resiliencia, Perspectiva Espiritual, Listado de síntomas de distrés y Tácticas de conflictos. Se realizó análisis de consistencia interna, correlación y análisis de componentes principales de carácter exploratorio. RESULTADOS: Las escalas mostraron consistencia interna. La resiliencia mostró correlación con la espiritualidad (r=0.22, p=0.0015) y negativamente con el total de síntomas positivos de aflicción (PST) (r=-0.39, p=<0.0001), el índice global de severidad (GSI) (r=-0.30, p=<0.0001) y las 9 dimensiones de síntomas de la SCL-90R. CONCLUSIONES: Los instrumentos utilizados son confiables y validos para medir las variables analizadas. Mujeres con más altos niveles de resiliencia reportaron altos niveles de espiritualidad y menor número de síntomas positivos de aflicción y menos aflicción.

[Resilience, spirituality, distress and tactics for battered women's conflict resolution]. / Resiliencia, espiritualidad, aflicción y tácticas de resolución de conflictos en mujeres maltratadas.

OBJECTIVE: Determining the relationship of resilience and spirituality in battered women to distress, the frequency and intensity of mistreatment and the severity of injury. MATERIALS AND METHODS: A sample was taken of 199 women who consulted Comisarías de Familia de Medellín, Colombia (family police/counselling stations). Resilience scales (RS), spiritual perspective (SPS), SCL-90R and conflict tactics (CTS) were used. Internal consistency, correlation and main exploratory components were measured. RESULTS: The scales revealed internal consistency. Resilience was positively correlated to spirituality (r = 0.22; p = 0.0015) and negatively correlated to total positive distress symptoms (PST) (r = -0.39; p < 0.0001), the global severity index (GSI) (r = -0.30; p = < 0.0001) and 9 dimensions of symptoms from SCL-90R. CONCLUSIONS: The scales used were reliable and valid for measuring the variables being studied. Women with higher levels of resilience reported high levels of spirituality, a lower number of positive distress symptoms and less distress.

[The midwives' experiences in the identification of battered women in pregnancy]. / Experiencia de las parteras en la identificación de mujeres maltratadas durante el embarazo.

OBJECTIVE: To explore the experiences of midwives in the identification of battered women during pregnancy and to describe the types of violence they identify most easily. MATERIAL AND METHODS: A qualitative study was conducted between January and September 2001 among twelve midwives from a group of midwives ascribed to the Instituto Nacional de Antropología e Historia (INAH, National Institute of Anthropology and History), in Morelos, Mexico. Participants were selected from those living in Cuernavaca City and surrounding areas. RESULTS: Study findings show that: a) the identification of battered pregnant women in prenatal care should be triggered by a pattern of behaviors and attitudes of battered women, such as being unkempt, shyness, and above all, poor control over decisions on their health care; b) physical and emotional violence were the most frequently types of violence identified by midwives during prenatal care visits. Sexual violence was more difficult to identify. CONCLUSIONS: It is necessary to incorporate midwives in the national plans and programs to prevent domestic violence. Midwives' practices provide opportunities to care for battered women. Specialized training strategies must be directed to midwives caring for pregnant women in Mexico.

Experiencia de las parteras en la identificación de mujeres maltratadas durante el embarazo / The midwives' experiences in the identification of battered women in pregnancy

OBJETIVO: Explorar las experiencias de las parteras en la detección de mujeres maltratadas durante el embarazo, además de conocer los tipos de violencia que identifican con mayor facilidad. MATERIAL Y MÉTODOS: Estudio cualitativo en donde se entrevistó, entre enero y septiembre de 2001, a 12 parteras que forman parte del grupo de parteras del Instituto Nacional de Antropología e Historia de Morelos, México. Se hizo una selección de aquellas que se ubicaban en Cuernavaca y sus alrededores. RESULTADOS: Se reporta: a) el proceso de identificación de violencia realizado por las parteras en la atención prenatal, el cual se basa en un patrón de conductas y actitudes de las mujeres maltratadas tales como descuido en su persona, timidez y, sobre todo, una falta de control en las decisiones sobre el cuidado a su salud, lo cual permite a las parteras hacer preguntas directas sobre violencia; b) las violencias que identifican las parteras con mayor facilidad son la física y la emocional. La violencia sexual fue más difícil para su identificación de manera directa. CONCLUSIONES: Incluir a las parteras dentro de los planes y programas para atender a la violencia intrafamiliar, debido a que su práctica permite una respuesta de apoyo directo a las mujeres maltratadas que lo solicitan. Se propone desarrollar estrategias de capacitación especializada para esta población que atiende a un sector importante de mujeres embarazadas en México.

Synergy in practice: caring for victims of intimate partner violence.

Intimate partner violence (IPV) is a significantly prevalent health issue that creates devastating effects for victims, their families, and the community IPV extends across social, religious, economical, geographical, and cultural groups. IPV has public health implications that affect current victims and may impact future generations. While all people are at risk for IPV, women are 5 times more likely to be victimized. Despite all of the literature regarding IPV, there is still a compliance issue regarding screening for IPV in health care settings. Utilizing the Synergy Model of Nursing Practice, this article demonstrates the care of victims of IPV by the clinical nurse specialist. The Synergy Model framework is described, and correlated with IPV The clinical nurse specialist plays a unique role that can improve patient outcomes through many domains including expert clinical practice, role modeling, education, global systems thinking, research, consultation, and holistic approaches to care. Current state of the science practice techniques and barriers to screening are discussed. The summary highlights suggestions for future research.