Trauma- and Violence-Informed Empowering Care for Sexual Assault Survivors.

BACKGROUND: Forensic nurse examiners, including sexual assault nurse examiners, provide care for survivors holistically through healthcare, emotional support, connection to follow-up care, safety planning, and, if desired, evidence collection to aid in the prosecution of sexual assault. There is increasing recognition that trauma-informed care must also include an understanding of the impacts of structural violence on minoritized patients to ensure health equity. AIM: To help address this guidance gap, we expanded Campbell and colleagues' empowering care model using a trauma- and violence-informed care (TVIC) lens. METHODS: We used an iterative discussion-based process that included five joint meetings between a seven-member transdisciplinary research team and a five-member nurse advisory board. RESULTS: In a TVIC-informed empowering care model, we propose behavioral examples for forensic nurses for each of Campbell et al.'s five key domains of empowering care for forensic nurse examinations (i.e., build rapport and establish trust, show compassion, provide patient-directed care, convey professionalism, and provide resource referral and follow-up). CONCLUSIONS: These behavioral examples for nurses can help guide forensic nurse training and practice to reduce disparities in treatment and follow-up support. Structures and systems are needed that enable forensic nurses to provide trauma- and violence-informed empowering care to survivors of sexual assault and, over time, increase the accessibility of forensic nurse examinations and improve patient outcomes.

Intimate partner violence in the lives of Indigenous and Black women in the upper Midwest of the United States during the COVID-19 pandemic: A mixed-methods protocol examining help-seeking behaviours and experiences.

Violent behaviour perpetrated against women has long-lasting negative physical and mental health consequences for women, their children, their families, and their communities. Intimate partner violence (IPV) is associated with many adverse physical, psychological, and emotional consequences. Structural racism and historical trauma affect women's trust and further hinder the ability of Indigenous and Black women to seek help after experiencing IPV. The availability of IPV support services, which can include shelter, food, group therapy, legal assistance, and advocacy, can be inaccessible to women due to the inability to access often limited resources in urban environments and reasons compounded by potential geographic distance if living in rural areas or living in community. Understanding the unique reasons why Indigenous and Black women do not seek help, and the barriers they experience when seeking help after IPV, is critical. Pandemics have the potential to create further complexities on how IPV is experienced. Black and Indigenous women experiencing IPV were therefore at even greater risk for IPV-related harm because of state and local "stay at home" measures put in place to minimise the spread COVID-19. The purpose of this manuscript is to explicate the methods for a large R01 study in the Upper Midwest.

Social Cognitive Theory-Based Interventions to Address Interpersonal Violence Among Hispanic Youth-A Systematic Review.

Introduction: The prevalence of interpersonal violence among Hispanic youth is high and effective interventions are sparse yet needed to prevent and address interpersonal violence. Theory-based interventions are crucial for creating robust interventions for public health concerns, such as interpersonal violence. Methods: In our systematic literature review, we sought to examine social cognitive theory (SCT)-based Interventions addressing interpersonal violence among Hispanic youth. Searching in both English and Spanish, we used the search engines, PubMed, Google Scholar, CINAHL, Web of Science, and Lilacs, and restricted the years to 2010-2022. Results: Self-efficacy and normative beliefs were the two most commonly addressed SCT constructs in the interventions. SCT-based interventions were found to increase confidence in not engaging in negative behaviors and improve coping skills. Moreover, within the context of implementing SCT-based interventions, school-based interventions and Participatory Action Research, were foundational to the SCT-based interventions. Conclusion: Overall, SCT-based interventions were found to be effective in interpersonal violence mitigation and reduction among Hispanic youths. There was a synergistic effect between the number of SCT constructs incorporated in an intervention and the positive results of the intervention. Thus, future studies are both needed and should robustly incorporate SCT constructs to yield the best possible outcomes.

Experiences of dehumanizing: Examining secondary victimization within the nurse-patient relationship among African American women survivors of sexual assault in the Upper Midwest.

Despite calls recognizing the need for culturally sensitive responses to minimize the occurrence of secondary victimization for African American women following an experience of sexual assault, few studies have focused on hearing from African American women survivors about their experiences receiving healthcare services in a hospital setting following sexual assault. Employing critical ethnography as our methodology and using intersectionality theory as a lens, we centered the voices of African American women survivors about their experiences receiving nursing care in urban acute care or hospital settings in the Upper Midwest of the United States following sexual assault. In this qualitative study, 30 African American women survivors were interviewed using in-depth, semi-structured interviews about their post-sexual assault care. Interviews were analyzed using thematic analysis. An important theme identified focused on survivors' experiences of dehumanization when receiving healthcare services following sexual assault. These experiences included: discrediting, dismissing, shaming, and blaming. To mitigate and prevent secondary victimization in the future, we present practice and education change recommendations for nurses, and healthcare providers more broadly, based on the voices of African American female survivors of sexual assault.

The impact of the COVID-19 pandemic on help-seeking behaviours of Indigenous and Black women experiencing intimate partner violence in the United States.

AIMS: This article discusses possible barriers to help-seeking that Indigenous and Black women encountered when seeking help related to experiences of intimate partner violence during the COVID-19 pandemic. DESIGN: This article is focused on understanding the impact of the COVID-19 pandemic on populations at highest risk for intimate partner violence in its most severe forms. DATA SOURCES: Literature sources range from 2010 to 2022. The article is also informed by the experiences of scholars and advocates working with Indigenous and Black women experiencing intimate partner violence in Wisconsin. In our write-up, we draw on Indigenous feminism and Black feminist thought. IMPLICATIONS FOR NURSING: Help seeking is contextual. The context in which help seeking occurs or does not occur for Indigenous and Black women, due to the barriers we discuss is vital for nurses to understand in order to provide efficient and meaningful nursing care. CONCLUSION: Our goal is to center the nursing profession in a leadership position in addressing the complex and unique needs of Indigenous and Black women who experience the highest rates of intimate partner violence and also experience the greatest barriers to care and support. IMPACT: We seek to contribute theory-driven knowledge that informs the work of nurses who are often the first to encounter survivors of intimate partner violence within the clinical setting. Help-seeking is often hindered by factors such as geographic and jurisdictional, economic, and structural response barriers. This knowledge will enhance nurses' ability to lead and advocate for clinical practice and policies that minimize the barriers women experience following intimate partner violence, especially during pandemics, disasters, and other extraordinary circumstances. PUBLIC CONTRIBUTIONS: This article is based on the collaboration of community advocates, nurse scientists, and public health scholars, who work closely with Indigenous and Black survivors of violence and seek to meet their needs and offer them meaningful support.

Centering Our Voices: Experiences of Violence Among Homeless African American Women.

Women experiencing homelessness who are also survivors of violence require uniquely tailored programs to accommodate complex needs. To understand how violence shaped the lives of formerly homeless African American women, an instrumental case study design and community-based participatory research approach was utilized in this qualitative study. Focus group interviews with graduates (N = 40) from a long-term transitional housing program were conducted. Using thematic analysis, identified themes included: cycles of violence, violence in the community, relationships with children, and coping with violence. These themes illustrated survivors' growth through supportive programming and highlighted services dedicated to empowering women who have experienced violence.

Application of Postcolonial Feminist Theory, Chicana Feminist Thought, and Black Feminist Thought in Analyzing the Mental Health Needs of Latina Migrant Farmworkers: A Shared Legacy.

The purpose of this theoretical article is to analyze the utility of postcolonial, Black, and Chicana feminist frameworks to inform nursing research and practice specific to mental health needs of Latina women migrant farmworkers. Twentieth-century Western feminist narratives overlooked the intersecting systems of oppression experienced by women of color, including Latina women. Feminist epistemologies are useful in understanding the complex sociopolitical contexts that have impacted women's health outcomes and well-being. This analysis is critical to shaping nursing care that meets the unique health needs of migrant farmworker women while considering their sociopolitical realities.

An integrative literature review and critical reflection of intersectionality theory.

Intersectionality theory has been used by nursing scholars to offer insight into how multiple systems of oppression mutually interact to impact health and to examine how multiple social modes of existence shape individual and group experiences of health inequality. The application of intersectionality theory, however, requires a reflexive critical lens to more effectively inform nursing science and practice. We draw on a comprehensive integrative literature review to offer a critical reflection by considering the semantic and structural consistency, generalizability, simplicity and complexity, and the utility and value of intersectionality theory to nursing science and practice. If nurses are to effectively utilize intersectionality theory, it is essential that we are able to analyze and speak to the multiple modes of existence based on historical, social, economic, and political processes that impact the health of those we serve. Critical examination of intersectionality enables nurses to further consider its value and usefulness when applied to nursing science and practice, particularly when addressing health and social inequalities.

The Utility of Postcolonial and Indigenous Feminist Frameworks in Guiding Nursing Research and Practice About Intimate Partner Violence in the Lives of American Indian Women.

The purpose of this theoretical article is to analyze the utility of postcolonial and Indigenous feminist frameworks in informing nursing research and practice specific to addressing intimate partner violence (IPV) in the lives of Indigenous women. Prevailing feminist narratives of the 20th century focused overwhelmingly on patriarchy as the sole source of oppression against women and root cause of IPV. These narratives failed to consider the complex historical ways in which patriarchy intersected with colonialism and racism to produce violence, affecting the contemporary realities of Indigenous women. In contrast, postcolonial and Indigenous feminist frameworks consider the colonial history that has disempowered Indigenous women and their nations over centuries of settler occupation. Situating IPV within historical, legal, social, and political contexts can unmask how current research and health care discourses may continue to constrain, rather than improve, access, care, and services for Indigenous victims of IPV.

A Historical Analysis of the Impact of Hegemonic Masculinities on Sexual Assault in the Lives of Ethnic Minority Women: Informing Nursing Interventions and Health Policy.

Women's experiences of sexual assault are rooted in and informed by a history that nurses need to understand in order to provide meaningful and effective care. In this article, we present a comprehensive literature review guided by intersectionality theory to deepen our understanding of the historical role that hegemonic masculinity plays in shaping ethnic minority women's experiences of sexual assault. Final sources included were analyzed using thematic analysis. On the basis of our analyses, we identified 4 themes: social order hierarchies, "othering" dynamics, economic labor divisions, and negative media/mass communication depiction. Our findings contribute to our understanding of these important histories that speak to the trauma of sexual violence inflicted upon the bodies of ethnic minority women, which we can incorporate into nursing education curricula. Incorporating this knowledge would equip nurses and allied health professionals with the necessary knowledge and skills that would enable them to help patients navigate multiple systems of oppression as they engage in help seeking following a sexual assault experience. This knowledge also acknowledges rather than dismisses the historically acceptable use of sexual violence against ethnic minority women. In addition, acknowledging these histories enables us to move forward as a society in engaging in an urgently needed cultural shift to address the hegemonic masculinities that perpetuate violence against women in the United States.

Promoting the health of refugee women: a scoping literature review incorporating the social ecological model.

The health of refugee women after settlement in a new country, can be adversely or positively affected by individual, interpersonal, community, and organizational factors. While much of the previous literature highlights these factors individually, there is a lack of comprehensive synthesis regarding how the factors interact to influence the health of refugee women. We conducted a thematic analysis in our literature review to elucidate how providers can work with refugee women to prevent adverse health outcomes and intervene at multiple levels to improve their health outcomes after resettlement. We reviewed peer-reviewed literature from 2009 to 2019 from Google Scholar, JSTOR, Global Health, PubMed, CINAHL, Sociological Abstracts, and Social Service Abstracts, and also used citation chaining, to identify relevant information pertaining to refugee women's health. The key terms used for our literature review were, health care, violence, social support, and mental health. In total, we included 52 articles, 3 books, and 8 other sources. We found that refugee women are vulnerable to violence during migration and typically have high rates of post-traumatic stress disorder. There were also concerns of secondary victimization by providers after resettlement. We also found that social support is an important factor for reducing isolation, and improving access to health care, as well as improving mental health outcomes. However, social support was often difficult to maintain, and was moderated by factors such as English language fluency. Health care was influenced by health literacy, cultural difference, communication concerns, and access issues. The findings suggest that at the individual and interpersonal levels there is a need to address language barriers, improve provider-patient communication, and provide appropriate medical and mental health screenings. At the organizational level, inter-organizational communication and awareness are vital. At the community level, providers can work with community leaders, to educate, create dialogue and collaboration, to help facilitate understanding and bolster community social support. Improved communication and knowledge about the unique needs and concerns of refugee women through an integrated, multi-system approach is necessary to improve their health outcomes.

The intersection of food insecurity and health for rural Malawian women at the end of life.

BACKGROUND: One of the poorest countries in the world, Malawi's palliative care system is under-resourced, and one-third of the population is food-insecure. AIMS: This study describes the lived experience of female palliative care patients, and their caregivers, and aimed to: (1) analyse their physical, spiritual and mental health needs; and (2) analyse best palliative nursing practice for patients at the end of life. An unexpected finding was the impact of food insecurity on the women and their caregivers. METHODS: We conducted interviews with 26 women who at the end of life and 14 of their caregivers. All were participating in a community palliative care programme offered by an AIDS support organisation in Kasungu, Malawi. We used deductive qualitative analysis to organise identified themes using the four pillars of food security: availability, access, utilisation and stability. FINDINGS: All study participants experienced challenges with food security. CONCLUSIONS: We offer policy recommendations for palliative care nurses, and other allied health professionals.

The Role of Nurses as Allies Against Racism and Discrimination: An Analysis of Key Resistance Movements of Our Time.

The remnants of colonialism manifesting as structural violence, racism, and oppression continue to plague our society as evidenced by the persistence of health inequities, particularly for minority populations in the United States. As a profession bound by moral and ethical mandates, nursing must resist and deconstruct oppression in all its forms. Nurses, informed by critical race theory, intersectionality, and historical trauma, can become formidable allies with marginalized populations in the fight for social justice and health equity.

Women's work at end of life: The intersecting gendered vulnerabilities of patients and caregivers in rural Malawi.

Gender inequality in the form of gender-based violence manifests throughout the course of women's lives but has a particularly unique impact at end of life. We sampled 26 patients and 14 caregivers for this qualitative critical ethnographic study. The study purpose was to describe the lived experience of female palliative care patients in rural Malawi and their caregivers. The specific aims were to (i) analyse physical, spiritual and mental health needs and (ii) guide best healthcare practice. The study was informed by feminist epistemology, which drew us to an analysis focused on how gender inequality and gender-based violence affect the care of those with terminal illness. In this article, based on our findings, we demonstrate how gender inequality manifests through the intersecting gendered vulnerabilities of patients and their caregivers in rural Malawi. The findings specifically provide insight into the gendered nature of care work and how the gendered life trajectories of both patients and caregivers intersect to impact the health and well-being of both groups. Our findings have implications on how palliative care can be scaled up in rural Malawi in support of women who are experiencing intimate partner violence at end of life, and the caregivers responsible for their well-being.

An Emancipatory Approach to Cultural Competency: The Application of Critical Race, Postcolonial, and Intersectionality Theories.

Nurses teach, work, and conduct research in an increasingly hostile sociopolitical climate where health inequities persist among marginalized communities. Current approaches to cultural competency do not adequately equip nurses to address these complex factors and risk perpetuating stereotypes and discrimination. A theory-driven emancipatory approach to cultural competency will instead lead to lasting change and uphold the core nursing value of commitment to social justice. This article explicates key tenets of critical race, postcolonial feminist, and intersectionality theories and then applies them, using an emancipatory approach to cultural competency that can reshape nursing education, research, and practice.