A scoping review of the healthcare provided by nurses to people experiencing domestic violence in primary health care settings

Understanding Australian Massage Therapist's Awareness of and Knowledge to Recognize Domestic and Family Violence: Findings from a Community Survey

The objective of this study is to investigate massage therapists' knowledge, confidence, and awareness of domestic and family violence (DFV) in clinical practice. An online questionnaire methodology was used to collect data from Australian massage therapists who were 18 years or over. The study was open for participation for 6 months. The authors developed the questionnaire based on a previous massage therapy profession questionnaire; it included 64 questions in three sections. Two hundred and seventeen respondents formed the dataset. This study found respondents with prior experience of DFV were significantly more likely to have undertaken DFV training than respondents with no prior experience of DFV (p = 0.004). Almost two-thirds of respondents either strongly agreed or agreed that they would like some training to better understand DFV (n = 142, 65.4%) and to better understand their responsibilities around DFV (n = 149, 68.7%). Over half of the respondents were somewhat or very confident they would recognize the signs and symptoms of DFV (n = 126, 58.3%). Over half of respondents (n = 119, 54.8%) felt somewhat knowledgeable about DFV. The main theme from the qualitative analysis was absent resources. The subthemes were (i) without training I cannot help, (ii) prepare me, train me early, and (iii) support me with resources. This study concluded that there is a lack of resources and a deficiency in skills and knowledge among massage therapists to recognize and respond appropriately to domestic violence in clinic. Respondents indicated a desire to learn more about DFV in their practices as they deemed that without training, education, and resources they cannot provide the best of care for their clients.

Violence, Abuse and Neglect in Older Women in Rural and Remote Areas: A Scoping Review and Prevalence Meta-Analysis

This systematic review addressed the issue of the abuse and neglect of older women (age 60 and over) in rural and remote areas, examining these phenomena's prevalence, risk and protective factors, consequences, and associated perceptions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Arksey and O'Malley methodological framework, peer-reviewed articles published until September 2023 were identified in six electronic databases. Out of the manuscripts initially identified (n = 219), 28 articles met the selection criteria. The study's quality was assessed using the Mixed Methods Appraisal Tool. The included studies provided a comprehensive overview of this phenomenon, encompassing data from 6,579 older rural women. Prevalence rates of abuse and neglect exhibited wide variability, with an average of 27.3%. Among the risk factors, financial dependence and incapacity stood out, while higher income and education levels were protective factors, among others. Emotional/psychological abuse emerged as the most common form, with significant impacts on older women's physical and mental health. Cultural norms and gender expectations also influenced perceptions of abuse and victims' coping mechanisms. In a context in which access to specialized resources and services is hampered by significant limitations, community awareness and education prove vital to address this issue, which positions social work as key to addressing these challenges. The prevalence of abuse against older rural women is significant. Emotional abuse stands out as a major issue, underscoring the need for comprehensive interventions accounting for cultural and gender factors.

Examining the Intrapersonal, Interpersonal and Community Level Correlates of Access to Medical Care Among Women Employed by Sex Work in Southern Uganda: A cross-sectional Analysis of the Kyaterekera Study

Women employed by sex work (WESW) experience significant gaps in accessing necessary healthcare services, leading to unmet health needs. Yet, there is a dearth of literature on the barriers to medical care access among WESW in Uganda. We used data from the Kyaterekera baseline to examine the correlates of access to medical care among WESW, defined as the ability of individuals to obtain the necessary healthcare services they require in a timely, affordable, and equitable manner. The Kyaterekera study recruited 542 WESW aged 18-58 years from Southern Uganda. We conducted a multilevel linear regression model to determine the intrapersonal (age, education level, marital status, HIV knowledge, and asset ownership), interpersonal (family cohesion and domestic violence attitudes), and community (community satisfaction, sex work stigma and distance to health facility) level correlates of access to medical care among WESW. Intrapersonal and interpersonal factors were associated with access to medical care among WESW. There was no significant association between community level factors and access to medical care. WESW with secondary education (β = 0.928, 95% CI = 0.007, 1.849) were associated with increased access to medical care. WESW with high asset ownership (β = -1.154, 95% CI= -1.903, -0.405), high family cohesion (β = -0.069, 95% CI= -0.106, -0.031), and high domestic violence attitudes (β = -0.253, 95% CI= -0.438, -0.068) were associated with decreased access to medical care. The findings emphasize the critical need for targeted family strengthening interventions to enhance family support for WESW and address domestic violence.

Health professionals' intervention in the context of domestic violence against women: exploring perceptions and experiences of providing healthcare

Domestic violence against women is a complex social phenomenon and a widely recognised issue of public health, which requires that all sectors of society, including the health sector, take the necessary action to prevent and address it. This paper aims to contribute to the discussion on the role of the primary health care in addressing domestic violence against women, by analysing health professionals' perceptions of their practice as well as the difficulties they experience in providing healthcare to victims. To fulfil this aim, a qualitative approach was chosen, using focus groups with health professionals working in the area of primary health care in an inland region of Portugal. The main findings point to the lack of a specific protocol and insufficient information and skills to respond to domestic violence situations, which hinders health professionals' confidence to intervene and tends to orientate them towards a more medical response. Resulting from these findings, implications for practice are discussed: the need for clear and specific orientations to guide health professionals' intervention; the need to offer training that enables them to provide appropriate healthcare to women experiencing domestic violence; and the need to position themselves in the context of an integrated, multi-sectoral intervention.

Assessing primary health care provider and organization readiness to address family violence in Alberta, Canada: development of a Delphi consensus readiness tool

BACKGROUND

Family violence, which includes intimate partner abuse, child abuse, and elder abuse, is a serious public health concern. Primary healthcare (PHC) offers a vital opportunity to identify and address family violence, yet barriers prevent the effective implementation of family violence interventions in PHC settings. The purpose of this study is to improve family violence identification and response in Alberta's PHC settings by exploring readiness factors.

METHODS

An integrated knowledge translation approach, combining implementation science and participatory action research, was employed to develop a readiness assessment tool for addressing family violence within PHC settings in Alberta. The research involved three phases: phase 1 involved a rapid evidence assessment, phase 2 engaged a panel of healthcare and family violence experts to explore readiness components in the Alberta context, and phase 3 utilized a 3-round Delphi consensus-building process to refine readiness indicators.

RESULTS

Phase 1 findings from a rapid evidence assessment highlighted five main models/tools for assessing readiness to implement family violence interventions in PHC settings. In phase 2, additional concepts were identified through exploration with healthcare and family violence expert panel members, resulting in a total of 16 concepts for assessing family violence readiness within the Alberta PHC context. The 3-round Delphi consensus-building process in Phase 3 involved nine panelists, who collectively agreed on the inclusion of all concepts and indicators, yielding a total of 60 items for the proposed readiness assessment tool for addressing family violence in PHC within Alberta.

CONCLUSION

The current study lays the groundwork for future family violence intervention programs, offering insights into key components that promote readiness for implementing comprehensive programs and supporting PHC organizations in effectively addressing family violence.

Interprofessional Education for Domestic Violence Safety Planning in Nursing and Social Work: A Scoping Review

Rationale

Nurses and social workers in healthcare settings are positioned to identify abuse and contribute to improving the wellbeing of victims and their family members by screening for, providing safety education about, and reporting abuse when required by law.

Objective

The review aims to assess the current state of the simulation education for addressing the needs of domestic violence (DV) survivors to screen, assess, and intervene in DV cases in healthcare settings.

Method

A scoping review to map the peer-reviewed evidence on interprofessional education (IPE) was conducted by means of automated database search for nursing and social work students. The methodology was informed by Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

Results

Categories identified across the included articles were grouped according to the 1) methods of instruction and student assessment; 4) benefits of conducting DV-focused IPE; and 2) challenges of conducting DV-focused IPE.

Conclusions

These results have assessed what is known about educating social work professionals to collaborate across disciplines and highlight the need for IPE opportunities to enhance student knowledge of best practices in relation to the screening, assessment, and management of DV in healthcare settings.

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.

Ethically Driven and Methodologically Tailored: Setting the Agenda for Systematic Reviews in Domestic Violence and Abuse

Purpose

Systematic reviews have an important, and growing, role to play in the global evidence eco-system of domestic violence and abuse. Alongside substantive contributions to knowledge, such reviews stimulate debates about ethical reviewing practices and the importance of tailoring methods to the nuances of the field. This paper aims to pinpoint a set of ethical and methodological priorities to guide and enhance review practices specifically in the field of domestic abuse.

Method

The five Pillars of the Research Integrity Framework (ethical guidelines for domestic abuse research) are used to interrogate the systematic review process. To do so, the Framework is retrospectively applied to a recently completed systematic review in domestic abuse. The review included a rapid systematic map and in-depth analysis of interventions aimed at creating or enhancing informal support and social networks for victim-survivors of abuse.

Results

Ethical and methodological priorities for systematic reviews in domestic abuse include (1) Safety and wellbeing: maintaining the wellbeing of researchers and stakeholders, and appraising the ethics of included studies, (2) Transparency/ accountability: transparent reporting of research funding, aims and methods together with explicit consideration of authorship of outputs, (3) Equality, human rights and social justice: developing diverse review teams/ Advisory groups, and review methods that aim to search for, and report, diverse perspectives. Considering researcher positionality/ reflexivity in the review, (4) Engagement: collaboration with non-academic stakeholders and individuals with lived experience throughout the review process, (5) Research Ethics: independent ethical scrutiny of systematic review proposals with input from researchers with expertise in systematic reviews and domestic abuse.

Conclusion

Additional research is required to comprehensively examine the ethics of each stage of the review process. In the meantime, attention should be given to the underpinning ethical framework for our systematic review practices and the wider research infrastructure that governs reviews.

Qualitative study of the perspectives of women with lived experience of domestic and family violence on accessing healthcare

AIMS

To explore the perceptions of women with lived experience of domestic and family violence on accessing healthcare and to identify how nurses can facilitate and support women experiencing domestic and family violence to receive the care they need.

DESIGN

A qualitative single site study.

METHODS

As part of an evaluation of a nurse-led domestic and family violence service, a 2-h focus group was conducted with four women with lived experience of domestic and family violence on 14 December 2021. The Levesque Framework provided a novel approach to identify barriers and facilitators to healthcare access. The focus group guide included eight open-ended questions. The audio recording was transcribed and analysed using Braun and Clark's thematic analysis process.

RESULTS

The Levesque Framework helped highlight individual and structural challenges in accessing healthcare faced by women experiencing domestic and family violence. Dominant themes were first contact, comprehensiveness of services and domestic violence awareness.

CONCLUSION

The growing incidences of domestic and family violence are confounding communities worldwide. Despite the high profile of domestic and family violence in Australia, access to healthcare remains problematic. These preliminary findings suggest that nurses have opportunities to facilitate access in relation to the approachability, acceptability and appropriateness of services. Realizing these opportunities requires education that enables nurses' capacity to provide an effective first contact and facilitate comprehensive care by embodying a no wrong door culture. We intend to explore these concepts in future focus groups.

IMPACT

This study explored the factors impacting access to healthcare for women experiencing domestic and family violence. Accessing healthcare when experiencing domestic and family violence in Australia is problematic. Findings suggest that nursing has opportunities to facilitate the approachability, acceptability and appropriateness of services. These findings will be valuable to nurses across all healthcare settings, nursing education providers and health workforce planners.

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.