Primary healthcare nurses' experiences of addressing intimate partner violence in supportive legal and health system contexts

Primary healthcare providers' perceived preparedness to respond to intimate partner violence in the public primary healthcare setting: a cross-sectional study

BACKGROUND

Intimate partner violence (IPV) is the most prevalent form of violence against women globally, leading to various adverse health consequences. Primary healthcare providers (PHCPs) are often the first point of contact for identifying and managing IPV. However, research on PHCPs' responses to IPV in low- and middle-income countries, including Malaysia, remains limited. This study aimed to determine the perceived preparedness to respond to IPV and its associated factors among PHCPs in Malaysia.

METHODS

This cross-sectional study involved 1505 PHCPs selected through multistage stratified cluster random sampling from public primary healthcare clinics in Malaysia. Data were collected via self-administered online surveys using the validated Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS)-Malay tool. Complex sample analysis of descriptive data, general linear model (GLM) and logistic regression were performed. The GLM was used to determine knowledge and opinion score variables predicting the mean perceived preparedness score, whereas multivariable logistic regression identified factors associated with a good level of perceived preparedness to manage IPV. A p-value ≤ 0.05 was considered statistically significant.

RESULTS

Most Malaysian PHCPs (81.0%) had not received any IPV training. Only 29.1% of the PHCPs reported a good level of perceived preparedness, 12.2% had good perceived knowledge, and a mere 8.6% had good actual knowledge. The perceived and actual knowledge, workplace/self-efficacy, and staff constraints scores were positively associated with the preparedness score, whereas the victim understanding score was negatively associated with the preparedness score. Multivariable logistic regression analysis revealed that longer work experience (≥ 10 years) (AOR = 1.70, 95% CI: 1.28-2.26), prior IPV training (AOR = 1.68, 95% CI: 1.12-2.51), previous experience with IPV inquiry (AOR = 1.55, 95% CI: 1.10-2.19), good perceived knowledge (AOR = 15.21, 95% CI: 11.15-20.74), and good actual knowledge (AOR = 1.79, 95% CI: 1.10-2.94) were significantly associated with a good level of perceived preparedness.

CONCLUSIONS

A high percentage of Malaysian PHCPs have not received IPV training, and only a small proportion felt they are prepared to manage IPV, with even fewer possessing adequate knowledge about IPV. These findings highlight the urgent need to prioritize IPV training programs at the primary care level to better equip PHCPs with the knowledge and skills necessary to manage IPV effectively.

The Impact of Intimate Partner Violence on Homelessness and Returns to Housing: A Qualitative Analysis From the California Statewide Study of People Experiencing Homelessness

Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Qualitative methods can provide a greater understanding of the lived experience of IPV and homelessness to identify potential solutions. We purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. We administered semi-structured interviews focusing on IPV and six other topic areas pertaining to homelessness from October 2021 to May 2022. We created and applied a codebook with a multidisciplinary team using a hybrid of deductive and inductive logic. Our analysis included all participants who discussed IPV and homelessness across the seven studies. We conducted a thematic analysis using an interpretivist approach and informed by grounded theory. We found that violence within a partnership was multidimensional (physical, sexual, emotional, and financial) and bidirectional. We identified six themes: (1) IPV precipitated and prolonged homelessness; (2) Need for housing, financial stability, and material resources influenced staying in abusive relationships; (3) Alcohol and illicit substance use exacerbated violence between partners; (4) Participants struggled to find resources in domestic violence (DV) shelters; (5) The healthcare system did not provide substantial support; and (6) discrimination and stigma influenced equitable access to housing and DV resources. Experiencing IPV contributed to homelessness and impeded returns to housing. Limitations in current IPV resources impede care. We propose equitable expansion of survivor-centered services that improve access to long-term subsidized housing, prevent IPV and homelessness with flexible funding options, and facilitate rapid exits from homelessness through trauma-informed, non-congregate shelter that transitions to permanent housing.

When safety becomes the priority: defensive nursing practice and its associated factors among nurses in Egypt: a cross-sectional study

Background

Defensive nursing practices, which prioritize legal protection over patient care, are becoming increasingly common. This study aims to explore the prevalence and factors associated with defensive nursing practices among nurses in Egypt, considering the impact of workplace violence and legal threats.

Methods

A descriptive cross-sectional study was conducted from February to April 2024 using a self-report online questionnaire. The target population included clinical nurses working in various hospitals in Egypt. A sample size of 1,267 nurses was achieved through convenience sampling. The questionnaire assessed demographic data, experiences of workplace violence, legal consequences, and defensive nursing practices, categorized into positive and negative behaviors.

Results

The sample consisted of 1,267 nurses, predominantly female (75.9%), with a mean age of 28.57 years. Positive defensive practices, such as detailed documentation (79%) and thorough explanation of procedures (58.5%), were highly prevalent. Negative practices included avoiding high-risk procedures (15.9%) and patients more likely to file lawsuits (13.6%). Older nurses and those with higher educational qualifications were more likely to engage in positive defensive practices. Nurses who experienced workplace violence or legal threats were significantly more likely to avoid high-complication procedures.

Conclusion

The study identified a high engagement in both positive and negative defensive practices among nurses in Egypt. These practices are influenced by factors such as age, education level, and experiences of workplace violence and legal threats. The findings underscore the need for strategies to support nurses, reduce reliance on defensive practices, and ensure better patient outcomes.

"A Fire in My Belly": The Health of Community Workers Who Support Women Survivors of Intimate Partner Violence

Nonprofit community-based workers (CWs) provide vital support to women survivors of intimate partner violence (IPV), and they are repeatedly exposed to secondary trauma in their everyday work lives which may influence health and wellness. Guided by the salutogenesis model, this qualitative study explored 19 CWs' work experiences in relation to health and wellness in the Niagara Region, Canada. Five themes were generated using thematic analysis: (a) mental processing and alternations; (b) unmanageable structural challenges; (c) women empowering women; (d) unique ways of coping; and (e) recommendations for system improvements. Implications for intersectoral collaboration, health promotion, and chronic disease prevention are discussed to inform the development of tailored support strategies for CWs.

Views of nurses and midwives working in primary healthcare services on intimate partner violence against women

Background Violence against women is a global public health problem. Primary healthcare services and health workers play an important role in managing this problem. The aim was to identify barriers and facilitators to the identification and management of intimate partner violence (IPV) among women presenting to primary healthcare services from the perspective of nurses/midwives, and to identify the challenges and needs to improve practices. Methods This was a qualitative descriptive study, in which semistructured interviews were conducted with 19 nurses/midwives working in primary healthcare services. The interviews were analysed using a thematic analysis approach through an inductive process. The Consolidated Criteria for Reporting Qualitative Research was used to ensure comprehensive reporting of the protocol for this qualitative study. Results Four main themes were identified: (1) detection of intimate partner violence, (2) nurses'/midwives' current practices, (3) barriers to identification and management, and (4) needs. Conclusions Primary care nurses/midwives in this study perceived that they were not responsible for the detection and management of intimate partner violence, and a majority reported they did not want to take an active role. However, those who were willing to engage in the detection and management of IPV required sufficient time for patient consultations, a reduced workload and a separate room with suitable physical conditions. It is recommended that nurses/midwives be provided with training on IPV detection and management at specific intervals, and studies be conducted to evaluate the outcomes of such training, and initiate the professional decision-making process of nurses/midwives to effectively identify, respond to and support individuals affected by IPV.

Health and Wellness Outcomes of Intimate Partner Violence Support Workers: A Narrative Review

Workers who support survivors of intimate partner violence (IPV) witness some of the most traumatic acts of violence in their everyday work life. These experiences may cause distress that has implications for health and their ability to cope. This narrative literature review sought to explore what is known about the health, wellness, and coping strategies of IPV workers in diverse settings. A comprehensive academic literature search of five databases for peer-reviewed journal articles, available in English, published between January 2000 and October 2023 was conducted. A total of 34 articles on workers' experiences in relation to health, wellness, and coping strategies were included in the review. Thematic analysis generated the following themes: (a) diversity of IPV workplace settings and roles; (b) meaningful aspects of IPV support work including purpose and fulfillment, compassion satisfaction, rewarding and valuable work; (c) adverse experiences such as psychological distress and physiological discomfort, interpersonal social challenges, environment and organizational challenges, burnout, compassion fatigue and secondary trauma; and (d) coping strategies that considered coping behaviors and self-care, workplace support and accommodation, and meaningful sacrifice and adaptation. While the review provided important insights regarding the meaningful aspects of IPV support work and coping strategies, the adverse experiences of supporting survivors significantly dominated the literature. Unfortunately, the majority of studies did not clarify the context of workplaces, and this represents a gap in understanding workers' experiences. Future research is needed to understand context-related experiences of IPV support workers in relation to health and coping. The current review provides unique insights on diverse IPV support work settings and roles, work-related issues that may influence workers' wellness, and rewarding aspects of IPV support work.

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.