Background: Intimate partner violence is a structural problem in our society because of the inequality between men and women. Nurses are often the first person to meet the abused woman in health care and therefore have an important role in identifying the violence and in trying to influence the women's future choices in life. Aim: To illustrate nurses' experiences of meeting women exposed to partner violence. Method: A literature-based study based on analysis of 10 qualitative scientific articles. Results: Nurses meeting women subjected to partner violence experienced a lot of emotions both at work and in private. They experienced that the lack of time in care was crucial to how they were able to respond to the women. According to the nurses, lack of training and knowledge were the main reasons to why they refrained from posing questions on experiences of violence. Fear, frustration, suffering and the feeling of not being able to perform good care affected the well-being of the nurses. Conclusion: Knowledge about the topic and time for the healthcare encounter are crucial for nurses to create trustworthy relationships and provide a good care for women subjected to partner violence. Importantly, the findings in this study show that time and knowledge are the major barriers in the care of these women. / En av fyra kvinnor i Sverige blir utsatta för partnervåld. Partnervåld förklaras vanligen med att vi lever i ett ojämställt samhälle där män som grupp strukturellt har mer makt än kvinnor. Forskning visar att orsaken till våldet framförallt handlar om mannens behov av att kontrollera kvinnan. Våld mot kvinnor går långt tillbaka i tiden och var länge ett accepterat beteende för män i samhället. Våldet är i dagens samhälle ett tabubelagt problem vilket gör att många våldsutsatta kvinnor lever i tystnad med skam och rädsla för att anmäla. Det är känt att våldsutsatta kvinnor ofta söker vård för andra symtom än de våldet orsakat. Det är därför av stor vikt att sjuksköterskan har kunskap och tid för att kunna identifiera de eventuella underliggande orsakerna till vårdbesöket samt det våld som kvinnan utsatts för. Mötet mellan den våldsutsatta kvinnan och sjuksköterskan utspelar sig olika beroende på hur sjuksköterskan väljer att bemöta henne. Personcentrerad vård lyfts ofta fram som nyckeln till bättre förutsättningar för sjuksköterskan att möta den våldsutsatta kvinnan där hon befinner sig psykiskt. En utmaning är samtidigt den emotionella påfrestning som dessa möten utgör för sjuksköterskan. Ledningen inom sjukvården har här ett stort ansvar att stötta sjuksköterskor för att kunna möta kvinnor som är utsatta för partnervåld. Studien är en kvalitativ evidensbaserad litteraturstudie. I studien har artiklar från olika länder systematiskt och osystematiskt sökts fram och använts i resultatet. Artiklarna som valdes att inkluderas har sjuksköterskor som är erfarna av att möta våldsutsatta kvinnor. De artiklar som valdes att exkluderas var där de våldsutsatta kvinnorna hade barn eller då den våldsutsatta inte var en kvinna i partnerrelation till mannen som utövade våldet. Samtliga artiklar är granskade med Fribergs (2012) femstegsanalysmetod. Samtliga artiklar granskades även med kvalitetsbedömningsmall samt att alla artiklar har ett etiskt förhållningssätt.  Resultatet är uppbyggt på tre teman och nio subteman som visade att sjuksköterskor har brist på utbildning, brist på tid, är rädda och upplever frustration under mötet med den våldsutsatta kvinnan. Dessa faktorer kunde leda till att sjuksköterskan valde att inte fråga eller se våldet. Många sjuksköterskor var också rädda för att mötet kunde drabba det personliga välmåendet. Resultatets olika teman som framkom var påverkan på sjuksköterskans personliga liv, sjuksköterskans upplevda känslor och att våga fråga om våld. Sjuksköterskor behöver mer stöd i arbetet med våldsutsatta kvinnor. Både en ökad praktisk samt teoretisk utbildning är nödvändigt för att kunna minska våld mot kvinnor.

Influente político, autor de diversos livros e industrial de sucesso, o general José Vieira Couto de Magalhães (1837-1898) foi um dos raros homens de seu tempo que deixou registradas preciosas informações cotidianas quanto aos medicamentos e cuidados com seu próprio corpo na busca por reestabelecer a saúde. Suas anotações pessoais corresponderam a dois momentos distintos de sua vida. Primeiro ao início da década de 1880, quando vivia sempre muito incomodado pela frequente dificuldade de digestão. Nessa fase, Couto demonstrou estar mais interessado em se medicar a partir da leitura de compêndios de medicina. Posteriormente, entre os anos 1887-1890, o general escreveu um caderno de anotações onde redigiu breves referências sobre o diagnóstico de sífilis dado a ele por dois médicos que estiveram em sua casa, quando tinha 52 anos e era presidente da Província de São Paulo. Doença incurável e fortemente atrelada à moral, a sífilis era então associada à prostituição e considerada uma das causas da degeneração da prole. Bastante debilitado quando estava no estágio terciário da sífilis, o general se consultou com os melhores médicos do Brasil e também da França, onde esteve por duas vezes a tratamento. Na tentativa de compreender qual teria sido o sentido desse diagnóstico para um homem de alta projeção social, eu me deparo nesse trabalho com algumas questões caras para a época. Uma delas diz respeito à vida nem sempre fácil e muito menos prestigiada dos médicos os mesmos que por muito tempo foram analisados a partir de um enfoque predominantemente foucaultiano como sendo detentores de um poder disciplinar sobre a sociedade. Para trabalhar com a história de vida e as anotações do general Couto de Magalhães e, acima de tudo, com os silêncios contidos em seus escritos, procuro cruzar informações dos diários com alguns periódicos, teses e livros de medicina da época. / As an influential politician and a successful industrialist, and having written a number of books, General José Vieira Couto de Magalhães (1837-1998) was one of the few men of his time leaving a register with precious information about everyday life concerning medicine and body care aiming to the restoring of health. His personal notes correspond to two different moments of his life. Firstly, to the beginning of the 1880s, when he was affected by digestion problems. In this phase, Couto demonstrated more interest in self-medication based on the reading of medical compendiums. Afterwards, between 1887 and 1890, the General kept a notebook in which he wrote brief reference notes on the syphilis diagnosis he was given at home by two doctors. At this time he was 52 and used to be the president of the Province of São Paulo. Incurable and closely related to moral issues, syphilis was then associated with prostitution, being considered one of the causes of degeneration in offspring. At the third stage of the disease, the General was quite impaired and thus had appointments with the best physicians in Brazil as well as in France, where he travelled to twice during the treatment. In an attempt to understand the implications of such diagnosis for a man in a high social position, this study faces crucial issues for that time period. One of them concerns the usually difficult and much less prestigious life of medical doctors who were for a long time analyzed from a predominantly foucaultian perspective as having a disciplinary power over society. In order to work with Magalhãess life story and notes and above all with the silences inside his writings I try to compare the information in his journals with other from periodicals , theses and medical books from that historical period.

Intimate partner violence (IPV) involves physical, psychological, and/or emotional violence within intimate (e.g., dating) relationships. In this thesis, I examined narcissism as a predictor of IPV. I used an offensive- and defensive-trait framework to come up with 10 potential mediator variables that often typify narcissism and underlie IPV. Correlation analyses confirmed the expected link between narcissism and IPV. Subsequent bootstrapping mediation analysis of IPV-frequency revealed significant indirect effects for 2 mediators - social dominance orientation and the hostile attribution bias-based tendency to retaliate in the face of ambiguous but potentially malevolent social interactions. Bootstrapping analysis of IPV-prevalence also revealed an additional significant indirect effect for hypercompetitiveness. In both bootstrapping analyses the mediator variables only provided partial mediation of the narcissismto- IPV link. In the discussion I focus on the implications for IPV perpetration and research, including avenues for future research and potential interventions for IPV centered on mitigating narcissism.

Historically, African American lesbians (AALs) experiencing intimate partner violence (IPV) have received little or no support from therapists due to stigmas concerning the same-sex relationships of AALs in particular, who have been racially marginalized. The purpose of this study was to explore the experiences, attitudes, and perceptions of therapists who provide counseling for AALs who have experienced IPV. The findings of this study may help to better understand the challenges, perceptions, and attitudes of therapists regarding their experiences in working with AALs in domestic violent relationships because existing research was limited on mental health therapists' perceptions of working with AALs who are experiencing IPV in their relationships. Attribution theory provided a framework through which to explore and describe this topic. A phenomenological research design was used to explore the perceptions and lived experiences of 10 mental health professionals who have worked with AALs in IPV relationships. Data collection, using semistructured continued until data saturation was attained. Moustakas' phenomenological steps for data analysis were used to identify 4 themes in the data: challenges, IPV, resources available, and outcomes. Understanding the attitudes and experiences of therapists working with AALs in abusive relationships may result in positive social change through increasing knowledge of the issues involved. This may result in improved counseling and other services to AALs.

Patients experiencing nonfatal strangulation during intimate partner violence (IPV) are suffering the consequences of unrecognized injuries and delayed life-threatening medical sequela. Forensic nurses offer expertise in the physical assessment and documentation to a variety of assault victims including those impacted by IPV. This project addressed whether an educational program on nonfatal strangulation increased the knowledge and assessment skills of forensic nurse examiners. The purpose of this doctoral project was to develop a continuing education program on the topic of nonfatal strangulation for forensic nurse examiners. The project design was created using Knowles's adult learning theory principles. The content outline was guided by the International Association of Forensic Nurses Nonfatal Strangulation Toolkit as well as input from content experts on nonfatal strangulation. The evaluation of the project was through pre- and posttest scores. The nonfatal strangulation continuing education training resulted in a statistically significant increase in participants' posttest scores (z-value= -3.064; p value =.002) indicating that the training material and teaching modality positively affected the participants test scores. This continuing education program on nonfatal strangulation increased knowledge of forensic nurse examiners and its application in the field might contribute to positive social change by increasing the identification of IPV and providing appropriate intervention.

People of Chinese heritage often face complex challenges because of the conflicting values from China and America, especially on sexuality. Through two thousand years of socialization, Chinese culture grew to endorse conservative sexual values and gender roles. In traditional Chinese culture, women are expected to remain chaste and play submissive roles in marriage. Sexuality is treated as a taboo topic that should not be discussed directly. Asian American youth who endorse less traditional Chinese values experience lower sexual satisfaction, lower confidence in their own abilities, and higher adherence to traditional gender roles. Language has also been found to potentially influence how people engage in sexuality by triggering a mindset of Chinese or English culture background. The current study assessed ethnic identity and acculturation experiences as correlates of sexual and intimate interactions with partners among people with Chinese heritage, and how English and Chinese language are used in relationships. For men, more endorsement of traditional Chinese and mainstream American culture was associated with greater feelings of conflict in their cultural identity. Greater feelings of identity conflict linked to lower ability to effectively and assertively communicate with a partner on sexual topics. Men with higher feelings of identity conflict also reported higher double sexual standard. Women, on the other hand, did not report increased feelings of conflict as they endorsed Chinese and American cultures more strongly. Women's preference for English language was related to their ability to effectively and assertively communicate with partner on sexual topics, whereas men's preference for English language was related to greater communication with partner and lower double sexual standard. Moreover, language fluency was the strongest indicator of language preferences regardless of the contexts or the topics. When making decisions or expressing positive feelings to partner, participants considered a language more effective when they are more fluent in it. However, when expressing negative emotion or discussing sexual topic with partner, people tended to prefer English because English has clearer labels for emotions and sexual terms. In sum, cultural identity, acculturation experiences, and language proficiency all related to Chinese bilinguals' sexual and romantic attitudes and behaviors, although unique patterns emerged for men and women.

Emerging adulthood (ages 18-25 years) is a developmental period marked by changes in attachment, the onset of serious dating relationships, and rates of intimate partner violence (IPV) up to 40% and 90% for physical and psychological IPV, respectively. This dissertation aims to investigate moderators of the link between insecure attachment, a known risk factor for IPV, and psychological IPV, coercive controlling behaviours, and relational aggression in emerging adulthood. One hundred and seventeen undergraduate students in dating relationships were recruited to partake in a baseline assessment followed by a 14-day daily diary study. During the baseline assessment, participants self-reported on putative trait level risk factors such as demographics and insecure attachment. During the daily diary portion, participants reported on their use of partner aggression (physical and psychological IPV, coercive controlling behaviours, and relational aggression; however, due to low base rates, physical IPV could not be analyzed as an outcome), as well as their experiences of felt partner acceptance and rejection, support and conflict in their relationships, alcohol use, and stress for each day. I hypothesized that attachment anxiety, problems in the dyadic relationship (inadequate support, conflict, and felt rejection and anxiety about acceptance), and putative disinhibitors (stress and alcohol consumption) would be directly linked to risk for perpetration of all forms of aggression and interact to predict risk for partner aggression. Hypotheses regarding partner support, conflict, and felt regard were also tested. Specifically, I hypothesized that ratings of partner support fit, hurt as a result of conflict, and daily felt regard would differ for more insecurely attached versus more securely attached individuals. Following application of exclusion criteria, data from 98 participants were analyzed using multilevel modeling in Hierarchical Linear Modeling (Raudenbush et al., 1995). The results from this dissertation underscore the importance of attachment anxiety as an individual risk factor for IPV and identified more proximal risk factors that fluctuate on a daily basis. Attachment anxiety, felt rejection, and conflict were related to risk for all three forms of IPV. Unexpectedly, attachment avoidance was linked to decreased risk for coercive control. Anxiety about acceptance was uniquely associated with risk for psychological IPV, and inadequate support fit was uniquely associated with risk for coercive control. Greater attachment anxiety interacted with high conflict to predict greater risk for coercive control. No other significant two-way interactions between attachment anxiety and problems in the dyadic relationship emerged. Contrary to hypotheses, stress and alcohol consumption were linked to decreased risk for coercive control. Stress also appeared to suppress the link between dyadic problems and risk for psychological IPV on a given day, and dyadic problems paired with alcohol consumption was related to a decreased risk of coercive control. High stress and greater dyadic problems interacted to predict greater risk for coercive control as expected. No conclusions could be drawn about 2-way interactions between stress and dyadic problems and alcohol consumption and dyadic problems when predicting relational aggression, as the model did not converge. This study did not find support for the “perfect storm theory” of aggression (in which a 3-way interaction between risk factors is associated with greatest risk of IPV) when predicting psychological IPV. The “perfect storm theory” could not be tested in relation to coercive control and relational aggression as these models did not converge. The findings from this study contribute to our knowledge of why some people perpetrate IPV and not others, and why people perpetrate IPV on some days and not others. These results inform the multiple possible points of entry for prevention and interventions aiming to promote healthy relationships in emerging adults. / Graduate

This thesis is comprised of two separate studies, the first of which set out to examine the Intimate Partner Abuse behaviour and attitudes of young Australian students. Intimate Partner Abuse (IPA) may be defined as a pattern of deliberate physical, sexual, or psychological abuse within a married, de-facto, dating, or courting relationship (Miller & Bukva, 2001: Victoria Health Promotion Foundation, 2004). Specifically, Study One aimed to explore the IPA attitudes of Australian students and examine the relationships between these attitudes with a view to provide theoretical guidance for understanding how negative IPA attitudes may be maintained. A total of 400 students (male = 99, female = 301) with ages ranging from 15 to 25 years (M = 19.38, SD = 2.04) participated in Study One. Participants completed the Conflict Tactics Scale - Revised (CTS2; Straus, Hamby, Boney-McCoy, & Surgarman, 1996), which measures the number of times respondents have experienced physic al and psychological abuse over the previous 12-month period. Attitudinal questionnaires were also completed by participants, including a measure of IPA victim blame and endorsement of IPA myths. Overall, rates of IPA among the present sample were consistent with those reported in overseas samples, with over 85% of women reporting being the victim of psychological abuse in the previous 12-months, and over 30% having been the victim of physical abuse. Lower scores on measures of victim blaming attitudes were associated with more positive attitudes towards women and less endorsement of IPA myths. These findings implicate the importance of addressing attitudes towards women and commonly held IPA myths within IPA prevention programs for young people. Study Two evaluated a brief educational program for Australian Technical And Further Education (TAFE) and high school students, which was selected and modified on the basis of a literature review of published program evaluations and the findings of Study One of this thesis. The program, titled Through New Eyes: Exploring the Hidden Dynamics of Domestic Violence (Hunter Women's Centre, 2003), aimed to inform the IPA attitudes of students and comprised of videos and discussion questions. A quasi-experimental pre-post design was used with a non-randomised experimental and control group. The program was evaluated using a questionnaire measure of participants' attitudes as well as their experience of the program. There were 98 students who consented to participate in Study Two, 48 (male = 26, female = 22) of whom fulfilled all the requirements of participation and were included in the results of the study. Participants' ages ranged from 14 to 25 years (M = 16.91, SD = 2.12). Several statistically significant desi rable changes were observed among participants of the program, however there were similar changes observed among control group participants. Study Two provides some support for the effectiveness of the Through New Eyes program in informing the attitudes of young Australians. However, it is recommended that future research evaluate this program in combination with skill building programs in order to assist students to translate attitudinal changes into behavioural ones.

Several theories have attempted to explain the stay/leave decisions of women experiencing intimate partner violence (IPV). One recent study suggests that women’s intent to return to their abusive partners was related to forgiveness of the abuse; consequently, this study aims to identify factors that may make women more likely to forgive IPV. It was hypothesized that commitment, specifically both personal dedication and constraint commitment (Stanley & Markman, 1992), would predict forgiveness and that denial of injury would mediate the relation between commitment and forgiveness, as women may be more likely to deny the severity of the abuse in order to reduce the experienced dissonance that arises from being committed to an unhealthy relationship. Finally, it was hypothesized that silencing the self (Jack, 1991) would moderate the relation between personal dedication and denial of injury. Results generally supported the hypothesis that denial of injury would mediate the relation between commitment and forgiveness. Silencing the self was not found to be a moderator. These findings, limitations, and future directions are discussed.

Child maltreatment is a significant public health problem that increases when children live in homes in which intimate partner violence (IPV) is present. Child maltreatment and IPV often co-occur, and the sequelae of IPV frequently appear in both the victimized mother and her children. Home visitation programs, such as SafeCare®, are used as intervention strategies to reduce the risk of child maltreatment, but rarely are these programs adapted for Latino populations. The importance of cultural sensitivity in parenting programs has been highlighted as a means of producing successful outcomes when working with Latino families. The present single-case research design study evaluated the efficacy of SafeCare's Parent-Infant Interaction (PII) module when delivered in Spanish to a Latino mother with prior experiences of IPV. Observational data were used to document changes in parenting behaviors, while self-report measures assessed exposure to IPV and changes in mental health, parenting stress, and the risk of child maltreatment. Qualitative data provided suggestions for culturally adapting PII for Latino families. Data from this study suggest that PII improves parent-infant interactions when delivered in Spanish and reduces the risk of child maltreatment. Additionally, self-report measures indicate that IPV, parent mental health distress, and the risk of child maltreatment co-occur. This study also shares with the field the importance of providing culturally adapted programs when working with Latino families.