The Nurse-Family Partnership (NFP) is an evidence-based public health initiative targeted to young, pregnant, first-time mothers impacted by social and economic disadvantage. This study is part of an embedded qualitative process evaluation from a larger cluster RCT trial. The purpose of this study was to understand NFP supervisor roles, responsibilities, and experiences associated with the uptake of a new IPV intervention by nurse home visitor into existing NFP practice. / The Nurse-Family Partnership® (NFP) is a home visitation program for young pregnant and first-time mothers affected by social and economic disadvantage. In response to intimate partner violence (IPV) experienced by women and children involved in the program, a nursing intervention was developed to support nurse home visitors identify and respond to IPV. Within each participating NFP team, supervisors were accountable for facilitating the implementation process of the IPV intervention for uptake into nurse home visitor practice. To understand the functions of NFP supervisors involved with the facilitation of the implementation process for the IPV intervention, an interpretive description approach was utilized involving primary data collection from interviews with 11 supervisors and 2 managers, and triangulated with secondary data from 7 focus groups (n=35 nurses). From this analysis, an NFP supervision framework was developed that included 4 domains, 7 roles, 3 sub-roles and multiple responsibilities. Supervision was found to involve roles and sub-roles functioning in oversight of implementation and others that functioned in the direct implementation of the IPV intervention, forming levels of supervision, and creating a hierarchy. A comprehensive appreciation of NFP supervisor domains, roles, sub-roles and responsibilities enacted during the implementation process is important to help identify the best alignment of human resources, recognize how the NFP can best support supervisors, and to champion achievement of current and future innovation implementation goals. Recommendations of support for supervisors include facilitating educational opportunities, creating transparency of the implementation process, developing a quality improvement strategy, providing supervisor mentorship, improving standardization, and recognizing the competing NFP priorities for supervisors and nurse home visitors. / Thesis / Master of Science (MSc) / The Nurse-Family Partnership® (NFP) is a home visitation program targeted to young mothers, pregnant with their first child. To support nurse home visitors identify and respond to intimate partner violence (IPV) experienced by NFP mothers and children, an IPV intervention was developed. Within the NFP implementing agencies, supervisors were instrumental in ensuring the IPV intervention was delivered as intended, forming what is known as the implementation process. This qualitative interpretive descriptive study involved interviews with 11 supervisors and 2 managers, as well as a secondary analysis of 7 focus groups (n=35 nurses) to understand and describe the roles and responsibilities supervisors had within this process. From the analysis of these data, an NFP supervision framework was developed that included articulation of 4 domains, 7 roles, 7 sub-roles and multiple responsibilities affiliated with this position. This framework offers a new language for supervision which may become a first step to better understanding, communicating, and developing supervision in home visitation, and in particular, articulating the functions supervisors are required to lead when faced with the responsibility for implementing a new innovation within their program. It is important to understand NFP supervisor functions of the implementation process to enable NFP strategies that will best support supervisors, ensure responsibilities belong to the right person, and meet implementation goals when adopting evidence into NFP nurse home visiting practice.

Bakgrund: Våld i nära relation är ett folkhälsoproblem som drabbar kvinnor och förekommer i alla samhällen. Utsatta kvinnor söker ofta vård men stigmatisering gör det svårt att berätta om sin utsatthet. Sjuksköterskan har omvårdnad som huvudkompetens och har därför ett ansvar i mötet med kvinnor. Syfte: Syftet var att beskriva aspekter av omvårdnad relaterade till sjuksköterskans förmåga att fråga kvinnor om våld i nära relation. Metod: En allmän litteraturstudie med kvalitativ och induktiv ansats. Design i enlighet med Polit och Becks nio-stegsmodell. Data har analyserats genom att använda Braun och Clarkes modell för tematisk analys. Resultat: Två teman identifierades med sex subteman. Utmaningar i vårdmötet, med subtemana Sjuksköterskans färdigheter, Påverkad av känslor, Formad av samhällets normer och Begränsningar i vårdmiljön, med subtemana Tillgång till resurser, Riktlinjer, Arbetsplatskultur. Slutsatser: Omvårdnaden för våldsutsatta kvinnor kan utvecklas genom förståelsen för utmaningar i vårdmötet samt begränsningar i vårdmiljön. Det stärker litteraturstudiens kliniska relevans. Ytterligare forskning behövs för att förstå komplexiteten av identifierade aspekter samt hur de samverkar i sjuksköterskans omvårdnadsarbete med kvinnor som utsatts för våld i nära relation. / Background: Intimate partner violence is a public health problem that affects women and occurs in all communities. Abused women often seek health care, but stigma makes it difficult to disclose violence. Nursing care is the nurse’s main competence and therefore the nurse has a responsibility when encountering women. Aim: The aim was to describe aspects of nursing related to the nurse's ability to ask women about intimate partner violence. Method: A general literature study with a qualitative and inductive approach. Design in accordance with Polit and Beck's nine-step model. Data was analyzed using Braun and Clarke's model for thematic analysis. Results: Two themes were identified with six subthemes. Challenges in the healthcare meeting, with subthemes The nurse's skills, Influenced by emotions, Shaped by society's norms and Limitations in the healthcare environment, with subthemes Access to resources, Guidelines, Workplace culture. Conclusions: Nursing care for abused women can be developed through the understanding of challenges in the care meeting and limitations in the care environment. This strengthens the clinical relevance of the literature study. Further research is needed to understand the complexity of identified aspects and how they interact in the nurse's work with women who have been subjected to intimate partner violence.

The purpose of this study was to explore women's dual experiences of IPV to examine whether their motivations fit the current framework on four types of intimate partner violence (IPV) in light of Johnson's typology, which includes: violent resistance (VR), situational couple violence (SCV), mutual violent combat (MVC), and intimate terrorism (IT) (Kelly and Johnson 2008). I applied these types of IPV to describe women's physical aggression, control, and emotional responses experienced and performed during IPV. Johnson's typology classified six of 10 participant experiences; to describe the remaining four, I applied blended types of IPV. Findings in this study indicated that VR and SCV overlooked women's use of controlling physical aggression; this study identified alternative concepts and additional dimensions of control and resistance, and introduced tempered violence resistance (TVR), a new IPV type to describe women's use of controlling physical aggression during protective violence. Correspondingly, findings also indicated that interpretations of physical aggression and control in MVC and IT did not consider wide-ranging degrees of control such as self-control, situational control, and partner control. Hence, distinctions between SCV or MVC and MVC or IT were limited by vague interpretations of control. Furthermore, VR, MVC, and IT did not fully describe women's emotional responses. These types of violence focused solely on the context of physical aggression and control, which minimized perceptions of conflict and omitted reported samples of motivations. Forthcoming studies applying Johnson's typology should include external contexts of relationship conflict and consider multiple types control and dimensions of resistance. / Ph. D.

Trauma recovery and post trauma growth are two desirable outcomes of a traumatic event. Meaning-making and narrative development are two processes that support both trauma recovery and post trauma growth. The way in which we make meaning or develop stories about the events in our lives however, are governed by socio-cultural contexts. Social constructivism emphasizes that the way in which individuals think, feel, and act are engrained in her being early on by the social and cultural networks that surround her. Therefore, even though an individual may think that she is generating a thought or making a choice, these processes have already been influenced by socio-cultural contexts long before she learned how to speak or formulate a worldview. This study aimed to examine the lived experiences of women who have been through intimate partner violence, tracing their journey towards trauma recovery and post trauma growth, and trying to find how and the extent to which their journeys were affected by socio-cultural contexts. This study takes a social constructivist lens that emphasizes the effects of our socio-cultural environment on individual meaning-making, narrative development, and decision making post trauma. The results of the study indicate that socio-cultural contexts play a significant role in individual responses to trauma like intimate partner violence, and there are socio-cultural components that can facilitate trauma recovery and post trauma growth. / Doctor of Philosophy / When human beings experience adverse events in life, they can develop a traumatic response to the event. Traumatic response however, is just one possibility. Sometimes individuals who have been through events that have led to a trauma response can also experience resilience, recovery, and even growth. The way in which human beings respond is not only in their power but is also influenced by their environment. Socio-cultural contexts that surround us influence the way in which we make meaning of life events and develop stories or narratives regarding those events. This purpose of this study was to find whether socio-cultural contexts affected women who had experienced intimate partner violence in their meaning-making and narrative development, and how these influences played out in their decision making process post trauma. The study intended to find to what extent trauma recovery and post trauma growth could be influenced by socio-cultural contexts. Additionally, the study wanted to explore how professional counselors may contribute to survivor’s journeys. The results indicate that socio-cultural contexts deeply influence the process of meaning-making and narrative development, thereby affecting trauma recovery and post trauma growth. Additionally, results indicate that professional counselors can play an essential role in facilitating processes that lead to recovery and growth post trauma.

Bakgrund: Våld i nära relationer är ett utbrett folkhälsoproblem världen över och orsakar många kvinnor fysiska och psykiska skador. Det är oftast män som utsätter kvinnor för våld, detta tyder på en tydlig mansdominerad samhällsstruktur och är en direkt kränkning av kvinnors rättigheter. Sjuksköterskor utgör en nyckelroll i att identifiera våldsutsatta kvinnor då dessa fall förekommer i alla olika vårdinstanser. Syfte: Att beskriva sjuksköterskors upplevelser av att möta våldsutsatta kvinnor i vården. Metod: En beskrivande litteraturstudie vars resultat är baserat på 12 vetenskapliga artiklar. Artiklarna är hämtade från PubMed och har både kvantitativ och kvalitativ ansats. Huvudresultat: Sjuksköterskor upplever brist på kunskap och utbildning i sitt yrke för att identifiera och bemöta våldsutsatta kvinnor. Brister i verksamheten som avsaknaden av rutiner och riktlinjer eller för hög arbetsbelastning gör att sjuksköterskor inte kan eller hinner ta sig tiden att hjälpa dessa kvinnor. Att ämnet är stigmatiserat och kulturella skillnader är bidragande faktorer till att sjuksköterskor upplever ett hinder i sitt yrke att ta sig an fall av våld i nära relationer. Slutsats: För att arbetet mot våld i nära relationer ska gå framåt och för att kvinnor ska få god och relevant vård så är detta ett ämne som bör uppmärksammas mer. Vidare krävs tydliga rutiner och riktlinjer från arbetsplatser som sjuksköterskor kan förhålla sig till och stödja sig emot. Utbildning på sin aktuella arbetsplats men även så tidigt som under utbildningen till sjuksköterska behövs för att sjuksköterskor ska känna sig självsäkra och bekväma i sin roll att bemöta våldsutsatta kvinnor. / Background: Intimate partner violence is a public health problem worldwide and is the cause of many women’s physical and psychological injuries. The fact that men often subject violence against women indicates a male-dominant social structure and is a direct violation of women’s rights. Nurses therefore play a key role in identifying women exposed to violence as these cases occur in various healthcare institutions.  Aim: To describe nurse’s experiences of meeting women exposed to intimate partner violence.  Method: A descriptive literature study. The results are based on 12 scientific articles. These articles were collected from the database PubMed and have both qualitative and quantitative approach.  Result: Nurses experience a lack of knowledge and training to identify and respond to intimate partner violence. Shortage in healthcare operations such as a lack of routines and guidelines or heavy workload means that nurses cannot or do not have the time to help these women. Stigma and cultural differences contribute to nurses experiencing obstacles in their profession to deal with cases of intimate partner violence.  Conclusion: In order for the work against intimate partner violence to progress and for women to receive qualitative care, this is a topic that should receive more attention. Furthermore, routines and guidelines from the workplace are required for the nurses to relate to and lean against. Training in the current workplace, but also as early as in nursingschool are needed so that the nurses feel confident and comfortable in their role of responding to women exposed to intimate partner violence.

The purpose of the study was to develop an understanding of how perceptions of same-sex relationships affect counselors'-in-training (CITs) identification of intimate partner violence. The researcher examined whether the sexual orientation of a client has an impact on CITs identification of violence, identification of victimization and perpetration and how homonegative attitudes shape perceptions of same-sex relationship violence. Data was collected via information questionnaires regarding demographic and professional background, experimental vignettes modified from Blasko, Winek, and Bieschke']s (2007) study, and the 10-item version of the Modern Homonegativity Scale (Morrison and Morrison, 2002; Morrison, Kenny, and Harrington, 2005). The sample included 203 master and doctoral students from CACREP-accredited counseling programs in the southern region of the United States. The results indicated that most respondents were able to appropriately identify intimate partner violence. The levels of agreement regarding types of violence varied between vignette types. An ANOVA revealed significant differences between relationship type and identification of mutual violence, victim, and perpetrator. Respondents attributed more responsibility for the violence to female victims when the perpetrator was also female. Findings suggest that gender of the initiator (perpetrator) and non-initiator (victim) of violence may impact identification of violence more than sexual orientation. The results also suggest that respondents' homonegative attitudes impact perceptions of violence in same-sex relationships, particularly female partnerships. More research is needed on counselor response to relationship violence and sexual orientation. Exploring how beliefs in heteronormative gender-roles and homonegative attitudes impact perceptions of same-sex intimate partner violence among CITs is crucial for competent and ethical practitioners. / Ph. D.

Introduktion: Våld i nära relation är ett samhällsproblem som globalt drabbar ungefär en tredjedel av världens kvinnor. Sjuksköterskor har ett ansvar att arbeta etiskt och respektera människors värde och rättigheter. Forskning visar på faktorer som gör att sjuksköterskan inte uppmärksammar att en kvinna blir utsatt för våld i nära relation och som kan skapa hinder i bemötandet. Det är därför nödvändigt att beskriva kvinnors upplevelse av bemötandet för att eventuellt kunna utveckla bemötandet inom vården. Syfte: Syftet var att beskriva kvinnors upplevelse av bemötandet i vården efter att ha blivit utsatta för våld i nära relation. Metod: Metoden var litteraturöversikt med beskrivande design. Totalt 12 kvalitativa studier i originalartiklar från databaserna PubMed respektive CINAHL inkluderades i resultatet. Artiklarna kvalitetsgranskades med SBU:s kvalitetsgranskningsmall. Resultat: Resultatet beskrivs utifrån kategorierna önskat och ej önskat bemötande med nio underkategorier. Ej önskat bemötande var upplevelsen av personalens ifrågasättande eller skuldbeläggande av kvinnorna samt att de känt sig avfärdade. Även att de inte känt sig sedda, förstådda eller tillfrågade om våldet de utsatts för. Det önskade bemötandet var tillräckligt med tid, stöd och bekräftelse samt hjälp med information. En etablerad relation med vårdpersonalen ansågs även positivt. Slutsats: Kvinnorna beskrev positiva och negativa upplevelser av bemötandet i vården och det fanns faktorer som kunde påverka mötet till det bättre eller det sämre. Resultatet visar inverkan vårdpersonalen kan ha på den våldsutsatta kvinnans upplevelse av bemötandet. Sjuksköterskans bemötande kan antingen göra kvinnan bekväm att tala om våldet eller tvärtom och då riskerar kvinnan att inte få den vård hon behöver. / Introduction: Intimate partner violence is a societal issue that globally affects about a third of the female population. Nurses have a responsibility to work ethically and to respect human values and rights. However, research shows that there are factors that prevent nurses from recognizing when a woman is being subjected to interpersonal violence, factors that can create obstacles in encountering the women. It’s therefore important to describe women's experiences to be able to possibly develop the patient encounter in health care. Aim: The aim was to describe women's experiences of their encounter with healthcare providers after they had been exposed to intimate partner violence. Method: The method used for this work was literature review with a descriptive design. A total of 12 studies in original qualitative articles from the databases PubMed and CINAHL were included in the results. The articles were quality reviewed using SBU's quality review template. Results: The results were divided into desired and undesired encounters with nine subcategories. Undesired encounter was the experience of staff questioning or blaming the women and that they felt dismissed. They also felt that they had not been seen, understood, or asked about the violence they had experienced. The desired encounter was sufficient time, support, acknowledgement and help with information as well as an established relationship with healthcare professionals. Conclusion: The women described positive and negative experiences of encounters in health care and there were factors that could influence the encounter for better or worse. The result shows the influence health care staff can have on the battered woman's experience of encounters. The way nurses' encounter these women can make them feel either comfortable talking about the violence or vice versa and that could lead to her not getting the care she needs.

This report presents the findings of a research study exploring the health service response to domestic violence within Wakefield. Recent international, national and local research has identified domestic violence as a serious health care issue resulting in a wide range of long and short term health implications for women1 (Butler, 1995: Stark and Flitcraft, 1995, 1996: Campbell, 2002). The research highlights the changing face of domestic violence considering the implications of the recent reframing of domestic violence from a social care issue into an integrated health and social care issue (Glendinning, 2003). Explored is the impact of such changes for health policy makers, health professionals and women who having experienced domestic violence then access health care services in the District. / Eastern Wakefield Primary Care Trust

Background. Decades of research have found alcohol and negative affect (NA) are global and proximal risk factors for psychological and physical intimate partner violence (IPV), especially among college students. Despite recognition as the most common form of IPV, bidirectional psychological and physical IPV (i.e., instances where both partners are perpetrating and experiencing victimization) remains an understudied topic. Clarifying alcohol and NA’s influences on bidirectional IPV may inform the development of intervention programs. We hypothesized that the association between alcohol use (number of daily drinks and Heavy Episodic Drinking [HED]) and IPV would vary as a function of NA. Methods. Dating college students (N = 232; 67.7% women; 83.89% white) who drink alcohol completed daily surveys for 60 consecutive days assessing daily alcohol use, NA, and IPV perpetration and victimization. Generalized linear mixed models (GLMMs) tested the within- and between-person associations and interactions between alcohol use, NA, and psychological and physical unidirectional and bidirectional IPV. Results. A significant interaction between NA and the number of drinks before unidirectional psychological IPV perpetration emerged, such that the alcohol-IPV association was weaker at lower levels of NA. A main effect of NA emerged as a proximal antecedent of unidirectional psychological victimization and bidirectional psychological IPV. Main effects of within- and between-person alcohol use were insignificant across other models. Conclusion. On days of low NA, college students were less likely to perpetrate psychological IPV after drinking. Future research should clarify whether positive affect weakens the alcohol-IPV association and assess additional moderators of this link. / These data were collected by the author’s advisor (Dr. Meagan J. Brem) and was supported by a Visionary Grant from the American Psychological Foundation (APF) and by grant F31AA026489 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) awarded to Dr. Brem. The content is solely the responsibility of the authors and does not necessarily represent the official views of the APF, NIAAA, or the National Institutes of Health. / Master of Science

Introduktion: Våld mot kvinnor i nära relation är ett globalt hälsoproblem och utgör en kränkning mot kvinnors mänskliga rättigheter. Vårdpersonal har som ansvar att uppmärksamma våldet samt inneha kunskap om adekvat vård för att hjälpa kvinnorna. Syfte: Syftet var att undersöka hur våldsutsatta kvinnor upplever bemötandet av hälso- och sjukvårdpersonal.  Metod: En beskrivande design med litteraturöversikt som datainsamlingsmetod. Litteratursökningen gjordes i databaserna PubMed och CINAHL. Artiklarna som användes i litteraturöversikten hade en kvalitativ ansats där artiklarnas resultat analyserades med hjälp av Popenoe et al. (2021).  Resultat: Av resultatet framkom tre huvudkategorier. Relationsbyggandet mellan kvinnan och vårdpersonal där kvinnorna tyckte att det var viktigt att etablera en tillitsfull relation till vårdpersonalen. Kvinnorna upplevde en känsla av trygghet när deras situation togs på allvar och de formella rollerna förkastades. Att inte känna sig uppmärksammad eller sedd där kvinnorna upplevde att vårdpersonalen inte lyssnade till dem och bortprioriterade våldet. Kvinnorna upplevde att vårdpersonalen förstärkte deras känslor av skam och skuld. Vårdpersonalens ställningstagande där flertalet kvinnor upplevde att frågan om våldet skulle komma från vårdpersonalen för att de skulle vara villiga att dela med sig. Kvinnorna upplevde också att de inte fick hjälpen som de var i behov av.   Slutsats: Kvinnorna upplevde goda samt bristfälliga bemötanden av vårdpersonal. Flera kvinnor rapporterade om möten där de blev uppmärksammade och respekterade. Tidsbrist och brist på empati från vårdpersonal hindrade kvinnorna från att dela med sig av våldet. Flera av kvinnorna berättade hur de inte fått frågan eller den hjälp som de varit i behov av från vårdpersonal. Det behövs ökad kunskap och förståelse från hälso- och sjukvårdspersonal gällande våld i nära relation för att kunna säkerställa ett gott och tryggt bemötande. / Introduction: Intimate partner violence is a global health issue and constitutes a violation of the human rights of women. Healthcare personnel are responsible for noticing the violence and having knowledge of adequate care to help the women.   Purpose: The aim was to investigate how women exposed to intimate partner violence experience the treatment of healthcare personnel.   Method: A descriptive design with literature review as the data collection method. The literature search was done in the databases PubMed and CINAHL. Articles used in this literature review have a qualitative approach where the results of the articles was analyzed with the help of Popenoe et al. (2021). Results:  The result emerged in three main categories. The relationship building between the women and the healthcare personnel where the women thought it was important to establish a relationship based on trust with the healthcare personnel. The women felt a sense of safety when their situation was taken seriously and the formal roles were reprobated. Not feeling noticed or seen where the women felt that the healthcare personnel was not listening to them and deprioritized the violence. The women then felt that the healthcare personnel reinforced their feeling of shame and guilt. The healthcare personnel stance, where the majority of women felt that the question about the violence should be asked by the healthcare personnel for them to be willing to share their story. The women also felt that they did not get the help they needed.   Conclusion: The women experienced good as well as poor treatment by the healthcare personnel. Multiple women reported having appointments where they felt noticed and respected. Lack of time and lack of empathy from the healthcare personnel prevented the women from sharing their story of violence. Several of the women stated how they had not received the question or the help they needed from the healthcare personnel. There is a desideratum for an increased knowledge and understanding from healthcare personnel regarding intimate partner violence in order to ensure good and safe treatment.