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.

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.

Titel: Våld i nära relationer – Sjuksköterskors erfarenheter av att möta våldsutsatta kvinnor, en systematisk litteraturstudie. Bakgrund: År 2011 anmälde 12 471 kvinnor att de blivit utsatta för våld i en nära relation. Skador som våldsutsatta kvinnor drabbas av är allt från psykiska besvär till svåra fysiska skador. Många av dessa kvinnor behöver komma i kontakt med sjukvården och sjuksköterskor i olika organisationer. Syfte: Syftet med litteraturstudien är att beskriva sjuksköterskans erfarenheter av att möta kvinnor som utsätts för våld i nära relationer. Metod: En systematisk litteraturstudie där inkluderade studier granskades och kvalitetsbedömdes. Resultaten analyserades och tematiserades utifrån likheter och skillnader. Resultat: Huvudresultatet påvisade sjuksköterskornas känslomässiga svårigheter att möta kvinnor som utsätts för våld i nära relationer, då det bland annat påverkade sjuksköterskans privatliv. Det var även svårt för sjuksköterskan att ställa frågan till kvinnan angående våldsförekomst om sjuksköterskan misstänkte det, samt hur sjuksköterskan skulle ställa frågan. Sjuksköterskan fann även svårigheter att finna tid och en bra miljö för dessa kvinnor att känna sig trygga i. Många sjuksköterskor strävade efter att få utbildning inom ämnet våld i nära relationer eller att få ytterligare utbildning inom ämnet. Slutsats: Litteraturstudiens resultat visar att utbildning inom området våld i nära relationer är en nödvändig och central faktor som i dagsläget inte är tillräcklig. Nyckelord: “intimate partner violence”, “domestic violence”, “encounter*”, “experienc*” och “nurse- patient relations”

Latina survivors of intimate partner violence (IPV) experience IPV at similar rates as other ethnic groups. However, the intersection of multiple cultural factors, including acculturation, can greatly influence a woman’s experience of IPV. For example, research suggests that Latinas experience unique forms of control and unique barriers to service in addition to positive coping. Nevertheless, a scarcity of culturally relevant interventions plagues the IPV field. Moreover, evaluations of such programs are remarkably scarce in the research literature. The current study evaluates an innovative peer leadership intervention, the Líderes program, which is grounded in a self-empowerment framework. The Líderes program is a peer education leadership initiative that taps into the natural leadership skills of Latinas. Although the effectiveness of similar peer leadership models addressing public and occupational health concerns, education outcomes, and nursing leadership can be found in the literature, this is the first documented attempt to include survivors of IPV as participants in such a program. The study used a mixed methods design. The quantitative component included a multiple baseline research design including nine participants. The survey measured variables related to leadership development and a facilitator rating was utilized to measure behavioral change. The qualitative component included analysis of journals written by the participants documenting their experience of the program. Results revealed that the Líderes curriculum was effective in influencing the self-empowerment of participants across the intrapersonal, interactional, and behavioral domains of leadership. The qualitative results supported this finding and provided evidence for the important role of a supportive environment for this change to occur. The Líderes training program is the first training program for Latina community leaders who are also survivors of IPV. This study highlights the advantages of a peer-intervention training program as a way to develop existing strengths among Latina survivors of IPV.

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.

Women who have experienced violence in their intimate partnerships have consistently reported poorer physical and mental health and higher medical care utilization than women who have not experienced intimate partner violence. Because of the many deleterious impacts of relationship abuse, investigations into coping processes among women who have experienced intimate partner violence take on heightened importance. The complexity of circumstances and the unique responses to intimate partner violence indicate that women employ as many coping strategies as are available to them at the time. Effective coping behaviours and the recovery environment are critical for battered women’s positive adjustment (Carlson, 1997; Sullivan & Bybee, 1999). This study examined the relationships between emotion-focused coping, symptoms of post-traumatic stress and exposure to intimate partner violence in a sample of 670 women across the Prairie Provinces. The Composite Abuse Scale, Emotion-Focused Coping Strategies questionnaire, and the Posttraumatic Stress Checklist were used to measure the variables. Findings confirmed a strong correlation between greater exposure to abuse and symptoms of posttraumatic stress. They also confirmed that greater use of emotion-focused coping strategies was associated with escalation of abuse and more symptoms of posttraumatic stress within this group of women. This study adds to the current body of literature on ways women cope with intimate partner violence.