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.

The current study focused on the challenging task of providing treatment to male batterers and the various factors that may positively affect the outcome of treatment. Group treatment has been shown to be a successful modality to working with partner abusers, due to the unique environment that is created where males interact with and establish relationships with other males. This male-male socialization may have potential positive effects on the course and outcome of therapy. This study sought to provide support for Jennings and Murphy’s theory of domestic violence that malefemale disrupted relationships have roots in disrupted male-male relationships and male identity issues and rigid gender role ideals. This study predicted that over the course of a 15-week court mandated domestic violence group, improving male-male relationships would be correlated with improvements in male identity issues and rigid sex role attitudes and improvements in male-female relationship issues. These expectations were supported by the research data. Additionally, it was expected that an improvement in same sex relationships would be related to an overall dimensional change in their attachment system. This hypothesis was not supported by the data. Moreover, process variables such as group climate and working alliance were also examined throughout the course of the group to shed light on any changes that were found. The results showed steadily increasing reports of positive working alliance ratings by counselors and clients, and increasing levels of group cohesion among the group members. The discussion and conclusions focus on the clinical significance of the study’s findings and include specific examples from the groups in this study. Implications for treatment with this population, limitations of the study, and suggestions for future research are also addressed.

The study proposed to distinguish differences in perpetrators of Intimate Partner Violence (i.e., Common Couple Violence and Patriarchal Terrorism) due to the mediating effect of their presentations of narcissism (covert and overt). Distinguishing perpetrators of Intimate Partner Violence by their narcissistic presentations should assist clinicians in batterer treatment programs to create specific lessons/interventions for perpetrators of Intimate Partner Violence based on their narcissistic quality. The study of a cross-section of men in a Batterer Intervention Program included measures on self-perception, views of partner, and history of violent, aggressive, controlling, and psychologically abusive interactions with their partner. Structural Equation Modeling with Analysis of Moment Structures was used to determine the structure and function of narcissism and interpersonal violence. Intimate Partner Violence was distinguishable as Common Couple Violence or Patriarchal Terrorism, but the results were not sufficiently conclusive to warrant an absolute classification system. Overt Narcissism was somewhat useful in distinguishing Patriarchal Terrorism from Common Couple Violence by mediating the effects of violent behaviors, controlling behaviors, and psychological abuse when mediated by type of narcissism. That information is useful for clinicians interested in creating targeted interventions to participants in Batterer Intervention Programs to reduce Intimate Partner Violence and violent recidivism. Specifically, Common Couple Violence was described by the number of times the participant physically injured the partner over the past year, the total number of conflict tactics used, and whether their partner needed medical attention following physical injury. Patriarchal Terrorism was described by psychological abuse and controlling behaviors. Overt Narcissism increased Patriarchal Terrorism, whereas, Covert Narcissism did not assist in distinguishing Common Couple Violence from Patriarchal Terrorism. The mediating effect that Covert Narcissism had on violent behaviors, controlling behaviors, and psychological abuse was weak. Overt Narcissism is a more useful construct when identifying potential Patriarchal Terrorists, while Covert Narcissism was not found to provide additional detail to either Patriarchal Terrorism or Common Couple Violence. Knowing the differing and similar impacts of those constructs can potentially grant greater clinical effectiveness with perpetrators of Intimate Partner Violence.

Intimate partner violence (IPV) is a global public health problem and occurs in all countries including Hong Kong. Women are significantly more likely to report being victimized by intimate partner than men. IPV can result in high personal and social costs in terms of personal health consequences, burden on the medical care and loss productivity for the society. Early and effective interventions for women survivors of IPV are utmost importance. Increasing the safety behaviours education to abused women is one of the aims of advocacy interventions that may prevent further abuse and increase the safety and well-being of those women. It is crucial for nurses to assess the effectiveness of the advocacy intervention in order to apply the best evidence into practice in the local settings. However, there are no specific interventions or guidelines for women survivors of IPV are available in Hong Kong local healthcare system including the STD clinics or the Social Hygiene Clinics. In this dissertation, a translational nursing research related to an effective advocacy intervention for women survivors of IPV is described. The purposes of this study are (1) to conduct a systematic literature review on interventions to increase safety behaviours for women survivors of IPV; (2) to summarize and synthesize the data from the identified literatures; (3) to assess the implementation potential of the proposed innovation on advocacy intervention; (4) to develop an evidence-based practice guideline; (5) to develop an implementation plan; and (6) to develop an evaluation plan to assess the effectiveness of the proposed evidence-based guideline. A systematic literature search was conducted and a total of nine studies were identified in the review. The level of evidence and critical appraisal of each selected study was criticized by using the grading system of Scottish Intercollegiate Guideline Network (SIGN). After the integrative review, the implementation potential of the proposed innovation on advocacy intervention for women survivors of IPV was assessed in terms of different aspects, including target audience and setting, transferability, feasibility and cost-benefit ratio. Then an evidence-based guideline was developed based on the level of evidence with grades of recommendation stated. For the implementation plan was divided into two parts, the communication plan and the pilot study plan. After communicating with the different identified stakeholders and providing proper training programme to the innovators, a pilot study test was carried out for concrete information on the feasibility of the proposed innovation. Finally, an evaluation plan was designed to evaluate the effectiveness of the proposed innovation. The aim of this dissertation is to increase the safety behaviours of the target population and to reduce further abuse. With the implementation of the evidence-based advocacy intervention, the women client’s knowledge on safety-promoting behaviours should be improved significantly thus to improve their health and also to increase their safety. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Introduction: Intimate partner violence (IPV) is a prevalent public health problem that brings many adverse outcomes to individuals and societies. Understanding, preventing, and reducing IPV is important to minimize the consequences. Instead of studying IPV as a single phenomenon, Johnson’s typology of domestic violence suggests that there are four types of IPV which have differential effects on survivors’ health. Violence and coercive control used by individuals in the relationship are the key components to categorizing the types of IPV. Hence before applying this categorization to the Chinese context, it is first essential to examine the coercive control. Aims: This study aimed (a) to examine pattern of coercive control in Chinese intimate relationships, (b) to establish a cut-off score on the Chinese version of the Revised Controlling Behaviors Scale (C-CBS-R) to differentiate the use of coercive control, and (c) to identify Intimate Terrorism (IT) and Situational Couple Violence (SCV) in Johnson’s typology and their impact on the mental health of women survivors. Methods: A cross-sectional, mixed-methods design study was conducted. Chinese women aged 18 or above who reported being physically abused by an intimate partner in the past 12 months were recruited from shelter and community settings. The study consisted of three parts: (a) semi-structured, in-depth individual interviews to examine the coercive control used in Chinese intimate relationships, (b) qualitative and quantitative data to establish a cut-off score on C-CBS-R, and (c) a survey using a researcher-administered questionnaire to categorize types of IPV and examine their mental health effects. A set of questionnaires was used to elicit participants’ experiences of IPV, frequency of physical violence used, controlling behaviors, depressive symptoms, post-traumatic stress disorder (PTSD) symptoms, and demographic characteristics. Results: In Part 1 of the study, a pattern of coercive control was identified in the abusive intimate relationships from the interviews of 20 physically abused women. Then a cut-off score of C-CBS-R was identified as greater than 1.145 to differentiate control with and without a pattern in Part 2 of the study. Finally, a total of 334 physically abused women were recruited with 133 (40%) being identified as IT survivors while 137 (41%) were SCV survivors. IT women survivors were found to experience a significantly higher frequency of physical violence, physical injuries, and use of medical services than SCV survivors. The age difference between the woman and her partner, expressed fear of her partner, experience of financial hardship, and sexual coercion by an intimate partner in the previous year were significantly associated with the occurrence of IT. Using linear regression model analysis, IT women survivors were found to report more severe depressive and PTSD symptoms than SCV survivors with and without confounding by other factors. Conclusion: This study developed a cut-off score on C-CBS-R to differentiate the use of control and identified IT and SCV based on the use of control and violence by individuals according to Johnson’s typology. IT women survivors were found to experience more severe mental health impacts than SCV survivors, showing the differential effect on women survivors’ health. / published_or_final_version / Nursing Studies / Master / Master of Philosophy

Survivors of intimate partner violence often suffer from a number of serious aftereffects, but current prevalent treatments lack effectiveness for this population. Along with typical trauma symptoms such as avoidance and constriction, other common challenges unique to survivors include a loss of sense of self, negative self-appraisal, and a lack of self- efficacy. Therapeutic Assessment is well-suited to this population due to its potential for helping clients to replace distorted beliefs about the self with more adaptive ones, engaging clients as equals, and helping clients to form cohesive life narratives. The proposed study will measure the effectiveness of this approach with three to five subjects using a time-series design. Subjects will provide daily ratings of their personal experiences evaluating five areas of concern, three to be shared across subjects and two tailored to the priorities of each specific participant. The resulting indices will be tested using Simulation Modeling Analysis (SMA), controlling for autocorrelation using the Lag 1 correlation, to see whether statistically significant changes occur in the desired directions. / text

A study investigated men and women's attributions of criticism, rejection, and threats to gender status in a fictitious partner conflict scenario in which the victim was either a man or a woman. The results indicated that in the context of a partner conflict scenario that ends in violence, greater perceived threats to gender status are attributed to a female victim who criticizes a man's manhood more than a male victim who criticizes a woman's womanhood. The results also revealed that women attribute greater amounts of criticism/rejection and gender status threat in a victim's statements toward an abuser than men do, regardless of the gender of the victim. Individual differences in gender role stress, ambivalent sexism, and propensity for abusiveness failed to moderate these effects. These results present preliminary evidence grounded in precarious manhood theory that attributions of intention during domestic conflicts differ along gendered lines.