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.

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.

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

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.