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Intimate Partner Violence: What Does Research Reveal About Screening and Intervention

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  1. Intimate Partner Violence:What Does Research Reveal About Screening and Intervention Tonya Allendorfer, Andrea Bengston, Sarah Delaat, Dawn Platt, and Kaija Sherman http://www.google.com/imgres?hl=en&biw=1618&bih=994&tbm=isch&tbnid=T1b8Gefk5IixIM:&imgrefurl=http://www.omahawomensfund.org/studies/research/details.aspx%3FID%3D59&docid=06cxKvsBuMCgTM&imgurl=http://www.omahawomensfund.org/Post/sections/31/Images/violence%252520for%252520name%252520tags.jpg&w=2012&h=1031&ei=rfEBUMPgM8ShrAHI1rGxDA&zoom=1&iact=hc&vpx=470&vpy=193&dur=2123&hovh=161&hovw=314&tx=161&ty=101&sig=102660474818701814850&page=1&tbnh=79&tbnw=154&start=0&ndsp=43&ved=1t:429,r:2,s:0,i:119

  2. Intimate Partner Violence (IPV)World Health Organization (WHO) describes IPV as: “Acts of physical aggression such as hitting or kicking, violence by intimate partners includes forced intercourse and other forms of sexual coercion, psychological abuse such as intimidation and humiliation, and controlling behaviors such as isolating a person from family and friends or restricting access to information and assistance” (Drug, Dahlberg, Mercy, Zwi, & Lozano, 2002, p. 24).

  3. IPV: Interesting facts • Over a lifetime the likelihood of IPV is between 25% and 35% • 18% to 25% of women seen in ER are victims of IPV • Estimated that emergency healthcare providers detect only 5% of battered women • U. S. has highest number of deaths related to IPV • IPV can occur from adolescence to elderly

  4. Article #1:Development of a Brief Motivational Enhancement Intervention for IPV in Alcohol Treatment Settings • Study designed to improve effectiveness of screening • Used as a referral for IPV in alcohol treatment settings • Used to improve IPV treatment outcomes by increasing motivation to change IPV and IPV related behaviors http://getdownpsa.blogspot.com/2011/11/dangerous-liaison-antifeminist-culture.html

  5. Article #1 • 2-part study that compared men who were enrolled in substance abuse treatment centers who admitted to IPV within the last year • Control group received no assessment • Study group received assessment followed by a 90-minute motivational interviewing-style therapy

  6. Article #1: Study 1a, Participants • 13 men ages 21 to 44 • 12 had high school diploma or GED • 7 currently employed • 7 men were white • 5 men were black • 1 man was non-Hispanic other

  7. Article #1: Study 1a, Assessment Tools Used • Quality of Marriage Index • Assess relationship satisfaction • 90-day Timeline • Documenting alcohol usage and spousal violence • Self-reported Conflict Tactic Scale • Assess frequency of verbal and physical aggression • Pros and Cons of Partner Abuse Scale • Measure perceived positive and negative consequences of abusive relationships • State Trait Anger Expression Inventory http://www.soberlanding.com/wp-content/uploads/2010/10/Alcohol-and-men.jpg

  8. Article #1: Study 1a, Results • Most expressed the sessions as therapeutic • 12 men stated they were willing to make changes in 1-3 behaviors • 11 men were willing to work on making relationships more positive • 2 men thought it would be best to end abusive relationship • Men were given list of community resources but were not sure how to utilize them • Self-help packets were then given to increase communication, reduce conflict, and improve well-being

  9. Article #1: Study 1b, Participants • Attempted to include partners of men to assess if IPV had decreased • 23 men with average age of 32 and same requirement as first study • 12 men in control group (no assessment) • 11 men in treatment group • 16 women • No indication of number in control or treatment groups

  10. Article #1: Study 1b, Assessment Tools Used • All tools in first study • Personal Assessment of Intimacy in Relationships • The University of Rhode Island Change Assessment • Question asking if they had participated in any help seeking http://www.google.com/imgres?start=91&hl=en&biw=1618&bih=994&tbm=isch&tbnid=4B5NbDPa_Epj4M:&imgrefurl=http://harrellcenter.hsc.usf.edu/research2.html&docid=nAcBiDO9quUF1M&imgurl=http://harrellcenter.hsc.usf.edu/images/IntimatePartner.jpg&w=1024&h=1024&ei=270BUOeoGoXfqgG-s42xDA&zoom=1

  11. Article #1: Study 1b, Results • All participants completed 2-week follow-up • Reported seeking additional help for IPV in comparison to control group • 7 men and 15 women completed 3-month and 6-month follow-up • Findings for treatment and control groups • Increased intimacy (no change for control group) • Both groups reported decrease in anger • Women and men that completed the program reported decrease in physical and psychological aggression

  12. Article #1: Critical Appraisal • Study limitations • Small sample size • Inability to recruit all female partners • Several variables • Purpose clearly stated regarding the men, but unclear regarding the women • Relevant to nursing • Author referenced 36 articles using secondary information

  13. Article #1: Conclusion • Interventions that started in substance abuse programs increased short-term help-seeking behaviors • Biggest factor: Alcohol cessation • Feasible to introduce IPV assistance in substance abuse treatment centers • More research needs to be done • Unfortunately, many women will not report their abusers even when the abusers admit to the acts of violence

  14. Article #2A Theory-Based Primary Health Care Intervention for Women Who Have Left Abusive Partners • Study to showcase how women who have left their abusive relationship can utilize iHEAL intervention • iHEAL: Intervention for Health Enhancement After Leaving • Comprehensive, trauma-informed, primary-care intervention which builds on grounded theory Strengthening Capacity to Limit Intrusion • Goal: To improve women’s health and quality of life after leaving abusive partner

  15. Article #2 • Qualitative study used open- and closed- ended questions • Participants included 309 women found by entering outreach services for abused women • Requirement: Had to have left abusive partner at least 3 months to 3 years prior to study • Completed by a nurse and domestic violence advocate http://www.google.com/imgres?start=186&hl=en&biw=1618&bih=994&addh=36&tbm=isch&tbnid=Yy-_Ftf7IaYrZM:&imgrefurl=http://theawarenesscenter.blogspot.com/2006_06_01_archive.html&docid=SKZ2tICbB2q44M&imgurl=http://3.bp.blogspot.com/-qUULscg2blI/T-BwW5-CRkI/AAAAAAAAAzU/KD6rPW6LMTA/s1600/heal.jpg&w=640&h=480&ei=I8UBUJOSPMv2rAGN0vW3DA&zoom=1

  16. Article #2: Three Phases • Phase 1 • “Getting in Sync” • To establish a beginning level of trust and relationship between interventionist and woman • To discuss how they will work together • Typically takes 2-4 meetings

  17. Article #2: Three Phases (cont.) • Phase 2 • “Working Together” • Involves focused work on each of the six components to achieve goals of reducing intrusion and enhancing women’s capacity to limit intrusion and improve their health and quality of life • Six component: safeguarding, managing basics, managing symptoms, cautious connecting, renewing self, and regenerating family • Takes up to 4 months and 8-10 meetings

  18. Article #2: Three Phases (cont.) • Phase 3 • “Moving On” • To provide closure • Name and emphasize woman’s capacities • Help the woman reflect on changes in intrusion, health and quality of life • Reinforce potential sources of support • End relationship in positive way that is fortifying to the woman • Occurs in the very last month of intervention

  19. Article #2: Results • 208 women felt iHEAL intervention helped them gain a better quality of life, limit intrusions, identify better coping mechanisms • 7% reported being diagnosed with post-traumatic stress disorder after completion http://www.google.com/imgres?start=91&hl=en&biw=1618&bih=994&addh=36&tbm=isch&tbnid=vKeglSgk5UbQUM:&imgrefurl=http://www.internetmonk.com/archive/the-intruder-and-his-world&docid=fg-X9k02twsSxM&imgurl=http://www.internetmonk.com/wp-content/uploads/stopviolence.jpg&w=500&h=313&ei=Ns0BUMbxI8HlrQGlmqWxDA&zoom=1

  20. Article #2: Critical Appraisal • Study limitations • Few tested interventions designed to improve women’s health and quality of life beyond the crisis of leaving • Sample did not represent women outside of outreach service centers for women • iHEAL is a new intervention so interventionists had very little training • Not representative to all women • Provided insights useful in refining the iHEAL intervention for future studies, as authors concluded • Authors did not indicate whether goals were met or not

  21. Article #2: Conclusion • Further research needs to be done • iHEAL interventions are a great starting point • Very little research about women leaving abusive relationships http://www.google.com/imgres?start=322&hl=en&biw=1618&bih=994&tbm=isch&tbnid=THI_qrCYtct3iM:&imgrefurl=http://usafricaonline.com/2010/08/06/violence-against-nigerian-women-by-uche-nworah/&docid=ObyKt2ziFILKaM&imgurl=http://www.usafricaonline.com/wp-content/uploads/2010/08/stop-violence-against-women.jpg&w=380&h=373&ei=xOoBUNnwGMqjrQGh87GxDA&zoom=1&iact=hc&vpx=855&vpy=390&dur=37&hovh=222&hovw=227&tx=153&ty=120&sig=102660474818701814850&page=8&tbnh=152&tbnw=155&ndsp=47&ved=1t:429,r:43,s:322,i:217

  22. Article #3The Lived Experiences of a Male Survivor of IPV • An interview of a male survivor of IPV • To gain understanding of lived experience and the real-life context of which the violence emerged • To provide men that are victims of IPV appropriate and supportive care http://www.google.com/imgres?hl=en&biw=1618&bih=994&tbm=isch&tbnid=zORa5_xFqe3CqM:&imgrefurl=http://www.articlesaboutmen.com/2010/07/intimate-partner-abuse-of-men-911/1572/&docid=64kyRRFGRBKNmM&imgurl=http://www.articlesaboutmen.com/wp-content/uploads/2010/07/DomesticViolence-against-men2.jpg&w=750&h=600&ei=7dIBUI2vDZC0qAHT64m1DA&zoom=1&iact=hc&vpx=409&vpy=151&dur=5573&hovh=201&hovw=251&tx=151&ty=112&sig=102660474818701814850&page=1&tbnh=149&tbnw=186&start=0&ndsp=38&ved=1t:429,r:1,s:0,i:76

  23. Article #3 • Phenomenological study conducted over a 1-month period using Colaizzi’s method • Approach: to facilitate an understanding of the life experiences that radically alter and shape the meanings people give to themselves and their experiences • Sample size: 1 male (of course) • Self-reported survivor of physical, emotional, and verbal abuse; harassment, and humiliation by current or former intimate partner • Violence occurred in context of heterosexual relationship • Process of leaving or had left relationship

  24. Article #3: Results • Three separate themes • Living in the relationship-confrontation from within • Living in the relationship-confrontation from without • Leaving the relationship—realization and relinquishment • One overarching theme • Living with a knot in your stomach • Themes discussed the feelings as he relived the abusive relationship during interview

  25. Article #3: Critical Appraisal • Study limitations • Only 1 participant • No recordings of concrete data expressed • Further qualitative studies using larger sample sizes would enable a richer, more inclusive description of the experiences of male IPV victims • No supportive evidence of how to provide intervention to male victims of IPV

  26. Article #3: Conclusion • IPV is not isolated to male to female abuser and victim, respectively • More research needs to be done to study the impact of male IPV victims http://www.google.com/imgres?start=195&hl=en&biw=1618&bih=994&tbm=isch&tbnid=CknF9i3uJ8bElM:&imgrefurl=http://www.facebook.com/MaleDomesticAbuse&docid=u9M6zGtXDS_mZM&imgurl=http://profile.ak.fbcdn.net/hprofile-ak-ash2/195796_102447226503408_3461851_n.jpg&w=200&h=232&ei=W-0BUNiaLYqorQGiyM2xDA&zoom=1

  27. Article #4Myths and Stereotypes: How Registered Nurses Screen for IPV • Phenomenological, qualitative study performed in an interview form • Goals included: • To identify how RNs screen for IPV in emergency department • Barriers to screening • How RNs perceive the effectiveness of screening • What resources are needed • How nurses perceive victims of IPV • How nurse perceives his or her role in assisting victims of IPV http://www.google.com/imgres?hl=en&biw=1618&bih=994&tbm=isch&tbnid=JiT-FO83ZLJStM:&imgrefurl=http://www.mautnerproject.org/health_info/ipv.cfm&docid=k0sgDmtj1PcN0M&imgurl=http://www.mautnerproject.org/images/health_info_ipv_header.gif&w=525&h=150&ei=LdwBUMPWN42HqQG69ZyxDA&zoom=1&iact=hc&vpx=1157&vpy=336&dur=82&hovh=120&hovw=420&tx=383&ty=78&sig=102660474818701814850&page=2&tbnh=57&tbnw=200&start=38&ndsp=43&ved=1t:429,r:35,s:38,i:305

  28. Article #4: Participants • 13 emergency department nurses participated • Selected in a convenience-type sample by entering emergency department • Participants were interviewed in open-ended technique 10 questions or statements, 6 were included in the article: • Tell me about screening for IPV in the emergency department. • What does screening for IPV mean to you, or how would you define screening? • Tell me about a time you screened for IPV. • What was that like for you? • Can you think of a time that you had a bad experience screening? • Can you tell me about your most/least successful experience working with a victim of IPV in the emergency department?

  29. Article #4: Results • 4 major themes emerged • Myths, stereotypes, and fears • Stereotyped based on demeanor when entering emergency department • The questions needed to ask would be perceived as offensive • Demeanor • Frustrations • Only being able to provide temporary help • The nurse would receive inaccurate information from the patient • The victim would go back to the abuser • Safety benefits • Attitude of negativity toward the victim of IPV or having to deal with the added responsibilities of an IPV victim

  30. Article #4: Critical Appraisal • Study limitations • Lack of literature for interpretation and analysis • Possibility that nurses were responding to questions or statements professionally instead of accurately for fear of appearing unprofessional • Very small sample size • Author referenced several articles only supporting findings • No concrete evidence referenced to support findings • Complete results of interviews were not included, only generalized statements • Conclusion that future studies are recommended is accurate

  31. Article #4: Conclusion • Myths, stereotypical beliefs, and victim-blaming attitudes are still held by practicing nurses • Further studies need to be done regarding screening for IPV in the emergency department • To evaluate educational programs designed to eliminate victim-blaming • To integrate myth/stereotype/blame-free screening into routine practice http://www.google.com/imgres?start=325&hl=en&biw=1618&bih=994&tbm=isch&tbnid=-ShkpjRjtuweAM:&imgrefurl=http://www.postiar.com/post/26290/a-post-that-could-save-your-life-someone.html&docid=zo1z__4jXZsfyM&imgurl=http://2.bp.blogspot.com/_o6mtNNhaUW0/SxQJRiexNsI/AAAAAAAAGN0/oUtzcYjMq2I/s1600/abused-woman.jpg&w=865&h=1024&ei=3-4BUOPBC8riqAGA1KyzDA&zoom=1&iact=hc&vpx=983&vpy=637&dur=82&hovh=244&hovw=206&tx=80&ty=228&sig=102660474818701814850&page=8&tbnh=149&tbnw=137&ndsp=49&ved=1t:429,r:38,s:325,i:280

  32. IPV: Utilization of Evidence • More research needs to be performed to provide solid concrete evidence about how nurses screen for and provide interventions to IPV • Factors that can affect implementation include • Nurse’s lack of experience • Time consumption in dealing with unknown and possibly fearful situation • Perceived negative responses in asking about IPV • Screening and Intervention are steps in the right direction • Patients want to be asked about IPV • All patients need to be asked about IPV • Nurses need to put aside biases or stereotyping • Nurses need to explore and examine their own feelings toward IVP

  33. IPV: Final Conclusion • IPV is still a major problem worldwide • More research is needed regarding screening and intervention • Interventions such as iHEAL need to be utilized and researched to conclude effectiveness • Nurses have a very important role in helping victims of IPV

  34. References Alhabib, S., Nur, U., & Jones, R. (2010). Domestic violence against women: systematic review of prevalence studies. Journal of Family Violence, 25(4), 369-382. Burns, N., & Grove, S. (2011). Understanding Nursing Research Building an Evidence Based Practice (5th ed.). Maryland Heights, MO: Elsevier. Coffey, S.F., Fals-Stewart, W., Leonard, K.E., Murphy, C.M., Schumacher, J.A., & Stasiewicz, P.R. (2011). Development of a Brief Motivational Enhancement Intervention for Intimate Partner Violence in Alcohol Treatment Settings. J Aggress Maltreat Trauma, 20(2), 103-127. Ford-Gilboe, M., & Varcoe, C. (2011). A Theory-Based Primary Health Care Intervention for Women Who Have Left Abusive Partners. Advances in Nursing Science, 34(3), 198-214. doi:10.1097/ANS.0b013e3182228cdc Krug, E. G., Dahlberg, J. A., Mercy, J. A., Zwi, A. B., & Lozano, R. (2002). World Health Organization (Ed.). Geneva, Switzerland. Nayback-Beebe, A., & Yoder, L. (2012, March-April). The Lived Experiences of a Male Survivor of Intimate Partner Violence: A Qualitative Case Study. MedSurg Nursing, 21(2), 89-95. Robinson, R. (2010). Myths and stereotypes: How registered nurses screen for intimate partner violence. Journal of Emergency Nursing, 36(6), 572-576. doi: 10.1016/j.jen.2009.09.008