Intimate partner violence (IPV) against women as a serious global health issue and violation of women’ human rights, affects approximately one in three women within their lifetime globally, and leads to negative results on women’s psychological, physical, and sexual health. Nurses (including midwives) are the largest professional group in health care, and have a critical role in identification and management of IPV. However, lack of training or preparedness for managing IPV was frequently identified among nursing professionals from not only low and middle income countries but also high-income settings. Thus a better understanding of nurses’ perceptions and current practice toward IPV can be useful for future IPV intervention and prevention. The purpose of this meta-synthesis was to systematically search, interpret, and synthesize the literature on knowledge, attitudes, and practice of nurses toward IPV, adopting the meta-synthesis approach for integrating qualitative evidence.
Methods:
We used MeSH terms (e.g., “perception”, “knowledge”, “attitude”, “behavior”, “intimate partner violence”, “domestic violence”, “nurses”, “midwifery”, “health personnel”) and keywords (e.g., “knowledge, attitudes and practice”, “dating violence”, “health care provider”) to search the following databases: PubMed, Embase, CINAHL, PsycINFO, and MEDLINE, from inception to October, 2018. We included articles published in English, as primary research report, in full-text on peer-reviewed journals, focused on knowledge, attitudes, and practice of nurses toward IPV, used appropriate qualitative research methods or mixed methods design, and reported qualitative data. Meanwhile, we excluded articles published as secondary data analysis paper, review, commentary, targeted health care providers but did not provide separated data relevant to nurses, explored experiences regarding intervention program or evaluated the effectiveness of intervention program, and published as dissertation, thesis, conference abstract. We extracted author & year, study aim (s), country, design & methods, participants & setting, and results. Joanna Briggs Institute critical appraisal tools were used for quality appraisal. Two researchers independently retrieved, appraised, and extracted data, and discrepancy was solved by discussion. We adopted the thematic synthesis method introduced by Thomas and Harden to identify themes in an inductive approach, and analyzed similarities and differences across the studies. The study followed PRISMA guidelines.
Results:
Totally 23 articles consisting of 21 qualitative studies and 2 questionnaire survey studies with open-ended questions were included. All the included studies have been published since 2001 (range: 2001-2017). The studies were conducted in Australia (n=3), Brazil (n=1), Canada (n=2), Finland (n=1), Israel (n=1), Italy (n=1), Jamaica (n=1), Japan (n=2), Jordan (n=1), Norway (n=1), Sri Lanka (n=1), South Africa (n=2), Sweden (n=3), and USA (n=4). For all included 23 studies, 7 studies explicitly stated midwives were recruited; 9 studies recruited both female and male nurses whereas only female nurses were enrolled for 7 studies, and 7 studies did not explicitly report sex of the participants. Of the 21 qualitative studies, purposive sampling (n=12) and convenience sampling (n=4) were the most commonly used methods to recruit participants, while 5 studies did not report a specific approach; phenomenology was employed in 5 studies, 4 studies used qualitative descriptive design and 4 studies used a grounded theory approach, 1 study adopted Denzin’s interpretive interactionism, and the rest of 7 studies did not report relevant information.
Through meta-synthesis, 2 main themes emerged including 2 subthemes for each theme: (1) Struggling to intervene IPV victims: a) boundaries between professional role and personal experience, b) lack of preparedness; (2) Influencing factors for screening and caring IPV victims: a) barriers, b) facilitators.
Nurses generally felt it was a challenge to fully implement screening during practice and provide appropriate care for victims of IPV. For the majority of the nurses, the professional role of nursing in IPV was recognized though it was challenging. Anger, frustration, confusion, and shame were mentioned by nurses as their personal experiences when facing IPV victims: on one hand, nurses realized their professional role in identifying and helping victims of IPV (especially for nurses who were victims of IPV themselves); on the other hand, nurses attempted to block the overwhelming emotions from influencing their professional practice as well as invading their individual life. There was a prevalent expression for lack of preparedness among nurses, regardless of experience in screening and training. Nurses identified several factors influencing screening and caring for victims of IPV, including both barriers (e.g., lack of knowledge/training/time/resources/strategies, partner presence, inadequate institutional/societal support, legal issues) and facilitators (e.g., training, having time, IPV experience: professional & personal, supports from community/intuition/policy, multidisciplinary collaboration: police, social service, shelter home workers).
Conclusion:
This meta-synthesis is the first of its kind that provides insight into knowledge, attitudes, and practice of nurses toward IPV in global settings. The challenging and complex nature of intervening victims of IPV for nurses was confirmed. Both barriers and facilitators to screening and caring for victims of IPV were identified. Current evidence highlights the need for nursing professionals to improve knowledge, enhance preparedness, and implement practice for screening and caring for victims of IPV. Special attention should be paid to awareness raising, in-service training, and multidisciplinary collaboration targeting IPV for nurses especially in low and middle income countries.