Describing the healthcare experiences and strategies of women survivors of violence

Reeves, Elizabeth; Humphreys, Janice

doi:10.1111/jocn.14152

Cited by 31 publications

(59 citation statements)

References 45 publications

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“…Generally, women believe health professionals should ask about DFV. Screening in itself can be considered a low-key approach for informing and supporting women experiencing DFV (13,19). Our findings are in line with previous research on women's attitudes towards screening.…”

Section: Discussionsupporting

confidence: 90%

A cross-sectional survey of pregnant women’s perceptions of routine domestic and family violence screening and responses by midwives: Testing of three new tools

2020

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BackgroundImplementing Domestic and Family Violence (DFV) screening, support, and prevention within maternity services is becoming common practice but women's experiences of screening are not routinely evaluated. Aims(1) Explore pregnant women's experiences of routine DFV screening and perceptions of responses by midwives; and (2) undertake preliminary testing of three new tools. MethodsUsing a cross-sectional design, pregnant women (n = 210) attending an antenatal service were surveyed. Three new measures: Beliefs about DFV Screening; Non-disclosure of DFV; and Midwifery Support were tested. ResultsMost women (92.3% n = 194) were asked about DFV during pregnancy. Twelve (5.8%) respondents had/were experiencing DFV but not all disclosed. A quarter (24.1% n = 49) had experienced abuse during childhood. The scales were reliable and factor analysis established validity. Women reported positive Beliefs (Mean 35.38, SD 3.63 range 19-40) and views about Midwifery Support (Mean 24.88, SD 3.08 range 18-30). There was less agreement about why some women do not disclose DFV (Mean 21.97, SD 4.27,. Women who reported abuse as a child (t (199) = -2.283, p = 0.23), or experiencing violence now (t (199) = -2.283, p = 0.016) were less comfortable with screening. Comments (n = 75) revealed support for routine enquiry that was confidential, explained, and occurred in a trusting relationship. DiscussionWomen were supportive of screening, but actual rates of disclosure were low. Women acknowledged the importance of screening but did not want their information shared. ConclusionsWomen value screening, even if DFV is not disclosed. Exploring women's experiences is central to ensuring quality care.

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Section: Discussionsupporting

confidence: 90%

A cross-sectional survey of pregnant women’s perceptions of routine domestic and family violence screening and responses by midwives: Testing of three new tools

2020

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“…Included studies were conducted in 11 countries (see table 1). Ten were conducted in the USA [44][45][46][47][48][49][50][51][52][53] ; 4 were conducted in the UK [54][55][56][57] ; and 3 were conducted in Canada [58][59][60] and Australia, [61][62][63] respectively. Two studies were conducted in Sweden, [61][62][63] and one study was conducted in Mexico by Swedish researchers.…”

Section: Resultsmentioning

confidence: 99%

Women’s experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis

et al. 2020

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ObjectiveTo identify and synthesise the experiences and expectations of women victim/survivors of intimate partner abuse (IPA) following disclosure to a healthcare provider (HCP).MethodsThe databases MEDLINE, Embase, CINAHL, PsychINFO, SocINDEX, ASSIA and the Cochrane Library were searched in February 2020. Included studies needed to focus on women’s experiences with and expectations of HCPs after disclosure of IPA. We considered primary studies using qualitative methods for both data collection and analysis published since 2004. Studies conducted in any country, in any type of healthcare setting, were included. The quality of individual studies was assessed using an adaptation of the Critical Appraisal Skills Programme checklist for qualitative studies. The confidence in the overall evidence base was determined using Grading of Recommendations, Assessment, Development and Evaluations (GRADE)-Confidence in the Evidence from Reviews of Qualitative Research methods. Thematic synthesis was used for analysis.ResultsThirty-one papers describing 30 studies were included in the final review. These were conducted in a range of health settings, predominantly in the USA and other high-income countries. All studies were in English. Four main themes were developed through the analysis, describing women’s experiences and expectations of HCPs: (1) connection through kindness and care; (2) see the evil, hear the evil, speak the evil; (3) do more than just listen; and (4) plant the right seed. If these key expectations were absent from care, it resulted in a range of negative emotional impacts for women.ConclusionsOur findings strongly align with the principles of woman-centred care, indicating that women value emotional connection, practical support through action and advocacy and an approach that recognises their autonomy and is tailored to their individual needs. Drawing on the evidence, we have developed a best practice model to guide practitioners in how to deliver woman-centred care. This review has critical implications for practice, highlighting the simplicity of what HCPs can do to support women experiencing IPA, although its applicability to low-income and-middle income settings remains to be explored.

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“…Individualized accommodations, such as deferring portions of an examination, 53 giving anticipatory guidance on possible sensations like pressure or temperature, and stepwise consent processes, are also sensitive components of care for survivors. 52 Health care providers staying attentive to and supportive of effective coping mechanisms, such as distraction with music or social media and deep breathing techniques, can facilitate patient resilience during difficult examinations.…”

Section: History Of Sexual Assaultmentioning

confidence: 99%

“…Even with all guidelines for informed consent and shared decision making in place, patients may misinterpret or experience appropriate health care through traumatic lenses. 52 ACOG now recommends the presence of chaperones for all breast or chest, genital, and rectal examinations; this is irrespective of the sex or gender of the person performing the examination and includes all examinations performed in outpatient and inpatient settings, including labor and birth units, as well as during diagnostic studies such as transvaginal ultrasonography. 45 These recommendations occur in the context of significant publicity surrounding Larry Nassar's sexual assault of patients, as well as with increased reporting and disclosure of misconduct among nurses and physicians.…”

Section: Chaperonesmentioning

confidence: 99%

Consent in Pelvic Care

Tillman

2020

J Midwife Womens Health

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Consent is a clear dialogue between individuals to engage in a specific activity. Expectations for consent to intimate examinations in health care should be equal to, if not exceed, expectations for intimate interactions in society. In reality, current definitions of consent in health care vary. These blurry definitions lead to individualized interpretation, incomplete fulfillment, and opportunities for misunderstanding by both patient and health care provider. If a patient does not believe they have consented to an examination or procedure, they are likely to rightfully identify with one of consent's antonyms, assault. Within the field of gynecology, a history of misogyny, racism, and classism illuminates abhorrent contexts of assault disguised as care. Similar practices persist in the modern application of pelvic care, ranging from overt sexual assault to coercion disguised as guidance. Health care providers and students who seek to improve consent practices can look to evidence-based frameworks such as trauma-informed care and shared decision making, both of which are embraced widely by professional organizations. These approaches often take precedence during the first pelvic examination; care for people who are lesbian, bisexual, queer, transgender, or nonbinary; and care for anyone with a known history of sexual assault; they can be easily extrapolated to all intimate examinations. Beyond obtaining consent for the examination itself, health care providers must also intentionally obtain consent to include students in care and openly discuss new universal recommendations for chaperone presence. Scripting for common procedures, such as bimanual examinations for pelvic care or cervical examinations in labor, allows health care providers to practice trauma-informed language, include evidence-based guidance, and avoid unintentional bias. Contemporary providers of intimate pelvic care must work to understand and strengthen the definition of consent and ensure its realization in practice.

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Describing the healthcare experiences and strategies of women survivors of violence

Abstract: Findings from this study indicate the importance of comprehensive trauma history screening during health assessments, development of trusting and mutually respectful provider-patient relationships and provider training programmes focused on trauma-informed care practices.

Cited by 31 publications

References 45 publications

A cross-sectional survey of pregnant women’s perceptions of routine domestic and family violence screening and responses by midwives: Testing of three new tools

A cross-sectional survey of pregnant women’s perceptions of routine domestic and family violence screening and responses by midwives: Testing of three new tools

Women’s experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: A qualitative meta-synthesis

Consent in Pelvic Care

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