Primary healthcare nurses' experiences of addressing intimate partner violence in supportive legal and health system contexts

Abstract

Aim: To explore the experiences of primary healthcare (PHC) nurses caring for women experiencing intimate partner violence (IPV) in a context of institutional support for the management of this health issue. Design: Secondary qualitative analysis.Methods: A purposeful sample (n = 19) of registered nurses, working in a PHC setting, with experience providing care to women who had disclosed intimate partner violence completed an in-depth interview. Thematic analysis was used to code, categorize and synthesize the data.Results: Four themes were developed from the analysis of the interview transcripts.The first two themes address the characteristics of the type of violence most frequently encountered by participants, and how these characteristics shape the needs of women and the care nurses provide them. The third theme encompasses uncertainties and strategies developed to deal with the aggressor during the consultations as the woman's companion or as the patient himself. Finally, the fourth theme reflects the positive and negative consequences of caring for women exposed to intimate partner violence. Conclusion:When there is a supportive legal framework and health system to address IPV, nurses are able to implement evidence-based best practices in caring for women experiencing intimate partner violence. The predominant type of violence experienced by women at the time they enter the healthcare system shapes their needs and the service/unit they reach. These varying needs should be considered in the development of training programmes for nurses and should be adapted for different healthcare services. Caring for women experiencing intimate partner violence implies an emotional burden even in an institutional supportive context. Therefore, actions to prevent nurses' burnout should be considered and implemented.Impact: Lack of institutional support usually hinders the potential role nurses can play in the care provided to women who have experienced intimate partner violence. Findings

Advancing nursing's response to the wicked problem of intimate partner violence

“…Comprehensive organizational support is essential for ensuring that IPV training initiatives are sustained and that nursing approaches to IPV assessment and intervention are implemented and consistently delivered. In Spain, Maquibar Landa et al (2023) explain that the enactment of the ‘ Andalusion Protocol for Healthcare Response to Gender Based Violence’ has enabled the establishment of a supportive legal framework and health system to address IPV, and that this has created a care context where nurses are able to implement evidence‐informed practices for caring for women who have experienced IPV. At a practical level, organizational support should at minimum consist of an investment of time and resources to provide nurses with high‐quality reflective and clinical supervision, the identification of IPV practice ‘champions’ to role model best practices, the development and implementation of care pathways, protocols and the establishment of partnerships between service organization to facilitate interagency referrals (Drake & Murphy Tighe, 2023; Jack et al, 2023).…”

Assistência do enfermeiro na Atenção Primária à Saúde à mulher vítima de violência por parceiro íntimo: revisão integrativa

“…Um estudo qualitativo, conduzido na Espanha com enfermeiros, identificou que o cuidado prestado por esses profissionais apresenta uma perspectiva não crítica, respeitando as decisões ou omissões das mulheres vítimas de VPI, seu processo e seu tempo. Em outras palavras, o papel do enfermeiro é visto como um processo individual e que necessita de tempo para um atendimento de qualidade (MAQUIBAR et al, 2022).…”

“…Em sua assistência, ele conta com o auxílio dos protocolos, da capacitação e da colaboração interprofissional, o que propicia uma melhor qualidade de atendimento às vítimas. E em caso de suspeita de VPI, o enfermeiro deve realizar abordagem ponderada que consiste mais em ouvir do que falar, de modo a garantir o acompanhamento dessa vítima (MAQUIBAR et al, 2022), além de atuar com responsabilidade e ética profissional, desenhando e implementando programas que respondam às necessidades de restabelecimento da saúde integral dessas vítimas com o intuito de prevenir a persistência da violência que geralmente termina em feminicídio (GUTIÉRREZ-ARAÚJO; VILLANUEVA-CARRILLO, 2022).…”

“…Com relação ao Treinamento dos enfermeiros da APS acerca da VPI, é fundamental que eles sejam conscientizados quanto a responsabilidade profissional na identificação das mulheres expostas, desse modo, treinamentos, estratégias para identificar a violência e apoio profissional são medidas que devem ser implementadas nesse cenário (SUNDBORG et al, 2015). Estudos confirmam que, para identificar os sinais e sintomas da VPI, os enfermeiros necessitam de treinamentos (BRIONES-VOZMEDIANO et al, 2021;FELIX, 2018;FELIX;HAM-BALOYI;STRÜMPHER, 2020;JOYNER;MASH, 2014;MAQUIBAR et al, 2022;MPHEPHU, 2021;SUNDBORG et al, 2015).…”

“…Ressalta-se que o treinamento sobre VPI na APS visa a integração com o sistema de saúde, proporcionando conhecimento atualizado junto aos recursos disponíveis, a fim de melhor atender às vítimas. Dessa forma, é relevante para o sistema de saúde e para as mulheres em situação de violência, que haja um enfermeiro que seja referência em VPI (MAQUIBAR et al, 2022).…”