collaborative research to reduce disparities for abused women and their children
TRANSCRIPT
Collaborative Research to ReduceDisparities for Abused Women andTheir Children
Nancy Glass and
Phyllis Sharps
Guest Editors
CorrespondenceNancy Glass, PhD, MPH,RN, Johns HopkinsUniversity School of Nursing525 N, Wolfe Street, Rm 439Baltimore, MD [email protected]
Nancy Glass, PhD,MPH, RN is associateprofessor, School ofNursing and AssociateDirector, Johns HopkinsCenter for GlobalHealth, Johns HopkinsUniversity, Baltimore,MD.
Phyllis Sharps, PhD,RN, CNE, FAAN, is aprofessor and chair,Department ofCommunity PublicHealth Nursing,Johns HopkinsUniversity, School ofNursing, Baltimore,MD.
Intimate partner violence (IPV) can occur against
women or men and be perpetrated by women or
men. However, the severity of IPV and its impact dif-
fers between men and women. Women are more
likely than men to report on-going fear and/or hav-
ing changed their behaviors to accommodate the
violent partner. Further, IPV against women takes
place in a context of on-going issues of gender
inequity in our society. This inequity is evidenced
by higher rates of poverty and lower wages
for women compared with their male counterparts,
even with similar education and experience.
Gender inequity signi¢cantly impacts a woman’s
ability to safely leave the abusive relationship
and a man’s ability to abuse with limited conse-
quence.
Over the past three decades, there has been a dra-
matic transformation in the response to IPV across
all sectors of society including the health care sys-
tem. Important clinical and policy advances that
address IPV have been implemented, but nurse
scientists continue collaboratively to build the evi-
dence to reduce disparities for abused women and
their children and address the gender inequity that
supports IPV. This In Focus series reports on three
such e¡orts.
In the ¢rst paper, Dr. Sharps and colleagues review
evidence on the e¡ectiveness of nurse home visit-
ing in preventing and addressing IPV in prenatal
and/or postpartum women and their infants. After
a careful review, only eight studies met the inclusion
criteria, but these yielded important recommen-
dations for nursing interventions on home visits in-
cluding routine assessment of IPV, safety planning,
and establishing a network of support and commu-
nity resources.
In the second paper, Bhandari and colleagues
describe the daily lives of rural pregnant smokers
with a focus on the sources of stress for women with
and without IPV. Based on content analysis of re-
search nurses’ telephone logs, women were found
to share common goals regarding the desire to
be a good mother as well as attaining health for
themselves and the baby, but rural women experi-
enced barriers that increased their stress and
isolation and made it challenging to obtain these
goals. These barriers were further exacerbated
by abusive intimate relationships. The authors ad-
vocate for nurses and other health care providers
working in rural communities to recognize how IPV
compounds the stressors of pregnancy and poverty
in rural areas. Providing rural women a chance to
talk about their lives can help them not only to
locate necessary resources, but also to break down
barriers.
In the last paper, Laughon and colleagues propose
a permanent change to the Abuse Assessment
Screen (AAS), a clinical and research tool devel-
oped by nurse researchers that is in widespread
use in health care settings to identify women
experiencing IPV. They propose including an as-
sessment for attempted strangulation, or the
more commonly used term by IPV survivors,
‘‘choking.’’ Attempted strangulation is a common
form of violence against women, has serious
physical and mental health consequences, and
has been linked to increased risk of beingmurdered
by an abusive partner. Adding the word ‘‘choking’’
to the AAS will add little time to the clinical
assessment protocol but will likely provide
important information that nurses can use to col-
laboratively develop a safety plan with women. This
addition will also provide documentation in the
medical record for the woman’s use in future civil
or criminal cases.
This In Focus series highlights nurses’ important
contribution toward ending violence against wo-
men. When policy makers understand the role of
evidence-based practices such as nurse home
visitation and social support in assessing and inter-
vening with violent families in urban and rural
communities, they may eventually direct limited
JOGNN I N F O C U S E D I T O R I A L
478 & 2008 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses http://jognn.awhonn.org
health system funding to public health nursing pro-
grams. When clinicians understand the value of
assessing attempted strangulation with women ex-
periencing IPV and add it to their assessment
protocols, this important change will likely provide
information to improve safety planning with women
and their children. The newly revised AAS can be
immediately used by nurses in diverse health care
settings.
Although these are positive steps, violence against
women is far too common in our society. Supporting
and funding research by nurses in neglected topic
areas such as nurse home visitation, rurality and
poverty, and assessment tools to screen for IPV
and homicide risk is critical. With continuing
research, nurses can adopt evidence-based prac-
tices to prevent the serious health and social costs
of IPV to individuals, families, and communities.
JOGNN 2008; Vol. 37, Issue 4 479
Nancy Glass and Phyllis Sharps I N F O C U S E D I T O R I A L