Litteraturstudien har gjorts för att belysa sjuksköterskans attityder till att handla vid misstanke om våld och/eller sexuella övergrepp mot kvinnor och göra olika brister och styrkor i sjuksköterskans arbete synliga. Denna studie kan hjälpa både oerfarna och erfarna sjuksköterskor att bli medvetna om vilka faktorer som kan tänkas finnas och påverkar till om frågan om våld ställs i mötet med patienten. Förhoppningsvis blir läsare av denna litteraturstudie medvetna om egna eventuella brister i arbetet och kan på så vis göra något åt dem för att lyckas ge sina patienter den adekvata vården de förtjänar oavsett vem den våldsutsatta kvinnan är. I stort hoppas författarparet även att kunskapen som litteraturstudien för fram ska kunna påverka det ständiga förbättringsarbetet som sker inom sjukvården. För att
säkerställa en god och adekvat vård för kvinnor som råkat ut för övergrepp bör mer utbildning och kontinuerlig fortbildning ges till sjuksköterskorna som ska ge dem omvårdnad. Även handledning och omvårdnadshandledning verkar vara en viktig del för att sjuksköterskorna ska kunna hantera arbetet med våldsutsatta kvinnor på ett professionellt sätt. Ytterligare forskning på hur den oerfarna sjuksköterskans attityder påverkas av att hen får stöd genom handledning av sjuksköterskor med längre erfarenhet av arbetet med våldsutsatta kvinnor behövs för en fortsatt kunskapsutveckling. Även hur stora effekter
omvårdnadshandledning har för sjuksköterskans attityd i relation till att handla vid misstanke om fysiska och/eller sexuella övergrepp vore intressant för ett fortsatta kunskaps och förbättringsarbete i sjukvården.
Under litteraturstudiens gång har kunskap inhämtats vad beträffar faktorer som kan påverka attityden hos sjuksköterskor vid mötet med våldsutsatta kvinnor. Medvetenhet har gjorts om egna förutfattade meningar och vilka känslor som väcks av ämnet. Förutom detta har även kraven som bör kunna ställas på en arbetsplats, där omvårdnad till våldsutsatta kvinnor ges, gjorts tydligare, samt vilka krav som kan ställas för att sjuksköterskans egen säkerhet och hälsa inte ska äventyras. Det egna behovet av fortsatt kunskapsutveckling ligger i att ständigt söka ny forskning kring ämnet för att hållas uppdaterade samt att fortsätta vara medvetna om egna förutfattade meningar. Även att aktivt söka erfarenhet av arbetet med våldsutsatta kvinnor och lära av sjuksköterskor med lång erfarenhet av arbetet för att själva utvecklas enligt Benner’s modell för utveckling (bilaga 1) kommer att eftersträvas.
30
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Hurley KF, Brown-Maher T, Campbell SG, Wallace T, Venugopal R & Baggs D (2005). Emergency department patients’ opinions of screening for intimate partner violence among women. Emergency Medicine Journal. 22 (2), 97–98.
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*Iverson K M, Wells S Y, Wiltsey-Sterman S, Vaughn R & Gerber M R, (2013) VHA Primary Care Providers´ Perspectives on Screening Female Veterans for Intimate Partner Violence: A Preliminary Assessment. Journal of Family Violence, 28 (8), 823-831.
31
Linnarsson J R, Benzein E, Årestedt K, (2015) Nurses´ views of forensic care in emergency departments and their attitudes and involvement of family members. Journal of clinical nursing, 24, 266-274.
Lundgren E, Heimer G, Westerstrand J, Kalliokoski A-M, (2001) Slagen dam. Mäns våld mot kvinnor i jämställda Sverige - en omfångsundersökning. Umeå, Brottsoffermyndigheten.
McNutt LA, Carlson BE, Gagen D & Winterbauer N (1999). Reproductive violence screening in primary care: Perspectives and experiences of patients and battered women. Journal of the American Medical Women’s Association. 54 (2), 85-90.
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BILAGA 1
Figur2. Patricia Benner’s modell för sjuksköterskans utveckling, Från Novis till Expert (1982).
1. Novis – I första utvecklingsstadiet kallas sjuksköterskan för novis (Benner 1982). I detta stadie saknar hen erfarenhet och bakgrundsförståelse av de situationer hen möter och även erfarenhet av hur hen förväntas handla i situationen. Beteendet styrs av regler och riktlinjer som är en nödvändig vägledning i detta stadie men som också gör sjuksköterskan begränsad och oflexibel i sitt bemötande. Sjuksköterskor, såväl nya som de med lång erfarenhet av yrket, anses som noviser då de ställs inför nya kliniska verksamhetsområden som de saknar tidigare erfarenhet av. 2. Avancerad nybörjare – I det andra stadiet av utveckling kallas sjuksköterskan för avancerad nybörjare. Precis som novisen har den avancerade
nybörjaren inte möjlighet att uppfatta helheten i situationen och måste koncentrera sig på att följa reglerna. De kan behöva hjälp med till exempel prioritering. Dock börjar den avancerade nybörjaren få en medvetenhet om återkommande betydelsefulla mönster i det kliniska arbetet.
3. Kompetent – I sjuksköterskans tredje utvecklingsstadie kallas hen kompetent. Kompetent blir sjuksköterskan efter att ha arbetat en tid inom området (i detta fall med våldsutsatta kvinnor), och känner att hen behärskar det. Förmågan att prioritera har utvecklats och även det kritiska tänkandet. Den kompetenta sjuksköterskan har också medvetenhet om sina egna handlingar och vilken betydelse de har på längre sikt. 4. Skicklig – Sjuksköterskan når fjärde stadiet och kallas för skicklig när hen klarar av att se helheten i en situation, betydelsen av aktuella
åtgärder i förhållande till långsiktigt mål. Sjuksköterskan känner igen typiska händelser och normala mönster som förväntas i situationen men även avvikelser från detta. Sjuksköterskan är bekväm i situationen och beslutsfattande är inte längre jobbigt.
5. Expert – Detta är sjuksköterskans femte och sista stadie i utveckling. Expert blir sjuksköterskan då hen har utvecklat en förmåga att snabbt och genom intuition se vad som är mest centralt i situationen och kan fokusera omvårdnadsåtgärderna utifrån det. Sjuksköterskan har nu en djup total förståelse, en vision av vilka mål som är möjliga och ett holistiskt arbetssätt gentemot sina patienter (a.a.).
5. Expert 4. Skicklig 3. Kompetent 2. Avancerad nybörjare
34
BILAGA 2
Tabell 2. Sökningar med sökresultat i valda databaser.
# = antal dubbletter i urvalet som framkommit i fler än en sökning.
Databas Datum 16-04- 18
Sökord
(kontrollerade termer och fritext)
Begränsningar (filter, limits, refine) Antal träffar Lästa abstract Preliminärt användbara artiklar Inkluderade artiklar
Cinahl S1: (((MH "Nurses+")) OR ((MH "Health Personnel+")) OR nurse*)
Search modes - Boolean/Phrase 591,104
S2: (((MH "Nursing Interventions")) OR intervention OR act OR ask)
Search modes - Boolean/Phrase 282,670
S3: (((MH "Sexual Abuse+")) OR ((MH "Intimate Partner Violence")) OR ((MH "Domestic Violence+")) OR ((MH "Violence") OR (MH "Exposure to Violence")))
Search modes - Boolean/Phrase 40,628
S4: (((MH "Battered Women")) OR ((MH "Women+")) OR (female OR women) OR (female patient) OR ("female patients"))
Search modes - Boolean/Phrase 1,038,127
S1 AND S2 AND S3 AND S4 Abstract Available; Published Date:
20000101-20181231 Narrow by language: english Source types: Academic journals Search modes - Boolean/Phrase
35
Databas Datum 16-04-18
Sökord
(kontrollerade termer och fritext)
Begränsningar (filter, limits,refine) Antal träffar Lästa abstract Preliminärt användbara artiklar Inkluderade artiklar
PubMed S1: (("Nurses"[Mesh]) OR "Health Personnel"[Mesh]) OR nurse*
701,113
S:2 ((intervention) OR act) OR ask 7,271,744
S3: (((((((("Sex Offenses"[Mesh]) OR "Domestic Violence"[Mesh]) OR "Spouse Abuse"[Mesh]) OR "Gender-Based Violence"[Mesh]) OR "Intimate Partner Violence"[Mesh]) OR "Rape"[Mesh]) OR sexual abuse) OR physical abuse) OR "Physical Abuse"[Mesh]
68,879
S4: (("Women"[Mesh]) OR "Battered Women"[Mesh]) OR women
876,736
S1 AND S2 AND S3 AND S4 Abstract Available; Published
Date: 20000101-20181231 Narrow by language: english Article types: Clinical trials Interview Journal article
358 73 20 3 (#2)
36
Databas Datum 16-04-18
Sökord
(kontrollerade termer och fritext)
Begränsningar (filter, limits,refine) Antal träffar Lästa abstract Preliminärt användbara artiklar Inkluderade artiklar PsycINFO S1: MAINSUBJECT.EXACT.EXPLODE("Nurses") OR MAINSUBJECT.EXACT.EXPLODE("Health Personnel") OR Nurse* 163,035 S2: MAINSUBJECT.EXACT.EXPLODE("Intervention") OR intervention OR ask OR act
483,345
S3: MAINSUBJECT.EXACT.EXPLODE("Domestic Violence") OR MAINSUBJECT.EXACT.EXPLODE("Intimate Partner Violence") OR MAINSUBJECT.EXACT.EXPLODE("Partner Abuse") OR MAINSUBJECT.EXACT.EXPLODE("Sexual Abuse") OR noft(sexual abuse) OR noft(physical abuse)
86,584
S4: MAINSUBJECT.EXACT.EXPLODE("Battered Females") OR MAINSUBJECT.EXACT.EXPLODE("Human Females") OR noft(women)
360,598
S1 AND S2 AND S3 AND S4 Full text Peer
reviewed Published Date: 20000101- 20181231 Narrow by language: english Source types: Scholarly Journals 209 49 12 7 (#3)
37
BILAGA 3
40
BILAGA 4
Author, Title, Year, Country
The aim Method Participants Main findings Study quality
Baig, A A. Ryan, G W. & Rodriguez, M A. Provider Barriers and Facilitators to
Screening for Intimate Partner Violence in Bogotá, Colombia. 2012
Colombia
To describe the barriers that Colombian health care personnel reported in identifying survivors of IPV and their proposed solutions to improve detection of IPV in the health care setting.
Systematic qualitative analysis with semi- structured interviews. For the analysis descriptive statistics was used.
28 health care personnel (nurses, social workers and psychologists), the
majority working in outpatient settings, from eight different hospitals.
A majority of the respondents only asked about domestic violence when they suspected it. They listed many barriers to screening such as lack of time, lack of training and the need for more personnel. They also expressed a personal fear of legal involvement as a barrier to ask and the difficulties building trust in the relations to their patient.
Above average Weaknesses: Doesn't describe relationship between author and participants, data or analysis saturation or
preunderstanding.
Efe, Ş Y. & Taşkın, L. Emergency Nurses' Barriers to Intervention of Domestic Violence in Turkey: A Qualitative Study. 2012. Turkey.
Determine factors that prevent the nurse from taking care of women who suffer from domestic violence.
In-depth interview method was used. Each interview lasted 20-30 min and were performed at the emergency
department after the nurse’s shift had ended. The interviews were tape-recorded. A descriptive analysis was used.
30 nurses who had worked in the emergency
department for at least 1 year.
The participants claimed that there was a lack of knowledge on the subject, lack of time and the lack of appropriate environment to intervene on the subject. They also thought that it was not the nurses’ duty to care for women who suffer from domestic violence and that domestic violence is a family business.
41
Author, Title, Year, Country
The aim Method Participants Main findings Study quality
Goldblatt, H. Caring for abused women: impact on nurses’ professional and personal life
experiences. 2009. Israel.
Explore the impact of caring for abused women on nurses’ professional and personal life experiences.
Phenomenological approach focusing on the participants’ lived experiences. In-depth interviews, tape-recorded and transcribed. The analysis was performed inductively in Hebrew, in line with the phenomenological paradigm.
22 female nurses. A purposive sample of nurses working with abused women in different health care settings. Sample size was determined by the saturation principle.
The encounter with domestic violence challenged the nurses’ professional role perception by a flood of emotions and
judgemental attitudes. They also found it hard to separate between work and home since the impact from dealing with domestic violence invaded their private sphere. Above average Weaknesses: Doesn't describe relationship between author and participants. Doesn't describe data or analysis saturation. Iverson, K M. Wells, S Y. Wiltsey-Sterman, S. Vaughn, R. & Gerber, M R.
VHA Primary Care Providers´ Perspectives on Screening Female Veterans for Intimate Partner Violence: A Preliminary Assessment. 2013. USA.
To provide and initial qualitative assessment of Veterans Health
Administration (VHA) primary care providers’ perspectives regarding intimate partner violence screening practices.
Pilot study. In-depth, semi- structured interviews including open-ended questions over phone. Interviews were audio-taped and transcribed. Data analysis were analyzed qualitatively using procedures informed by Grounded Theory methodology.
12 primary care providers (physicians and nurses) from New England VA Healthcare System, which compromises Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and Connecticut.
The personnel were positive towards screening and thought it should be routine to screen all female patients. They did however identify both logistical and educational barriers to screening, such as lack of time, lack of awareness and knowledge with respect to the prevalence and health consequences of intimate partner violence (IPV) and the feeling of being uncomfortable to screening and responding to IPV.
Above average Weaknesses: Doesn't describe either relationship between author and participants, data or analysis saturation or preunderstanding. Only three participants were nurses.
42
Author, Title, Year, Country
The aim Method Participants Main findings Study quality
Ritchie, M. Nelson, K. & Wills, R.
Family violence intervention within an emergency department: achieving change requires multifaceted processes to maximize safety.
2009 New Zealand
Identifying barriers and enablers to routine
questioning one year after the program was launched to inform program
improvements
Semi-structured interviews were used in this study.
The interview included open and closed questions and the
participant got to choose if they wanted to be interviewed in groups or single. Three single and two group interviews were carried out and each interview lasted approximately one hour. The data was analyzed individually and as a team in 3 phases.
11 nurses that were working in the emergency department and who had attended the FVIP training or were scheduled to attend the training.
Barriers that were find in the study were described as organizational and personal barriers. The organizational barriers included lack of time, lack of privacy and lack of training. The personal barriers included comfort to ask, forgetting and perception of role.
High
Robinson, R.
Myths and Stereotypes: How Registered Nurses Screen for Intimate Partner Violence 2010
USA
Identify the intimate partner screening practices of registered nurses in
emergency departments and how the nurses respond to intimate partner violence when women disclose.
Phenomenological qualitative approach to examine the role of the registered nurse in the emergency setting as it relates to intimate partner violence. Structured open-ended interview. A seven –set method of data analysis of Colaizzi was used.
13 emergency nurses from a mid-size urban county in the South Central United States.
Beliefs and preconceptions held by nurses related to intimate partner violence. The nurses believed they could tell by someone’s appearance he or she was being abused. The nurses felt frustration when the women went back to an abusive situation but also the feeling of encouragement by the benefits screening may have for the patient, maybe not immediate but in the future.
Above average Weaknesses: Doesn't describe either the relationship between author and participants, data or analysis saturation or preunderstanding.
43
Author, Title, Year, Country
The aim Method Participants Main findings Study quality
Sundborg, E. Törnkvist, L. Saleh-Stattin, N. Wändell, P. & Hylander, I.
To ask, or not to ask: the hesitation process described by district nurses encountering women exposed to intimate partner violence. 2015 Sweden To improve the understanding of district nurses’ experiences of encountering women exposed to intimate partner violence.
Grounded theory using a constructivist lens. The approach focused on
interactions and social events and aimed to generate theory and concepts grounded in empirical data. Individual in- depth interviews.
11 district nurses from randomly selected primary health care centers in Stockholm.
The hesitation process is central in these encounters. Several barriers to asking and factors that facilitated asking impacted the hesitation process. Under the influence of these factors, district nurses moved from being unaware that identifying intimate partner violence was their professional responsibility, to becoming ambivalent about asking, to starting to prepare themselves to ask about intimate partner violence. The presence of factors that facilitated asking finally made district nurses feel prepared, and the decided to ask women about intimate partner violence.
Above average Weaknesses: Doesn't describe either the relationship between author and participants, data or analysis saturation or preunderstanding.
Wath, A. van der Wyk, N. van Rensburg, E J. van Emergency nurses’ experiences of caring for survivors of intimate partner violence. 2013
South Africa
Report emergency nurses’ experiences of caring for survivors of intimate partner violence
A descriptive
phenomenological inquiry were used. The eleven interviews lasted between 45- 70 minutes each and were recorded. For the data analysis a descriptive
phenomenological analysis was used.
11 nurses who worked at the emergency department and had been in contact with survivors of intimate partner violence of the year before the study was conducted.
Meeting women who suffer from abuse has an emotional impact on the nurses. The nurses respond to the women affected were more sympathetic rather than empathetic. Above average Weaknesses: Doesn't describe either the relationship between author and participants, data or analysis saturation or preunderstanding.
44
Author, Title, Year, Country
The aim Method Participants Main findings Study quality
Watt, M H. Borbrow, E A. & Moracco, K E.
Providing Support to IPV Victims in the Emergency Department. Vingette- based Interviews With IPV Survivors and Emergency Department Nurses
2008 USA
To compare perspectives of intimate partner violence (IPV) survivors and
emergency department (ED)