Reconceptualising Health and Health Care for Women Affected by Domestic Violence

By Tower, Marion; Rowe, Jennifer et al. | Contemporary Nurse : a Journal for the Australian Nursing Profession, October 1, 2012 | Go to article overview

Reconceptualising Health and Health Care for Women Affected by Domestic Violence


Tower, Marion, Rowe, Jennifer, Wallis, Marianne, Contemporary Nurse : a Journal for the Australian Nursing Profession


Domestic violence is a major public health issue that influences all aspects of affected women's lives (World Health Organisation, 2010). In particular, the impact of domestic violence on women's health is said to be devastating and is believed to result in long-term poor, general, reproductive and psychological health that continues even after the violence has ended (Campbell et al., 2002; Garcia-Moreno & Watts, 2011; Parker & Lee, 2002; Woods, 2000). Studies estimate that women who experience domestic violence use health care services almost twice as often as women who do not experience domestic violence (Ulrich, Cain, Sugg, Rivara, Rubanowice, & Thompson, 2003). However, studies indicate that overwhelmingly, women's experiences with health professionals tend to be negative (Hague & Mullender, 2006; Humphreys & Thiara, 2003; Mezey, 2001; Tower, McMurray, Rowe, & Wallis, 2006; Waalen, Goodwin, Spitz, Petersen, & Saltzman, 2000).

This paper reports on the findings of phase II in a two-phase study. In order to give context to the findings discussed in this paper, a brief overview of the findings from phase I is presented below.

The first phase of the study reported on a purposeful sample of 12 women's emerging health needs, their efforts to seek help and their experiences of seeking health care while living with domestic violence (Tower et al., 2006). Narrative analysis of in-depth interviews provided rich information regarding these issues. Phase I highlighted that while experiencing domestic violence, women's health moved along a fragile and complex continuum with ramifications to their sense of self. Their experiences were personal, lived experiences, marked by chaos, deteriorating health and disruption to their sense of self that led to a sense of confusion, selfblame, hopelessness and helplessness. Their health care presentations were frequent, and to a variety of settings and services, most often emergency departments (ED's) and community health (CH) services. Women described inadequate assessment and quick labelling of their health issues that leftthem feeling stigmatised, their situations judged. They felt punished and undeserving of care. As a result, they resisted, passively or proactively, what they perceived to be diversionary management processes by health professionals. Concomitantly they disengaged from health care providers and became further isolated (Tower et al., 2006).

In this paper, we report on the findings of phase II of the study and bring together the findings from both phases. Phase II involved in-depth qualitative interviews with nurses who were frequently involved in the care of women affected by domestic violence. We argue there is a disconnection between women's experiences and needs and how nurses construct women's health needs and deliver care within current health systems. Knowledge generated from this study can provide nurses and other health professionals with a woman-centred understanding of health and can guide a more responsive nursing service.

LITERATURE REVIEW

Women who are subjected to domestic violence encounter a wide range of professionals within health and social care sectors and as stated previously, encounters result in negative experiences for women. Women describe doctors and nurses who are disinterested, respond inappropriately by either ignoring the cause of their presentation or offering unhelpful advice, and who at times perpetuate the situation by openly doubting women's experiences (Bacchus, Mezey, & Bewley, 2003; Chang et al., 2005; Yoshihama, 2002). Lavis, Horrocks, Kelly, and Barker (2005) assert that holding women individually accountable for domestic violence-related symptoms and injuries reduces the political significance of domestic violence and enables health care providers to distance themselves from interacting effectively with women. Yam (2000) and Anderson and Aviles (2006) also report that women experienced anger, embarrassment and frustration when encountering health professionals and believed they were blamed, pitied or misunderstood. …

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