A Meta-Summary of Qualitative Findings on the Lived Experience among Culturally Diverse Domestic Violence Survivors

This meta-summary study explores, extracts, and summarizes themes from related qualitative studies on the lived experiences and coping mechanisms among culturally diverse domestic violence survivors. Using Sandelowski and Barroso's meta-summary strategy, a systematic literature review of articles published between 1990 and 2010 was conducted using a qualitative approach. Of a total of 802 studies, nine met the study inclusion criteria. This meta-summary of nine studies confirms the recurring themes in primary qualitative studies in the literature that illustrate women's experiences of domestic violence. These themes include (a) the effects of violence, (b) the cyclical nature of violence, (c) normalizing and tolerating violence, (d) the strength and resilience of victims, (e) barriers to help-seeking, and (f) the role of substance use in domestic violence. The review shows key cross-cultural differences in women's perceptions of abuse and the causes and strategies for responding to abuse. The review also reveals the lack of studies on domestic violence among women from Central Asia and the former Soviet Union.     

The weWomen and ourCircle randomized controlled trial protocol: A web-based intervention for immigrant,refugee and indigenous women with intimate partner violence experiences

Intimate partner violence (IPV), including homicides is a widespread and significant public health problem, disproportionately affecting immigrant, refugee and indigenous women in the United States (US). This paper describes the protocol of a randomized control trial testing the utility of administering culturally tailored versions of the danger assessment (DA, measure to assess risk of homicide, near lethality and potentially lethal injury by an intimate partner) along with culturally adapted versions of the safety planning (myPlan) intervention: a) weWomen (designed for immigrant and refugee women) and b) ourCircle (designed for indigenous women). Safety planning is tailored to women's priorities, culture and levels of danger. Many abused women from immigrant, refugee and indigenous groups never access services because of factors such as stigma, and lack of knowledge of resources. Research is, therefore, needed to support interventions that are most effective and suited to the needs of abused women from these populations in the US. In this two-arm trial, 1250 women are being recruited and randomized to either the web-based weWomen or ourCircle intervention or a usual safety planning control website. Data on outcomes (i.e., safety, mental health and empowerment) are collected at baseline and at 3, 6, and 12 months post- baseline. It is anticipated that the findings will result in an evidence-based culturally tailored intervention for use by healthcare and domestic violence providers serving immigrant, refugee and indigenous survivors of IPV. The intervention may not only reduce risk for violence victimization, but also empower abused women and improve their mental health outcomes.     

Workplace violence: A qualitative study drawing on the perspectives of UK nursing students

BackgroundWorkplace violence (WV) remains problematic and highly prevalent in healthcare with nursing students being particularly vulnerable.AimTo investigate the impact of WV from the perspective of nursing students.MethodsA qualitative design was employed. A total of 444 nursing students in the UK participated in the study.FindingsThe qualitative data were analysed, coded and three main themes emerged; (1) violence culture in nursing, (2) tolerating violence and (3) the impact of violence.DiscussionThe undesirable truth is each year nearly more than half of the students face WV in environments where such a behaviour becomes culturally embedded and passed between generations of nurses. This process of normalisation requires intervention that will break this cycle to enable more appropriate workplace behaviours to flourish.ConclusionThe impact of WV can be extremely destructive for the individual, the profession and ultimately patient care with large numbers choosing to leave at a time when there is a national shortage of qualified staff.     

Beginning with the end in mind: Evaluating outcomes of cultural competence instruction in a doctor of physical therapy programme

The education of physical therapists must prepare them for autonomous practice providing culturally appropriate care. Models are available to guide curricular changes for cultural competence but little is available on methods to assess the outcomes. This article describes two methods to measure outcomes of cultural competence instruction in physical therapy education. These methods are the integrated standardised patient examination (ISPE) and a refugee screening program. These outcomes will determine how cultural curricular changes will drive student learning. The ISPE assesses cultural competence in a simulated clinical setting, utilising standardised patients (SP), who are trained lay people, to portray particular medical conditions. Patient concerns such as depression, anger, silence, cultural barriers, signs of domestic violence, etc. that students may not be exposed to in clinical experiences can be portrayed in the ISPE and assessed against defined standards of cultural competence. A refugee screening programme allows students to practice culturally appropriate care and measures outcomes of the cultural curriculum. Students meet with recent refugees while using a translator to obtain a health history and complete a systems review. Students discuss the results of their screening and make recommendations to the refugee and the primary physician. Students complete a debriefing questionnaire about the experience and their academic preparation.     

Systematic review of the primary research on minority ethnic groups and end-of-life care from the United Kingdom

ContextPatients from minority ethnic groups experience lower rates of referrals to end-of-life (EoL) care services, higher levels of dissatisfaction with services, and perceive some services as culturally inappropriate.ObjectivesTo systematically review original studies of minority ethnic groups and EoL care in the U.K. and appraise their quality.MethodsSearches were carried out in 13 electronic databases, eight journals, reference lists, and the gray literature. Studies of minority ethnic groups and EoL care in the U.K. were included. Studies were graded for quality and key themes were identified.ResultsForty-five studies met inclusion criteria. Study quality was good on average. Identified key themes included age structure; inequality by disease group; referrals; caregivers; place of care and death; awareness of services and communication; and cultural competency. Strategies described for the reduction of inequities were partial and reactive. The format of 10 studies prevented quality grading; these were, however, reviewed as they provided unique insights. Variations in terminology and sampling frames complicated comparison across studies.ConclusionThe results highlight the multiple and related factors that contribute to low service use and substandard quality of services experienced by minority ethnic groups, and the need for authors to clarify what they mean by “culturally competent” EoL care. The synthesis of diverse and disparate studies underpins a number of key recommendations for health care professionals and policymakers. Tackling these epidemiological, demographic, institutional, social, and cultural factors will require a systematic and organization-wide approach rather than the current piecemeal and reactive interventions.     

Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review

BackgroundSystematic literature reviews identify, select, appraise, and synthesize relevant literature on a particular topic. Typically, these reviews examine primary studies based on similar methods, e.g., experimental trials. In contrast, interest in a new form of review, known as mixed studies review (MSR), which includes qualitative, quantitative, and mixed methods studies, is growing. In MSRs, reviewers appraise studies that use different methods allowing them to obtain in-depth answers to complex research questions. However, appraising the quality of studies with different methods remains challenging. To facilitate systematic MSRs, a pilot Mixed Methods Appraisal Tool (MMAT) has been developed at McGill University (a checklist and a tutorial), which can be used to concurrently appraise the methodological quality of qualitative, quantitative, and mixed methods studies.ObjectivesThe purpose of the present study is to test the reliability and efficiency of a pilot version of the MMAT.MethodsThe Center for Participatory Research at McGill conducted a systematic MSR on the benefits of Participatory Research (PR). Thirty-two PR evaluation studies were appraised by two independent reviewers using the pilot MMAT. Among these, 11 (34%) involved nurses as researchers or research partners. Appraisal time was measured to assess efficiency. Inter-rater reliability was assessed by calculating a kappa statistic based on dichotomized responses for each criterion. An appraisal score was determined for each study, which allowed the calculation of an overall intra-class correlation.ResultsOn average, it took 14 min to appraise a study (excluding the initial reading of articles). Agreement between reviewers was moderate to perfect with regards to MMAT criteria, and substantial with respect to the overall quality score of appraised studies.ConclusionThe MMAT is unique, thus the reliability of the pilot MMAT is promising, and encourages further development.     

Health visitors' understandings of domestic violence

BACKGROUND: Feminist work has made visible the extent and nature of domestic violence and the problems women face in having their experiences recognized by health and welfare professionals. Research has demonstrated that many health care professionals, including nurses, midwives and health visitors have little working knowledge about this issue. This impacts on their ability to recognize and respond to domestic violence within their practice. AIM: This paper is based upon a study of British health visitors, which explored their practice in relation to domestic violence. Drawing upon empirical data from interviews with health visitors, it explores their understandings of the extent and nature of domestic violence in the context of their work. METHODS: Semi-structured interviews were undertaken with 24 health visitors selected by convenience and purposive sampling. Data collection took place during 1997-1998. The research draws on the theoretical perspectives of feminist poststructuralism. FINDINGS: The findings demonstrate considerable differences between health visitors in their understandings of the extent of domestic violence in their caseloads and their recognition of different types of abuse experienced by women. There were also differences between participants in their willingness to name situations other than physical violence as abusive, as well as the extent to which they recognized domestic violence within different social groups. CONCLUSIONS: A feminist perspective provides critical insight into the professional knowledge base in relation to domestic violence, demonstrating the need for health visitors to develop their understandings further in order to respond appropriately to women and children experiencing domestic violence. This is discussed in the context of ongoing struggles for professional identity within an ever-changing arena of health and welfare provision.     

What has the literature taught us about culturally competent care of women and children

This article describes what is currently in the literature about culturally competent care for women and children. With the population of the United States growing increasingly diverse, there is a developing need for cultural competency among nurses and throughout healthcare organizations. Cultural competence includes both culture-specific and culture-generic knowledge, attitudes, and skills. While databased literature on cultural competency still requires further development, we do have evidence of positive outcomes of culturally competent care. The end result of the provision of culturally competent care by culturally competent nurses and healthcare organizations can be significant improvements in the health and well-being of women and children.     

Psychological partner violence and women's vulnerability to depression,stress, and anxiety

Psychological partner violence is a considerable problem, despite its invisible outcomes on victims' physical health. Focusing on mental health, the present study looked at differences in mental illness, such as depression, stress, and anxiety, among victims and non‐victims of psychological violence. A convenience sample of women (n = 267) visiting health‐care centres in refugee camps in Jordan provided data about their experiences of psychological violence and their mental health status. The results indicated that, compared to their non‐victimized counterparts, women reporting psychological violence had significantly higher mean scores of depression (t = ?4.92), stress (t = ?3.73), and anxiety (t = ?4.22), with P < 0.0001 for all results. It was suggested that factors that have significant roles in determining poor mental health status included victims' low self‐esteem; poor socioeconomic profile, in terms of education level and income; and responsibilities associated with child and family requirements. The impacts of these factors on victims' mental health status are discussed.     

Critical care nurses’ experiences of withdrawal of treatment: A systematic review of qualitative evidence

BackgroundDeath and dying is a reality of the clinical context of the intensive care unit. Death often follows a decision to withdraw life-sustaining treatments. Critical care nurses, are the primary care providers to patients and families at the end-of-life in the intensive care unit.ObjectiveTo synthesize qualitative evidence on the experiences of critical care nurses who have cared for patients and families throughout the process of withdrawal of life-sustaining treatment.MethodsThis was a systematic review and qualitative evidence synthesis modeled on the Joanna Briggs Methodology. Pre-defined keywords were searched for in Medline, CINAHL, PsycInfo, and Web of Science to locate studies published in the English, French, and Greek languages in any year. Two reviewers independently screened articles for congruence with eligibility criteria, engaged in data extraction, and assessed quality of the included studies. Meta-aggregation was performed to synthesize the findings. A protocol was developed by two members of the review team prior to initiation of the study.ResultsThirteen studies were included in the review, 12 qualitative and one mixed-methods. Four key themes were identified from the original research: Navigating Complexity and Conflict; Focusing on the Patient; Working with Families; and Dealing with Emotions Related to Treatment Withdrawal. Critical care nurses provide care to patients and families during the process of withdrawal of life-sustaining treatment which is described as complex and challenging. Despite the inherent challenges, nurses strive towards doing their utmost for patients and families.     

Nurse-led interventions to manage hypertension in general practice: A systematic review protocol

AimThis systematic review seeks to synthesise randomised controlled trials reporting the impact of interventions delivered by nurses in primary care to enhance blood pressure control and minimise lifestyle risk factors in hypertensive patients.BackgroundGiven the growing demand for chronic care management, there has been a rapid increase in the primary care nursing workforce and emerging diversity in their roles. The primary care nurse’s role has evolved to work in collaboration with general practitioners to manage patients with chronic conditions like hypertension. Despite the nurse’s role in lifestyle modification and behaviour change, there is limited evidence exploring the impact of primary care nurse-initiated interventions for lifestyle modification in those with hypertension.Design/methodsA systematic review of randomised controlled trials will be conducted. Electronic databases will be searched from January 2000 to January 2019, using a structured search strategy. Two reviewers will review title and abstract, screen full-text papers and extract data. The Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) will be used to appraise study quality. Data will be synthesised using either meta-analysis or narrative synthesis depending on the heterogeneity of included studies.DiscussionThis review will assist in understanding the evidence available on the impact of general practice nurse interventions to manage hypertension. The findings will assist in informing effective nurse-directed interventions for controlling hypertension and will identify gaps in the literature for future research to address.     

Barriers and facilitators to the provision of preconception care by healthcare providers: A systematic review

BackgroundHealthcare providers play an important role in providing preconception care to women and men of childbearing age. Yet, the provision of preconception care by healthcare providers remains low.ObjectivesTo provide an overview of barriers and facilitators at multiple levels that influence the provision of preconception care by healthcare providers.DesignA mixed-methods systematic review.Data sourcesPubMed, Web of Science, CINAHL, The Cochrane Library, and EMBASE were systematically searched up to April 27, 2017. The search strategy contained MeSH terms and key words related to preconception care and healthcare providers. Reference lists of included studies and systematic reviews on preconception care were screened.Review methodsPublications were eligible if they reported on barriers and facilitators influencing the provision of preconception care by healthcare providers. Data were extracted by two independent reviewers using a data extraction form. Barriers and facilitators were organized based on the social ecological model. The methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme Qualitative checklist for qualitative studies, the Quality Assessment Tool for quantitative studies, and the Mixed Methods Appraisal Tool for mixed methods studies.ResultsThirty-one articles were included. Barriers were more reported than facilitators. These were situated at provider level (unfavourable attitude and lack of knowledge of preconception care, not working in the field of obstetrics and gynaecology, lack of clarity on the responsibility for providing preconception care) and client level (not contacting a healthcare provider in the preconception stage, negative attitude, and lack of knowledge of preconception care). Limited resources (lack of time, tools, guidelines, and reimbursement) were frequently reported at the organizational and societal level.ConclusionsHealthcare providers reported more barriers than facilitators to provide preconception care, which might explain why the provision of preconception care is low. To overcome the different client, provider, organizational, and societal barriers, it is necessary to develop and implement multilevel interventions.     

A Glance at the Future of Cultural Competency in Healthcare

Cultural competency was first articulated in the 1980s to address the issues of discrimination and disparities in the provision of healthcare services. Since then, countless efforts have been made to educate and train a culturally competent healthcare task force. As the current US government unveils its healthcare reform, one might wonder what will be the future of the cultural competency in health care. The question is even more pertinent if the upcoming demographic shift of the US population is added to the picture. The most recent data from the Census Bureau stated that Asians and Hispanics are the fastest-growing ethnic groups in the US population.¹ Therefore the majority of the patients receiving primary and preventive care under the changes with the Affordable Care Act will be among today’s minority groups. So more than ever before, time needs to be spent on analysis and discussion of how these important changes will shape the quality of care that ought to be culturally sensitive as an aspect of delivery of excellent care.     

Care for emergency department patients who have experienced domestic violence: a review of the evidence base

Aims. A literature review was conducted to identify and evaluate the research base underpinning care for emergency department patients who have experienced domestic violence. Background. The extent of domestic violence in the general population has placed it high on health and social policy agendas. The Department of Health has recognized the role of health care professionals to identify and provide interventions for patients who have experienced domestic violence. Method. Systematic review. Results. At least 6% of emergency department patients have experienced domestic violence in the previous 12 months although actual prevalence rates are probably higher. Simple direct questioning in a supportive environment is effective in facilitating disclosure and hence detecting cases of abuse. Although routine screening is most effective, index of suspicion screening is the current mode of practice in the UK. Index of suspicion screening is likely to contribute to under‐detection and result in inequitable health care. Patients with supportive networks have reduced adverse mental health outcomes. Women will have negative perceptions of emergency care if their abuse is minimalized or not identified. Women want their needs and the needs of their children to be explored and addressed. Access to community resources is increased if patients receive education and information. Conclusion. Domestic violence is an indisputable health issue for many emergency department patients. Practitioners face challenges from ambiguity in practice guidelines and the paucity of research to support interventions. Recommendations for practice based on the current evidence base are presented. Relevance to clinical practice. The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self‐efficacy.     

Talk-story: perspectives of children, parents, and community leaders on community violence in rural Hawaii

PURPOSE: To enhance our understanding of what community violence means to a multiethnic school community in rural Hawaii and obtain people's perspectives of how to deal with and prevent violence-related behaviors among children. DESIGN AND SAMPLE: An exploratory design was used to collect qualitative data from a purposive sample of 150 key stakeholder participants, including 84 school children aged 5-10 years and 66 adults. MEASUREMENT: Focus group methodology via Hawaiian island-style (culturally adapted techniques) of "talk-story" and a metaphor of introduction were used to elicit contextual data on the experiences, meanings, and perceptions of youth violence. Qualitative narrative analyses were used to analyze the data. RESULTS: Five higher order themes were found, including the need to: build a common understanding of what violence looks like; develop school-based identification, management, and prevention efforts; develop comprehensive school health services; develop state-level school health policies; and conduct outreach to make violence prevention a community affair. CONCLUSION: The findings will inform the development of a school-based culturally adapted violence-prevention program led by teachers, in partnership with parents, students, and community-cultural leaders.     

Using Critical Ethnography to Explore Issues among Immigrant and Refugee Women Seeking Help for Postpartum Depression

Critical ethnography was used as a pragmatic research methodology to explore the postpartum depression (PPD) experiences of immigrant and refugee women. We examined the social, political, economic, and historical factors that affected the help-seeking behavior of these women during PPD episodes. The critical ethnography method allowed participants to share their experiences with each other and afforded opportunities to the researchers to acknowledge and validate, rather than simply observe and record, their testimony. This study of PPD thus increased our awareness and understanding of the health issues of immigrant and refugee women.     

Finding information on immigrant and refugee health.

Health care providers working with immigrant and refugee populations need to find and access information related to patient care and to direct patients to culturally and linguistically appropriate health information. This article shows how to find this type of information using online databases, library catalogs, and the internet. Special emphasis is placed on conducting subject searches in online databases such as PubMed and the Cumulative Index to Nursing and Allied Health Literature. Also provided is an appendix listing Websites on immigrant and refugee health.     

Factors affecting the compliance of Israeli women with screening for intimate partner violence

Violence against women has become a frequent occurrence. In Israel, some 200 000 women are subjected to various types of violence by their intimate partners annually. Routine screening for intimate partner violence is endorsed by the Ministry of Health in Israel; however, screening rates in health‐care settings remain problematic. This study aimed to examine whether the model based on the Theory of Reasoned Action (TRA) succeeds in predicting women's intention to comply with screening for intimate partner violence. A questionnaire based on the literature review and research model was administered to a convenience sample of 200 married women. Although only 4.5% (n = 9) of respondents were screened for violence at various health‐care institutions over the past year, 75% (n = 150) of women declared that they intend to cooperate with screening. A positive correlation was found between women's marriage duration, beliefs concerning violence, attitudes towards screening, family member support for compliance with screening—and women's intention to comply with screening. The TRA succeeds in partially predicting women's intention to comply with screening.