Antenatal care experiences of uninfected pregnant women during the COVID-19 pandemic: A qualitative systematic review

BackgroundThere is a limited understanding of pregnant women's antenatal care experiences during the COVID-19 pandemic.PurposeTo review and synthesize qualitative studies on uninfected pregnant women's antenatal care experiences during the COVID-19 pandemic.MethodsFive databases were searched for qualitative studies published between January 2020 and January 2023. This study used a thematic synthesis of qualitative evidence and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Furthermore, this review was registered with PROSPERO and a quality appraisal was assessed.ResultsNine published qualitative studies were included in this review. The studies were conducted in eight countries and included 3,709 participants. Five themes were identified: (a) disruptions of normal antenatal care services, (b) feelings of uncertainty, (c) desire for sufficient spousal support, (d) coping strategies, and (e) trust in health care providers.Discussion and ConclusionThe themes can be utilized to reform current interventions for pregnant women by nurse-midwife managers and by health care policymakers to improve current practice and direct new research to prepare for future pandemics.     

Indigenous women's experiences of diabetes in pregnancy: A thematic synthesis

BackgroundIndigenous women's voices are largely silent in the literature because of a lack of opportunity to share their experiences and understandings of diabetes in pregnancy (DiP).AimTo synthesise qualitative literature describing the experiences of Indigenous women with DiP.MethodsA librarian assisted, systematic search was conducted across CINAHL, EMBASE, Global Health, Medline, ProQuest, PubMed, Scopus and the Web of Science databases. International, peer reviewed studies published in English, between the years 1999 and 2019 that explored Indigenous women's experiences of DiP were sought. Thirteen papers were coded for recurring patterns and conceptual overlaps and synthesised into themes.FindingsAnalysis revealed four themes: ‘Poverty and Vulnerability: Colonisation's Legacy’; ‘Contradictions and Confusion: Understandings of DiP’; ‘Shame and Blame: Experiences with Health Professionals’; and, ‘Community and Care: Cultural Constructions of Health’.DiscussionThis review has revealed similar concerns and experiences of DiP among Indigenous women across communities in Canada, Alaska, the United States and Aotearoa New Zealand. To work with and effectively engage with Indigenous women, requires a shift from focusing on individual behaviours, to recognising and including cultural strengths, and addressing structural inequity in relation to healthcare.ConclusionThis review has resulted in a call to action for researchers to work collaboratively with Indigenous communities to co-design culturally safe, appropriate, and relevant policies, programs, models of care and educational materials with Indigenous women.     

Safety first? The impact of domestic abuse on women's treatment experience

This paper presents the findings of an exploratory study designed to investigate what is known about women's experiences of domestic abuse and their impact on treatment outcomes.

Aims: To explore whether domestic abuse has an impact on women's access to treatment, retention, relapse, or increase in their substance use.

Design: A literature review and key informant interviews.

Participants: Thirteen key informants were drawn from a range of agencies working with women using alcohol or drugs in England.

Measurement: The empirical research was read using set criteria including: type of treatment setting, single or mixed gender treatment, number in the sample, methods used, and key findings. The key themes were then extracted from the literature. The interviews were recorded, transcribed, and analysed using thematic coding.

Findings: Practice‐based evidence suggests women's engagement with and retention in treatment is negatively affected by domestic abuse. Literature‐based evidence is equivocal and limited in scope, quality and quantity.

Conclusions: While further research is required to substantiate the practice‐based evidence, it appears that treatment service providers are failing to recognize and address the issue of domestic abuse among their service users, leaving women and their children at risk.     

WOMEN'S EXPERIENCES OF ABUSE: A REVIEW OF QUALITATIVE RESEARCH

This article reviews qualitative research published within the past 15 years based on women's first person accounts of their abuse experiences. Battered women's accounts of their experiences in abusive relationships aid in understanding why they stay, how they cope, and how others can help. Women's views of the emotional consequences of battering, the process of leaving, and the impact of social systems and community resources were consistent. Other themes in the literature were abuse in pregnancy, women who fight back, substance use, sex after beatings, family origins, and women who are elderly, minority, or from other cultures. Future research is needed on minority and affluent women, as well as the role of batterer's patriarchal attitudes and religious beliefs. Practice suggestions include expanding screening and parent education to pediatricians' offices and schools.     

“You Comfort Yourself and Believe in Yourself”: Exploring Lived Experiences of Stigma in HIV-Positive Kenyan Women

HIV-related stigma has a negative effect on women's health and can hinder interventions aimed at eradicating HIV. In Kenya, women withstand the worst of HIV-related stigma, because they are the most affected. In this longitudinal qualitative study, we explored experiences of stigma among 54 HIV-positive Kenyan women. Using Goffman's stigma definition and Foucault's social construction of stigma to analyze women's narratives, two main themes emerged: (1) women's experience of socially constructed HIV-related stigma and (2) women's resistance of socially constructed HIV-related stigma. Even though women are creative in resisting HIV-related stigma, psychological impact of stigma can hinder HIV prevention, care, treatment, and support. Interventions that empower women are critical in reducing HIV-related stigma.     

“An Existential Place of Pain”: The Essence of Despair in Women

While there is a substantive body of knowledge on depression, little is known about the experience of despair. Though the terms depression and despair are often used interchangeably, studies of despair suggest that it is distinguishable from depression as experienced by women. This study explored women's experience of despair through qualitative interviews with 14 women ages 28 to 55 (M = 45) who self-identified as experiencing despair. Three themes emerged: “Crippling and Debilitating,” “There's Nothing You Can Do,” and ‘‘It’ll Never End.” The findings lend support to the notion that despair is distinguishable from depression, but this warrants further study. The findings also suggest that while there are common elements of despair among women, there are also unique experiences of despair.

While there is a substantive body of knowledge on depression, little is known about the experience of despair. This phenomenological study explored women's experience of despair through qualitative interviews with 14 women ages 28 to 55 (M = 45) who self-identified as experiencing despair. Three themes emerged: “Crippling and Debilitating,” “There's Nothing You Can Do,” and “It’ll Never End.” The findings suggest that women desire to have their experiences recognized and validated while simultaneously receiving acknowledgment of their ability to overcome the past and to shape their own destinies.     

The lived experiences of adult female victims of child abuse

The purpose of this study was to investigate the lived experiences of female victims of domestic violence who also identified themselves as victims of physical abuse as children. There have been numerous studies of identifying perpetrators of violence as having a history of experienced violence in the family of origin. However, few studies address the victims/survivors of domestic violence and the historical significance of abuse in the family of origin. It is estimated that greater than 50% of the victims of domestic violence were also victims of abuse as a child. The research design partially followed the qualitative ethnonursing methodology. This pilot project consisted of seven females between the ages of 37 and 58. These women were members of a long-standing support group for battered women. The Pitts-Williams Inventory was used to obtain data. The instrument contained six major research questions, with sub questions. Data analysis was done by identifying major themes that emerged. Eight themes were identified. The majority of the women identified their mother as the perpetrator. They described a continuous cluster of violence, which included several different forms of violence being used consistently in order to maintain control and foster isolations. This type of violence continued in throughout their childhood and adult life.     

The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice

Violence against women continues to be a serious public health issue afflicting women worldwide. The intersection of Adverse Childhood Experiences (ACEs) and intimate partner violence is detrimental to a woman's well-being. This review aims to identify the types of ACEs reported by women who also report partner violence and the subsequent negative impact of this combination of experiences on the women's health. The evidence supports the cumulative effects of Adverse Childhood Experiences on women, particularly when coupled with experiences of intimate partner violence. Early interventions by providers have the potential to mitigate negative health outcomes of abused women and interrupt the intergenerational transmission of violence to their children.     

Strength and Vulnerability: Spirituality in Abused American Muslim Women's Lives

The importance of spirituality for individuals coping with and recovering from trauma has been widely recognized. Despite this recognition, little information is available addressing the influence of spirituality on the abuse experiences of women surviving intimate partner violence (IPV). This paper begins to amend this gap in knowledge by examining the influence of spirituality on the abuse experiences of American Muslim women, a large and growing population. Findings from this qualitative study indicate that spirituality provided participants with an important means of coping with ongoing violence while in many instances also creating barriers to safety. These findings underscore the complex role spirituality may play as a source of both strength and vulnerability in American Muslim women's response to IPV.     

A Qualitative Study of a Maintenance Support Program for Women at Risk of Homelessness: Part 3: Societal Factors

Homelessness is a collective societal problem, and people who are homeless are often treated as society's underclass, stigmatised and excluded. These issues are often exacerbated among homeless people from countries other than the one in which they are currently living. In this article we report findings from a qualitative study of homeless women, case managers and health professionals from a Maintenance Support Program and their personal accounts and insights into their experiences of the program. This article presents the third and last sub-theme “societal factors” of the study where the overarching theme was “A life-changing event: I have the power to change.” This sub-theme is supported by three categories including gender, race and ethnicity, and environment. The findings highlight the impact of the societal factors that linked women's experiences with domestic violence and abuse. Further cultural views regarding the role of women in society hinder their capacity to recognise that they should not be treated differently and that they should be supported to access health and social services to improve their lives in a safe and supportive environment.     

Capital,change and Elsie's Place: Understanding the history of safe accommodation in Australia

Gendered violence, specifically, domestic violence, continues to be a global issue impacting the health and well-being of women despite the improvements to women's rights and the expansion of women's health and well-being services in the 1970s. While considerable attention has been given to this period of time, scant attention has been given to understanding the resources and change processes involved in the opening of Australia's feminist-led women's health and wellbeing services from a theoretical perspective. During a Visiting Scholar appointment at the State Library of New South Wales, Sydney, Australia I undertook a review of historical documentation and academic literature search pertaining to the opening of Australia's first feminist-led safe accommodation for women fleeing domestic violence: Elsie's Place. The concepts of Bourdieu (1977) Theory of Practice informed my understanding of resources, while Lewin (1947) Change Theory provided a conceptual lens through which to view change within the textual and graphical documents. The findings from this project point to the importance of capital, particularly social capital, in the forms of cooperation, collaboration, and networking, in the supporting of change within this sector during the opening of foundational services for women in Australia.     

A literature review: Qualitative studies of women parenting during abuse

Many women worldwide are physically and emotionally abused, and their children are exposed to violence as well, resulting in what has become a worldwide epidemic. The Millennium Development Goals Report 2013 adopted through the United Nations’ Development Program recognizes the continued need for global efforts to empower women, reduce child mortality, and improve child health. This literature review of women's experiences while parenting during abuse revealed the utilization of parenting strategies to parent their child(ren) effectively in the most difficult and traumatic of circumstances. Recommendations from all of the articles caution not to remove the child from the mother, but to give both mother and child tailored interventions and a compassionate and empathetic understanding of what these abused mothers’ parenting experiences are.     

A Qualitative Meta-Synthesis and Theory of Postpartum Depression

To synthesize existing qualitative literature on the first-hand experiences of women suffering from postpartum depression (PPD), to uncover potential common themes, a meta-synthesis of 12 qualitative studies using Noblit and Hare's 7-phase model of meta-ethnography was used. Four themes were discovered: crushed maternal role expectation, going into hiding, loss of sense of self, intense feelings of vulnerability, plus practical life concerns. A preliminary theory of PPD as a 4-step process is proposed, based on the relationships between the themes in this meta-synthesis. This 4-step process is compared and contrasted with Cheryl Tatano Beck's 4-stage theory of PPD “Teetering on the Edge”. This meta-synthesis and theory offers a significant contribution to the literature in helping identify PPD distinctly from depression outside of the postpartum period, and deserves further study.     

Nursing students’ experiences with patient death and palliative and end-of-life care: A systematic review and meta-synthesis

AimTo synthesise the experiences of nursing students encountering patient death and caring for patients under palliative care or at end-of-life and their families in clinical settingsBackgroundNurses are pivotal in caring for dying patients and families. It has been reported that nursing students feel unprepared in caring for dying patients and handling patient death. Understanding their experiences would better inform how palliative care education can be improved and how students can be better supported in clinical settings.DesignA qualitative systematic review and meta-synthesisMethodsPubMed, Embase, CINAHL, PsycINFO, ProQuest and Google Scholar were searched for peer-reviewed articles and theses/dissertations published between 1 January 2012–25 Feb 2023. Qualitative studies of any design reporting nursing students’ experiences of patient death, caring for patients under palliative care, at end-of-life, or with time-limiting diseases in clinical settings in English were included. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Data were synthesised using Sandelowski and Barroso’s 2-step framework through a meta-summary using thematic analysis, which were then integrated into meta-syntheses using an event timeline.ResultsThe review included 71 studies from 26 countries (n = 1586 nursing students). The meta-summary contained 8 themes and 23 subthemes: (1) Communication experience with patients and families, (2) Satisfaction with care provided to patients and families, (3) Impact of the COVID-19 pandemic on death and dying, (4) Perceptions of death and dying, (5) Impact of death, (6) Nursing education on palliative end-of-life care, (7) Support systems and coping methods, (8) Learning outcomes. The meta-synthesis depicted nursing students' experiences before, during and after encountering dying patients, families and patient death. Suggestions for nursing faculty and clinical staff on how they could equip students with necessary skills and knowledge and support them in clinical settings were also provided.ConclusionsWhile caring for dying patients and families was beneficial to nursing students' learning and professional development, they encountered many challenges. Governments, clinical and academic nursing leaders must prioritise the integration of palliative care content into the curricula across nursing schools in face of increasing palliative and end-of-life care needs in patients. Nursing schools should ensure that students are adequately prepared by designing culturally and socioeconomically relevant curricula, integrating theoretical and experiential learning and offering students a thorough understanding of palliative and end-of-life care. Clinical staff and nursing instructors should support students emotionally and guide them in patient care.     

Violence against women with mental illness and routine screening: Nurses' knowledge,confidence, barriers and learning needs

Violence against women is a major public health issue and women with mental illness (WMI) are at a double disadvantage. While nurses play a key role in identifying and responding to abused women, research is limited on this issue from India. This qualitative study was aimed to explore nurses' knowledge, confidence, and learning needs in the identification and responding to disclosure of abuse in women with mental illness. The focus group discussions were conducted among nurses (N = 21) working in psychiatry units at a tertiary care center. An interview guide with semi-structured questions was used to collect the data. Five dominant themes and fifteen sub-themes have emerged from qualitative analysis. The dominant themes include; Awareness of abuse among women with mental illness (AWMI), Experiences of recognizing and responding to abuse, Barriers for routine screening for abuse, Educational preparedness, and learning needs, and Prevention of abuse in women with mental illness. The identified barriers include personal related (personal discomfort, lack of knowledge, etc.), job related (Time consuming, not a nurse's job, lack of time, etc.) and organizational (lack of policies and administrative support, etc.). Most of the participants expressed that they lack confidence in the routine screening of women for abuse due to inadequate training. Therefore, it is critical to include a topic on domestic violence in the nursing curriculum and provide ongoing learning opportunities to the nurses through CNE programs, workshops, and conferences.     

Culturally competent primary care response for women of immigrant and refugee backgrounds experiencing family violence: A systematic review protocol

AimThis review will identify, critically appraise, and synthesise evidence on culturally competent approaches to the provision of primary care to women of immigrant and refugee backgrounds who experience family and domestic violence.BackgroundWomen from some immigrant and refugee backgrounds are known to be at a higher risk for harms from family and domestic violence. However, little is known about cultural competency in the provision of primary care for these women and how this enables, or hinders, clinicians in caring for them.Design/methodsA systematic review using Critical Interpretive Synthesis of quantitative, qualitative, and mixed-methods studies and grey literature that report cultural competency in the provision of primary care for women over 16 years of age experiencing family and domestic violence. Our search strategy will include electronic database searches, citation tracking, and grey literature searches. Two reviewers will independently carry out title, abstract, and full text screening using the Covidence software, then quality assessment, and data extraction. We will appraise quality using the Crowe Critical Appraisal Tool for quantitative and mixed methods studies; Quality Framework for qualitative studies; and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature. A qualitative critical synthesis of the included studies and grey literature will be completed.DiscussionCritical interpretive synthesis is an iterative method that allows reviewers to explore various foci of the concept in question and answer the research question posed at the outset comprehensively. The expected outcome of the review is an evidence-based model of culturally competent primary care related to family and domestic violence.     

Intimate Partner Violence in the Eastern Part of Iran: A Path Analysis of Risk Factors

Intimate partner violence against women is a widespread phenomenon that is the cause of many deleterious health and social consequences. This study examines the impact of some risk factors on partner violence in the eastern region of Iran, using path analysis. The study used a population-based cross sectional study design. In this study, 251 married women who were referred to the health centers were selected through a proportionally stratified and randomized sampling method. Domestic violence was measured using Conflict Tactics Scale and the socio-demographic variable was assessed by a self-report questionnaire. Bayesian Structural Equation Modeling was used for evaluating the overall path analysis and the direct and indirect p-value was estimated by Bootstrap method. AMOS and SPSS software were used to analyze data. The prevalence of overall violence was 78.1%, with 37.8% and 0.8% of women reporting minor and severe violence, respectively, and 39.8% reporting both severe and minor forms of violence. Psychological violence was the most common type of violence reported (66.5%). The model showed that husbands’ drug abuse and women's higher level of education compared to their husbands were the first and second most important factors that significantly and directly influenced the violence. The women's attitude, however, had the least effect on the violence. The findings indicated that higher educated women and women with addicted husbands were more likely to experience violence. Treating the drug abuse disorders, especially mental disorders, using behavioral couple's therapy, as well as modifying certain traditional and cultural biases against women's empowerment are suggested.