A woman abuse can be defined as any abuse of power that violates the rights of a woman by a socially unacceptable behavior and has a negative impact on the wellbeing of herself and her community. Psychology points to an evolutionary imbalance of power between men and women resulting in a situation where more than 90% of the victims of this power abuse are women.  Women abuse occurs as physical, sexual, emotional, verbal, economic, intellectual and spiritual abuse. Due to the confidential and accessible service offered to the clients abused or battered women who frequently present with injuries both visible and non-visible are treated solely for their injuries and pass through the healthcare system unnoticed (Corbally, 2001). Research studies have explored in depth the role of expert nurses in care for such abused women and have shown that nurses play an important role in the restoration of physical and psychological health of these women.

The Nurse’s Attitude in abused women care

Nurses are often the first health care professionals to interact with abused women and abuse has been shown to be a serious concern to nurses. A study to explore and describe nurses’ attitudes toward the survivors and perpetrators of domestic violence by a qualitative investigation in which thirteen participants expert in the care of abused women were interviewed using semistructured questions to describe their attitudes toward survivors and perpetrators has identified general themes and specific categories relating to attitudes nurses have about abused women and against those who abuse them. Thus, nurses’ attitude is an important influencing factor in the nurse’s interactions with women and families involved in abuse (Woodtli, 2001). A recent study using the grounded theory method has elucidated two key themes namely the nurses’ personal perceptions toward intimate partner abuse and nurses’ feeling equipped to intervene as key factors that influence the nurse care of the abused women (Häggblom, 2006). Access to quality health care for victims of abuse is often limited by the attitudes of health care professionals (Coleman and Stith, 2004). Traditional cultural beliefs have been found to be an important factor influencing nurses' attitude in care of the abused women (Chung et.al, 1996). A study to assess the comfort, attitudes, identified competencies, and educational needs of psychiatric nurses who work with such clients based on surveys mailed to a random sample of 3542 nursing personnel with comfort, sexual attitudes, competencies, and educational needs as measures has shown that comfort and competency regarding working with clients is influenced by educational preparation, gender of the nurse, and a personal history of abuse (Gallop et.al, 1998). A study based on a survey of  nurses in 2004 on their attitudes and behaviours with respect to IPV, including whether they routinely inquire about IPV, as well as potentially relevant barriers, facilitators, experiential, and practice-related factors in the care process using a  modified Dillman Tailored Design approach has shown preparedness, self-confidence, professional supports, abuse inquiry, practitioner consequences of asking, comfort following disclosure, practitioner lack of control, and practice pressures as important factors in nurse care or the abused women. Inadequate preparation, both educational and experiential, emerged has been identified as a key barrier to routine inquiry in the study (Gutmanis et.al, 2007). 

Attitudes and Awareness Aid Interventions                        
Most women confide in their health care provider about domestic abuse only when probed and expect that the provider will recognize the situation offering them support and advice (Edwards, 2005). Women often remain in a relationship with their partner after experiencing violence. Hence, nurses must be aware of this feature and at the same time actively find effective ways of that help reduce recurrence (Bennett & Williams, [n.d.]). A study has shown that nurse practitioners must be aware of client needs and should emphasize the seriousness of IPV, adapt content for gender-specific audiences, and increase awareness about local resources (Moracco et.al, 2005).For more than a decade, professional nursing associations have been following a universal screening for intimate partner abuse (IPA). Some do argue that there is not enough evidence to recommend for or against routine universal screening of women for domestic violence. Yet some experts argue that routine enquiry is justified.A review of 44 studies to identify the influences on IPA screening, summarize what is known about altering these influences, and to outline an agenda for improving IPA screening has indicated that screening is not universal at all taking us to the conclusion that interventions and screening should be tailored to various practice settings (Duncan, 2005). Research studies have shown that the medical model has limitations in the care of battered women and need for a Sociological model of nurse care for such practice settings. An analysis of records of women at risk for abuse shows that epistemologic model of care reconstructs abusive relationships through a medical encounter in which what is most significant is not seen (Warshaw ,1989). Studies have also identified that nurses have no adequate knowledge or therapeutic skills to work with these clients (Gallop et.al, 1998). A study to assess the attitudes and beliefs of the nurses toward the identification and management of abused patients and perpetrators of domestic violence (DV) using a confidential questionnaire has shown that these health care professionals were less confident about dealing DV and did not have any strategies to help the abused women(Sugg et.al, 1999).    

Studies on nurses working with low-income single mothers have shown that these nurses must evaluate mothers’ risk status relative to mental health and family violence on an ongoing basis and provide appropriate treatment or referral (Lutenbacher, 2000). A descriptive survey assessing nurses' knowledge, training, and practices regarding the care of abused women using a self-administered questionnaire has shown that nurses have no formal training in domestic violence and other forms of women abuse to intervene with abused women suggesting an urgent need for training nurses to identify survivors of abuse and to intervene more effectively (Häggblom et.al, 2005). An educational module focused on domestic violence developed to prepare nurses to deal with the complexities of family violence includes experiential learning to capture the full impact of violence, desensitize students to the "stories" of violence, and encourage maturity as the students developed wisdom beyond classroom knowledge. Data from four semesters have indicated a significant increase in knowledge about domestic violence and resources, decreased anxiety, increased confidence, and improvement in communication and assessment skills (Evans et.al, 2001).      

A study to measure the effects of an administrative intervention of a 4-tiered hospital-approved disciplinary action, on health care provider compliance with universal domestic violence screening protocols using a simple, interrupted-time-series design in a stratified random sample of female emergency department patients has shown enhanced compliance with universal domestic violence screening (Larkin et al, 2000).

Conclusions

Nurses’ attitude is an important influencing factor in the nurse’s interactions with women and families involved in abuse. Nurses should be aware that abuse of women by their intimate partners occurs at all levels of society and in all races and cultures. Nurse practitioners must be aware of client needs and should emphasize the seriousness of IPV, adapt content for gender-specific audiences, and increase awareness about local resources The ultimate goal of the nurse practioner  is to empower the client to take control, to provide support and to maximize safety. In USA, most states require health care professionals to report injuries due to criminal acts. Recently, states have regulated these laws by strict procedures that require health care professionals to specifically report intimate partner violence (IPV) to the police, even if contrary to a patient's wishes since 1994.

References

• Alisa Smith (2000).  A Research Note on Battered Women's Perceptions of Mandatory Intervention Laws. Violence Against Women 6(12); 1384-1402.
• Anette M. E. Häggblom (2006). On a Life-Saving Mission: Nurses’ Willingness to Encounter with Intimate Partner Abuse. Qualitative Health Research 16(8); 1075-1090.
• Bennett, L., & Williams, O. (n.d.). Controversies and recent studies of batterer intervention program effectiveness. Violence against Women Online Resources.  Retrieved July 10, 2006, from http:// www.vaw.umn.edu/documents/
  vawnet/ ar_bip/ar_bip.html.
• Carole Warshaw (1989). Limitations of the Medical Model in the Care of Battered Women. Gender & Society, 3(4); 506-517.
• Catherine D. Stayton and Mary M. Duncan (2005). Mutable Influences on Intimate Partner Abuse Screening in Health Care Settings. Trauma, Violence, & Abuse 6(4); 271-285.
• Edwards, M. (2005). Raising the subject of domestic violence. Practice Nurse, 29(2), 26-30.
• G L Larkin, S Rolniak, K B Hyman, B A MacLeod, and R Savage (2000). Effect of an administrative intervention on rates of screening for domestic violence in an urban emergency department.  Am J Public Health. 90(9): 1444–1448.
• Gallop et.al (1998). A Survey of Psychiatric Nurses Regarding Working with Clients who have a History of Sexual Abuse. Journal of the American Psychiatric Nurses Association, 4(1); 9-17.
• Ginger W. Evans et.al (2001). Students Go to Court: Experiential Learning about Domestic Violence. Journal of the American Psychiatric Nurses Association 7(3); 84-88.
• Gutmanis et.al (2007). Factors influencing identification of and response to intimate partner violence: a survey of physicians and nurses. BMC public Health.7 (12).
• Häggblom, A. M. E.; Hallberg, L. R.-M.; Möller, Anders R (2005). Nurses' attitudes and practices towards abused women. Nursing and Health Sciences, 7(4); 235-242.
• Jean U. Coleman  and Sandra M. Stith (1997). Nursing Students' Attitudes toward Victims of Domestic Violence as Predicted by Selected Individual and Relationship Variables. Journal of Family Violence. 12(2); 113-138.
• M. A. Corbally (2001). Factors affecting nurses’ attitudes towards the screening and care of battered women in Dublin A&E departments: a literature review. Accident and Emergency Nursing 9; 27-37.
• M. Anne Woodtli (2001). Nurses’ Attitudes toward Survivors and Perpetrators of Domestic Violence. Journal of Holistic Nursing19 (4); 340-359.  
• M. Y. Chung, T. W. Wong and J. J. K. Yiu (1996). Wife battering in Hong Kong: Accident and emergency nurses' attitudes and beliefs. Accident and Emergency Nursing 4(3); 152-155.
• Melanie Lutenbacher (2000). Perceptions of Health Status and the Relationship with Abuse History and Mental Health in Low-Income Single Mothers. Journal of Family Nursing. 6(4); 320-340.
• Moracco et.al (2005). Knowledge and Attitudes about Intimate Partner Violence Among Immigrant Latinos in Rural North Carolina. Violence Against Women, Vol. 11, No. 3, 337-352.
• Nancy K. Sugg, Robert S. Thompson, Diane C. Thompson, Roland Maiuro, Frederick P. Rivara, (1999). Attitudes, Practices and Beliefs. Arch Fam Med; 8:301-306.

Copyright 2008- American Society of Registered Nurses -All Rights Reserved