Journal of Obstetric, Gynecologic & Neonatal Nursing
In FocusInterrupting Intimate Partner Violence During Pregnancy With an Effective Screening and Assessment Program
Section snippets
Maternal Health Outcomes Related to IPV During Pregnancy
Poor maternal health during the antepartum and postpartum periods is associated with abuse during pregnancy (WHO, 2011). Women abused during pregnancy experience all forms of IPV (Catalano, 2013), including psychological distress up to 8 months beyond pregnancy (Romito et al., 2009). Early identification is necessary to minimize the effects IPV has on the pregnant woman.
Prenatal care throughout the pregnancy is essential for the promotion of optimal maternal health. Pregnant women typically
Infant Health Outcomes Related to IPV During Pregnancy
Poor infant health after birth may be a reflection of the physical and psychological aggression experienced by women during pregnancy. For example, physical assaults toward pregnant women may be associated with preterm birth (El Kady et al. 2005), which directly influences the health outcomes of infants. Adverse infant health outcomes have been associated with IPV, such as low birth weight (Alhusen et al., 2014, Coker et al., 2004, Murphy et al., 2001, Pavey et al., 2014, Shah and Shah, 2010),
Low Reported Rates of IVP Among Women
Currently, the reported rates of IPV during pregnancy do not reflect the magnitude of the problem (American College of Obstetricians and Gynecologists, 2012), and if health care providers do not ask, women may not disclose. Low reported rates of IVP may reflect the fact that health care providers do not routinely screen for IPV in the clinical setting. The simple act of screening for IPV may serve as an intervention in itself and bring attention to the underlying cause of many physical and
Barriers to Routine IPV Assessment
In the clinical environment, many barriers may prevent routine screening for IPV, but lack of time is the most frequently cited (Beynon et al., 2012, Miller et al., 2015, Sprague et al., 2012, Yonaka et al., 2007). Lack of privacy, the presence of the abusive partner (Ramsden and Bonner, 2002, Beynon et al., 2012), and lack of protocols and policies are also barriers to routine assessment for IPV (Miller et al., 2015). Lack of training and knowledge about community resources among providers can
Removal of Barriers so Women Feel Safe to Disclose Abuse
Attention to time constraints, provision of private areas for the direct assessment of IPV, and provider education and training may have the potential to remove screening barriers (Beynon et al., 2012, Ramsden and Bonner, 2002, World Health Organization, 2009, Yonaka et al., 2007). This requires a system-wide approach that focuses on the integration of health care delivery services and advocates for policies that support routine screening and assessment for IPV (Miller et al., 2015). The same
Policy Development
Development of policies and protocols that support effective IPV assessment programs requires input from multiple stakeholders. Ramsden and Bonner (2002) suggested that formalized written protocols validate the assessment process, and a “top-down, bottom-up approach” (p. 35) encourages ownership. A framework for policy development may include the identification of stakeholders, development of a well-defined policy with a clear intent, identification of procedures for implementation, and
Training Programs
Intimate partner violence training programs may include but are not limited to the development of skills needed to identify clinical signs and symptoms, frame questions, use screening tools, conduct an assessment, assist in the development of a safety plan, access available resources, and facilitate referrals. The acquisition of knowledge and skills to effectively screen all women has the potential to increase comfort with screening, and for training to be successful, health care providers must
Components of an Effective Screening, Assessment, and Referral Program for IPV During Pregnancy
Components of an effective IPV screening and assessment program include a safe environment in which women feel they can disclose abuse. Once disclosure is made, the health care provider will assess for safety, conduct a physical assessment, formulate a safety plan, and make referrals to supportive departments within the organization or appropriate agencies outside the organization (McFarlane et al., 2007). This process is an ongoing collaborative effort that requires close coordination.
Conclusion
Provisions must be made to ensure that assessment programs for IPV remain effective and encourage 100% compliance among health care providers. Quality improvement must be ongoing and will serve to address gaps identified in the screening, assessment, and referral process. Bringing together the stakeholders and continued collaboration between institutions and across disciplines to further address this public health problem will help improve the health and safety of all women abused during
Ann L. Bianchi, PhD, RN, is an associate professor in the College of Nursing, University of Alabama in Huntsville, Huntsville, AL.
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2021, Nursing for Women's HealthCitation Excerpt :The IPV assessment screening infographic poster may be used not only during the COVID-19 pandemic but in a variety of clinical settings where a struggle to safely assess for violence is identified. Evidence indicates that the act of screening for IPV may serve as an intervention itself, bringing the needed attention to the root cause of physical and mental health problems reported by individuals who experience IPV (Bianchi et al., 2016). Potential barriers to screening for IPV in the health care setting include lack of time, lack of a private location for discussions, and lack of consistent education and policies (Bianchi et al., 2016).
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2017, American Journal of Obstetrics and GynecologyCitation Excerpt :It is incumbent upon physicians to have an understanding of the tool used and associated attributes. For instance, the HITS and Woman Abuse Screening Tool tools assess only physical violence and emotional (psychological aggression) but not sexual violence or stalking aggression.14 While some instruments are very brief and require little time, others are extensive and very time consuming.
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2017, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation Excerpt :There are already numerous research initiatives, social service programs, and policy initiatives for working with various regions of these intersecting cycles. An excellent example of such research is a recent article by Bianchi, Cesario, and McFarlane (2016), who studied interrupting intimate partner violence during pregnancy; they provided recommendations for identification, assessment, and health care provider training and explored essential components of an assessment program. The cycles-breaking framework seeks to incorporate such efforts under one rubric.
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Ann L. Bianchi, PhD, RN, is an associate professor in the College of Nursing, University of Alabama in Huntsville, Huntsville, AL.
Sandra Cesario, PhD, RNC, FAAN, is a professor and the PhD/DNP Program Coordinator in the College of Nursing, Texas Woman's University, Houston, TX.
Judith McFarlane, DrPH, RN, is a professor in the College of Nursing, Texas Woman's University, Houston, TX.
The authors and planners for this activity report no conflict of interest or relevant financial relationships. No commercial support was received for this educational activity.