Judith Wuest

Feminist Grounded Theory: An Exploration of the Congruency and Tensions between Two Traditions in Knowledge Discovery

The feminist perspective applied to the method of grounded theory offers an approach to knowledge discovery for nursing that incorporates diversity and change. The epistemological congruency of feminist theory and grounded theory is discussed. Tensions created by the application of feminist methodological features to the grounded theory method are explored and reflexivity suggested as a means of ensuring that both traditions are respected.

Modelling the effects of intimate partner violence and access to resources on women's health in the early years after leaving an abusive partner ☆

Although the negative health effects of intimate partner violence (IPV) are well documented, little is known about the mechanisms or determinants of health outcomes for women who had left their abusive partners. Using data collected from a community sample of 309 Canadian women who left an abusive partner, we examined whether womens personal, social and economic resources mediate the relationships between the severity of past IPV and current health using structural equation modelling. A good fit was found between the model and data for hypothesized models of mental and physical health. In the mental health model, both the direct and total indirect effects of IPV were significant. In the physical health model, the direct effect of IPV on physical health was about four times as large as the total indirect effects. In both models, more severe past IPV was associated with lower health and womens personal, social, and economic resources, when combined, mediated the relationship between IPV and health. These findings demonstrate that the health outcomes of IPV for women who have left an abusive partner must be understood in context of womens resources.

Understanding Women’s Journey of Recovering From Anorexia Nervosa

Previous studies of recovery from anorexia nervosa (AN) have concentrated on discrete behavioral responses of individual women. Little is understood about the subjective process of women’s recovery in the context of family, community, or society. In this feminist grounded theory study, the authors explored the perceptions of 12 women who considered themselves recovered or recovering from AN. They discovered a substantive theory of selfdevelopment that explains, within the current social context, women’s journey from the perilous self-soothing of devastating weight loss to the informed self-care of healthy eating and problem-solving practices. The findings provide an urgently needed explanatory framework to inform women, clinicians, and health policy makers in their prevention and recovery efforts.

Negotiating With Helping Systems: An Example of Grounded Theory Evolving Through Emergent Fit

A strength of substantive grounded theories is that they are modifiable. Yet, little attention is given in the research literature to the evolution of grounded theories through the process of emergent fit. In this article, emergent fit is discussed, and the evolution of the theoretical understanding of relationships with helping systems is provided as an example. In a feminist grounded-theory study of women’s caring, emergent fit with existing inductive research on health care relationships resulted in a framework of negotiating, which includes four strategies: reframing responsibility, becoming an expert, harnessing resources, and taking on more. This explanatory model demonstrates how the use of emergent fit can avoid the generation of isolated theories and contribute to knowledge accumulation by producing a substantive theory with wider applicability.

Strengthening Capacity to Limit Intrusion: Theorizing Family Health Promotion in the Aftermath of Woman Abuse

Children’s health is a key factor in women’s decisions to leave abusive partners, yet how these families promote their health after leaving is poorly understood. In this feminist grounded theory study, the authors conducted repeat interviews with 40 single-parent families that had left abusive partners/fathers and analyzed the data using constant comparative methods. Findings reveal the central problem faced by families is intrusion, unwanted interference in everyday life that stems from abuse and its fallout. Over time, families promote their health through the basic social process of strengthening capacity to limit intrusion via four subprocesses: providing, regenerating family, renewing self, and rebuilding security. Depending on the degree of intrusion, the focus strengthening capacity shifts between practical goals of surviving and more proactive efforts directed toward positioning for the future. This theory adds to our knowledge of the long-term consequences of IPV for families and provides direction for practice and policy.

PRECARIOUS ORDERING: TOWARD A FORMAL THEORY OF WOMEN'S CARING

Given the current societal and political trends toward increasing demands on women to provide care, a conceptualization of caring that captures the common processes of diverse womens caring experiences, and makes the consequences of caring for womens health visible, is critical for the development of a health and social policy that is responsive to women. The findings of this feminist grounded theory study go beyond the current theoretical understandings of womens caring, framed as either burden or fulfilment. The complex strategies women use to manage the dissonance created by competing and changing caring demands are revealed as a process I have named precarious ordering. This middle range theory demonstrates the power and resilience in womens management through the interdependent processes of setting boundaries, negotiating, and repatterning care. In addition, the method of theoretical sampling used in this study is explicated to move toward a formal theory applicable to diverse womens caring in a wide range of health, illness, and developmental situations.

Abuse‐Related Injury and Symptoms of Posttraumatic Stress Disorder as Mechanisms of Chronic Pain in Survivors of Intimate Partner Violence

OBJECTIVE To examine the role of abuse-related injury and posttraumatic stress disorder (PTSD) symptom severity in mediating the effects of assaultive intimate partner violence (IPV) severity, psychological IPV severity, and child abuse severity on chronic pain severity in women survivors of IPV. METHODS Using data collected from a community sample of 309 women survivors of IPV, structural equation modeling was used to test a theoretical model of the relationships among the key variables. RESULTS The theoretical model accounted for almost 38% of the variance in chronic pain severity. PTSD symptom severity was a significant mediator of the relationships of both child abuse severity (beta = 0.13) and assaultive IPV severity (beta = 0.06) with chronic pain severity. Lifetime abuse-related injury was also a significant mediator of the relationships between both child abuse severity (beta = 0.05) and assaultive IPV severity (beta = 0.06) and chronic pain severity. Child abuse severity made the largest significant contribution to the model (beta = 0.35). Assaultive IPV severity had a significant indirect effect (beta = 0.12) on chronic pain severity while psychological IPV severity had a significant direct effect (beta = 0.20). CONCLUSIONS Management of chronic pain in IPV survivors requires attention to symptoms of PTSD, abuse-related injury, and lifetime experiences of violence. Ensuring that acute pain from injury is adequately treated and followed over time may reduce the extent of chronic pain in abused women. The results also support the importance of routine assessment for IPV and child abuse.

Attributing Selected Costs to Intimate Partner Violence in a Sample of Women Who Have Left Abusive Partners: A Social Determinants of Health Approach

Cet article rend compte d’une étude qui nous a permis d’évaluer certains coûts associés à la violence conjugale au sein d’un échantillon de 309 femmes qui avaient quitté leur conjoint abuseur depuis 20 mois en moyenne. Nous estimons ces coûts – c’est-à-dire les dépenses publiques et privées associées à la violence conjugale – à 13 162,39

Pathways of Chronic Pain in Survivors of Intimate Partner Violence

par femme en moyenne. Si l’on considère l’ensemble des femmes canadiennes de 19 à 65 ans ayant un conjoint abuseur, les coûts associés à la violence conjugale se chiffrent donc à 6,9 milliards de dollars, et à 3,1 milliards si l’on considère les femmes victimes de violence conjugale au cours des trois dernières années. Ces résultats indiquent que la violence conjugale implique des coûts qui persistent longtemps après la séparation des conjoints. Il est donc important, en matière de politiques de lutte contre la violence conjugale, que les décideurs tiennent compte du fait que la séparation ne met pas un terme à cette violence.

Feminist critique: Searching for meaning in research

OBJECTIVE To examine the roles of lifetime abuse-related injury, posttraumatic stress disorder (PTSD) symptom severity, and depressive symptom severity in mediating the effects of severity of assaultive intimate partner violence (IPV), psychological IPV, and child abuse on chronic pain severity in women survivors of IPV. METHODS Structural equation modeling of data from a community sample of 309 women survivors of IPV was used to test partial and full theoretical models of the relationships among the variables of interest. RESULTS The full model had good fit and accounted for 40.2% of the variance in chronic pain severity. Abuse-related injury, PTSD symptom severity, and depressive symptom severity significantly mediated the relationship between child abuse severity and chronic pain severity, but only abuse-related injury significantly mediated the relationship between assaultive IPV severity and chronic pain severity. Psychological IPV severity was the only abuse variable with significant direct effects on chronic pain severity but had no significant indirect effects. CONCLUSIONS These findings can inform clinical care of women with chronic pain in all areas of healthcare delivery by reinforcing the importance of assessing for a history of child abuse and IPV. Moreover, they highlight the relevance of routinely assessing for abuse-related injury and PTSD and depressive symptom severity when working with women who report chronic pain.