Leesa Hooker

Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): a cluster randomised trial

BackgroundMothers are at risk of domestic violence (DV) and its harmful consequences postpartum. There is no evidence to date for sustainability of DV screening in primary care settings. We aimed to test whether a theory-informed, maternal and child health (MCH) nurse-designed model increased and sustained DV screening, disclosure, safety planning and referrals compared with usual care.MethodsCluster randomised controlled trial of 12 month MCH DV screening and care intervention with 24 month follow-up.The study was set in community-based MCH nurse teams (91 centres, 163 nurses) in north-west Melbourne, Australia.Eight eligible teams were recruited. Team randomisation occurred at a public meeting using opaque envelopes. Teams were unable to be blinded.The intervention was informed by Normalisation Process Theory, the nurse-designed good practice model incorporated nurse mentors, strengthened relationships with DV services, nurse safety, a self-completion maternal health screening checklist at three or four month consultations and DV clinical guidelines. Usual care involved government mandated face-to-face DV screening at four weeks postpartum and follow-up as required.Primary outcomes were MCH team screening, disclosure, safety planning and referral rates from routine government data and a postal survey sent to 10,472 women with babies ≤ 12 months in study areas. Secondary outcomes included DV prevalence (Composite Abuse Scale, CAS) and harm measures (postal survey).ResultsNo significant differences were found in routine screening at four months (IG 2,330/6,381 consultations (36.5 %) versus CG 1,792/7,638 consultations (23.5 %), RR = 1.56 CI 0.96–2.52) but data from maternal health checklists (n = 2,771) at three month IG consultations showed average screening rates of 63.1 %. Two years post-intervention, IG safety planning rates had increased from three (RR 2.95, CI 1.11–7.82) to four times those of CG (RR 4.22 CI 1.64–10.9). Referrals remained low in both intervention groups (IGs) and comparison groups (CGs) (<1 %).2,621/10,472 mothers (25 %) returned surveys. No difference was found between arms in preference or comfort with being asked about DV or feelings about self.ConclusionA nurse-designed screening and care model did not increase routine screening or referrals, but achieved significantly increased safety planning over 36 months among postpartum women. Self-completion DV screening was welcomed by nurses and women and contributed to sustainability.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12609000424202, 10/03/2009

Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: a mixed method process evaluation of a randomised controlled trial

BackgroundIn Victoria, Australia, Maternal and Child Health (MCH) services deliver primary health care to families with children 0–6 years, focusing on health promotion, parenting support and early intervention. Family violence (FV) has been identified as a major public health concern, with increased prevalence in the child-bearing years. Victorian Government policy recommends routine FV screening of all women attending MCH services. Using Normalization Process Theory (NPT), we aimed to understand the barriers and facilitators of implementing an enhanced screening model into MCH nurse clinical practice.MethodsNPT informed the process evaluation of a pragmatic, cluster randomised controlled trial in eight MCH nurse teams in metropolitan Melbourne, Victoria, Australia. Using mixed methods (surveys and interviews), we explored the views of MCH nurses, MCH nurse team leaders, FV liaison workers and FV managers on implementation of the model. Quantitative data were analysed by comparing proportionate group differences and change within trial arm over time between interim and impact nurse surveys. Qualitative data were inductively coded, thematically analysed and mapped to NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) to enhance our understanding of the outcome evaluation.ResultsMCH nurse participation rates for interim and impact surveys were 79% (127/160) and 71% (114/160), respectively. Twenty-three key stakeholder interviews were completed. FV screening work was meaningful and valued by participants; however, the implementation coincided with a significant (government directed) change in clinical practice which impacted on full engagement with the model (coherence and cognitive participation). The use of MCH nurse-designed FV screening/management tools in focussed women’s health consultations and links with FV services enhanced the participants’ work (collective action). Monitoring of FV work (reflexive monitoring) was limited.ConclusionsThe use of theory-based process evaluation helped identify both what inhibited and enhanced intervention effectiveness. Successful implementation of an enhanced FV screening model for MCH nurses occurred in the context of focussed women’s health consultations, with the use of a maternal health and wellbeing checklist and greater collaboration with FV services. Improving links with these services and the ongoing appraisal of nurse work would overcome the barriers identified in this study.

Nurse and midwifery education and intimate partner violence: a scoping review

AIMS AND OBJECTIVES This scoping review aims to identify the scope of current literature considering nurse/midwife educational practices in the areas of intimate partner violence to inform future nursing/midwifery educational policy and practice. BACKGROUND Intimate partner violence is a global issue affecting a significant portion of the community. Healthcare professionals including nurses/midwives in hospital- and community-based environments are likely to encounter affected women and need educational strategies that support best practice and promote positive outcomes for abused women and their families. DESIGN Scoping review of relevant literature from January 2000 to July 2015. METHOD Search of databases: CINHAL, MEDLINE, EMBASE, PROQUEST Central and COCHRANE Library. Reference lists from included articles were searched for relevant literature as were several grey literature sources. RESULTS This review demonstrates low levels of undergraduate or postregistration intimate partner violence education for nursing/midwifery staff and students. Existing intimate partner violence education strategies are varied in implementation, method and content. Outcomes of these educational programmes are not always rigorously evaluated for staff or client-based outcomes. CONCLUSIONS Further research is needed to evaluate existing intimate partner violence education programmes for nurses/midwives and identify the most effective strategies to promote improved clinical practice and outcomes for abused women and their families. RELEVANCE TO CLINICAL PRACTICE Intimate partner violence has a significant social and public health impact. The World Health Organization has identified the need to ensure that healthcare professionals are adequately trained to meet the needs of abused women. Intimate partner violence education programmes, commencing at undergraduate studies for nurses/midwives, need to be implemented with rigorously evaluated programmes to ensure they meet identified objectives, promote best practice and improve care for abused women.

Intimate partner violence and the experience of early motherhood: a cross-sectional analysis of factors associated with a poor experience of motherhood

OBJECTIVE to examine the relationship between intimate partner violence and other factors associated with the experience of early motherhood. DESIGN cross sectional secondary data analysis (n=1534) from MOVE: a cluster randomised controlled trial that evaluated a model of enhanced nurse screening and supportive care for abused women. SETTING Victoria, Australia. PARTICIPANTS postpartum women attending community based maternal and child health clinics. MEASUREMENTS survey included the Experience of Motherhood Questionnaire; measures of partner abuse, depression, anxiety, stress and social support. Multivariable robust regression analysis used. FINDINGS independent of other factors, abused women were more likely to have a poorer mothering experience (Adj b=2.01, 95% CI=0.78, 3.25). Poor mental health, abuse as a child and being born overseas were also associated with a poor experience. Busy mothers who had a multiple birth and those balancing work and study simultaneously had higher experience of motherhood scores, indicating a poorer experience. Social support was protective. KEY CONCLUSIONS AND IMPLICATIONS exposure to partner violence is adversely associated with early motherhood, independent of other correlates of poor motherhood experience. Greater awareness of factors associated with intimate partner violence and mothering would enable health care professionals and policy makers to improve support for women and children experiencing violence.

Interventions to support recovery after domestic and sexual violence in primary care

Abstract Experiences of domestic and sexual violence are common in patients attending primary care. Most often they are not identified due to barriers to asking by health practitioners and disclosure by patients. Women are more likely than men to experience such violence and present with mental and physical health symptoms to health practitioners. If identified through screening or case finding as experiencing violence they need to be supported to recover from these traumas. This paper draws on systematic reviews published in 2013–2015 and a further literature search undertaken to identify recent intervention studies relevant to recovery from domestic and sexual violence in primary care. There is limited evidence as to what interventions in primary care assist with recovery from domestic violence; however, they can be categorized into the following areas: first line response and referral, psychological treatments, safety planning and advocacy, including through home visitation and peer support programmes, and parenting and mother–child interventions. Sexual violence interventions usually include trauma informed care and models to support recovery. The most promising results have been from nurse home visiting advocacy programmes, mother–child psychotherapeutic interventions, and specific psychological treatments (Cognitive Behaviour Therapy, Trauma informed Cognitive Behaviour Therapy and, for sexual assault, Exposure and Eye Movement Desensitization and Reprocessing Interventions). Holistic healing models have not been formally tested by randomized controlled trials, but show some promise. Further research into what supports women and their children on their trajectory of recovery from domestic and sexual violence is urgently needed.

Using theory to design, implement and evaluate sustained nurse domestic violence screening and supportive care

Domestic violence is prevalent and harmful for abused women and children and damages women’s capacity to maintain wellbeing and parent effectively. As women’s health is likely to be poor, greater identification and support by nurses for abused women is needed. The aim of this study is to highlight the importance of theory in nursing intervention research on domestic violence and how the application of implementation theory can be used to promote programme sustainability. In particular, we discuss the use of Normalization Process Theory (NPT) in the MOVE (improving maternal and child health care for vulnerable mothers) study, a randomised controlled trial which aimed to increase nurse inquiry, safety planning and referral of abused women. NPT was used in the participatory action research and design stage of the trial, in the implementation and process evaluation phases. In conclusion, the use of implementation theory in nursing research can enhance the uptake of complex interventions, address the knowledge–practice gap and potentially improve outcomes for women experiencing domestic violence.

Reflections on maternal health care within the Victorian Maternal and Child Health Service

Women suffer significant morbidity following childbirth and there is a lack of focussed, primary maternal health care to support them. Victorian Maternal and Child Health (MCH) nurses are ideally suited to provide additional care for women when caring for the family with a new baby. With additional training and support, MCH nurses could better fill this health demand and practice gap. This discussion paper reviews what we know about maternal morbidity, current postnatal services for women and the maternal healthcare gap, and makes recommendations for enhancing MCH nursing practice to address this deficit.

Intimate-partner violence and reproductive decision-making by women attending Victorian Maternal- and Child-Health services: a cross-sectional study

The reproductive years are a critical period where women experience greater risk of intimate-partner violence (IPV). Most studies investigating the association between IPV and reproductive health have been completed in low- and middle-income countries. This study aimed to examine the relationship between IPV and womens reproductive decision-making in Victoria, Australia. We analysed secondary data from a cluster-randomised trial of IPV screening that surveyed new mothers attending Maternal- and Child-Health centres in Melbourne. Survey measures included the experience of partner abuse in the past 12 months using the Composite Abuse Scale and four reproductive decision-making indicators. Results showed that IPV affects reproductive decision-making among postpartum women. Women who reported abuse were less likely to plan for a baby (adjusted Odds Ratio 0.48, 95% CI: 0.31-0.75) than were non-abused women, significantly more likely to have partners make decisions for them about contraception (Risk ratio (RR) 4.09, 95% CI: 1.31-12.75), and whether and when to have a baby (RR 12.35, 95% CI: 4.46-34.16), than they were to make decisions jointly. Pregnant and postpartum women need to be screened for partner violence that compromises womens decision-making power regarding their reproductive rights.

Partner violence and postnatal mental health: cross-sectional analysis of factors associated with depression and anxiety in new mothers

Intimate-partner violence and poor mental health are common, harmful issues for women of childbearing age. Although the prevalence and correlates of postpartum depression are well established, far less is known about postpartum anxiety. We aimed to investigate the association between postnatal depression and anxiety, and intimate-partner violence among women attending Victorian Maternal and Child Health services, using data from a randomised control trial: Improving Maternal and Child Health care for Vulnerable Mothers (MOVE). These data included postnatal women who had given birth between May and December 2010. Multiple logistic regression was used to estimate the association between intimate partner violence (using the Composite Abuse Scale) and postnatal depression and anxiety (Depression, Anxiety and Stress Scale), controlling for participant socio-demographic characteristics. Findings showed that abused women were more likely to report postnatal depressive and anxiety symptoms. There was an almost two-fold (odds ratio (OR) 1.76, 95% CI 1.03-3.01) and three-fold (OR 2.6, 95% CI 1.58-4.28) increase in the odds of reporting depressive and anxiety symptoms respectively, among abused compared with non-abused women. Abused women are at a higher risk of mental health problems. This study validated findings that intimate-partner violence is strongly associated with an increased risk of postnatal depression and highlighted the previously under-reported relationship with postnatal anxiety.

Violence Against Young Women in Non-urban Areas of Australia: A Scoping Review

Violence against women is globally prevalent and harmful to women’s health and well-being. Younger women are at higher risk of abuse, especially those from non-urban areas who may face specific barriers to disclosure and support. The aim of this review was to map the breadth and nature of the “violence against women” literature particular to young non-urban Australian women and identify research gaps to inform future research with young people. A comprehensive scoping review methodology, as outlined by Arksey and O’Malley, was adopted. English language, peer-reviewed articles were identified from five databases between January 2000 and July 2015. Grey literature was also examined. Inclusion criteria for the review included young women (15–24 years) from non-urban areas of Australia. Twenty-four full-text articles were included in this review. Themes identified include prevalence and type of abuse, experiences and response to violence, and the consequences of abuse. Recommendations from the review which are relevant to a global audience include the need for improved service access, improved data collection on the prevalence of violence, and a focus on more research with young women in non-urban areas. There is limited research on violence against young women living in non-urban areas of Australia. Evidence to date consists of predominantly quantitative data generated from general population surveys. There is a lack of qualitative research on this topic, and we argue that more is needed to gain a better understanding of the violence that young women experience.