Collaborative Research to ReduceDisparities for Abused Women andTheir Children

Nancy Glass and

Phyllis Sharps

Guest Editors

CorrespondenceNancy Glass, PhD, MPH,RN, Johns HopkinsUniversity School of Nursing525 N, Wolfe Street, Rm 439Baltimore, MD 21205.nglass1@son.jhmi.edu

Nancy Glass, PhD,MPH, RN is associateprofessor, School ofNursing and AssociateDirector, Johns HopkinsCenter for GlobalHealth, Johns HopkinsUniversity, Baltimore,MD.

Phyllis Sharps, PhD,RN, CNE, FAAN, is aprofessor and chair,Department ofCommunity PublicHealth Nursing,Johns HopkinsUniversity, School ofNursing, Baltimore,MD.

Intimate partner violence (IPV) can occur against

women or men and be perpetrated by women or

men. However, the severity of IPV and its impact dif-

fers between men and women. Women are more

likely than men to report on-going fear and/or hav-

ing changed their behaviors to accommodate the

violent partner. Further, IPV against women takes

place in a context of on-going issues of gender

inequity in our society. This inequity is evidenced

by higher rates of poverty and lower wages

for women compared with their male counterparts,

even with similar education and experience.

Gender inequity signi¢cantly impacts a woman’s

ability to safely leave the abusive relationship

and a man’s ability to abuse with limited conse-

quence.

Over the past three decades, there has been a dra-

matic transformation in the response to IPV across

all sectors of society including the health care sys-

tem. Important clinical and policy advances that

address IPV have been implemented, but nurse

scientists continue collaboratively to build the evi-

dence to reduce disparities for abused women and

their children and address the gender inequity that

supports IPV. This In Focus series reports on three

such e¡orts.

In the ¢rst paper, Dr. Sharps and colleagues review

evidence on the e¡ectiveness of nurse home visit-

ing in preventing and addressing IPV in prenatal

and/or postpartum women and their infants. After

a careful review, only eight studies met the inclusion

criteria, but these yielded important recommen-

dations for nursing interventions on home visits in-

cluding routine assessment of IPV, safety planning,

and establishing a network of support and commu-

nity resources.

In the second paper, Bhandari and colleagues

describe the daily lives of rural pregnant smokers

with a focus on the sources of stress for women with

and without IPV. Based on content analysis of re-

search nurses’ telephone logs, women were found

to share common goals regarding the desire to

be a good mother as well as attaining health for

themselves and the baby, but rural women experi-

enced barriers that increased their stress and

isolation and made it challenging to obtain these

goals. These barriers were further exacerbated

by abusive intimate relationships. The authors ad-

vocate for nurses and other health care providers

working in rural communities to recognize how IPV

compounds the stressors of pregnancy and poverty

in rural areas. Providing rural women a chance to

talk about their lives can help them not only to

locate necessary resources, but also to break down

barriers.

In the last paper, Laughon and colleagues propose

a permanent change to the Abuse Assessment

Screen (AAS), a clinical and research tool devel-

oped by nurse researchers that is in widespread

use in health care settings to identify women

experiencing IPV. They propose including an as-

sessment for attempted strangulation, or the

more commonly used term by IPV survivors,

‘‘choking.’’ Attempted strangulation is a common

form of violence against women, has serious

physical and mental health consequences, and

has been linked to increased risk of beingmurdered

by an abusive partner. Adding the word ‘‘choking’’

to the AAS will add little time to the clinical

assessment protocol but will likely provide

important information that nurses can use to col-

laboratively develop a safety plan with women. This

addition will also provide documentation in the

medical record for the woman’s use in future civil

or criminal cases.

This In Focus series highlights nurses’ important

contribution toward ending violence against wo-

men. When policy makers understand the role of

evidence-based practices such as nurse home

visitation and social support in assessing and inter-

vening with violent families in urban and rural

communities, they may eventually direct limited

JOGNN I N F O C U S E D I T O R I A L

478 & 2008 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses http://jognn.awhonn.org

health system funding to public health nursing pro-

grams. When clinicians understand the value of

assessing attempted strangulation with women ex-

periencing IPV and add it to their assessment

protocols, this important change will likely provide

information to improve safety planning with women

and their children. The newly revised AAS can be

immediately used by nurses in diverse health care

settings.

Although these are positive steps, violence against

women is far too common in our society. Supporting

and funding research by nurses in neglected topic

areas such as nurse home visitation, rurality and

poverty, and assessment tools to screen for IPV

and homicide risk is critical. With continuing

research, nurses can adopt evidence-based prac-

tices to prevent the serious health and social costs

of IPV to individuals, families, and communities.

JOGNN 2008; Vol. 37, Issue 4 479

Nancy Glass and Phyllis Sharps I N F O C U S E D I T O R I A L