Philosophical Stance and Socio-Ecological Factors that Silence Women Who Experience Intimate Partner Violence

  • Author / Creator
    Pokharel, Bijaya
  • Background
    Intimate Partner Violence (IPV) is a global health issue with long-term physical and mental health impacts. Most women may endure IPV silently before they disclose the problem and seek effective help. Healthcare providers are potential and feasible points of disclosure of IPV. To overcome barriers of disclosure, healthcare providers, especially nurses, need to have an integrated understanding of how their interactions with affected women are shaped by factors within their profession, the healthcare and community milieu, as well as factors related to affected women; and how these could reinforce silencing about the violence. Although some studies have been done in this area, we found a dearth of literature summarizing and synthesizing those studies.
    This thesis aimed to identify the dominant conceptualizations within the nursing profession and the socio-ecological factors which silence women who have experienced intimate partner violence from their male partners. It unfolds in two phases: In the first phase, I explored nursing theory conceptualizations that could affect care practices and could potentially silence women, and in the second phase, I investigated factors related to women and their environment, which reinforced silencing of women about IPV. For the first phase, I explore the potential effects of the philosophical stance of nursing theories on the interactions between nurses and women who experience IPV. For the second phase, I employ an ecological model (micro-, meso-, exo-, and macrosystems) to synthesize and interpret factors affecting the silencing of women who experience IPV.
    We used critical interpretive synthesis and integrative review design for the first and the second phase, respectively.
    For the critical interpretive synthesis, we followed the steps described by Dixon-Woods et al. (2006). We hand searched nursing theory books to identify the five most commonly used nursing theories. Then, we searched PubMed, CINAHL, and Scopus to identify articles which report on the application of theories in the caring context of IPV. For the integrative review, we followed the steps described by Whittemore and Knafl (2005). We screened articles searched at seven electronic databases namely PubMed, Medline, Scopus, CINAHL, Web of Science, Sociological Abstract, and Gender Studies against pre-defined eligibility criteria using a web application, Rayyan.
    During the first phase, we identified the five most commonly used nursing theories. The findings revealed that nursing theories express predominant conceptualizations about care and care recipients, which are not commensurate with the principles of care identified by the four studies which applied the different theoretical framework in the caring context of IPV. This misalignment between the conceptualization of nursing care and the defining qualities of a patient could lead nurses to respond inappropriately, hence, silencing women rather than supporting them. In the second phase, we identified 21 articles for the analysis. The microsystem level factor was the most influential in reinforcing silencing. However, each subsystem interacts with each other to affect women’s response to IPV.
    It is imperative that nurses develop the knowledge and skills to establish therapeutic interactions with women who have experienced IPV. Underpinning such development is the careful consideration of an appropriate theoretical framework. This framework could be based on the principles of care identified by this study and could incorporate the understanding of ecological influences on silencing about IPV and on shaping the responses of nurses to affected women.

  • Subjects / Keywords
  • Graduation date
    Fall 2018
  • Type of Item
  • Degree
    Master of Nursing
  • DOI
  • License
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