First Contact: Acute stress reactions and experiences of emergency department consultations following an incident of intimate partner violence

My paper ‘First Contact: Acute stress reactions and experiences of emergency department consultations following an incident of intimate partner violence’ was recently published. This paper and the research findings it reports arose from my practice as an emergency nurse providing care for women in the immediate aftermath of being physically assaulted by their partner. During these encounters many women were distressed and troubled and I sometimes felt that I might not be best meeting women victim-survivors’ needs for the short and longer term. These practice experiences made me think about women’s experiences of going to an emergency department after being assaulted by their partner, question our practices in responding, and consider what good consultation outcomes for women victim-survivors might look like.

This paper is the first to be published from my research, part of which involved interviewing women victim-survivors of intimate partner violence about their experiences of attending an emergency department after being physically assaulted by their partner. For this work it was important for women victim-survivor participants’ voices to be forefront and central. I hope I have managed to do this. Looking back on my practice as an emergency nurse I do not think that I had the range and depth of knowledge and skills to deliver best possible consultation outcomes. I hope that the findings from this research will be helpful to practitioners responding to and caring for victim-survivors of partner violence and improve victim-survivor health consultation outcomes and experiences in the future.

With thanks to the women who gave up their time to participate in this research without whom this paper and their knowledge would not available to us all.

 

Paper details: Olive, P. (2016) ‘First Contact: Acute stress reactions and experiences of emergency department consultations following an incident of intimate partner violence’, Journal of Clinical Nursing DOI:10.1111/jocn.13311.

ABSTRACT

Aims and objectives:
The aim of this research was to explore women’s emotional and affective responses following an incident of intimate partner violence experienced during emergency department attendances.

Background:
A growing body of research has explored women’s experiences of emergency departments following intimate partner violence still little remains known about the experience and impact of emotional and affective responses during these attendances.

Design:
A descriptive qualitative design was used, underpinned theoretically by critical realism and postmodern complexity theory to attend to multiple, intersecting mechanisms that lie behind events and experiences.

Methods:
Semi-structured interviews with six women who had attended an emergency department directly following an incident of intimate partner violence. Interview data were transcribed and thematically analysed in NVIVO9 using a coding framework.

Results:
There were three interconnected key findings. First, was the commonality of acute stress experiences among women attending an emergency department following partner violence, second was that these acute stress reactions negatively impacted women’s consultations, and third was the need for specialist domestic violence services at the point of first contact to assist service users navigate an effective consultation.

Conclusions:
Acute stress reactions were an important feature of women’s experiences of emergency department consultations following intimate partner violence. Attending to psychological first aid; providing a safe and quiet space; and affording access to specialist violence advocacy services at the point of first contact will limit harm and improve health consultation outcomes for this population.

Relevance to clinical practice:
This research provides an account of emotional and affective responses experienced by women attending emergency departments following intimate partner violence and explicates how these acute stress reactions impacted their consultation. This research has relevance for practitioners in many first contact health services, such as urgent and emergency care, general practice, community public health and mental health.

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A paper on the economic costs of violence against women for BIMR CWP conference: The role of parliamentarians in the elimination of VAW&G

Earlier this year I was invited to present a paper on The Economic Costs of Violence against Women to the British Islands and Mediterranean Region Commonwealth Women Parliamentarians at their second annual conference held in Gibraltar on 6th – 8th February 2015. The focus of this conference was: The role of parliamentarians in the elimination of violence against women and girls. It was great to meet so many women parliamentarians and to be able to share my research on the impacts, and economic costs of impacts, of violence against women with them. It was also invaluable to hear about the work of other experts working in diverse ways to end violence against women.

CWP Gibraltar 2015 openingCWP February 2015 presenting

In this paper I presented the findings of a study that Professor Sylvia Walby and I undertook in 2014 for the European Institute of Gender Equality in which we i) examined the methodological options available to cost violence against women, and ii) estimated the cost of gender-based violence for the UK and European Union based on the best and most robust methods available.

My paper began by contextualizing the importance of comprehending violence against women in economic terms before going on to explicate the underpinning rationale of methods that we employed to estimate the costs of violence against women.

Why cost?

Our shared goal is to end gender-based violence, and we know that gender inequality is both cause and consequence of violence against women, so why should we frame violence against women by cost specifically? What is the point of costing violence against women?

Articulating violence against women in economic terms is important. Firstly it is important because we know that gendered economic inequalities such as income, access to money, employment, housing tenancy, contribute to higher rates of violence against women. Second, victim-survivors have economic needs in terms of income and housing, as well as needs for health care and specialized services and which are currently facing funding cuts.  Third, violence against women effects women’s capacity for employment impacting women’s economic status. These economic factors intersect to (re)produce conditions under which violence against women is more likely and, that in turn, produce greater economic needs and sharpen economic inequality. Economic analysis of violence against women is therefore a useful tool alongside other policy frames such as gender equality, fundamental rights, justice, public health, and social inclusion.

Earlier costing studies established that violence against women was a big societal problem; costing studies now are increasingly nuanced, offering intrinsic comparability with other government policy and priorities. Translating violence against women into an economic frame translates this gender equality issue of violence against women into mainstream policy, though this is not a single mainstream but multiple mainstreams with impacts for:

  • Economic growth and social inclusion
  • Justice, freedom and security
  • Public health

Which costs and how to measure?

Measuring the costs of violence against women involves the translation of harms and impacts of violence against women into economic terms, and which raises questions about which costs should be measured and how the costs can be measured given the challenge of often limited data. In our study we:

  • Reviewed previous studies costing gender based violence in EU and OECD.
  • Evaluated the methodologies that had been used in terms of their comprehensiveness, robustness, replicability, simplicity, feasibility.
  • Identified preferred methodologies for each cost item.
  • Developed an example case study that estimated the costs of gender-based violence in the UK using the best methodology available, and building on this UK example we then extrapolated the costs to EU28.
  • Articulated the current data challenges in comparisons across EU and the further research needed to advance costing methodologies.

For the UK case study we calculated the costs for intimate partner violence (physical and sexual violence perpetrated by a current or former partner) and for the broader category of gender-based violence (physical and sexual violence perpetrated by either an intimate partner or other family member together with sexual violence by any perpetrator) and extended the analysis to violence against men as well.  We included these different costs in order to compare the extent and impacts of different forms of violence by gender. This is important information for policy makers so that resources can be distributed according to extent and impacts.

The costs included in our estimate were:

  • Cost to the economy
    • Lost economic output (GDP)
      • Lost working time
  • Cost to the public (state)
    • Justice: criminal and civil
    • Health care: physical and mental
    • Social welfare: income support, housing
    • Specialised services: shelters, advice
  • Value placed by public, ‘willingness to pay’, to avoid pain and suffering

We estimated that gender-based violence costs the EU €258billion each year and that only a very small percentage (less than 1%) of the costs is spent on specialised services to combat this violence. Reducing violence against women is likely to improve economic growth and development. Reducing economic inequalities is linked to the reduction of violence against women and it is clear that specialist services should command higher prioritization for increased sustainable funding streams from governments. We also found that data collection has improved over time but not sufficiently for key services to be able to identify the impacts, service demands and economic burden because of violence against women. Therefore, the statistical systems to identify the extent and impact of gender-based violence in Member States of the EU, and indeed most countries, need substantial improvement.

This is a brief synopsis of the paper I presented to the BIMR CWP. The full report of the second annual conference of the British Islands and Mediterranean Region Commonwealth Women Parliamentarians, The role of parliamentarians in the elimination of violence against women and girls,  Gibraltar on 6th – 8th February 2015 is available here. The full research report on estimating the costs of gender-based violence in the European Union is available here.

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sociology of violence, physical violence, sexual violence, psychological violence, emotional violence, economic violence, coercion, stalking, harassment, cyber-violence, structural violence, cultural violence, symbolic violence, intersectionality, inequality, intersectional violence, gender inequality, gender-based violence, sociology of health,  social determinants of health, health inequalities,  health impacts, measures of health, global burden of disease, GBD, valuing health, sociology of science, social science, critical realism, complexity theory, post-modernism, sociology of diagnosis, health systems, health information systems, international classification of diseases, ICD-10, injury surveillance systems,