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      Gender‐based violence and the role of healthcare professionals

      editorial
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      Nursing Open
      John Wiley and Sons Inc.

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          Abstract

          Academics, researchers, practitioners and millions of people from around the world participated in the violence against women campaign that ran from 25 November—International Day for the Elimination of Violence against Women—to 10 December—Human Rights Day. The campaign called “16 Days of Activism against Gender‐Based Violence” is an annual event that connects these two important dates and reminds the world that violence against women is a human rights issue. Therefore, this is an opportunity to write on the issue of gender‐based violence and its various forms to draw the attention of nurses, midwives and other healthcare professionals’ and the readers of Nursing Open to this subject. The United Nations (1993) defines violence against women as “any act of gender‐based violence that results in, or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life” (United Nations, 1993). More recently, in the UK, the definition was revised to include controlling and coercive control referring to: “a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour” (Home Office, 2012). Therefore, any “act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim” is an example of coercive control, and a punishable offence in the UK (Home Office, 2012). Of course, men can also be victims of violence, although available evidence suggest that frequency, severity and intensity of such violence is much greater for women than men. Also, in most cases, the perpetrator of abuse is usually someone known to the woman with current or former intimate partner and other family members likely to be the most common perpetrator. Women are subjected to various acts of violence in all aspects of life. It happens in public as well as private, at home, in the street, in the office, in peace and in war. It takes many forms, including physical, psychological and sexual abuse. It affects girls and women of all ages, in the form of female infanticide, female genital mutilation, child marriage, grooming, trafficking, forced marriage, honour killing, domestic violence and intimate partner violence. It is associated with significant physical, emotional and mental health impacts. It not only has an impact on the lives of women experiencing it, but also negatively affects their children. Disclosing abusive experiences to health and social care practitioners or police is not straightforward for women as it can create a sense of shame, embarrassment, powerlessness and hopelessness (Briones‐Vozmediano, Agudelo‐Suarez, Goicolea, & Vives‐Cases, 2014; Ortiz‐Barreda et al., 2014). However, there are subgroups of women who may experience additional difficulties when it comes to seeking support and these include older women (McGarry, Ali, & Hinchliff, 2017; McGarry & Bowden, 2017; Straka & Montminy, 2006), women from minority ethnic background (Ortiz‐Barreda et al., 2014; Stockman, Hayashi, & Campbell, 2015), women with disabilities (Dixon & Robb, 2015; Khalifeh et al., 2015) and those in institutional setting. In recent years, a lot has been done to recognize and criminalize the issue by developing appropriate laws against it, although implementation of these laws is still challenging in many parts of the world. At the same time, a lot has been done to increase awareness of the general public as well as healthcare professionals about the issue in an attempt to prepare practitioners to identify and respond appropriately to those who need help. However, much still needs to be done. We know that healthcare professionals including nurses and midwives work in diverse settings and can contribute by recognizing the manifestations and referring victims to appropriate sources of help and support (Ahmad, Ali, Rehman, Talpur, & Dhingrra, 2016). They need to be able to provide empathetic and supportive care to those who may be experiencing abuse to enable them to seek help and support. Nurses and other healthcare professionals need appropriate knowledge and skills to enable this. Active listening, an empathetic and non‐judgemental attitude and an awareness of one's own values and beliefs related to violence against women, prejudice and biases is necessary. Those nurses working in leadership positions can play their part by contributing to the development and implementation of appropriate policies, guidelines and legislations. Finally, nurses’ work and role exposes them to additional pressures as they not only care for those experiencing abuse, but at times, may have to care for those who perpetrate abuse on others and in such situations having self‐awareness, emotional intelligence and a knowledge of professional codes of conduct is useful. Identifying and helping perpetrators who recognize their behaviour and would like support to change their behaviour is also essential and nurses and healthcare professionals can do that by referring them to appropriate support programmes. Violence against women is a complex and multifactorial issue needing a multisectoral and ecological approach to deal with it and we as healthcare professionals can play a very important role in preventing it.

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          Intimate Partner Violence and Its Health Impact on Ethnic Minority Women

          In the United States, intimate partner violence (IPV) against women disproportionately affects ethnic minorities. Further, disparities related to socioeconomic and foreign-born status impact the adverse physical and mental health outcomes as a result of IPV, further exacerbating these health consequences. This article reviews 36 U.S. studies on the physical (e.g., multiple injuries, disordered eating patterns), mental (e.g., depression, post-traumatic stress disorder), and sexual and reproductive health conditions (e.g., HIV/STIs, unintended pregnancy) resulting from IPV victimization among ethnic minority (i.e., Black/African American, Hispanic/Latina, Native American/Alaska Native, Asian American) women, some of whom are immigrants. Most studies either did not have a sufficient sample size of ethnic minority women or did not use adequate statistical techniques to examine differences among different racial/ethnic groups. Few studies focused on Native American/Alaska Native and immigrant ethnic minority women and many of the intra-ethnic group studies have confounded race/ethnicity with income and other social determinants of health. Nonetheless, of the available data, there is evidence of health inequities associated with both minority ethnicity and IPV. To appropriately respond to the health needs of these groups of women, it is necessary to consider social, cultural, structural, and political barriers (e.g., medical mistrust, historical racism and trauma, perceived discrimination, immigration status) to patient-provider communication and help-seeking behaviors related to IPV, which can influence health outcomes. This comprehensive approach will mitigate the racial/ethnic and socioeconomic disparities related to IPV and associated health outcomes and behaviors.
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            Domestic and sexual violence against patients with severe mental illness

            Background Domestic and sexual violence are significant public health problems but little is known about the extent to which men and women with severe mental illness (SMI) are at risk compared with the general population. We aimed to compare the prevalence and impact of violence against SMI patients and the general population. Method Three hundred and three randomly recruited psychiatric patients, in contact with community services for ⩾1 year, were interviewed using the British Crime Survey domestic/sexual violence questionnaire. Prevalence and correlates of violence in this sample were compared with those from 22 606 general population controls participating in the contemporaneous 2011/12 national crime survey. Results Past-year domestic violence was reported by 27% v. 9% of SMI and control women, respectively [odds ratio (OR) adjusted for socio-demographics, aOR 2.7, 95% confidence interval (CI) 1.7–4.0], and by 13% v. 5% of SMI and control men, respectively (aOR 1.6, 95% CI 1.0–2.8). Past-year sexual violence was reported by 10% v. 2.0% of SMI and control women respectively (aOR 2.9, 95% CI 1.4–5.8). Family (non-partner) violence comprised a greater proportion of overall domestic violence among SMI than control victims (63% v. 35%, p < 0.01). Adulthood serious sexual assault led to attempted suicide more often among SMI than control female victims (53% v. 3.4%, p < 0.001). Conclusions Compared to the general population, patients with SMI are at substantially increased risk of domestic and sexual violence, with a relative excess of family violence and adverse health impact following victimization. Psychiatric services, and public health and criminal justice policies, need to address domestic and sexual violence in this at-risk group.
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              Responding to the needs of older women experiencing domestic violence.

              Older women experiencing domestic violence are an invisible group who fall into the gap between two forms of family violence: elder abuse and domestic violence. This article reviews the literature in both fields, describing each paradigm, how it explains and responds to its specific form of violence, and why neither has been able to provide an adequate response to domestic violence against older women. A collaborative response is needed, accounting for both the age and gender dimensions of the problem.
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                Author and article information

                Journal
                Nurs Open
                Nurs Open
                10.1002/(ISSN)2054-1058
                NOP2
                Nursing Open
                John Wiley and Sons Inc. (Hoboken )
                2054-1058
                21 December 2017
                January 2018
                : 5
                : 1 ( doiID: 10.1111/nop2.2018.5.issue-1 )
                : 4-5
                Affiliations
                [ 1 ] Nursing and Midwifery University of Sheffield Sheffield UK
                Author information
                http://orcid.org/0000-0002-7839-8130
                Article
                NOP2120
                10.1002/nop2.120
                5762759
                29344388
                9f6102f0-9d7b-4314-925f-5f19165f2c6b
                © 2017 The Authors. Nursing Open published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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                Editorial
                Editorial
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                2.0
                nop2120
                January 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.2.8 mode:remove_FC converted:10.01.2018

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