Advancing nursing's response to the wicked problem of intimate partner violence

As a wicked problem, intimate partner violence (IPV) is complex, multi-dimensional and global. It is influenced by intersecting social, environmental, and political factors. Therefore, it requires a multifaceted response to minimize the health, economic and social burdens associated with experiences of violence. Given the complexity of the problem of IPV, a ‘one size fits all’ approach to assessment and response is no longer sufficient. Our efforts must now be focused on advancing nurses' skills to deliver care that is tailored to meet the diverse needs of women and other groups at disproportionate risk of IPV. These nurse-led interventions then need to be strategically implemented and sufficiently resourced within care contexts, where cultural, physical and emotional safety are prioritized. In this Special Issue we use selected examples of the included articles to illustrate how internationally, nurses are leading the development, evaluation, and implementation of healthcare responses to identify and respond to individuals experiencing IPV. However, because of the complexity and tenacity of the problem of IPV, we cannot stand still. Nursing needs to evolve and adapt. With this in mind, we focus on advances in the following areas: improving nurse education on IPV; person-centred and trauma-and violence-informed care; healthcare organization's initiatives to tackling IPV. Global estimates are that one in three women will experience IPV or non-partner sexual violence at least once in their lifetime (World Health Organization, 2021) and that interpersonal violence is associated with negative and serious reproductive, physical and mental health outcomes. In a study to determine the prevalence of dating violence (a risk indicator for future IPV) among nursing students enrolled at a university in Spain, Barroso-Corroto et al. (2023) reported that 53.2% of nursing students had experienced dating violence in the last year, with the same number perpetrating violence, including cyberviolence, against their partner. Given the high prevalence of IPV, we can postulate with a high degree of certainty that all nurses will provide care to a survivor of violence during their career or be a survivor themselves. Yet nursing students and practicing nurses remain woefully unprepared to ask about, and more critically to provide comprehensive nursing care in response to IPV disclosures. In two studies of nursing students from Thailand (Udmuangpia, 2023) and Saudi Arabia (Shaqiqi & Innab, 2023), many participants (40–75%) reported not receiving IPV education; and even in the presence of positive intentions, attitudes or knowledge to ask about IPV, participants consistently reported low perceptions about their intentions to ask, or preparedness to manage IPV disclosures. It is imperative that organizations responsible for the accreditation of nursing education programs develop entry-to-practice competencies for the nursing care of individuals who experience interpersonal trauma across the life course. Moreover, educational opportunities for nursing students and practicing nurses must advance beyond the provision of single workshops focused on the epidemiology and health consequences of IPV. Instead, there need to be comprehensive and regular opportunities to engage in opportunities for skill development, practice and reflection. In their integrative review of community nurse-led interventions to identify and respond to domestic abuse in the postnatal period, one of the key training recommendations proposed by Drake and Murphy Tighe (2023) is for the provision of training that includes refresher updating, supervision, and ongoing mentorship. Nursing needs to move on from a focus on identifying strategies and barriers to recognize or ‘screen’ for IPV. We know enough about the problem. It is imperative now that the spotlight is on how to create safe environments that facilitate disclosures and appropriate responses that meet the individual needs of people who have a history of past or current IPV. In all care contexts, when individuals disclose experiences of IPV, all nurses need to be prepared to provide the first-line response of LIVES (Listen, Inquire about needs, Validate, Enhance safety and support) as recommended by the World Health Organization (2014). However, there will be certain contexts where a homogenous response to an IPV disclosure is not sufficient, and nurses must have the knowledge and skills to provide care that is tailored to the needs of a specific population. This needs to reflect the type(s) of IPV experienced and include interventions to promote safety, as well as address the health effects of IPV. In this Special Issue, we are pleased to include articles that deepen our understanding of the prevalence, risk indicators and experiences of violence among diverse populations. Awareness and identification of populations at disproportionate risk for IPV are critical for providing person-centred responses to individuals' health and social needs within healthcare contexts. Using data from the Pregnancy Risk Assessment Monitoring System (United States), in a cross-sectional sample of 43,837 individuals with a live birth, respondents with disabilities had 2.6 times the odds of experiencing IPV before pregnancy and 2.5 times the odds of experiencing IPV during pregnancy, compared to individuals in the perinatal period without disabilities (Alhusen et al., 2023). In a systematic review to examine the relationship between IPV exposure and women with breast and gynaecologic cancers, Sheikhnezhad et al. (2023) highlight that women with these types of cancer are at the greatest risk of psychological IPV and that maintaining a relationship with the perpetrator negatively influenced their use and access to treatment and quality of life during treatment. In addition to recognizing violence perpetrated against women and children, nurses have a responsibility to understand the types of IPV experienced by people from sexual and gender minority populations. In a qualitative descriptive study, Choi et al. (2023) provide a rich and in-depth analysis of the varied types of sexual violence, including chemsex, stealthing and image-based violence, as experienced by Chinese men who have sex with men who use dating ‘apps’ in Hong Kong. Acceptance or ‘normalization’ of sexual violence, along with experiences of stigmatization and discrimination, provides insights on how experiences of violence subsequently influence their health behaviours, including reticence to obtain HIV post-exposure prophylaxis (Choi et al., 2023). Nurses' understanding that experiences of different types of IPV necessitates different nursing responses is also critical. In their commentary on nurses' experiences in identifying and responding to IPV among gay and bisexual men, Callan et al. (2023) challenge the profession to recognize that applying heterosexual paradigms to capture different experiences/types of abuse in gay and bisexual populations may be problematic, and that differential tools and tailored responses are needed. Individual nurses cannot be expected to practice within a vacuum. Comprehensive organizational support is essential for ensuring that IPV training initiatives are sustained and that nursing approaches to IPV assessment and intervention are implemented and consistently delivered. In Spain, Maquibar Landa et al. (2023) explain that the enactment of the ‘Andalusion Protocol for Healthcare Response to Gender Based Violence’ has enabled the establishment of a supportive legal framework and health system to address IPV, and that this has created a care context where nurses are able to implement evidence-informed practices for caring for women who have experienced IPV. At a practical level, organizational support should at minimum consist of an investment of time and resources to provide nurses with high-quality reflective and clinical supervision, the identification of IPV practice ‘champions’ to role model best practices, the development and implementation of care pathways, protocols and the establishment of partnerships between service organization to facilitate interagency referrals (Drake & Murphy Tighe, 2023; Jack et al., 2023). With strong leadership and organizational support, nurses are better able to provide the person-centred and trauma-and violence-informed nursing care that are required. We consider it important that nurses move beyond the often-standard processes of identifying IPV and then referring onto other specialized supports, to delivering interventions that address the social or health effects associated with exposure to violence or traumatic stress. In home visitation programmes, where nurses provide health promotion supports and services to pregnant individuals or families with young children, findings from a systematic review and qualitative meta-synthesis, indicate that nurses have specialized roles in conducting risk assessments to inform the development of tailored safety plans, promoting child safeguarding and coordinating services (Adams et al., 2023). Researchers in nursing and health services are actively engaged in developing and evaluating new interventions to address the health effects associated with violence exposure. For pregnant women who have experienced IPV, the provision of 12 sessions of trauma-and violence-informed cognitive behavioural therapy by a clinical nurse specialist is showing promise as an intervention to identify potential triggers in pregnancy, develop appropriate coping strategies and advocate for their needs to best cope with their stressors and pain (Mantler et al., 2023). Similarly, for nurses working with perpetrators of violence, a nurse-led, 15-session videoconference-delivered cognitive behavioural group therapy is also showing promise as an intervention where participants report high levels of satisfaction and completion (Nesset et al., 2023). For women who receive care after non-fatal strangulation in an emergency department, forensic nurse examiners have a critical role in assessing symptoms and injuries, communicating diagnoses, validating patient experiences and ensuring a thorough and objective documentation of their findings (Patch et al., 2023). By its very nature, a wicked problem is difficult to solve, but nursing makes a considerable contribution to addressing IPV. The articles in this Special Issue attest to the cutting-edge work happening within the profession and we are delighted to showcase such work within JAN. However, if nursing is to continue to make the required strides and impacts, we have highlighted the imperative to improve nursing education on IPV and for nursing care to be person-centred and trauma-and violence-informed. We have also called for healthcare organizations to provide the resources and infrastructure that are required to support nursing's contribution to tackling IPV. All authors agreed the parameters of the editorial and were involved with the handling of the submitted manuscripts. SJ led on the analysis of the included articles and preparation of the first draft of the manuscript. CB-J edited the manuscript and agreed on the final version. None. There was no funding to support this work. The authors declare no conflicts of interest.

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