Emancipating emergency nurses towards taking care of survivors of intimate partner violence

Abstract

Emergency nurses have the opportunity to intervene when survivors of intimate partner violence (IPV) are most receptive for interventions following exposure. However, exposure to IPV is often not detected, and the majority of women still experience significant challenges to find help. The provision of care to survivors of IPV within the violence-prone South African landscape poses unique challenges to emergency nurses. The challenges seemed to be situated within emergency nurses’ own vulnerability to personal exposure to violence related to gender inequality, and their on-going professional exposure to survivors of IPV. The encounter with IPV can trigger overwhelming emotions in nurses that they are expected to suppress while on duty. These emotional experiences can lead to internal conflict, emotional detachment and vicarious traumatisation, which can in turn affect emergency nurses and the care they provide to survivors. When taking care of a survivor of IPV, emergency nurses need to facilitate a critical awareness in the survivor of the disadvantage she suffers. For nurses to make an impact, they need to reflect on their own personal and professional position in relation to power and need to deal with their own experiences of oppression through emancipation. The aim of this research was to explore and describe emergency nurses’ experiences of taking care of survivors of IPV; and develop and validate guidelines to facilitate the actualisation of emancipatory knowing in emergency nurses with regard to taking care of survivors of IPV. The research was conducted in two phases. Phase 1 of the research was conducted within a constructivist paradigm. A descriptive phenomenological inquiry, grounded within the philosophical foundations of Husserlian phenomenology, was used. The phenomenological reductions were applied throughout data collection and analysis. Concrete descriptions were obtained from interviewing nine nurses working in emergency units of two public hospitals in an urban setting in South Africa. In order to arrive at a description of the essence, the data were analysed by searching for the meaning given to the experience of caring for survivors of IPV. The findings were described in terms of the essence that was illuminated by the constituents that reflected the following meanings emergency nurses attached to the experience of taking care of survivors of IPV: the emotional and cognitive impact related to being witnesses to survivors’ experiences of IPV, identification with IPV survivors’ experiences, the interrelation between IPV related personal and professional domain experiences, attempts to cope with professional domain experiences related to IPV, attempts to make meaning out of IPV, formation of gender perceptions and assumptions related to IPV and provision of care to survivors of IPV. A literature review was conducted after data collection and analysis to ensure an open and unbiased approach towards participants’ lifeworld experiences. The literature review helped to clarify the meanings and deepened the researcher’s perspectives on the research phenomenon. Injustices and oppression uncovered in emergency nurses’ experiences of taking care of survivors of IPV guided the researcher to formulate nine guidelines in terms of emancipatory knowing processes in nursing. The draft guidelines based on the findings of the phenomenological inquiry and emancipatory knowing processes in nursing were validated through a Delphi technique. The guidelines were refined according to the suggestions of a panel of experts who rated the guidelines using the criteria of reliability, validity, applicability, clarity and flexibility. Recommendations were made in terms of organisational and supportive structures to enable emergency nurses to provide quality care to survivors of IPV, support structures to provide care for the carer, and realisation of emancipatory knowing with regard to taking care of survivors of IPV.