Strengthening Maternal and Child Health nursing practice for women and children experiencing family violence
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Background: Family violence (FV) is a prevalent and significant worldwide public health concern. Nurses face barriers to screening for FV and it is unclear if screening practices are sustainable. Improvements are needed in nurse identification and ongoing support of victims. This thesis examined ways to strengthen Maternal and Child Health (MCH) nurse care for women and children experiencing FV.
Methods: The papers in this thesis include a range of data collection methods and analysis. Improving MCH care for vulnerable mothers (MOVE) trial was a cluster randomised controlled trial involving implementation of an enhanced model of FV screening and supportive care within MCH services in Victoria, Australia. Normalization Process Theory informed trial design, intervention and evaluation. Primary outcomes included nurse FV screening, safety planning and referral. Mixed method process evaluation data at intervention and follow-up included MCH nurse surveys and key stakeholder interviews. Further investigation of FV, motherhood and parenting provided insight into methods of MCH nurse support for women.
Results: MCH nurse FV screening and care was enhanced and sustained when nurse teams used the MOVE model. At follow-up, MOVE teams were four times more likely to complete safety plans with women. Checklist use at later maternal health visits (once rapport was established), along with organisational support were key to sustainability. Motherhood and parenting capacity is compromised in an abusive environment, however social support is protective.
Conclusion: FV is prevalent and harmful. Strengthening MCH nurse FV practice can be achieved through the use of a nurse designed, theory informed model of FV screening and supportive care introduced at focused maternal health visits. These visits allow nurses opportunity to address FV disclosures, women and children’s safety and parenting concerns. Enhanced nurse FV training that builds understanding of abused women’s experience of motherhood and additional parenting demands is needed to optimise care.