School of Nursing, McMaster University, Hamilton, ON, Canada.
BMC Health Serv Res. 2012 Feb 29;12:50. doi: 10.1186/1472-6963-12-50.
Despite an increase in knowledge about the epidemiology of intimate partner violence (IPV), much less is known about interventions to reduce IPV and its associated impairment. One program that holds promise in preventing IPV and improving outcomes for women exposed to violence is the Nurse-Family Partnership (NFP), an evidence-based nurse home visitation program for socially disadvantaged first-time mothers. The present study developed an intervention model and modification process to address IPV within the context of the NFP. This included determining the extent to which the NFP curriculum addressed the needs of women at risk for IPV or its recurrence, along with client, nurse and broader stakeholder perspectives on how best to help NFP clients cope with abusive relationships.
Following a preliminary needs assessment, an exploratory multiple case study was conducted to identify the core components of the proposed IPV intervention. This included qualitative interviews with purposeful samples of NFP clients and community stakeholders, and focus groups with nurse home visitors recruited from four NFP sites. Conventional content analysis and constant comparison guided data coding and synthesis. A process for developing complex interventions was then implemented.
Based on data from 69 respondents, an IPV intervention was developed that focused on identifying and responding to IPV; assessing a client's level of safety risk associated with IPV; understanding the process of leaving and resolving an abusive relationship and system navigation. A need was identified for the intervention to include both universal elements of healthy relationships and those tailored to a woman's specific level of readiness to promote change within her life. A clinical pathway guides nurses through the intervention, with a set of facilitators and corresponding instructions for each component.
NFP clients, nurses and stakeholders identified the need for modifications to the existing NFP program; this led to the development of an intervention that includes universal and targeted components to assist NFP nurses in addressing IPV with their clients. Plans for feasibility testing and evaluation of the effectiveness of the IPV intervention embedded within the NFP, and compared to NFP-only, are discussed.
尽管人们对亲密伴侣暴力（IPV）的流行病学有了更多的了解，但对于减少 IPV 及其相关损伤的干预措施知之甚少。一种有望预防 IPV 并改善遭受暴力妇女结局的方案是护士家庭伙伴关系（NFP），这是一种针对社会弱势首次生育母亲的基于证据的护士家访项目。本研究制定了一种干预模型和修改流程，以在 NFP 背景下解决 IPV 问题。这包括确定 NFP 课程在多大程度上满足了处于 IPV 或其复发风险中的妇女的需求，以及客户、护士和更广泛的利益相关者对如何最好地帮助 NFP 客户应对虐待关系的看法。
在初步需求评估之后，进行了探索性多案例研究，以确定拟议的 IPV 干预的核心组成部分。这包括对 NFP 客户和社区利益相关者进行有针对性的定性访谈，以及从四个 NFP 地点招募的护士家访者的焦点小组。常规内容分析和恒定性比较指导数据编码和综合。然后实施了开发复杂干预措施的过程。
根据来自 69 名受访者的数据，制定了一项 IPV 干预措施，该措施侧重于识别和应对 IPV；评估与 IPV 相关的客户安全风险水平；了解离开和解决虐待关系的过程以及系统导航。确定需要在干预措施中纳入健康关系的普遍要素以及针对妇女特定准备程度的要素，以促进其生活中的变化。临床途径指导护士进行干预，每个组成部分都有一组促进者和相应的说明。
NFP 客户、护士和利益相关者确定需要对现有 NFP 计划进行修改；这导致开发了一种干预措施，其中包括普遍和针对性的组成部分，以帮助 NFP 护士在与客户一起解决 IPV 问题。讨论了在 NFP 中嵌入 IPV 干预措施并与仅 NFP 进行比较的可行性测试和有效性评估计划。
