Title:
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The health visitors' response to family violence and abuse : A grounded theory study
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Background: Whilst there are examples of good practice and models of care currently being delivered
by health visitors in Northern Ireland to families where there is, or has been, family violence and abuse,
current audits indicate that there is variation in the quality of health visiting service delivered to
victims, perpetrators and onlookers of family violence and abuse.
The study: This study generated a practice theory from findings that emerged from an investigation
into victim, perpetrator and onlooker respondents’ perceptions of needs when enduring the lived
experience of family violence and abuse.
Method: Qualitative research using a grounded theory approach was employed.
Sample: Volunteers were recruited from local newspapers. Theoretical sampling was used until
saturation of categories materialized. The sample comprised victim (n=13), perpetrator (n=1) and
onlooker respondents (n=2) making a total of (n=16).
Findings:
A total of 21 key categories were identified in this study. Within causal conditions the categories which
emerged were: competing emotions; developing roles of victims, perpetrators and onlookers; influences
on abuse; barriers to disclosure; tolerance to violence; client-professional relationships. Six categories
emerged from the context: the dynamics among adults and children; motivation to change; the
realization of grave danger; from decision making to planning to action; and the aftermath. The
intervening conditions generated three categories: - health visitors’ attitude to families; support systems
versus barriers to care and protection; and health visitors’ knowledge and skills in relation to family
violence and abuse. Four categories were generated in action – interaction strategies. They were: facing
fears; trust versus mistrust; a felt sense of relief about the situation, and moving on. Emergent
categories from consequences were: decision-making during recovery, decision-making for the future
and growth and development.
Recommendations: Findings from the study include the recommendation for health visitors to engage
with families in order to identify those families who have suffered family violence and abuse and
accurately assess each family member’s needs and aspirations. Therapeutic programmes of care need to
be designed and implemented to meet these individual’s unique needs. A compilation of the findings
demonstrates that members of society would need to be educated regarding the signs and symptoms of
family violence and abuse and provided with information on where to go to get help. Further research
relating to the health and wellbeing needs and aspiration of victims, perpetrators and onlookers of
family violence and abuse is recommended.
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