Development of a programme for nurses to manage survivors of sexual and gender-based violence in primary health settings

Abstract

Background: Sexual and gender-based violence (SGBV) is a world-wide problem and South Africa is no exception. In a report released by the World Health Organisation in 2018 it was estimated that almost twenty-three percent of adults suffered physical abuse in their childhood, and that as many as thirty-five percent of women globally will experience either sexual or physical violence during their lifetime. Evidence indicates that most survivors of SGBV will look to nursing services for their first port of call. The literature reveals that nurses generally feel ill-equipped to deal with these survivors because there is a lack of adequate training, which will impact on their level of appropriate care, especially with regards to their lack of knowledge about referring survivors for further management. Purpose: The purpose of this study was to develop the outline of a programme which would assist nurses in recognizing and managing these survivors, as most nurses felt ill-equipped to recognize and manage these patients effectively. The training currently provided does not address these issues adequately, and no protocols or guidelines have been established for healthcare providers in South Africa. Research Design: This study used qualitative methodology in four sequential phases. Qualitative research is a research method which is used to explore real world issues. It gathers information on the meanings of phenomena, that have been experienced by individuals in their natural environments. It focuses on obtaining people’s stories and insights. (Brink, H., van der Walt, C., van Rensburg, G., 2018). Phases one to three were used to inform phase four of the study where a programme was developed using the data from the first three phases guided by the ADDIE model. Methodology: The methodology that was used in this qualitative study was to conduct indepth interviews with experts on the subject who are involved in the management of SGBV in South Africa, have focus groups with nurses at primary health care units who deal with the community on a daily basis and who have experience in managing survivors of SGBV, to establish the content that should be included in this programme, including the format of such a programme, and have in-depth interviews with educators with at least two years’ experience in online and/or didactic teaching experience, to solicit their opinions on content, the best methods of delivery and effective presentation methods for a programme to assist the nurses. The interviews were digitally recorded and analysed using Braun and Clarke’s phases of thematic analysis. The programme was then developed according to the ADDIE model. Sampling method: Purposive sampling was used in phase one and three of the study and convenience sampling was used in phase two of the study. In the first phase experts from five different NGOs were interviewed. In the second phase, the researcher invited all nurses who were available to be part of the study. Six (n = 6) academics took part in the third phase of the study, all of whom had at least a master’s degree and experience in nursing education. Results: The data was analysed under two themes: Content that should be included in the programme which included the theoretical basis of SGBV, the recognition of SGBV, the role of the nurse and support systems and teaching and learning which included the curriculum to be covered and the process required to deliver the information. The nurses which were currently practicing felt underprepared to identify and manage survivors of SGBV. They felt that although some had a minimal amount of exposure to the subject of SGBV in their third and fourth year, they still felt ill-equipped. An important point made was that they were trained on dealing with medical issues and not trained to deal with emotional issues. The Registered nurses that were already in practice indicated a need for a CPD programme to be introduced, as they themselves had not been trained in their undergraduate programme. Recommendations: The researcher felt that a training programme should be designed for undergraduates continuing on to trained nurses, to ensure they receive up to date information on how to identify and manage survivors of SGBV. The nursing education system should be adjusted to include training material in the subject.