American Journal of Nursing Research. 2018, 6(4), 198-207
DOI: 10.12691/AJNR-6-4-8
Original Research

Effect of Educational Training Intervention on Overcoming Nurses' Barriers to Screening Intimate Partner Violence against Women in Outpatient Clinics

Mervat Mostafa Arrab1, and Hanady Shaaban Ibrahim1

1Family and Community Health Nursing, Faculty of Nursing, Menoufia University, Egypt

Pub. Date: May 25, 2018

Cite this paper

Mervat Mostafa Arrab and Hanady Shaaban Ibrahim. Effect of Educational Training Intervention on Overcoming Nurses' Barriers to Screening Intimate Partner Violence against Women in Outpatient Clinics. American Journal of Nursing Research. 2018; 6(4):198-207. doi: 10.12691/AJNR-6-4-8


Intimate partner violence (IPV) against women is an important public health problem facing women globally. Many barriers facing nurses and other healthcare providers to screen abused women were reported in many studies. Aim: The aim of the current study had twofold; First, to examine barriers to intimate partner violence screening among nurses in outpatient clinics. Second, to evaluate the effect of an educational training intervention on nurses for barriers to intimate partner violence screening. Study design: A Quasi-experimental study was used. Setting: The study was conducted in outpatient clinics at two hospitals (University Hospital and Education Hospital in Shebin El-Kom City. Menoufia Governorate, Egypt). Subjects: Seventy-five nurses who completed the educational training intervention were included according to power analysis estimation. Tools: Self-administered questionnaire to examine the barriers for IPV screening among nurses which consisted of two parts: part 1: demographic data of studied nurses and part 2: The Domestic Violence Health Care Provider Survey instrument to investigate the barriers to IPV screening among nurses. Results: Nurses reported several sources of barriers based on the DVHCPS instrument items including self-efficacy, system support, victim blaming, professional role resistance, and victim provider safety. There was a highly statistically significant difference regarding barriers to IPV screening (P<0.001) and screening examination rate was increased by nurses (P<0.001) after the implementation of the educational training intervention. Conclusion: This study highlights the beneficial effect of the educational training intervention as an effective method in reducing the barriers for IPV screening among nurses for women attending the outpatient clinics; improving the rate of screening and periodical examination of nurses regarding IPV. Recommendation: In-service training courses for nurses on current updates regarding intimate partner violence screening examination technique, regular training for nurses about intimate partner violence screening tool in-addition, IPV protocol management for abused women attending outpatient clinics.


intimate partner violence, screening, barriers, educational training intervention


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[1]  Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R. Violence by intimate partners. In: World Report on Violence and Health, Geneva: World Health Organization; 2002. pp. 89-121.
[2]  World Health Organization (2014). Violence against women: Intimate partner and sexual violence against women (Fact sheet N°239). Available from:
[3]  Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Geneva: World Health Organization; 2013. Available from:[cited 2013 Oct 12].
[4]  Walton, L. M., Aerts, F., Burkhart, H., & Terry, T. (2015). Intimate Partner Violence Screening and Implications for Health Care Providers. Online Journal of Health Ethics, 11(1).
[5]  Black, M., Basile, K., & Breiding, M. (2011). The national intimate partner and sexual violence survey: 2010 summary report. Atlanta, GA:National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
[6]  Crombie N Hooker L & Reisenhofer S. (2016). Nurse and midwifery education and intimate partner violence: a scoping review. Journal of Clinical Nursing, 26, 2100-2125.
[7]  Carretta CM. (2008). Domestic violence: a worldwide exploration. Journal of Psychological Nursing& Mental Health Services 46, 26-35.
[8]  Guruge, S. (2012). Nurses’ role in caring for women Experiencing Intimate Partner Violence in the Sri Lankan Context, Journal List ISRN V.2012, 2012 PMC345684.
[9]  Al- Natouri, A., Gillespie, G., Felbinger, D., Wang, L., (2015) Intimate has bund violence screening barriers as perceived by Jordanian nurse: A qualitative descriptive atud. Journal of Nursing Education and Practice (5)9. P. 11-16.
[10]  Taft, A., O’Doherty, L., Hegarty, Ramsay, J., Davidson, L., Feder, G. (2013). Screening women for intimate partner violence in healthcare setting. Cochrane Database of Systematic Review, Issue 4. Art. No.:CD007007.
[11]  O’ Doherry L, Hegarty K, Ramsay J, Davidson L, Feder G & Taft A (2015). Screening women for intimate partner violence in healthcare setting. Cohrance Database Systematic Review, Issue 7, Art. No.: CD007007.
[12]  Spangaro, J.M, Zwi, A.B., Poulos, R.G., & Man, W.Y.N. (2013). Who tells and what happens: disclosure and health service responses to screening for intimate partner violence. Health and social care in the community, 18, 671-680.
[13]  Sprague S, Madden K, Simunovic N, Godin K, Pham NK, Bhandari M & Goslings JC (2012). Barriers to screening for intimate partner violence, Women and Health 52, 587-605.
[14]  Boinville, M.(2013). ASPE policy brief: screening for domestic violence in health care setting Avaialble from: http// (Accessed on 1-9-2016).
[15]  Hussein A M, 2012: Domestic Violence against Women and Its Consequences on Family Health in Maser El-Kadima District. Master thesis. Cairo university.
[16]  Guruge S .2012: Nurses' Role in Caring for Women Experiencing Intimate HasbundViolence in the Sri Lankan Context. ISRNNurs V.2012. P. (1-8).
[17]  Proportion of ever-partnered women aged 15-49 years experiencing intimate partner physical and/or sexual violence at least once in their lifetime. (2015) Source: Ministry of Health and Population, El-Zanaty and Associates, and ICF International. 2015. Egypt Demographic and Health Survey 2014. Cairo, Egypt and Rockville, Maryland, USA: Ministry of Health and Population and ICF International. Located at:
[18]  World Health Organization. WHO, (2012). Violence prevention alliance. Retrieved from
[19]  Kelvens J, Kee R, Trick W, et al. (2012). Effects of screening for partner violence on women’s quality of life. JAMA; 308:681-689.
[20]  Feder G. Davies RA, Baird K, et al. Identification and Referral to improve Safety (IRIS) of women experiencing domestic violence with a primary care training and support programme: A cluster randomized controlled trial. Lancet 2011; 378: 1788-1795.
[21]  Hewitt LN. (2015). Intimate partner violence: the role of nurses in protection of patients. Crit Care Nurs Clin North Am. 2015 Jun; 27(2): 271-5.
[22]  Hamberger, L.K., Rhodes, K and Brown, J., (2015): Screening and intervention for intimate partner violence in healthcare settings: creating sustainable system-level programs, Journal of women’s Health. Volume 24, number.
[23]  American Nurses Association. (2000). Position statements: Violence against women. Retrieved from
[24]  Hewins E, DiBella B, Mawla J (2015). White paper domestic violence and the role of the healthcare provider. the value of educating on assessment and intervention strategies. Version Foundation
[25]  Group Health Cooperative and Harborview Injury Prevention and Research Center (1997). Providers’ Knowledge, Attitudes, and Beliefs about Domestic Violence Scale.
[26]  Public Health Nursing Section (2001). Public Health Interventions–Applications for Public Health Nursing Practice. St. Paul: Minnesota Department of Health, 2001.
[27]  DeBoer, M.,Kothari, R., Kothari, C., Koestner, A., Rohs, T., (2013) What Are Barriers to Nurses Screening for Intimate Patner Violence? Journal of Trauma Nursing. 20 (3). P.155-160.
[28]  Colarossi, L., Breitbart, V., & Betancourt, G. (2010). Barriers to screening for intimate partner violence: A mixed- methods study of providers in family planning clinics. Perspectives on sexual and Reproductive Health, 42, 236-243.
[29]  Al-Natouri, A., Gillespie, G., Felblinger, D., Wang, L., (2014). Jordanian Nurses’ Barriers to Screening for Intimate Partner Violence Against Women. 20(12). P. 1473-1488.
[30]  D’Avolio, D.A. (2011). System Issues: Challenges to intimate partner violence screening and intervention. Clinical Nursing Research, 20, 64-80.
[31]  Al- Modallal, H., Abuidhail, J., Sowan, A., & AlRawashdeh, A. (2010). Determinants of depressive symptoms in Jordanian working women. Journal of psychiatric and Mental Health Nursing, 17, 569-576.
[32]  Hussein A M, 2012: Domestic Violence Against Women and Its Consequences on Family Health in Maser El-Kadima District. Master thesis. Cairo university.
[33]  Djikanovic, B., Celik,H., Simic,S., Matejic,B., &Cucic, V.(2010). Health professionals’ perceptions of intimate partner violence against women in Serbia: Opportunities and barriers for response improvement. Patient Education and counseling, 80, 88-93.
[34]  Ibrahim, K., Fahimi,F., Ismail, H., Mamdouh,H., Muhammad,Y., Tawfik,M., El-Sharkawy,O., Sallam,H., (2010). Spousal violence in Egypt. population Reference Bureau.
[35]  Felblinger, D. M., & Gates, D. (2008). Domestic violence screening and treatment in the workplace. American Association of Occupational Health Nursing, 56, 143-150.
[36]  Oweis, A., Gharaibeh, M., &Alhourani, R. (2010). Prevalence of violence during pregnancy: Findings from a Jordanian Survey. Maternal and Child Health Journal, 14, 437-445.
[37]  Btoush, R., Campbell, J.c., & Gebbie K.M. (2009). Care provided in visits coded for intimate partner violence in a national survey department. Women Health Issues, 19, 253-262.
[38]  Othman, S., & MatAdenan, N.A. (2008). Domestic violence management in Malaysia: A survey on the primary health care providers. Asia Pacific Family Medicine, 7 (2), 1-8.
[39]  East, L., Arudo, J., Loefler, M., Evans, C. (2014) Exploring the potential for advanced nursing practice role development in Kenya: A Qualitative. BMC Nursing 2014 (13) 33.
[40]  Johnson, N. L., Klingbeil, C., Melzer-Lange, M., Humphreys, C., Scanlon, M.C., & simpson, P. (2009). Evaluation of an intimate partner violence curriculum in a pediatric hospital. pediatric, 123, 562-568.
[41]  Schoening, A.M., Greenwood, J. L., McNichols, J.A., Heermann, J.A., & Agrawal, S. (2004). Effect of an intimate partner violence educational program on the attutude of nurses. JOGNN< 33, 572-579.
[42]  Davila, Y.R. (2006). Increasing nurses’ knowledge and skills for enhanced response to intimate partner violence. The journal of Continuing Education in Nursing, 37,171-177.
[43]  Ritchie M, Nelson K, Wills R & Jones L.(2013) Does training and documentation improve emergency department assessments of domestic violence victims? Journal of Family Violence 28, 471-477.
[44]  Davidson LL, Grisso JA, Garcia- Moreno C, Garcia J, King VJ & Marchant S (2001) Training programs for health care professionals in domestic violence. Journal of Women’s Health and Gender-Based Medicine 10,953-969.
[45]  Baird, K., Salmon, D & White, P. (2013). who studied A five-year follow-up study of the Bristol pregnancy domestic violence program to promote routine enquiry. Midwifery 29, 1003-1010.
[46]  Jayatilleke AC,Yoshikawa K, Yasuoka J, Poudel KC, Fernando N, Jayatilleke AU & Jimba M (2015) . Training Sri Lankan public health midwives on PIV: a pre and post intervention study. BioMed Central Public Health 15, 331.
[47]  O’ Campo P, Kirst M, Tsamis C, Chambers C,Ahmad F. Implementing successful intimate partner violence screening programs in health care settings: Evidence generted from a realist-informed systematic review. Soc Sci Med 2011; 72; 855-866.
[48]  Roark SV (2010) Intimate partner violence: screening and intervention in the health care setting. Journal of Continuing Education in Nursing, 41, 490-495; Quiz 496-497.
[49]  Hamberger, L.K. & Phelan, M. (2006). Domestic violence screening in medical and mental health care setting: overcoming barriers to screening, identifying, and helping partner violence victims. Journal of Aggression Maltreatment trauma, 13, 61-99.
[50]  Hamberger, L.K., Rhodes, K and Brown, J., (2015): Screening and intervention for intimate partner violence in healthcare settings: creating sustainable system-level programs, Journal of women’s Health. Volume 24, number, 2015.