The understandings, experiences, and practices of nurses and student nurses concerning domestic violence against women within healthcare encounters in Saudi Arabia: A hermeneutic phenomenological study
Background: Domestic violence and abuse against women (DVA) is a well-established public health issue and a violation of human fundamental rights. DVA is associated with numerous harms with detrimental health consequences on women. In the Saudi Arabian (SA) context, societal and cultural factors inhibit the expression of women’s rights and limit the violence disclosure within marriage and families, further controlling the ability to access or receive appropriate healthcare and support. The experiences and practices of nurses and student nurses concerning care for DVA victims in SA remain unexplored. Therefore, this study aimed to address this gap and also intended to contribute to the nursing educational practice on DVA in SA. Aim: To explore the practices, understanding, and experiences among nurses and nursing students surrounding DVA within the context of SA. Methodology and Methods: This study used a qualitative hermeneutic phenomenology design (Heidegger, 1962). Study participants included nurses and student nurses from one of the city of SA, identified using convenience sampling. Data was gathered between October 2017-February 2018 through semi-structured interviews (n = 18). Data analysis was performed along the interview process to identify consistent themes, and transcripts were carefully evaluated to develop situated structures and a general structure. Findings: The main concept explaining nurses’ experiences was “being disempowered”. Three themes that linked to this concept included: (i) being unequipped, (ii) being silent, and (iii) being constrained by social and religious contextual forces. Being unequipped with knowledge, training, and skills and lack of relevant care experience explain nurses’ feeling of disempowerment in theme 1. Theme 2 relates to nurses’ experiences of not speaking about DVA, which further associate with the organizational barriers, being unauthorized, experiencing dilemmas of reporting, and feelings of being unsafe. Theme 3 explains the social and religious contextual forces restricting nurses and/or victims from dealing with DVA including its normalization and acceptance, stigmatization and impacts of the guardianship role versus Saudi law. Discussion: Nurses’ disempowerment o undermines their ability to care for DVA victims. The themes stress the importance of nursing empowerment, approaching the barriers stemming from cultural, social, and religious norms and ensuring the availability of specific guidelines, policies, and procedures around protecting the privacy of victims, provision of care, reporting and support and safety of nurses as well. Conclusions: This study contributes significant insights on nurses’ experience in dealing with DVA and acknowledges the sensitivity and difficulty of addressing DVA in hospital settings, particularly in SA. Study findings can pave the way through effective and sensitive strategies, with required modifications in the curriculum, organizations, policy, procedures, and laws.