title: When nurses are also patients: Intimate partner violence and the health system as an enabler of women's health and agency in Johannesburg.
abstract: While violence against women is a recognised global health problem, women's agency in marginalised settings is poorly understood, particularly in relation to health systems. We explored agency as a practical and theoretical construct through qualitative research among 20 nurses with direct or indirect experiences of intimate partner violence (IPV) in Johannesburg. Interviews conducted from August 2013 to March 2014 generated rich descriptions from respondents in five health facilities. Nurses' self-reported IPV matched national prevalence of 24-31%. Findings revealed the way in which agency is enacted by nurses, allowing them the economic means to leave abusive partnerships, yet disabling them from agency and health promotion in their workplace. At the same time, nurses expanded agentic possibilities for patients by enabling a national response to IPV within South African health clinics - one that is largely undocumented. We posit that nurses can serve as important agentic actors in public health systems in low- and middle-income country settings by assisting patients to address IPV, even in the absence of targeted training and guidelines. To ensure the health and well-being of women experiencing IPV, nurses should be supported by the health sector to respond skilfully to patients and to safely process their own experiences of violence.
authors.affiliation: a Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies , University of Massachusetts Boston , Boston , MA , USA.|b College of Nursing and Health Sciences , University of Massachusetts Boston , Boston , MA , USA.|c Faculty of Health Sciences , Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Hillbrow (Johannesburg) , South Africa.
authors.forename: Courtenay
authors.initials: C
authors.lastname: Sprague
authors.affiliation: c Faculty of Health Sciences , Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Hillbrow (Johannesburg) , South Africa.
authors.forename: Nataly
authors.initials: N
authors.lastname: Woollett
authors.affiliation: a Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies , University of Massachusetts Boston , Boston , MA , USA.|d Department of Political Science , Stellenbosch University , Stellenbosch , South Africa.
authors.forename: Jane
authors.initials: J
authors.lastname: Parpart
authors.affiliation: c Faculty of Health Sciences , Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Hillbrow (Johannesburg) , South Africa.|e Bixby Center for Global Reproductive Health , University of California San Francisco , San Francisco , CA , USA.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Hatcher
authors.affiliation: a Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies , University of Massachusetts Boston , Boston , MA , USA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Sommers
authors.affiliation: a Department of Conflict Resolution, Human Security & Global Governance, McCormack Graduate School of Policy and Global Studies , University of Massachusetts Boston , Boston , MA , USA.|f Department of Health Sciences , Boston University , Boston , MA , USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Brown
authors.affiliation: c Faculty of Health Sciences , Wits Reproductive Health and HIV Institute, University of the Witwatersrand , Hillbrow (Johannesburg) , South Africa.
authors.forename: Vivian
authors.initials: V
authors.lastname: Black
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D044383:Black People / Q000193:education / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D000066505:Help-Seeking Behavior; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D000066511:Intimate Partner Violence / Q000191:economics / Q000523:psychology*; D008875:Middle Aged; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009726:Nurses / Q000191:economics / Q000523:psychology*; D015279:Organizational Culture; D015995:Prevalence; D036301:Qualitative Research; D057566:Self Report; D066262:Social Norms; D057545:Social Stigma; D012944:Social Support; D013019:South Africa / Q000453:epidemiology; D016387:Women's Health / Q000191:economics*; D014933:Women's Rights / Q000191:economics / Q000592:standards* / Q000639:trends
keywords: South Africa; agency; health systems; intimate partner violence; nursing