Health professionals\u2019 perceptions of how gender sensitive care is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence

Carol O’Dwyer,Sabin Fernbacher,Kelsey Hegarty,Laura Tarzia

doi:10.1186/s12913-019-4812-8

Carol O’Dwyer, Sabin Fernbacher + Show 2 more

Open Access

https://doi.org/10.1186/s12913-019-4812-8

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Abstract

BackgroundSexual violence is a global public health issue. It is a form of gender-based violence commonly experienced by women accessing mental health services. The biomedical model has been the dominant model of care in acute psychiatric units, however, there has been a global movement towards more gender-sensitive and trauma-informed models. To date, only a small amount of research has focused on evaluating these models of care and health professionals’ experiences of providing this care. The aim of this study is to gain an in-depth understanding of healthcare professionals’ perceptions of how Gender Sensitive Care (GSC) is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence.MethodsThis study used case study methodology and the Normalisation Process Theory (NPT) conceptual framework. NPT is a practical framework that can be used to evaluate the implementation of complex models of care in health settings. It included semi-structured interviews with 40 health professionals, document and policy reviews, and observations from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic and content analysis.ResultsThemes were developed under the four NPT core constructs; 1) Understanding GSC in acute psychiatric units: “Without the corridors there’s not a lot we can do”, 2) Engagement and Commitment to GSC in acute psychiatric units: “There are a few of us who have that gender sensitive lens”, 3) Organising, relating and involvement in GSC: “It’s band aid stuff”, 4) Monitoring and Evaluation of GSC in acute psychiatric units: “We are not perfect, we have to receive that feedback”.DiscussionMany health professionals held a simplistic understanding of GSC and avoided the responsibility of implementing it. Additionally, the competing demands of the biomedical model and a lack of appraisal has resulted in an inconsistent enactment of GSC.ConclusionsHealth professionals in this study enacted GSC to varying levels. Our findings suggest the need to address each NPT construct comprehensively to adequately implement GSC.

Highlights

Sexual violence is a global public health problem and the health system has a key part to play in a multisectoral response [1]
Previous research has shown that the shift towards trauma-informed principles in mental health settings is encouraging, there is limited research to date evaluating the implementation and effectiveness of models of care in acute psychiatric inpatient units
This research provides qualitive insights using a case study methodology and Normalisation Process Theory (NPT) to further understand that challenges of implementing a complex model of care

Summary

Introduction

Sexual violence is a global public health problem and the health system has a key part to play in a multisectoral response [1]. Staff report a lack of confidence and skills to respond appropriately to disclosures and frequently do not ask about sexual violence [10, 11], whether historical or experienced on the ward. This avoidance of sexual violence is further compounded by the dominant biomedical model that informs mental health services [9]. Sexual violence is a global public health issue It is a form of gender-based violence commonly experienced by women accessing mental health services. The aim of this study is to gain an in-depth understanding of healthcare professionals’ perceptions of how Gender Sensitive Care (GSC) is enacted across acute psychiatric inpatient units for women who are survivors of sexual violence

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