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.

Keywords:

• agency
• intimate partner violence
• health systems
• South Africa
• nursing

Acknowledgements

We thank the nurses who made this research possible, together with: Howard Monyonga, Mmakhukhu Masote, Fiona Scorgie, Ahmed Goolam, Laura Hayman, Jacqui Fawcett, Eben Weitzman, the Wits Reproductive Health and HIV Institute, two anonymous reviewers for the journal and colleagues at the LSE workshop on IPV in Marginalised Settings, hosted by Cathy Campbell and Jenevieve Mannell.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. Nurses in South Africa are commonly referred to as ‘sisters’ regardless of rank. This has subtle yet important echoes of apartheid, where sisters and brothers were viewed as comrades and allies in the freedom struggle. Calling a nurse a sister also connotes a level of trust and friendship, which could serve to break down barriers between nurses and their patients.

2. On self-care and nurse agency, see Orem (1980).