J Fam Viol (2016) 31:161–166 DOI 10.1007/s10896-015-9755-1
ORIGINAL ARTICLE
Intimate Partner Violence and Female Nurses’ Employment: Disclosure and Consequences Hanan Al-Modallal 1 & Hasan Al-Omari 1 & Sanaa Abujilban 2 & Lina Mrayan 2
Published online: 7 July 2015 # Springer Science+Business Media New York 2015
Abstract The study examined the relationship between women’s disclosure of intimate partner violence and their experience of employment interference, work-related consequences, and work participation in 140 nurses. Participants reported experiencing at least one employment interference tactic and 40 % of them disclosed their experience. Employment interference, work-related consequences, and work participation did not differ between nurses who disclosed violence/employment interference and those who did not. Further, our participants may have chosen to disclose employment interference in order to express their discomfort rather than to seek assistance or advice. Distribution of power governed by gender is an obstacle facing women in Jordan, limiting the extent to which they can be protected from experiencing IPV in the workplace. Keywords Consequences of violence . Disclosure of violence . Employment interference . Working women
Introduction Intimate partner violence (IPV) is an international concern facing women at homes and in the workplace. A World Health Organization (WHO) population-based study found that intimate partners were responsible for more than 70 % * Hanan Al-Modallal
[email protected] 1
Department of Community and Mental Health Nursing, Hashemite University College of Nursing, Zarqa, Jordan
2
Department of Maternal, Child, and Family Health Nursing, Hashemite University College of Nursing, Zarqa, Jordan
of violent actions against their female partners (GarciaMoreno et al. 2006). In a review of literature concerning IPV, the prevalence of the lifetime experience of physical violence in women in the Middle East and North Africa region ranged between 8.1 and 64.6 % (Boy and Kulczycki 2008). In Jordan, rates of IPV reached epidemic rates. In a largescale survey recruiting women from all 12 governorates in Jordan, the investigator indicated that family violence profoundly existed in the Jordanian community and reached 96 %, as reported by the 1,854 women who provided data for the study (Al-Badayneh 2012). Unfortunately, family violence, including IPV, is likely to spill outside the boundaries of the home and affect women in their workplace (known as employment interference), resulting in significant workrelated consequences. The effect of employment interference on women is presented in different forms including, but not limited to, tardiness, absenteeism, lost productivity, and lost jobs (Lloyd and Taluc 1999; Shepard and Pence 1988). These outcomes influence the total cost paid by employers in addition to the personal physical, psychological, and social consequences experienced by victimized women (United States Department of Health and Human Services 2003).
Literature Review Data from the WHO Multi-Country Study on Women’s Health and Domestic Violence against Women yielded that the prevalence of physical or sexual partner violence in some study sites reached 75 % (Garcia-Moreno et al. 2006). This number echoed the prevalence rates of IPV in some studies of Middle Eastern women. Surveys conducted in some Arab countries like Egypt, Tunisia, and Palestine found that, on average, one out of three women is beaten by her husband
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(Douki et al. 2003). These results are consistent with data from Jordanian society where, nearly, half of the participants (working women) reported experiencing violence from their partner (Al-Modallal 2010). The prevalence was even similar in some Jordanian subgroups. In one study targeting women living in Palestinian refugee camps in Jordan, one investigator indicated that 47.7 % of the participants were victims of psychological IPV (Al-Modallal 2012). Generally speaking, these numbers are alarming, indicating the seriousness of this problem internationally and in Jordanian women, specifically. The detrimental effect of IPV increases dramatically when the abusive partner’s behavior also affects the woman in the workplace; this is known as employment interference. Employment interference is confined to tactics inflicted by the male intimate partner in order to interfere with a woman’s work such as repeatedly calling her at work for no significant reason. It does not include sexual overtures by non intimate males, physical harm by strangers, or harassment by customers. Disclosure of IPV is required to help health professionals implement treatment strategies for victims of violence. Disclosure of violence victimization can further help victims protect themselves. For example, in a related study, disclosure of IPV resulted in a decrease of exposure to violence and increase in the use of safety behaviors adopted by victimized women (McFarlane et al. 2006). There are various factors that determine IPV disclosure. These factors may include women’s acceptance of men’s controlling behaviors over them. Controlling behaviors include actions such as limiting women’s contact with family and friends (Clark et al. 2009) and ultimately limiting their chance to disclose their experiences of violence. Another factor that may determine disclosure includes women’s concern of being stigmatized or dishonored because of disclosing familial issues to others (Al-Badayneh 2012; Btoush and Haj-Yahia 2008). Finally, women’s fear of being divorced (Al-Badayneh 2012) also plays a role in limiting disclosure of partner violence. It is worth noting that all these factors apply to Jordanian women as they were derived from Jordanian studies. Disclosure of IPV appears to be particularly helpful for working women. In a study by Swanberg and Logan (2005), disclosure of intimate partner violence had significant influences on victimized working women above and beyond those experienced by non-working women. For instance, formal and informal job support can be offered to women who disclose violence victimization to their employers (Swanberg and Logan 2005). Although it is still challenging to estimate the exact cost associated with employment interference, evaluating workrelated consequences, particularly work participation, would help do so. Outcomes including work-related consequences and work participation associated with employment interference have not been investigated in studies of Jordanian working women. Further, the effect of disclosure of IPV on
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exposure to employment interference, work-related consequences, and work participation has yet to be investigated. Therefore, this study aims to address this gap in the literature.
Methods Setting and Participants Approval for this study was obtained from the Hashemite University Institutional Review Board (IRB) as well as the Jordanian Ministry of Health and related hospitals where data was planned to be collected from. The setting for the study was Government and University hospitals of the Middle and Northern regions of Jordan. The participants were a convenience sample of nurses employed in the assigned hospitals. Inclusion criteria for the study included women that are: (1) married or engaged, (2) aged 18 years old or more, (3) working in any shift in the assigned hospitals, (4) have direct contact with the patients, and (5) able to read and write English to complete the study questionnaire. Nurses working in administrative positions were excluded from the study as they lack direct contact with hospitalized patients. Nurses who provide direct care for patients were included in the study. Data Collection This study was part of a larger study targeting workplace violence among nurses. Trained data collectors helped in data collection. Seven major hospitals were approached by the data collectors on different weekdays and work shifts to limit interruption of services. Nurses were approached when they finished working with their assigned patients. They were given a brief description about the study including its purpose and needed information. Nurses who agreed to participate in the study were asked to provide written consent. The study questionnaire was then provided to them and they were asked to complete it to the best of their knowledge. The data collectors were available to answer questions raised by participants. Completed questionnaires were then collected and kept in a locked cabinet to protect participants’ confidentiality. Completion of the questionnaire took 10–15 min. Instruments Employment Interference Employment interference tactics were measured using the Work/School Abuse Scale (W/SAS). The W\SAS was developed to measure abusive acts inflicted by partners that would interfere with a woman’s participation in work/school (Riger et al. 2000). In this study, we used items related to women’s work. Meanwhile, the perpetrator was limited to the male intimate partner. The scale includes items regarding on-the-job harassment such as personal harassment
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and bothering other employees and coworkers at work. The 12-items W/SAS scale is composed of two subscales: the Restraint Tactics subscale (items 4, 5, 6, 7, 8, and 9) and the Interference Tactics subscale (items 1, 2, 3, 10, 11, and 12). The Restraint Tactics subscale includes items that stop, prevent, or hinder women from going to work or delay their arrival to work. Examples of Restraint tactics include Bsabotage the car^ and Bdo not show care for children.^ The Interference Tactics subscale, on the other hand, includes items that interfere with women’s performance at work. Examples of Interference tactics include Bharass you at work^ and Blied about your children’s health.^ Responses to each item are dichotomized into Byes^ and Bno^ options. Items are scored by indicating whether or not an item/tactic had been used by the partner. Participants were asked to report all items that apply to them. Cronbach’s alpha for the W/SAS was 0.82. Validity of the scale was supported by significant correlations between the physical assault subscale of the modified Conflict Tactics Scale (CTS-2) with the Restraint Tactics subscale (r= 0.37, p<.05) and the Interference Tactics subscale (r=0.38, p<.05) (Riger, et al. 2000). Disclosure of Employment Interference One yes-no question was asked to report women’s choice to disclose employment interference tactics to people at work. Women’s choice to disclose employment interference tactics was coded as B1^ and their choice to not disclose employment interference tactics was coded as B0^. Consequences of Employment Interference Tactics Consequences associated with women’s experience of employment interference were measured using seven items developed and used previously (Swanberg and Macke 2006). Examples of items addressing consequences of employment interference include Bunable to concentrate,^ Bunable to go to work,^ and Bwent home sick because upset about abuse.^ Each item representing any of the seven consequences was rated on a 4-point rating scale ranging from B0=never^ to B3=daily.^ Cranbach’s alpha for the seven items in our study was 0.84. Work Participation Work participation as a consequence of employment interference was measured by three items. These items were: Blost work hours because of arriving late for work or leaving work early,^ Bbeing reprimanded for absenteeism or inefficient work performance,^ and Bbeing fired or quit the job.^ Each item was rated on a 4-point rating scale from Bnever^ to Bdaily.^ Analysis Data were analyzed Using SPSS software. Descriptive statistics were used to present participants’ demographic profile, employment interference tactics, and work-related
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consequences associated with employment interference. Associations between participants’ choice of disclosing employment interference with the total score of the W/SAS, including the Interference and Restraint subscales, were examined using a t-test. The t-test was also used to examine the association between the dichotomized (binary) disclosure variable and work-related consequences and work participation. To further support our findings, we implemented linear regression to test the predictive effect of disclosing employment interference on the study variables: Employment interference (total W/SAS score); Interference subscale; Restraint subscale; work participation; and work consequences. An alpha level of .05 was used to examine significance of examined associations.
Results A total of 140 female nurses met the inclusion criteria for the current study and thus their data was used in the analysis. Results indicated that the vast majority of the participants were under the age of 40 (n=118, 84.3 %) and had children (n=117, 83.6 %). Nearly, half of the participants (n=75, 53.6 %) held Bachelor’s degrees in Nursing and 80 % were workers in Government hospitals. See Table 1 for more information on demographic characteristics of the participants. Excluding the missing cases (n=10, 7.1 %), all participants reported at least one employment interference tactic on the W/SAS. The most common Interference tactic (of the Interference subscale) used was Bharass you at work^ which was reported by 33 (23.6 %) participants, followed by Bbother your coworkers^ which was reported by 32 (22.9 %) participants. For the Restraint subscale, the tactic Bdo not show care for your children^ was the most frequently reported tactic by the participants (n=40, 28.6 %). The tactics of Brestrain you from going to work^ and Bthreaten you to prevent you from going to work^ were nearly equally reported by participants. See Table 2 for further details. Regarding consequences associated with IPV, the most reported work-related consequence was women’s Binability to perform the job to the best ability^ and Bwent home sick because upset about abuse^ (n=66, 78 %). Further, more than 50 % of the participants reported quitting a job (n=46, 54.1 %) or losing a job as a result of employment interference tactics (n=44, 51.7 %). See Table 2 for details about consequences reported by participants. Less than half (n=56, 40 %) of the participants reported that they disclosed their experience of employment interference to somebody at work. The relationships between disclosure and participants’ experience of employment interference, work-related consequences, and work participation were examined using a t-test. Results indicated that there were no significant differences in the means of employment interference using the W/SAS including the Interference and
164 Table 1
J Fam Viol (2016) 31:161–166 Demographic characteristics of the participants (N=140)
Characteristic
Frequency N
Percentage %
20–29
56
40
30–39 40–49
62 18
44.3 12.9
≥50 Pregnant
3
2.1
Yes
16
11.4
121
86.4
117 23
83.6 16.4
High school Associate degree
7 48
5.0 34.3
College Graduate
75 10
53.6 7.1
38 42 38 16
27.1 30.0 27.1 11.4
5
3.6
112 23 4
80.0 16.4 2.9
Age
No Have children Yes No Level of education
Years of experience ≤5 years 6–10 years 11–15 years 16–20 years ≥21 years Type of hospital Government hospital University hospital Other
Restraint subscales based on women’s choice of disclosing employment interference. Similar results were reported for the relationship with work-related consequences and work participation. See Table 3. Results of linear regression also supported those of the ttest as none of the outcome (dependent) variables, Employment interference (total W/SAS score); Interference subscale; Restraint subscale; work participation; and workrelated consequences, were affected by women’s disclosure of employment interference (the independent variable). See Table 4.
Discussion This study was among the first few studies to examine employment interference in a sample of Jordanian working women. It is the first study where the W/SAS was used to assess for employment interference. Further, this study focused on an important group of women characterized by being employed,
educated, and English-proficient. All these criteria further highlight the significance of the current study. The prevalence of employment interference in this study was 100 %. All participants reported at least one Interference or Restraint tactic from their partner. This suggests that employment status did not protect women from experiencing IPV. Several factors may explain this finding, such as distribution of power governed by gender and women’s acceptance of social norms that justify use of violence as a way of disciplining women (Al-Badayneh 2012). Such factors limit the effect of employment in protecting women against experiencing IPV. Still, this relationship between violence and women’s employment needs further investigation to be supported, particularly in Jordanian women. Male partners used different Interference and Restraint tactics against their working female partners. An evaluation of the nature of employment interference tactics used by male partners (Table 2) suggests that most of these tactics were forms of control behaviors used against women. Controlling behavior is a common aspect of IPV and includes Bacts to constrain a woman’s mobility or her access to friends and relatives^ (Garcia-Moreno, et al. 2006, p.1262). In the current study, Restraint tactics such as Brestrain you from going to work,^ Bthreaten you to prevent you from going to work,^ and Brefuse to give you a ride to work^ are typical examples of controlling behaviors that can be specifically used at the workplace or against a working partner. Intimate partner violence, including employment interference, is a critical familial and social issue that needs to be dealt with in a collaborative fashion. A major obstacle facing resolution of IPV is related to gender inequality in society and in the workplace. Dominance over women based on gender is a tradition in some Jordanian families. Further, unequal pay in the workplace, despite women’s attainment of similar educational and professional goals as men, contributes to the problem of employment interference. Cumulatively, women may remain under the control of their spouse socially and financially; a situation that allows some males to practice violence against their female spouses. As yielded in the results, 40 % of our participants disclosed employment interference to somebody at work. However, disclosure of their experiences did not affect women’s suffering from employment interference tactics, their work-related consequences associated with employment interference, and their work participation. In an effort to understand why disclosure of employment interference did not affect the outcomes under investigation, we suggest two explanations. First, women, Jordanian women in particular, realize that disclosure of IPV may lead to undesirable social consequences such as divorce (Al-Badayneh 2012). For this reason, women try to be cautious with regards to who they choose to trust and disclose their experiences. Furthermore, women are likely cautious about what they specifically disclose, so as to
J Fam Viol (2016) 31:161–166 Table 2 Reported employment interference tactics and the associated consequences
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Employment Interference and Consequences
Frequency N
Percentage %
Harass you at work Bother your coworkers
33 32
23.6 22.9
Lied to your coworkers about you Forced you to leave work
23 28
16.4 20.0
Lied about your children’s health
30
21.4
27
19.3
Sabotage the car
25
17.9
Do not show care for your children Steal car/money to prevent you from going to work
40 18
28.6 12.9
Interference Subscale (M=10.7, SD=1.7)
Threatened you to leave work Restraint Subscale (M=11.3, SD=2.6)
Refused to give you a ride to work
30
21.4
32 33
22.9 23.6
Unable to concentrate at work Unable to perform job to the best ability
62 66
72.1 77.7
Called in sick because too upset to go in Unable to go to work
62 60
73.0 70.6
Went home sick because upset about abuse Caused to quit a job Caused to lose a job
66 46 44
77.7 54.1 51.7
Restrained you to prevent you from going to work Threatened you to prevent you from going to work Consequences of Employment Interference (M=7.7, SD=4.7)
guard their safety and dignity at work. For example, it is easier for a woman to disclose that her husband sabotaged her car rather than to report that she was forced to leave work or was restrained to prevent her from going to work. In these cases, violence tactics such as Bsabotaging the car^ would not stigmatize a woman.
Table 3 Differences in the means of employment interference, workrelated consequences, and work participation in relation to women’s disclosure of employment interference Dependent Variable
Disclosure
Mean
t-value*
Employment interference (total W/SAS score) Interference subscale
Yes No Yes No Yes No Yes No Yes No
21.3 22.1 10.4 10.8 10.9 11.3 10.8 9.0 4.1 4.0
−1.14
Restraint subscale Work-related consequences Work participation
*All p values associated with t-test were not significant
Second, it is likely that working women may disclose IPV to individuals who are friendly to them but not those who may help them find solutions to their issues. This may occur for different reasons. Primarily, it is possible that victimized Jordanian women do not believe that their experiences of IPV can be resolved. More specifically, they likely do not trust in others’ abilities to help them solve their problems. Ultimately, it can be speculated that in this study, women who disclosed violence to others at work may not have done so to seek help for their suffering, but rather to find ways to vent their feelings. For these two reasons, the relatively high disclosure rate was not effective in altering women’s exposure to employment interference and, thus, did not affect work-related consequences and work participation.
−1.24 −0.86
Conclusion and Recommendations
1.32 0.10
Recently, the number of Jordanian women participating in economical, political, and social fields began to increase. Different factors likely played a role in this transition. One of these factors is the political movement in Jordan, which
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Table 4 Linear regression of factors predicted by disclosure of employment interference Dependent Variable
R square
Beta (β)
P value
Employment interference (total W/SAS score) Interference subscale Restraint subscale
0.003
−0.11
0.26
0.005 0.002
−0.12 −0.08
0.22 0.39
Work-related consequences Work participation
0.012 0.02
0.01 0.18
0.92 0.11
Independent variable is disclosure of employment interference
emphasized women’s involvement and participation in the country’s development. Such a transition in women’s status from being only a housewife to becoming an effective participant in the workforce is a remarkable transition in Jordan. Despite this, gender-based violence is still an obstacle against some women’s development and advancement in society. Violence against women, including employment interference experienced by working women, can be considered a social problem that requires a multifaceted and collaborative solution. Health professionals and social workers, especially those in the workplace, are in critical positions to help victimized women. They can work on the primary level to prevent the occurrence of undesirable health and social outcomes associated with employment interference. Further, they can educate women about violence prevention and means of disclosing violence in early stages before the occurrence of persistent health and social consequences such as physical diseases, mental health issues, social and family problems, and workrelated malpractice.
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