A qualitative study exploring service users’ perspectives of the impact of a community-based nurse-led domestic violence service on women’s access to healthcare

For nursing students

Study summary

Globally, an estimated 27% of women aged 15 to 49 experience physical or sexual violence from an intimate partner at some point in their lives, and in Australia domestic violence is described as a public health concern of epidemic proportions. One of the biggest problems is that women who are experiencing violence often cannot access the healthcare they need, when they need it. This qualitative longitudinal study, published in BMC Nursing in 2025 by Hollingdrake, Alban Cruz, and Currie, looked at how a nurse-led, community-based domestic violence service in Brisbane, Australia, affected women's ability to get healthcare.

The service itself was run by a single registered nurse with specialist skills in women's health, sexual and reproductive health, mental health, and strangulation assessment, working inside a large not-for-profit organization that helps people find safety, housing, healthcare, justice, and social connection. The study design drew on the five pillars of the Research Integrity Framework on Violence and Abuse (which covers safety, transparency, equality, engagement, and research ethics) and was informed by social constructionism, a lens that pays attention to how people build meaning out of their interactions and experiences.

Researchers conducted semi-structured interviews with women at two points in time: once within about two months of first using the service, and again six to twelve months later. Fifteen women took part in the first round of interviews, most by phone, and ten of them returned for a second interview. All were living in emergency or short-term accommodation after experiencing domestic violence; several were pregnant or had children in their care, and three were migrant women who were not eligible for Medicare. Interviews ranged from 15 to 90 minutes, and one used an interpreter. The research team used Braun and Clarke's reflexive thematic analysis, coding transcripts independently before comparing and refining themes together.

Three themes described the difference the nurse made. The first, "living in between," captured the uncertainty women felt before their first contact with the nurse: displacement, unresolved violence and coercive control, unclear options, and isolation shaped by shame or mistrust of services. The second theme, "partnership-based nursing care," described how the nurse combined clinical care (wound care, medication, antenatal and sexual health services, all handled confidentially), practical care (transport, booking appointments, fuel vouchers, food gift cards, help with childcare), and emotional care (empathy, non-judgment, listening, and validation). One woman said simply that it was "the emotional support mostly" that made the difference. The third theme, "empowering choice and staying connected," tracked how women moved toward a stronger sense of agency, reflected on their own strength, found hope for the future, but also described ongoing struggles and some unmet expectations about longer-term support.

The study concluded that the nurse-led service worked well largely because of its flexibility: the nurse met women where they felt safe, responded quickly, and blended specialist clinical knowledge with a trauma-informed, person-centred style of communication that let women make their own decisions rather than being told what to do. This stands in contrast to some mainstream healthcare encounters, where women can feel pressured to behave in specific, prescribed ways.

For nursing students, this study is a useful example of how outreach and relationship-based care can lower real-world barriers to healthcare access, especially for people facing violence, housing instability, or immigration-related exclusion from public health coverage. It also shows the value of pairing clinical skill with practical problem-solving (transport, vouchers, childcare) and emotional attunement. A key caution: this was a single site with a single nurse, so findings may partly reflect that individual's skills rather than something guaranteed to happen with any nurse in a similar role. Students should think about what structures (training, staffing, funding) would need to be in place to reproduce this kind of outreach model more broadly, and how trauma-informed principles could be applied in their own future clinical settings, even outside dedicated domestic violence services.

For educators

Teaching and appraisal notes

This qualitative longitudinal study (Hollingdrake, Alban Cruz & Currie, 2025, BMC Nursing) examined how a single-nurse, community-based domestic violence outreach service in Brisbane, Australia, shaped women's access to healthcare. The design was informed by social constructionism and structured around the five pillars of the Research Integrity Framework on Violence and Abuse (safety/wellbeing, transparency/accountability, equality/human rights, engagement, and research ethics), which is a useful teaching example of embedding trauma-informed research ethics directly into study design rather than treating ethics as a separate compliance step.

Methodologically, the study used semi-structured interviews at two timepoints — within two months of service contact, and again at six to twelve months — to capture change over time rather than a single snapshot. Fifteen women completed first-round interviews (mostly by phone) and ten completed second-round interviews; participants were in emergency or short-term housing, several pregnant or parenting, and three were migrant women ineligible for Medicare. Interviews lasted 15–90 minutes, with interpreter support used once. Data were analyzed using Braun and Clarke's reflexive thematic analysis with independent coding followed by collaborative theme development, supported by NVivo.

Three themes are worth unpacking in seminar: (1) "Living in between" describes the pre-contact state of displacement, unresolved coercive control, uncertainty, and isolation — useful for discussing how structural and psychological barriers compound before a woman ever reaches a service. (2) "Partnership-based nursing care" identifies three integrated domains of nursing practice — clinical, practical, and emotional care — that together produced the outreach model's impact; this maps well onto broader nursing frameworks of holistic, person-centred care and can anchor a discussion of scope-of-practice and role expansion in community nursing. (3) "Empowering choice and staying connected" traces participants' movement toward agency and hope, while also honestly reporting ongoing struggles and gaps in longer-term support — a good prompt for discussing the limits of any single intervention and the need for coordinated referral pathways.

For appraisal purposes, the single-site, single-nurse design is the central limitation: findings may reflect this particular nurse's individual skill set, relational style, and clinical breadth as much as the generalizable features of an outreach model, threatening transferability. The sample is small and self-selected (women willing to be interviewed by researchers connected to the service they were using), which may skew toward more positive experiences and does not capture women who disengaged from the service. Two interview timepoints reduce (but do not eliminate) recall and attrition concerns, given a third of the first-round sample did not complete the second interview.

Instructionally, this article works well for teaching thematic analysis rigor (independent coding, iterative comparison), for illustrating trauma-informed and person-centred communication in a concrete clinical narrative, and for prompting discussion of how community/outreach nursing models intersect with health equity for structurally excluded groups (e.g., migrants ineligible for Medicare). It also pairs naturally with the companion mixed-methods evaluation of the same service (Currie et al., Journal of Advanced Nursing, 2025) for a fuller service-evaluation case study across qualitative and quantitative lenses.