In brief
In this Australian qualitative study, 15 women (10 followed up 6–12 months later) described how a single community-based nurse improved their access to healthcare after domestic violence through flexible outreach, combined clinical, practical, and emotional support, and trauma-informed, person-centred care — though...
What this article is about
Quick Answer
In this Australian qualitative study, 15 women (10 followed up 6–12 months later) described how a single community-based nurse improved their access to healthcare after domestic violence through flexible outreach, combined clinical, practical, and emotional support, and trauma-informed, person-centred care — though findings come from one nurse at one site.
Student takeaways
Key Takeaways
- Fifteen women completed first-round interviews (mostly by phone) within about two months of contacting the nurse-led service, and ten completed a second interview six to twelve months later.
- Thematic analysis identified three themes describing the service's impact: living in between, partnership-based nursing care, and empowering choice and staying connected.
- The nurse's care combined clinical care (health assessment, wound care, medication, antenatal and sexual health services), practical care (transport, appointment booking, fuel vouchers, food gift cards, childcare help), and emotional care (empathy, validation, non-judgmental listening).
- Women described a shift over time from uncertainty, isolation, and unresolved violence toward increased agency, reflection on their own strength, and hope, while some also reported unmet expectations for longer-term support.
- The study concluded the outreach model succeeded because of its flexibility to meet women in a place of safety, its capacity for an immediate healthcare response, and the nurse's combination of specialist clinical knowledge with trauma-informed, person-centred interpersonal skills.
Student summary
Why This Research Matters
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.
Source abstract
Study Overview
Abstract Background Domestic violence is a public health concern of epidemic proportions in Australia. Women experiencing domestic violence struggle to access the healthcare they need, when they need it. This qualitative longitudinal study explored service users’ perspectives on the impact of a nurse-led domestic violence service on their access to healthcare. Methods Study design was guided by the five pillars of best practice from the Research Integrity Framework on Violence and Abuse and informed by social constructionism. Semi-structured interviews were conducted with women at two time points: within two months of using the service and six to 12 months later. Thematic analysis explored how women’s interactions with the clinical nurse impacted their access to healthcare and their engagement with mainstream health services. Results Fifteen women participated in first round interviews and ten in the second round. All were housed in emergency accommodation following domestic violence incidents. The clinical nurse provided a safe and flexible way for women to access immediate healthcare in a place of safety, that enabled empathy, validation and practical support to address broader health needs. Three identified themes encompassed the ways the nurse-led service impacted women’s healthcare access: living in between, partnership-based nursing care and empowering choice and staying connected. Conclusion The nurse-led service was profoundly successful in enabling women’s access to healthcare through outreach and tailored follow up care. Critical to its success was the flexibility of the nurse-led service to meet women in their place of safety and provide an immediate healthcare response. The constellation of the nurse’s specialist knowledge and skills, along with person-centred and trauma informed interpersonal skills and attributes, collectively empowered women to transition towards a state of stability in their wellbeing. Clinical trial number Not applicable.
Evidence appraisal
Main Findings
- Fifteen women completed first-round interviews (mostly by phone) within about two months of contacting the nurse-led service, and ten completed a second interview six to twelve months later.
- Thematic analysis identified three themes describing the service's impact: living in between, partnership-based nursing care, and empowering choice and staying connected.
- The nurse's care combined clinical care (health assessment, wound care, medication, antenatal and sexual health services), practical care (transport, appointment booking, fuel vouchers, food gift cards, childcare help), and emotional care (empathy, validation, non-judgmental listening).
- Women described a shift over time from uncertainty, isolation, and unresolved violence toward increased agency, reflection on their own strength, and hope, while some also reported unmet expectations for longer-term support.
- The study concluded the outreach model succeeded because of its flexibility to meet women in a place of safety, its capacity for an immediate healthcare response, and the nurse's combination of specialist clinical knowledge with trauma-informed, person-centred interpersonal skills.
Practice transfer
Clinical Relevance
- Nurses working with survivors of domestic violence may improve healthcare engagement by offering outreach in locations the woman identifies as safe, rather than requiring attendance at a clinical setting.
- Combining clinical, practical (transport, vouchers, childcare), and emotional support within one nursing role can address multiple simultaneous barriers to care for women experiencing violence.
- A trauma-informed, person-centred communication style that emphasizes listening, validation, and shared decision-making may help rebuild trust and agency for women who have experienced coercive control.
- Services supporting women in unstable housing should anticipate needs such as antenatal care, sexual health services, and eligibility gaps (e.g., migrant women ineligible for Medicare) when designing outreach.
- Because this model relied on a single nurse's broad skill set, health systems considering similar programs should consider what training, scope, and staffing supports are needed to replicate the approach reliably.
Faculty notes
Educational Relevance
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.
Critical appraisal
Limitations
- The service and study were based at a single site with a single clinical nurse, limiting generalizability and making it hard to separate the model's effect from this individual nurse's particular skills and relational style.
- The sample of 15 (reduced to 10 at follow-up) is small and drawn from women who agreed to be interviewed about a service they were actively using, which may bias findings toward more positive experiences.
- A third of first-round participants did not complete the second interview, introducing possible attrition bias in the longitudinal comparison.
Classroom use
Discussion Questions
- How did the theme of 'living in between' capture the barriers women faced before their first contact with the nurse-led service, and how might nurses in other settings recognize similar pre-contact barriers?
- What made the 'partnership-based nursing care' model different from a purely clinical encounter, and why might that combination of clinical, practical, and emotional care matter for trauma survivors specifically?
- In what ways did women describe moving toward 'empowering choice' over the course of the study, and what unmet expectations remained even after this progress?
- Why might a single-nurse, single-site design limit how confidently these findings could be generalized to other community health services?
- How does the Research Integrity Framework on Violence and Abuse (with its five pillars) shape research design differently from a standard qualitative ethics protocol?
- What specific practical supports (e.g., transport, fuel vouchers, childcare) proved important in this study, and how could nurses in other roles identify similar hidden barriers for their own patients?
- How might social constructionism as a theoretical lens change the way researchers interpret women's descriptions of their interactions with the nurse, compared to a more clinical/outcomes-focused framework?
- What ethical and practical challenges arise in interviewing women who are still using emergency housing or are in an active crisis, and how did the study attempt to address them (e.g., interview location choice, interpreter use)?
- How might this outreach model need to be adapted to serve migrant women who are ineligible for public health coverage, such as the three participants described in this study?
- What are the risks of relying on a single, highly skilled nurse for a service model, and how might health systems build redundancy or shared training to sustain similar programs long-term?
Knowledge check
Quiz
1. What is the primary aim of this qualitative longitudinal study?
- To measure the cost-effectiveness of domestic violence shelters
- To explore service users' perspectives on the impact of a nurse-led domestic violence service on their access to healthcare
- To compare nurse-led and physician-led primary care models
- To evaluate a hospital-based emergency department triage protocol
Rationale: The abstract states the study 'explored service users' perspectives on the impact of a nurse-led domestic violence service on their access to healthcare.'
2. How many women participated in the first round of interviews, and how many returned for the second round?
- 10 in round one, 15 in round two
- 15 in round one, 10 in round two
- 20 in round one, 12 in round two
- 5 in round one, 5 in round two
Rationale: The abstract states: 'Fifteen women participated in first round interviews and ten in the second round.'
3. What theoretical/methodological frameworks guided the study design?
- Grounded theory and positivism
- The five pillars of the Research Integrity Framework on Violence and Abuse, informed by social constructionism
- Randomized controlled trial methodology and biomedical realism
- Ethnography guided by symbolic interactionism only
Rationale: The abstract states the study design 'was guided by the five pillars of best practice from the Research Integrity Framework on Violence and Abuse and informed by social constructionism.'
4. At what time points were interviews conducted with participants?
- Once, immediately after the first service contact
- Within two months of using the service, and again six to twelve months later
- Every month for a full year
- Only at the six-month mark
Rationale: The abstract states interviews were conducted 'at two time points: within two months of using the service and six to 12 months later.'
5. Which of the following is one of the three themes identified in the study?
- Living in between
- Managing medication adherence
- Hospital discharge planning
- Insurance navigation
Rationale: The full-text results describe three themes: 'living in between, partnership-based nursing care and empowering choice and staying connected.'
6. Within the theme 'partnership-based nursing care,' what three domains of support did the nurse provide?
- Legal, financial, and spiritual support
- Clinical, practical, and emotional care
- Diagnostic, surgical, and pharmacological care
- Administrative, technological, and educational support
Rationale: The full-text description of this theme identifies clinical care (assessment, wound care, medication), practical care (transport, vouchers, childcare help), and emotional care (empathy, listening, validation).
7. According to the study, what was critical to the success of the nurse-led service?
- Its ability to provide inpatient hospital admission
- The flexibility to meet women in their place of safety and provide an immediate healthcare response
- Its use of a large multidisciplinary clinical team
- Strict enforcement of standard appointment scheduling
Rationale: The abstract's conclusion states: 'Critical to its success was the flexibility of the nurse-led service to meet women in their place of safety and provide an immediate healthcare response.'
8. What limitation is most directly tied to the study's design, given it involved a single nurse at a single site?
- Lack of any ethical approval
- Concerns about generalizability and transferability of findings
- Absence of qualitative data
- Failure to interview any participants
Rationale: The full-text limitations note the single-site, single-nurse design raises questions about generalizability, since results may reflect this individual nurse's aptitudes rather than the model itself.
9. Which detail describes a structural barrier some participants faced, beyond domestic violence itself?
- All participants had full private health insurance
- Three participants were migrants who were ineligible for Medicare
- All participants lived in permanent housing
- None of the participants had children
Rationale: The full-text sample description notes 'Three identified as migrants ineligible for Medicare,' illustrating an additional access barrier beyond the violence itself.
10. Which analytic method was used to identify themes from the interview transcripts?
- Braun and Clarke's reflexive thematic analysis
- Content analysis with pre-set coding categories only
- Grounded theory constant comparison exclusively
- Discourse analysis using conversation transcription rules
Rationale: The full-text methods describe researchers using 'Braun and Clarke's reflexive thematic analysis,' with independent coding followed by collaborative theme development, supported by NVivo.
Study cards
Flashcards
What was the main aim of this study?
To explore how a community-based, nurse-led domestic violence service affected women's access to healthcare, from the perspective of the women who used it.
Where was the nurse-led service located, and who staffed it?
It operated within a large not-for-profit organization in metropolitan Brisbane, Australia, staffed by a single registered nurse with expertise in women's health, sexual/reproductive health, mental health, and strangulation assessment.
How many women completed first-round interviews, and how many completed the second round?
Fifteen women completed first-round interviews; ten completed the second round.
When were the two rounds of interviews conducted relative to service use?
Within about two months of first using the service, and again six to twelve months later.
What theoretical lens informed the study design?
Social constructionism, which examines how people build meaning from their interactions and experiences.
What ethics/safety framework guided the research design?
The Research Integrity Framework on Violence and Abuse, structured around five pillars: safety/wellbeing, transparency/accountability, equality/human rights, engagement, and research ethics.
What analytic method did the researchers use on the interview transcripts?
Braun and Clarke's reflexive thematic analysis, with independent coding by researchers followed by collaborative refinement of themes, supported by NVivo software.
Name the three themes identified in the study.
Living in between; partnership-based nursing care; and empowering choice and staying connected.
What does the theme 'living in between' describe?
The uncertainty women experienced before their first contact with the nurse, including displacement, unresolved violence and coercive control, unclear options, and isolation from shame or mistrust of services.
What three domains of support made up 'partnership-based nursing care'?
Clinical care (health assessment, wound care, medication, antenatal/sexual health services), practical care (transport, appointment booking, vouchers, childcare help), and emotional care (empathy, validation, non-judgmental listening).
What did the theme 'empowering choice and staying connected' capture?
Women's growing sense of agency, reflection on their own strength, hope for the future, alongside ongoing struggles and some unmet expectations for longer-term support.
According to the study's conclusion, what was critical to the service's success?
The flexibility to meet women in their place of safety and provide an immediate healthcare response, combined with the nurse's clinical expertise and trauma-informed, person-centred interpersonal skills.
What structural barrier did some participants face beyond the violence itself?
Three participants were migrant women who were ineligible for Medicare, limiting their access to publicly funded healthcare.
How long did interviews typically last, and was interpreter support used?
Interviews lasted 15 to 90 minutes; one interview used interpreter services.
What is the key limitation related to the study's setting?
It was a single-site study with a single clinical nurse, which limits generalizability, since findings may reflect that nurse's individual skills as much as the service model itself.
What kind of housing situation were all participants in at the time of the study?
All participants were living in emergency or short-term accommodation following domestic violence incidents.
How were most first-round interviews conducted?
Most first-round interviews (13 of 15) were conducted by phone.
What global statistic on intimate partner violence is cited as background context for the study?
Approximately 27% of women aged 15–49 worldwide experience intimate partner violence at some point in their lives.
What related study by some of the same authors offers a complementary evaluation of this service?
A mixed-methods evaluation of the same nurse-led domestic and family violence service, published by Currie and colleagues in the Journal of Advanced Nursing (2025).
Why is this study a useful teaching example for nursing students studying qualitative methods?
It demonstrates reflexive thematic analysis in a real trauma-informed context, shows how ethics frameworks specific to violence research are applied, and models person-centred, holistic nursing care combining clinical, practical, and emotional support.
Search-ready answers
Frequently asked questions
What was this study about?
It explored how women who experienced domestic violence perceived the impact of a community-based, nurse-led domestic violence service on their ability to access healthcare, based on interviews conducted at two time points.
Where was the study conducted?
In a large metropolitan area in Australia (Brisbane), through a nurse-led service embedded within a not-for-profit organization supporting safety, housing, healthcare, and justice access.
How many women were interviewed?
Fifteen women completed interviews within about two months of using the service, and ten of them completed a second interview six to twelve months later.
What method did the researchers use to analyze the interviews?
They used Braun and Clarke's reflexive thematic analysis, independently coding transcripts before working together to develop and refine themes, supported by NVivo software.
What were the main themes found in the study?
Three themes: living in between (pre-contact uncertainty and barriers), partnership-based nursing care (clinical, practical, and emotional support), and empowering choice and staying connected (growing agency alongside ongoing challenges).
What kind of support did the nurse provide?
A combination of clinical care (health assessments, wound care, medication, antenatal and sexual health services), practical care (transport, appointment booking, fuel vouchers, food gift cards, childcare help), and emotional care (empathy, validation, non-judgmental listening).
Why did the nurse-led model work well, according to the study?
Because it was flexible enough to meet women in a place they considered safe, offered an immediate healthcare response, and combined specialist clinical skills with trauma-informed, person-centred communication.
What are the main limitations of this study?
It involved a single nurse at a single site, which limits generalizability; the sample was small and may be biased toward more positive experiences; and a third of first-round participants did not complete a second interview.
Does this study apply directly to Canadian nursing practice?
The findings come from an Australian context and a single service, so direct transfer requires caution, but the underlying principles of outreach, trauma-informed care, and combined clinical/practical/emotional support are broadly relevant to community and public health nursing anywhere, including Canada.
Is there other published research on this same service?
Yes. A related mixed-methods evaluation of the same nurse-led domestic and family violence service was published by Currie and colleagues in the Journal of Advanced Nursing in 2025, offering a complementary quantitative and qualitative perspective.