UnivMed Universitas Médica Univ. Med. 0041-9095 2011-0839 Pontificia Universidad Javeriana Colombia revistascientificasjaveriana@gmail.com 6572622012 https://doi.org/10.11144/Javeriana.umed65.rsce Originales Social Representations of Nursing Care for Women Victims of Intimate Partner Violence: Perspectives from Medellín (Colombia) Representaciones sociales del cuidado de enfermería a mujeres víctimas de violencia por pareja íntima: perspectivas desde Medellín (Colombia) Representações sociais do cuidado de enfermagem a mulheres vítimas de violência por parceiro íntimo: perspectivas de Medellín (Colombia) https://orcid.org/0000-0001-7780-0733 Otálvaro Gallego Jennifer Alejandra a Universidad de Antioquia, Medellín Universidad de Antioquia Colombia a Corresponding author: jotalvaro@uco.edu.co Enero-Diciembre 2024 65 23 04 2024 30 05 2024 20 12 2024 https://creativecommons.org/licenses/by/4.0/ Esta obra está bajo una Licencia Creative Commons Atribución 4.0 Internacional. Abstract

Introduction: Intimate partner violence (IPV) is a social and public health problem that profoundly impacts women's lives. Nursing professionals, as the first point of contact within the health system, play a key role in detecting and addressing this phenomenon. However, their social representations (SR) of IPV and the care provided can influence the quality of interventions. Objective: To understand the SR of nursing professionals regarding the care of women victims of IPV in the city of Medellín. Method: A qualitative study conducted between 2021 and 2022, based on the SR Theory with a procedural approach. Twelve semi-structured interviews were conducted with nursing professionals with over five years of experience, selected through convenience and snowball sampling. Data were analyzed using the constructivist approach of Charmaz's Grounded Theory. Results: The SR of nursing professionals reflect broad but stigmatizing perceptions of women victims, who are seen as fragile and dependent. The care provided is perceived as insufficient due to institutional barriers and a lack of specific training, although active listening and emotional support are recognized as central strategies. Conclusions: Transforming these SR through formative and reflective processes is essential to promote comprehensive and humanized care. Furthermore, it is necessary to strengthen policies and protocols that expand the role of nursing professionals in the integral care and long-term follow-up of women victims.

 Resumen

Introducción: La violencia por pareja íntima (VPI) es un problema social y de salud pública que afecta profundamente la vida de las mujeres. Los profesionales de enfermería, como primer punto de contacto en el sistema de salud, desempeñan un importante papel en la identificación y atención de este fenómeno; sin embargo, sus representaciones sociales sobre la VPI y el cuidado brindado pueden influir en la calidad de las intervenciones realizadas. Objetivo: Comprender las representaciones sociales (RS) de los profesionales de enfermería sobre el cuidado a mujeres víctimas de VPI en la ciudad de Medellín (Colombia). Método: Estudio cualitativo realizado entre 2021 y 2022, basado en la teoría de las RS con enfoque procesual. Se realizaron 12 entrevistas semiestructuradas a profesionales de enfermería con más de cinco años de experiencia, seleccionados mediante muestreo a conveniencia y bola de nieve. El análisis se realizó utilizando el enfoque constructivista de la teoría fundamentada de Charmaz. Resultados: Las RS de los profesionales reflejan percepciones amplias pero estigmatizantes hacia las mujeres víctimas, quienes son vistas como frágiles y dependientes. El cuidado brindado se percibe como insuficiente, debido a barreras institucionales y falta de formación específica, aunque se reconoce la importancia de la escucha activa y el acompañamiento emocional como estrategias centrales. Conclusiones: Es fundamental transformar estas RS a través de procesos formativos y reflexivos, que promuevan un cuidado integral y humanizado. Además, es necesario fortalecer normativas y protocolos que amplíen el rol del profesional de enfermería en la atención integral de las mujeres víctimas VPI.

 Resumo

Introdução: A violência por parceiro íntimo (VPI) é um problema social e de saúde pública que impacta profundamente a vida das mulheres. Os profissionais de enfermagem, como primeiro ponto de contato no sistema de saúde, desempenham um papel fundamental na detecção e atendimento desse fenômeno. No entanto, suas representações sociais (RS) sobre a VPI e o cuidado prestado podem influenciar a qualidade das intervenções. Objetivo: Compreender as RS dos profissionais de enfermagem sobre o cuidado às mulheres vítimas de VPI na cidade de Medellín. Método: Estudo qualitativo realizado entre 2021 e 2022, baseado na Teoria das RS com abordagem processual. Foram realizadas 12 entrevistas semiestruturadas com profissionais de enfermagem com mais de cinco anos de experiência, selecionados por amostragem por conveniência e bola de neve. A análise foi realizada utilizando a abordagem construtivista da Teoria Fundamentada de Charmaz. Resultados: As RS dos profissionais refletem percepções amplas, porém estigmatizantes, sobre as mulheres vítimas, que são vistas como frágeis e dependentes. O cuidado prestado é percebido como insuficiente devido a barreiras institucionais e à falta de formação específica, embora a escuta ativa e o apoio emocional sejam reconhecidos como estratégias centrais. Conclusões: Transformar essas RS por meio de processos formativos e reflexivos é essencial para promover um cuidado integral e humanizado. Além disso, é necessário fortalecer políticas e protocolos que ampliem o papel dos profissionais de enfermagem no atendimento integral e no acompanhamento de longo prazo das mulheres vítimas.

 Keywords intimate partner violence social representations nursing care spousal abuse abused women Palabras clave violencia por la pareja íntima representaciones sociales cuidados de enfermería maltrato conyugal mujeres Palavras-chave violência conjugal representações sociais cuidados de enfermagem violência conjugal mulheres How to cite Otálvaro Gallego JA. Social Representations of Nursing Care for Women Victims of Intimate Partner Violence: Perspectives from Medellín (Colombia). Univ. Med. 2024;65. https://doi.org/10.11144/Javeriana.umed65.rsce Introduction

Intimate partner violence (IPV) against women is a critical manifestation of gender-based violence and a priority public health problem that transcends cultural, religious, and socioeconomic boundaries (1). The World Health Organization defines IPV as any act or pattern of aggressive behaviors—whether physical, sexual, or psychological—that cause harm or suffering to women, in both current and past relationships (2). Recent estimates (collected up to 2008 and published in 2021) indicate that one in three women worldwide has experienced physical or sexual violence in her lifetime, with most cases perpetrated by an intimate partner (1).

This phenomenon crosses cultures, religions, and socioeconomic levels, disproportionately affecting women (3,4). According to global data, approximately 27% of women aged 15 to 49 have experienced some form of violence from their partner (1).

In Latin America, gender-based violence remains one of the most prevalent forms of human rights violations, to the extent that the region has one of the highest femicide rates globally (5). In Colombia, between 2020 and 2022, more than 75% of reported cases of domestic violence were committed against women, with the aggressor often being the partner or ex-partner (6).

While the statistics highlight the scale of the problem, studies underline the underestimation of the phenomenon due to limited reporting and the cultural normalization of these practices in some contexts. Likewise, the urgent need to design effective strategies for its prevention, detection, and comprehensive intervention has been emphasized (3).

Caring for women who are victims of IPV poses a complex challenge for health systems (7). In Colombia, despite protocols such as the Comprehensive Health Care Path for Victims of Gender-Based Violence (Resolution 459 of 2012), structural and cultural barriers hinder timely intervention (8). Nursing professionals, as one of the first points of contact in health services, play a key role in recognizing and addressing these situations (9). However, the lack of specific training, limited time, and individual perceptions can restrict the effectiveness of interventions (10).

From a qualitative perspective, analyzing the social representations (SR) of nursing professionals provides a crucial tool for understanding how care practices are shaped in this context. According to Moscovici (11), SR are systems of values, ideas, and shared practices that allow social groups to construct their reality and guide their behavior. In the framework of grounded theory, Charmaz proposes a constructivist approach that emphasizes how individual narratives and perceptions intertwine with collective meanings (12), to explore complex phenomena such as IPV and its influence on nursing professionals' care.

Thus, this study aimed to understand the SR of nursing professionals regarding the care provided to women victims of IPV in health institutions in Medellín, Colombia. Through this analysis, the study seeks to contribute to the development of disciplinary strategies that not only optimize clinical care but also foster comprehensive, humanized, and gender-focused care practices. The research was conducted between 2021 and 2022, a period marked by an increase in reports of domestic violence due to the confinement measures derived from the COVID-19 pandemic (13), underscoring the relevance of these findings.

 Methodology

This was an exploratory qualitative study based on the theory of social representations (SR) and the constructivist grounded theory approach by Charmaz. This design allowed for an understanding of the SR of nursing professionals regarding the care provided to women victims of IPV in public and private health institutions in Medellín between 2021 and 2022.

The process included an initial exploration with three semi-structured interviews, two of which were incorporated into the main study. This exercise aimed to assess the relevance and clarity of the designed instrument for data collection and to optimize the quality of the information obtained. For the main study, twelve nursing professionals were included, selected through convenience sampling and complemented by the snowball technique. Participants had at least five years of work experience and were graduates after the enactment of Law 1257 of 2008.

Semi-structured interviews, conducted either in person or virtually, lasted an average of 60 minutes. These were held outside the workplace, at times and in spaces that ensured the participants' confidentiality and comfort. Written informed consent was obtained from all participants, who were informed about the study's objectives, data confidentiality, and exclusive use for research purposes. The study was approved by an Ethics Committee.

Data analysis followed Charmaz's constructivist approach, using initial line-by-line coding to identify emerging concepts, followed by focused coding to group concepts into analytical categories (12). The analysis was a collaborative process, involving discussion sessions between the author and her thesis advisor, which allowed for reflection on the data, strengthening the validity of interpretations, and mitigating biases arising from the interviewer-interviewee relationship. Additionally, the researcher maintained a reflective journal to document impressions and observations during the interviews.

To ensure the study's quality and rigor, three key criteria in qualitative research were considered: credibility, auditability (or confirmability), and transferability (or applicability). The following outlines how these criteria were met:

To ensure credibility, strategies such as source triangulation were employed. Additionally, the semi-structured interviews were complemented with a review of relevant literature, and the results were shared with the participants. This approach allowed the participants to validate the interpretations, thereby contributing to improved data accuracy.

Regarding auditability, the stages of analysis were described in detail, following the constructivist approach of Charmaz’s grounded theory. The coding process was clearly documented to ensure that the analysis could be replicated. Furthermore, a collaborative discussion was conducted to ensure rigor in data interpretation and the decisions made during the analytical process.

Finally, to enhance transferability, comprehensive contextual details were provided about the studied population, the institutional setting, and the characteristics of the participants. Additionally, information on the structural and cultural barriers affecting the care of women victims of IPV in the specific context of Medellín was included. This information allows other researchers, healthcare professionals, or policymakers to consider the findings within their respective contexts. Furthermore, the recommendations derived from the research were designed with a broad perspective, facilitating the application of the results in other similar contexts, both nationally and internationally.

 Results

The study involved 12 nursing professionals (8 women and 4 men) aged between 27 and 43 years, with an average of 7.5 years of professional experience in primary care, outpatient consultations, emergency care, hospitalization, and critical care. Most participants reported continuous training in areas such as critical care, palliative care, pain management, and triage. However, only 11 participants had received training in gender-based violence as part of the "Código Fucsia" protocol, while one lacked specific training in this area.

Through the analysis of the interviews, three main categories were identified that structure the social representations regarding the care of women victims of IPV: SR of intimate partner violence, SR of women victims of violence, and SR of care.

Social Representations of Intimate Partner Violence: "It's More Than Just Physical"

IPV was represented as a phenomenon that transcends physical harm, leaving deep and invisible marks on women’s mental and emotional health. Participants used terms like "soul pain" and "indelible marks" to describe the impact of this violence:

"It's not just what you see; it's not just the bruises. It's something that destroys the soul, self-esteem, the will to keep going." (Diana, 40 years old)

"It’s a kind of violence that gets into the most intimate parts—your psychology, your perception of yourself as a person." (Mia, 34 years old)

The complexity of the problem generated feelings of uncertainty and concern among participants:

"It’s a huge uncertainty because you don’t know if it could be someone close—a friend, your sister, even yourself." (Violeta, 35 years old)

"There’s no formula for dealing with this. It’s like a bomb that explodes all of a sudden." (Lucía, 39 years old)

Additionally, participants noted that IPV not only affects women individually but also their social and family environments: "When we care for a victim, we’re not just caring for one person but for everything that violence entails: children, family, the whole context." (Zeus, 36 years old)

 Social Representations of Women Victims of Violence: "The Foolish, the Victim, and the Belittled"

Women suffering IPV were represented as individuals with diminished autonomy, emotionally affected, and trapped in a cycle of abuse they find difficult to recognize. These perceptions are reflected in statements like:

"Many times, they don’t even know they’re victims. They think it’s normal, that it’s their fault." (Silvana, 31 years old)

"It’s as if they’re blind and deaf to the abuse, like they don’t want to see it." (Susana, 33 years old)

Although some participants used pejorative terms such as "foolish" or "weak" to describe victims, they also acknowledged that these perceptions might be influenced by societal prejudices:

"Sometimes we think, ‘Why don’t they just leave?’ But it’s not that easy. There’s fear, dependency, so much behind it..." (Cristina, 32 years old)

"They carry guilt that doesn’t belong to them, and that makes them feel smaller, more incapable." (Alejandro, 38 years old)

Other participants emphasized the need to empower women to recognize their value and transformative capacity: "When we help a woman see herself as valuable, as someone who doesn’t deserve to be treated like this, we’re taking a big step." (Mia, 34 years old)

 Social Representations of Care: Between Small Contributions and "Band-Aid Solutions"

The care provided to women victims of IPV was described as insufficient and conditioned by institutional limitations. Participants used the metaphor of a "band-aid solution" to describe their role:

"I feel like we do what we can, but it’s never enough. It’s like a band-aid: it soothes a little, but it doesn’t solve anything." (Cristina, 32 years old).

"It’s a lot of work for such little impact. You add a grain of sand, but the problem is a mountain." (David, 37 years old).

Despite these limitations, participants valued the importance of active listening and emotional support:

"Sometimes, the only thing we can do is listen, and that’s already a form of care. It’s showing the woman she’s not alone." (Alejandro, 38 years old)

"Sitting down to talk to her, telling her that what she feels is valid, that it’s not her fault, can make a difference." (Violeta, 35 years old)

However, several professionals pointed out the lack of training and resources as significant barriers:

"They teach us the 'Código Fucsia,' but not how to handle fear, frustration, or how to continue helping them after discharge." (Zeus, 36 years old)

"We feel that our intervention ends in the hospital, and that’s precisely where we need to be most." (Lucía, 39 years old)

<italic>Additional Findings</italic>

The analysis revealed relevant aspects that highlight the need to transform the social representations (SR) of care. For instance, several participants noted that, even when they feel empathy for the victims, the perception of them as “fragile” or “dependent” can influence how they structure their interventions, fostering assistentialist dynamics rather than emancipatory ones.

Furthermore, it was identified that current training on gender-based violence, which focuses on initial management and psychological first aid, shifts the long-term follow-up responsibility away from nursing professionals and onto physicians or psychologists. This shift limits the possibilities for comprehensive care from the nursing perspective.

In summary, nursing professionals view the care of women victims of IPV as a challenging task due to a lack of knowledge, time, and appropriate care protocols. However, they approach their work with a sense of responsibility, aiming to make an impact on the lives of these women by seeking changes and restoring their rights.

 Discussion

The findings of this study reflect the social representations (SR) of nursing professionals regarding IPV, women victims, and the care provided in this context. These representations are influenced by individual perceptions, previous experiences, and institutional barriers, elements that have been described in previous studies on the subject (14).

Intimate Partner Violence: A Complex and Multifaceted Problem

Participants perceived IPV as a phenomenon that transcends physical harm, emphasizing its impact on women’s mental and emotional health. This perspective aligns with studies from the World Health Organization, which highlight how women victims of IPV exhibit higher rates of depression, post-traumatic stress disorder, and self-harming behaviors (1,4,15).

Moreover, the view of IPV as a cultural and structural problem that affects not only women but also their family and social environments underscores the need for comprehensive interventions. Models such as that proposed by García-Moreno et al. (7) emphasize the importance of addressing IPV through an intersectoral approach that considers the care of victims and their support networks (16,17).

 Stigmas and Prejudices Towards Women Victims of Violence

The SR of women victims as “silent,” “submissive,” or “dependent” reflect stigmas that, according to Lynch (18), are deeply rooted in cultural and social narratives that normalize violence. These perceptions may limit nursing professionals’ ability to provide empowering care and instead foster assistentialist rather than transformative dynamics.

However, evidence suggests that empowerment-based interventions, such as the Women’s Empowerment Approach by Goicolea et al. (19), can effectively break these barriers and promote women’s autonomy. It is essential to integrate these strategies into the training of health professionals, especially nurses, given their role in the initial support of victims and survivors.

 Nursing Care: Between Limitations and Transformative Potential

Nursing professionals described the care provided to women victims as insufficient, constrained by lack of time, specific training, and resources. These barriers have already been identified in previous research as factors affecting the quality of care for victims of gender-based violence (4,20).

Despite these limitations, the study highlighted the importance of active listening and emotional support as essential tools in care (21). Studies by Romero Ballén (22) and Baides Noriega (23) support this notion, indicating that these strategies not only validate women’s experiences but can also serve as a starting point for personal change and recovery processes.

Nevertheless, it is evident that the scope of the nursing role in managing IPV cases remains limited by regulations that assign follow-up responsibilities to other health professionals (24). This finding is consistent with Colombini et al. (25), who argue that greater interdisciplinary collaboration could optimize the care process and ensure a comprehensive intervention.

 Implications for Nursing Practice and Training

Training nursing professionals on gender-based violence must go beyond initial management and psychological first aid; it should include tools for follow-up, victim empowerment, and coordination with other health system actors (26). As Charmaz (12) suggests, understanding professionals’ narratives and SR is key to transforming practices and improving the quality of care.

Additionally, institutional strategies must be developed to enable nursing professionals to actively participate in long-term follow-up and support processes, utilizing disciplinary tools to strengthen the autonomy of women victims and safeguard their rights (27).

 Conclusions

This study provided insights into the social representations (SR) of nursing professionals regarding IPV, the women affected by it, and the care provided in this context. The findings emphasize a complex view of IPV, where harm transcends the physical to affect psychological, emotional, and social dimensions. This perception underscores the need for a comprehensive approach to care, incorporating tools for initial intervention and long-term follow-up.

The SR of women victims, portraying them as vulnerable and with diminished autonomy, reveal the persistence of stigmas that can limit emancipatory care practices. It is essential for nursing professionals, through awareness and training processes, to develop competencies to recognize the strengths and capacities of women, promoting their empowerment and autonomy.

Regarding the care provided, nursing professionals described their role as constrained by institutional barriers, such as limited time, inadequate specific training, and scarce resources. Although these limitations hinder intervention, participants valued the importance of active listening and emotional support as critical tools for creating a positive impact on women’s lives. These strategies should be strengthened through gender-focused training and intersectoral collaboration, expanding the capacities of nursing professionals.

In this regard, it is imperative that healthcare institutions in Colombia reconsider the implementation of policies and protocols that assign a more active role to nursing professionals in the follow-up and support of IPV cases. Additionally, training on gender-based violence should be reinforced from undergraduate education, fostering a humanized, ethical, and comprehensive approach to caring for women.

Finally, this study highlights the importance of SR in nursing care practices, as well as the barriers and opportunities professionals face in their work. Transforming these representations through formative and reflective processes could become a key element in improving care management and ensuring the respect and protection of women’s rights.

 Conflict of Interest

None declared.

 Referencias 1. Organización Mundial de la Salud. Estimaciones de prevalencia de violencia contra las mujeres, 2018: resumen ejecutivo [internet]. 2021 [citado 2024 nov 18]. Disponible en: https://www.who.int/publications/i/item/9789240026681 Organización Mundial de la Salud Estimaciones de prevalencia de violencia contra las mujeres, 2018: resumen ejecutivo 2021 18 https://www.who.int/publications/i/item/9789240026681 internet 2024 2. Organización Mundial de la salud. Violencia de pareja contra la mujer [internet]. 2021 [citado 2024 nov 18]. Disponible en: https://www.who.int/es/news-room/fact-sheets/detail/violence-against-women Organización Mundial de la salud Violencia de pareja contra la mujer 2021 18 https://www.who.int/es/news-room/fact-sheets/detail/violence-against-women internet 2024 3. Organización Mundial de la Salud, Organización Panamericana de la Salud. Comprender y abordar la violencia contra la mujer: violencia de pareja [internet]. 2012 [citado 2024 nov 18]. Disponible en: https://iris.who.int/handle/10665/77432 Organización Mundial de la Salud Organización Panamericana de la Salud Comprender y abordar la violencia contra la mujer: violencia de pareja 2012 18 https://iris.who.int/handle/10665/77432 internet 2024 4. Organización Mundial de la Salud. Comprender y abordar la violencia contra las mujeres: violencia infligida por la pareja [internet]. 2013 [citado 2024 nov 18]. Disponible en: https://www.paho.org/hq/dmdocuments/2014/20184-ViolenciaPareja.pdf Organización Mundial de la Salud Comprender y abordar la violencia contra las mujeres: violencia infligida por la pareja 2013 18 https://www.paho.org/hq/dmdocuments/2014/20184-ViolenciaPareja.pdf internet 2024 5. Observatorio de Igualdad de Género de América Latina y el Caribe. Feminicidio [internet]. 2016 [citado 2024 nov 18]. Disponible en: https://oig.cepal.org/es/indicadores/feminicidio Observatorio de Igualdad de Género de América Latina y el Caribe Feminicidio 2016 18 https://oig.cepal.org/es/indicadores/feminicidio internet 2024 6. Instituto Nacional de Medicina Legal y Ciencias Forenses, Grupo Centro de Referencia Nacional sobre Violencia. Forensis Datos para la vida 2022 [internet]. [Citado 2024 nov 18]. Disponible en: https://www.medicinalegal.gov.co/documents/20143/989825/Forensis_2022.pdf Instituto Nacional de Medicina Legal y Ciencias Forenses Grupo Centro de Referencia Nacional sobre Violencia Forensis Datos para la vida 2022 2022 18 https://www.medicinalegal.gov.co/documents/20143/989825/Forensis_2022.pdf internet 2024 7. García-Moreno C, Hegarty K, d'Oliveira AFL, Koziol-McLain J, Colombini M, Feder G. La respuesta de los sistemas de salud a la violencia contra las mujeres. Lancet [internet]. 2015 [citado 2024 nov 18];385(9977):1567-7. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/S0140673614618377 García-Moreno C Hegarty K d'Oliveira AFL Koziol-McLain J Colombini M Feder G La respuesta de los sistemas de salud a la violencia contra las mujeres Lancet 2015 18 385 9977 7 1567 https://linkinghub.elsevier.com/retrieve/pii/S0140673614618377 internet 2024 8. Sánchez-Suárez, U. Barreras en el acceso a la justicia de las mujeres víctimas de violencia de género por parte de los órganos judiciales de Colombia [internet]. Bogotá: Universidad Católica de Colombia; 2023 [citado 2024 nov 18]. Disponible en: https://repository.ucatolica.edu.co/entities/publication/17303f65-d299-4b5a-872c-9cb5a162628d Sánchez-Suárez U Barreras en el acceso a la justicia de las mujeres víctimas de violencia de género por parte de los órganos judiciales de Colombia 2023 18 Bogotá Universidad Católica de Colombia https://repository.ucatolica.edu.co/entities/publication/17303f65-d299-4b5a-872c-9cb5a162628d 2024 9. Organización Mundial de la Salud. Respuesta a la violencia de pareja y la violencia sexual contra la mujer: directrices clínicas y normativas de la OMS [internet]. Ginebra, Suiza: OMS; 2013 [citado 2024 nov 18]. Disponible en: https://iris.who.int/handle/10665/85240 Organización Mundial de la Salud Respuesta a la violencia de pareja y la violencia sexual contra la mujer: directrices clínicas y normativas de la OMS 2013 18 Ginebra, Suiza OMS https://iris.who.int/handle/10665/85240 2024 10. Murillo P, San Sebastián M, Vives-Cases C, Goicolea I. Factores asociados a la respuesta a la violencia del compañero íntimo en atención primaria de salud en España. Gac Sanit [internet]. 2018 [citado 2024 nov 18];32(5). Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112018000500006&lng=es Murillo P San Sebastián M Vives-Cases C Goicolea I Factores asociados a la respuesta a la violencia del compañero íntimo en atención primaria de salud en España Gac Sanit 2018 18 32 5 http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-91112018000500006&lng=es internet 2024 11. Moscovici S. Representaciones sociales: exploraciones en psicología social. Buenos Aires: Polity Prees; 2000. Moscovici S Representaciones sociales: exploraciones en psicología social 2000 Buenos Aires Polity Prees 12. Charmaz K. Grounded theory in the 21st century: applications for advancing social justice studies. En Denzin N, Lincold Y, editores. The Sage handbook of qualitative research. 3.ª ed. Thousand Oaks: Sage; 2005. p. 507-35. Charmaz K Denzin N Lincold Y The Sage handbook of qualitative research 2005 35 507 Thousand Oaks Sage Grounded theory in the 21st century: applications for advancing social justice studies 3.ª 13. Bermúdez Ayala MA, Bachiller Moscoso CP, Fuentes López HJ. Violencia física contra la mujer durante el confinamiento por COVID-19 en Bogotá, Colombia. Cuad Geogr Rev Colomb Geogr. 2023;32(2). https://doi.org/10.15446/rcdg.v32n2.101555 Bermúdez Ayala MA Bachiller Moscoso CP Fuentes López HJ Violencia física contra la mujer durante el confinamiento por COVID-19 en Bogotá, Colombia Cuad Geogr Rev Colomb Geogr 2023 32 2 https://doi.org/10.15446/rcdg.v32n2.101555 10.15446/rcdg.v32n2.101555 14. Chardon MC. Representaciones sociales del cuidado: entre las prácticas y la noción de alteridad. Arq Bras Psicol [internet]. 2008 [citado 2024 nov 18];60(2). Disponible en: https://pepsic.bvsalud.org/pdf/arbp/v60n2/v60n2a03.pdf Chardon MC Representaciones sociales del cuidado: entre las prácticas y la noción de alteridad Arq Bras Psicol 2008 18 60 2 https://pepsic.bvsalud.org/pdf/arbp/v60n2/v60n2a03.pdf internet 2024 15. Mujeres para la Salud. Efectos y consecuencias de la violencia y el maltrato doméstico a mujeres [internet]. 2019 [citado 2024 nov 19]. Disponible en: https://www.mujeresparalasalud.org/informe-efectos-y-consecuencias-de-la-violencia-y-el-maltrato-domestico-a-mujeres/ Mujeres para la Salud Efectos y consecuencias de la violencia y el maltrato doméstico a mujeres 2019 18 https://www.mujeresparalasalud.org/informe-efectos-y-consecuencias-de-la-violencia-y-el-maltrato-domestico-a-mujeres/ internet 2024 16. Delgado A, Aguar M, Castellano M, Luna del Castillo JdeD. Validación de una escala para la medición de los malos tratos a mujeres. Aten Primaria. 2006 Jun 30;38(2):82-9. https://doi.org/10.1157/13090429 Delgado A Aguar M Castellano M Luna del Castillo JdeD Validación de una escala para la medición de los malos tratos a mujeres Aten Primaria 2006 30 38 2 9 82 https://doi.org/10.1157/13090429 10.1157/13090429 17. Ferrer-Pérez VA, Bosch-Fiol E. El género en el análisis de la violencia contra las mujeres en la pareja: de la “ceguera” de género a la investigación específica del mismo. An Psicol Juríd. 2018;29:69-76. https://doi.org/10.5093/apj2019a3 Ferrer-Pérez VA Bosch-Fiol E El género en el análisis de la violencia contra las mujeres en la pareja: de la “ceguera” de género a la investigación específica del mismo An Psicol Juríd 2018 29 69 76 https://doi.org/10.5093/apj2019a3 10.5093/apj2019a3 18. Lynch G. La investigación de las representaciones sociales: enfoques teóricos e implicaciones metodológicas. Red Sociales [internet]. 2020 [citado 2024 nov 19];7(1):102-18. Disponible en: https://ri.unlu.edu.ar/xmlui/bitstream/handle/rediunlu/1778/8.Lainvestigaci%C3%B3n-de-las-RepresentacionesSociales.Enfoqueste%C3%B3ricos-eimplicacionesmetodol%C3%B3gicas.%20%281%29.pdf?sequence=1&isAllowedy Lynch G La investigación de las representaciones sociales: enfoques teóricos e implicaciones metodológicas Red Sociales 2020 19 7 1 18 102 https://ri.unlu.edu.ar/xmlui/bitstream/handle/rediunlu/1778/8.Lainvestigaci%C3%B3n-de-las-RepresentacionesSociales.Enfoqueste%C3%B3ricos-eimplicacionesmetodol%C3%B3gicas.%20%281%29.pdf?sequence=1&isAllowedy internet 2024 19. Goicolea I, Mosquera P, Briones Vozmediano E, Otero García L, García Quinto M, Vives Cases C. Primary health care attributes and responses to intimate partner violence in Spain. Gac Sanit. 2017;31(3):187-93. https://doi.org/10.1016/j.gaceta.2016.11.012 Goicolea I Mosquera P Briones Vozmediano E Otero García L García Quinto M Vives Cases C Primary health care attributes and responses to intimate partner violence in Spain Gac Sanit 2017 31 3 93 187 https://doi.org/10.1016/j.gaceta.2016.11.012 10.1016/j.gaceta.2016.11.012 20. Organización Panamericana de la Salud. Fortalecimiento de los sistemas de salud para responder a las mujeres que sufren violencia de pareja o violencia sexual: manual para gerentes de salud [internet]. Washington, D.C.: OPS; 2020 [citado 2024 nov 19]. Disponible en: https://iris.paho.org/handle/10665.2/52483 Organización Panamericana de la Salud Fortalecimiento de los sistemas de salud para responder a las mujeres que sufren violencia de pareja o violencia sexual: manual para gerentes de salud 2020 19 Washington, D.C. OPS Fortalecimiento de los sistemas de salud para responder a las mujeres que sufren violencia de pareja o violencia sexual: manual para gerentes de salud https://iris.paho.org/handle/10665.2/52483 internet 2024 21. Tulia Uribe J, Diva Jaramillo V. Del laberinto a la luz: el proceso de cambio que viven las mujeres en una experiencia conyugal violenta. Index Enferm [internet]. 2000 [citado 2024 nov 18]. Disponible en: https://www.index-f.com/index-enfermeria/30revista/r30_articulo_12-16.php Tulia Urib J Diva Jaramillo V Del laberinto a la luz: el proceso de cambio que viven las mujeres en una experiencia conyugal violenta Index Enferm 2000 18 https://www.index-f.com/index-enfermeria/30revista/r30_articulo_12-16.php internet 2024 22. Romero Ballén MN. Cuidar en la adversidad a mujeres maltratadas. Index Enferm. 2015;24(1-2). https://doi.org/10.4321/S1132-12962015000100014 Romero Ballén MN Cuidar en la adversidad a mujeres maltratadas Index Enferm 2015 24 1 2 https://doi.org/10.4321/S1132-12962015000100014 0.4321/S1132-12962015000100014 23. Baides Noriega R. Violencia de género: papel de enfermería en la prevención secundaria desde atención primaria. Enferm Glob. 2018;17(3):484-508. https://doi.org/10.6018/eglobal.17.3.307241 Baides Noriega R Violencia de género: papel de enfermería en la prevención secundaria desde atención primaria Enferm Glob 2018 17 3 484 508 https://doi.org/10.6018/eglobal.17.3.307241 10.6018/eglobal.17.3.307241 24. De Arco-Canoles OdelC, Suárez-Calle ZK. Rol de los profesionales de enfermería en el sistema de salud colombiano. Univ Salud. 2018;20(2):171-82. https://doi.org/10.22267/rus.182002.121 De Arco-Canoles OdelC Suárez-Calle ZK Rol de los profesionales de enfermería en el sistema de salud colombiano Univ Salud 2018 20 2 82 171 https://doi.org/10.22267/rus.182002.121 10.22267/rus.182002.121 25. Colombini M, Mayhew SH, García-Moreno C, d'Oliveira AF, Feder G, Bacchus LJ. Improving health system readiness to address violence against women and girls: a conceptual framework. BMC Health Serv Res. 2022 Nov 28;22(1):1429. https://doi.org/10.1186/s12913-022-08826-1 Colombini M Mayhew SH García-Moreno C d'Oliveira AF Feder G Bacchus LJ Improving health system readiness to address violence against women and girls: a conceptual framework BMC Health Serv Res 2022 28 22 1 1429 https://doi.org/10.1186/s12913-022-08826-1 10.1186/s12913-022-08826-1 26. Larrauri Barandela MA, Rodríguez Alonso E, Castro Feijoó TM, Pérez Zorelle A, Ojea Montes B, Blanco Gómez MA. Conocimiento y actitudes de los profesionales de urgencias sobre la violencia de género. Páginasenferurg.com Rev Dig Enferm [internet]. 2010 [citado 2024 nov 19];2(7):36-45. Disponible en: https://dialnet.unirioja.es/servlet/articulo?codigo=8282245 Larrauri Barandela MA Rodríguez Alonso E Castro Feijoó TM Pérez Zorelle A Ojea Montes B Blanco Gómez MA Conocimiento y actitudes de los profesionales de urgencias sobre la violencia de género Rev Dig Enferm 2010 19 2 7 36 45 https://dialnet.unirioja.es/servlet/articulo?codigo=8282245 Páginasenferurg.com internet 2024 27. Saldías Fernández MA, Parra-Giordano D, Martí Gutiérrez T. Participación de enfermería en políticas públicas, ¿por qué es importante?: revisión integrativa de la literatura. Enferm Glob. 2022;21(1):590-624. https://doi.org/10.6018/eglobal.455361 Saldías Fernández MA Parra-Giordano D Martí Gutiérrez T Participación de enfermería en políticas públicas, ¿por qué es importante?: revisión integrativa de la literatura Enferm Glob 2022 21 1 590 624 https://doi.org/10.6018/eglobal.455361 10.6018/eglobal.455361