Improving Nurses’ Roles in Decreasing Domestic Violence During Pregnancy: A Literature Review Tolitu Aba-omer Background Domestic violence is a global health and social issue that occurs all over the world regardless of race, religion, economy, level of education, and cultural group. On average, approximately twenty people are victims of physical violence each minute (The National Intimate Partner and Sexual Violence Survey, 2015). Furthermore, domestic violence is on the rise with pregnant women. In the time it takes to read this paper, an assault of domestic violence will occur somewhere in the world (Walton-Moss & Campbell, 2002). Discussion This integrative review of the literature has a potential to benefit healthcare providers identify domestic violence during pregnancy could help prevent future violence. Since studies have shown that nurses lack adequate training to advocate for their patients experiencing domestic violence. Findings Nurses should consider each patient differently according to the victim’s condition of living with an abusive partner.   Nurses need to understand the importance of responding to patients disclosing domestic violence in a caring manner. Patients stated the majority of health care providers focus on patients’ physical abuse and not emotional abuse (Baig & Rodriguez, 2012). In addition, there is a need for nurses to learn how to record descriptive notes and observe any injuries upon arrival. Nurses should document the name and relation of the abuser, how many times the abuse occurred and what objects were used (Amar & Cox, 2006). Nurses have to learn how to build a trusting and a nonjudgmental relationship to ensure that the women will return for healthcare (Amar & Cox, 2006). Nurses must be able to ask open-ended questions in an empathetic way (Berlinger, 2004). When asking open-ended questions, nurses must be active listeners, using their therapeutic skills until the patients are ready to seek help. Also, nurses must educate their patients about domestic major impacts on health-related quality of life (Gharacheh, 2015). Nurses do not manage domestic violence well because they lack the understanding of how to screen and available resources for patients. Nurses have to be aware of clinical warning signs that might not be presentable in their patients. Thus, they need for education and training to assess patients (Stinson, 2006). Nurses should ask direct questions in non-judgmental ways. Nursing Implications   Nurses are the first and last health care providers that can help patients get out of their abusive relationships (Hawley & Barker, 2012). Nurses should provide more appropriate and effective care to their patients. Nurses require knowledge and confidence to identify people who have experienced domestic violence and should be able to respond appropriately to disclosure (Ali et al., 2016). Assessing the safety of the patient and the unborn child is crucial. Nurses should explore this by asking direct questions in non-judgmental ways. Referring patients to appropriate agencies or organizations that can support people who have experienced domestic violence is essential (Ali et al., 2016). Plus, educating the patient about domestic violence and the consequences of it on the unborn child; it is vital that victims have hope and can leave the abusive relationship. Purpose This integrative review of literature will examine how to improve nurses’ roles in decreasing domestic violence during pregnancy. It will discuss how to train nurses to screen and assess the patient and how to educate patients about domestic violence Research Questions To identify how to improve the nurses’ roles in decreasing domestic violence, specifically: Does educating nurses in screening and assessing a patient decrease domestic violence? Does educating patients decrease domestic violence? Methods Research Design An integrative review of the literature using Whittemore and Knafl's (2005) updated methodology was used. This literature review provided an understanding of the phenomenon of domestic violence and nurses’ roles. This review identifies qualitative and quantitative studies in an organized form to make informed decisions about the phenomenon of concern of nurses’ roles in domestic violence . Search Methods The literature review for this concept analysis was completed based on DePaul’s library databases: Academic Search Complete, Consume Health Complete, Cumulative Index of Nursing and Allied Health Complete (CINAHL Complete), Credo Reference, Health Source, Nursing/Academic Edition, MasterFILE Premier, ProQuest Nursing & Allied Health Source, Psycinfo, and UpToDate. All of the databases searched were between the years of 2002-2016. Search words included “domestic violence AND during pregnancy”, “educate”, “nurses’ roles”, “nurses”, “role” “pregnancy”, “domestic violence”, “intimate partner violence”, and “screening or assessing”. Data Analysis and Synthesis A two- point rating scale is used to assess the articles for rigor and relevance to the phenomenon. One point was assigned to low relevance and rigor and two points for a high rigor and relevance, for an overall of four points. Articles that scored high for accuracy or relevance were used to analyze the phenomenon being studied (Whittemore & Knafl, 2005). Conclusion According to the articles found in the three fields of nursing, psychology, and public health, in order to improve nurses’ roles, nurses should screen, assess, and educate the patient. Nurses need to overcome their fears and develop skills to screen and assess patients for domestic violence. Also educators and hospitals should provide programs or continuing education on domestic violence for nurses to improve their roles. References Ali, P., McGarry, J., & Dhingra, K. (2016). Identifying signs of intimate partner violence. Emergency Nurse, 23(9), 25-29. Amar, A., & Cox, C. (2006). Intimate partner violence: implications for critical care nursing. Critical Care Nursing Clinics of North America, 18(3), 287-296. Baig, A. A., Ryan, G. W., & Rodriguez, M. A. (2012). Provider barriers and facilitators to screening for intimate partner violence in Bogotá, Colombia. Health Care for Women International, 33(3), 250-261. doi:10.1080/07399332.2011.646368 Berlinger, J. (2004). Taking an intimate look at domestic violence. Nursing, 34(10), 42-46. Enders A, Brandt Z. Mapping disability-relevant resources. Map. Journal of Disability Policy Studies [serial online]. Spring 2007;17(4):227. Available from: Academic Search Premier, Ipswich, MA. Accessed December 14, 2007. Gharacheh, M., Azadi S., Mohammadi N., Montazeri S. & Khalajinia Z. (2015). Domestic violence during pregnancy and Women's Health-Related Quality of Life. Global journal of health science 8 (2), 27-34. Hawley, D. A., & Barker, H. A. C. (2012). Survivors of intimate partner violence: implications for nursing care. Critical care nursing clinics of North America, 24(1), 27-39. Stenson, K., Sidenvall, B., & Heimer, G. (2005). 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