Perceptions of nursing students about honor crimes Essay Example

offenses" refer to acts of violence against women aimed at preserving male or family "honor." Consequently, male relatives often receive support and praise for punishing their female relatives. The terms "cleansing" or "lavation" are commonly used when a dishonored woman is killed by a male family member as a reward. Though there is limited reliable statistical data on honor crimes in Turkish society, practices such as "virginity control" and "honor killings," which involve murdering individuals who bring shame to their families, occur more frequently than reported. According to the Turkish Human Rights Presidency's Honor Killings Report in 2007, a total of 1148 people were killed between 2003 and 2007 in Turkey under the pretext of honor. The text emphasizes that considering cultural context is crucial when studying violence against women in the name of honor.The importance of health services in addressing the needs of abused women is emphasized, particularly the role of healthcare workers such as nurses. It is crucial for these healthcare professionals to be aware and responsive to cultural and socioeconomic factors that impact their patients' health. The text also highlights the significance of nurses having cultural self-awareness in order to effectively interact with patients who may have different value judgments. This suggests that nursing students should explore their own beliefs during their academic training to better prepare for professional practice. However, there have been no studies conducted in Turkey on nurses' or nursing students' orientations towards honor-based violence. Therefore, this study aims to investigate Turkish nursing students' beliefs regarding honor offenses and how they view responding to victims' needs. Two hypotheses were tested in this study: firstly, nursing students have knowledge about

honor offenses and related factors; secondly, male and female nursing students hold differing beliefs about nurses' involvement in detecting honor offenses. Nurses frequently encounter instances of violence in various settings such as hospitals, community healthcare centers, and during home visits. Amnesty International (2006) states that nurses and midwives can promote human rights by refusing to participate in abuse and reporting any witnessed cases.Nurses in underserved areas with low socioeconomic status should receive training on culturally competent care to ensure the provision of effective healthcare. A factor hindering healthcare providers from screening for domestic violence is their reluctance towards assessing, identifying, and reporting cases of DV (AMA, 1992; Alpert, 1995). Further research is needed to assess healthcare workers' knowledge and beliefs regarding violence, including honor crimes. The objective of this study is to comprehend the underlying causes of violence against women.

In Turkey, nursing education programs can be categorized into two main types: Health Professional High Schools and university-based Nursing High Schools. Health Professional High Schools lead to a nursing diploma while university-based Nursing High Schools result in a Bachelor of Science in Nursing (BSN) degree. Admission into Health Professional High Schools requires completion of at least eight years of primary education followed by a four-year curriculum to become health professionals. Conversely, BSN High Schools accept students who have completed 11 years of elementary and secondary education and have passed a national examination. They also follow a four-year program. Although both BSN High Schools offer similar curricula, they are administered differently. Nevertheless, regardless of their educational background, all nurses graduate with the same title and responsibilities.It should be noted that male students are also eligible for acceptance

at these high schools and can graduate as health technicians, health secretaries, or paramedics. Male health technicians receive the same curriculum as nurses and work in nurse roles in hospitals and other healthcare settings. However, it was not until 2007 when men were officially recognized as capable of practicing nursing under the new Turkish Nursing Act implementation. Turkey is a country with various cultural groups and minorities that exhibit distinct cultural differences. These differences can be observed among citizens living in different regions such as the West, East, North, and South of the country. Health beliefs, attitudes towards illness, religious influences on healthcare decision-making, values, and other cultural factors may vary significantly among individuals from different regions. Nurses who are accustomed to Western practices but work in Eastern regions may experience culture shock when confronted with these differences. A study conducted in two cities located in Western and Eastern Turkey found that students from different cities faced cultural challenges while providing care to local patients (Tortumluoglu et al., 2005). The descriptive and cross-sectional study utilized a questionnaire consisting of 22 items which were developed based on important aspects identified in previous studies (Kaya et al., 2004; Aksan & Aksu, 2007; Ruban et al., 2007) as well as personal experiences working in an underprivileged area.The evaluation of the questionnaire was conducted by a professor specializing in psychopathology and another professor specializing in forensic medicine. These professors also provided an explanation of honor offenses at the start of the questionnaire. The first section consisted of demographic questions regarding place of birth and socioeconomic conditions. Based on data from the World Bank (2005), Turkey had a poverty rate

of 20%, with a daily limit set at US $2.15 (equivalent to a monthly income of $64.5 US). Participants were asked about their average monthly expenditure, categorized as low if below $64.5 or high if equal to or greater than $64.5 per month per person.

The second part involved using an 18-question Likert scale format to gather opinions, beliefs, and attitudes towards honor offenses. To ensure clarity and relevance, a pilot test was conducted with 12 students, and feedback from this test was used for adjustments. The questions covered various topics related to intimate relationships, knowledge about honor offenses, beliefs about their association with celibacy, and attitudes towards testing for honor offenses.

Ethical approval for the study was obtained from the Local Ethics Review Committee at the Faculty of Medicine of the University of Yuzuncu Yil, Van. Participants provided informed consent prior to taking part in the survey.To be eligible for the sample, participants had to be at least 21 years old and have lived in the region for over 15 years. They also needed to be enrolled in the final year of nursing high school and verbally agree to participate in the survey. Van is Turkey's largest city in East Anatolia.

During the survey period, there was one BSN High School at Yuzuncu Yil University and two Health Professional High Schools with a total of 800 pupils. Male and female pupils from the BSN High School in their final year of nursing program were invited to take part after receiving local approval.

It has been observed that individuals who are considered poor in Turkey are more likely to reside in Eastern and Southeastern Anatolia regions (Saatci & Akpinar,

2007). The challenging geographical conditions such as high altitudes, harsh climate, and infertile soil hinder progress in these areas.

In Eastern Anatolia, 62% of women do not receive prenatal care compared to only 13.9% lacking it in Western Anatolia (Saatci & Akpinar, 2007). Additionally, the maternal mortality rate is significantly higher at 55.5/100,000 compared to West Anatolia with a rate of 12.4 and an average rate of 28.5 for the entire country (Turkish National Maternal Mortality Survey, 2005).

For data collection purposes at BSN High School, two researchers gathered information directly from students within their classroom setting.The students were informed about the objectives of the study and asked to participate voluntarily. It was emphasized that their responses would be kept confidential and anonymous, accessible only to the research team. The questionnaires were completed by the participants during class time, while the authors waited outside. They were then returned to a designated box indoors. On average, it took 15 to 20 minutes for participants to complete their questionnaires, and all questionnaires were collected within one hour. SPSS (2005) for Windows Version 13 computer software program was used for data analysis. Descriptive statistics and the chi-square test were employed to examine associations between categorical variables. A significance level of 0.05 was considered statistically significant. A total of 280 nursing students agreed to participate in the study, resulting in an eligible response rate of 225 (80.3%). Among these participants, 174 (77.3%) were female and 51 (22.7%) were male. The average age of the students was 23 years old, ranging from 20-25 years old.They all came from East Turkey and shared similar socioeconomic backgrounds as well as religious beliefs since approximately

99% of Turkish population is Muslim.Therefore no information regarding religion was collected.Male students came from larger families but there was no significant difference in monthly expenditure between male and female students ($175 ± $50). This information can be found in Table 1.
The study aimed to investigate the attitudes and beliefs of nursing students regarding honor-related violence against women. Most students claimed to have knowledge about this subject matter. Male students reported higher rates of honor rules within their families and experiences of violence related to honor compared to female students (P < 0.01). The number of male students involved in honor offenses was significantly higher than that of females, although they were relatively low in quantity. These findings are presented in Table 2. When comparing monthly expenses among participants, there were no statistically significant differences concerning beliefs about relationships, honor rules, or offenses connected to honor. Overall, participating nursing students believed that honor offenses primarily stem from celibacy, religion, and a low level of education. More female students than male students believed that society dominated by men is linked to honor offenses. Most students from both genders agreed that it is helpful behavior to report honor offenses against assaulted women. However, while most female students supported screening for such offenses, over half of male students opposed it. Participants' economic status did not influence their responses as shown in Table 3. In this study's discussion section, our aim was to explore the beliefs and attitudes of nursing students towards violence against women related to honor. The text emphasizes the importance of understanding the underlying factors behind violence against women, regardless of whether it is based on gender or related to

honor or customs. The study found that male nursing students are opposed to screening for honor offenses. While more than 50% of students believe that testing for honor offenses is beneficial and victims should seek help from nurses, a larger number of male students disagree with asking patients about these offenses. The healthcare system has a crucial role in identifying and assisting domestic violence victims, but there are obstacles such as lack of support systems for victims and insufficient training for healthcare workers in recognizing physical abuse. Reporting violence victims poses challenges for nurses due to requirements by the Turkish Penal Code, which involve a prosecutor's request through the police. Violence reporting rates may be low in Turkey due to tolerance for violence in establishments like police stations, prosecutor's offices, courts, and healthcare facilities. Additionally, the nursing curriculum lacks sufficient coverage of DV-related topics including legal rights of violence victims and there are no established clinical guidelines or specific recommendations regarding DV.A study conducted by Aksan & Cetin (2015) found that both male and female students had similar attitudes towards honor regulations, with a slightly higher percentage of males favoring them. However, a significantly greater proportion of male students justified honor offenses compared to females.

Another study by Aksu (2007) examined nurses and doctors in the emergency room and discovered that both genders tended to accept at least one reason justifying physical force, with more males justifying it than females. In our survey, both male and female students agreed that females who experience physical force should seek professional medical aid. Beliefs about seeking help from healthcare professionals did not differ between genders.

However, there was a difference

between female and male students regarding their sense of responsibility when directly asking patients about honor offenses. This discrepancy may be due to the fact that male nursing students have witnessed more honor offenses within their families compared to female students. Consequently, they may accept and justify such offenses.

According to Hines and Saudino's (2002) social learning theory, individuals who witness or experience unchallenged violence are likely to internalize and perpetuate it, believing it is socially acceptable and justified.The male students in this study were likely influenced by the violence they experienced within their families during childhood and carried these beliefs into young adulthood. Research suggests that female health providers tend to show more empathy towards victims of intimate partner violence. Studies have also shown that female doctors are more successful in counseling on sensitive topics such as domestic violence and sexually transmitted diseases (Henderson, 2004; Rose, 1986). However, a study by Aksan & Aksu (2007) found that some healthcare workers actually justified domestic violence under certain circumstances and displayed negative attitudes towards physical force. Nevertheless, the same study revealed that female doctors had the most positive attitudes towards domestic violence.

The text implies that students' perceptions were shaped by their families' socialization processes which promoted tolerance and acceptance of various forms of violence, especially "honor offenses" (Hines and Saudino, 2002; O'Leary, 1988). Female students showed a significantly higher belief in the connection between honor offenses and a male-dominated society. The concept of "honor" and "shame" is closely associated with femininity, and overall violence against women is linked to controlling female behavior (Coomaraswamy, 2005). In this cultural context, it is expected for females to remain virgins until

marriage.The text highlights the potential dire consequences, including death penalty, that can result from suspicions of infidelity after marriage. It notes that a significant number of female students oppose engaging in premarital sexual activities due to their belief in the importance of female celibacy and purity for family honor. In contrast, male students support prenuptial sex as a way to challenge the punishment of women deemed dishonorable. This contradiction is attributed to living in a male-dominated society, as reported by a higher proportion of female students.

The text suggests that honor crimes are a form of gender-based violence against women and emphasizes how gender influences students' perceptions, attitudes, and tolerance towards such crimes. It also mentions that nursing students lack confidence in obtaining accurate information from victims despite acknowledging the need to address patients' honor offenses.

In societies where cultural norms align with laws and place high value on honor, many cases of honor crimes go unreported due to safety concerns for victims and staff. Additionally, providing care for traumatized women presents challenges that serve as barriers to investigating these crimes. Consequently, both victims and healthcare professionals are forced into silence regarding these issues.

Describing assaulted adult females faces obstacles because healthcare workers may share the same cultural norms and biases as the victims or perpetrators of honor crimes. This can have an impact on their professionalism.A study found that male nursing students from traditional family backgrounds who were familiar with honor codes were hesitant to screen for honor crimes. The participants in the study were nursing students who grew up in a remote rural area, where strong tribal relationships, affinity relationships, religious judgments prevail, and violence against

women is prevalent according to the Turkish Human Rights Presidency 2007 Honour Killings Report (2008). Some healthcare workers may have personal experiences with violence as victims or abusers, which can influence their response to clients living with violence. In South Africa, a study showed that many nurses believed women enjoy being punished (Kim, 2005), while another study in Latin America revealed that over half of healthcare workers felt that some women's inappropriate behavior provokes their spouse's aggression (Guedes, 2002). Previous research has shown that attitudes supporting patriarchal beliefs are associated with acceptance of violence against women and holding women accountable for violence against them. It also suggests that violent men are not responsible for their behavior towards their wives (Glick et al., 2002; Haj-Yahia and Uysal, 2008; Sakalli, 2001). However, there is limited data on the benefits of testing and available interventions for women. Furthermore, there is insufficient data regarding potential harm (Ramsay, 2002; Wathen, 2003; U.S. Preventive Task Force ,2004).Therefore, it may be more appropriate to focus resources on those in immediate need of care for a targeted approach to healthcare. In our study, we found both strengths and limitations. The term "honor offenses" was not explicitly defined, allowing for different interpretations, including other types of honor offenses against homosexual males. However, previous research in the region has shown that "honor offenses" typically refer to acts of violence against women aimed at protecting or restoring perceived male or family "honor" (Turkish Human Rights Presidency 2007 Honour Killings Report, 2008). We assume that our participants are aware of the cultural norm where men use violence to discipline or punish women for alleged misbehavior. Previous studies

on medical students have also found a positive correlation between attitudes supporting patriarchy and acceptance of wife beating, blaming women for violence against them, and exonerating violent men from responsibility towards their wives (Glick et al.2002; Sakalli 2001). Although we did not assess the validity of the questionnaire, it is important to consider this study as an initial effort to provide necessary information about nursing students' knowledge and attitudes towards honor offenses. This information can assist in guiding the development of a training program in Turkey. The lack of clear data on the benefits of screening for violence is another limitation identified by respondents in this study.Our survey is significant because it includes nursing students from diverse genders and geographic regions who closely resemble the target population in terms of demographics. This unique study focuses on comparing nursing students' behaviors and beliefs regarding honor offenses within the context of cultural competence, aiming to better understand their beliefs and capabilities in addressing these issues in healthcare. In summary, this initial endeavor aims to collect data on nursing students' knowledge and attitudes towards honor offenses to enhance cultural understanding and bridge the gap between cultural incompatibility and competence. It is believed that nurses should receive education on general and specific cultural knowledge for assessments and interventions, with a focus on reducing gender disparities in healthcare. Additionally, a training program should incorporate information about gender roles to mitigate the influence of gender in justifying violence and improve healthcare workers' perspectives on violence against women.