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Commentary by Zuk

The article “Abused African-American Women’s Processes of Staying Healthy” introduces us to the beginning theory of being “tired” and reminds us of the importance of viewing healthcare for women in a socioeconomic context. Intimate partner violence (IPV) rarely occurs in isolation and is linked to power, social position and frequently linked to poverty, education, and racism as well. The study eloquently points out the complexities in the participants’ lives and the struggles to stay healthy by avoiding STDs and substance abuse. In the tangle of all of the discouraging threats to the study participants’ health and safety, being “tired” builds on an underlying strength—the ability to acknowledge readiness to make changes in their lives. This turning point may not be linear and the journey away from IPV may be marked with failures, but as with facing any abuse, whether it be physical, emotional, or substance abuse, the critical point is acknowledgement of the problem and a willingness to change. This article is supported by the seminal work on IPV by Wuest, FordGilboe, Merritt-Gray, & Berman (2003), who have described the effects of abuse on women and their families for many years. Wuest et al. discuss the long-term health impact of abuse even after the woman has left the abusive environment. Wuest et al. also emphasize the strengths many women exhibit—strengths that are often overlooked and undervalued in a healthcare system that has become increasingly fragmented and difficult to navigate. Awareness of being “tired” can help not only at the provider level but at a program implementation and policy development level as well. Being “tired” brings up the dilemma involved in balancing the philosophy of accepting personal responsibility for one’s own healthcare with the growing body of research about institutional disparities in care to a broad spectrum of people, especially minorities. An editorial in the August 5, 2006, issue of the British Medical Journal (Godlee, 2006) asks the following questions: If patients have rights do they also have responsibilities? To what extent should we hold people seeking healthcare accountable for compliance with treatment goals or coordinating care? Compliance is a problematic Western Journal of Nursing Research Volume 29 Number 3 April 2007 389-391 © 2007 Sage Publications 10.1177/0193945906296562 http://wjn.sagepub.com hosted at http://online.sagepub.com