An exploration of the perceptions of emergency department nursing staff towards the role of a domestic abuse nurse specialist: a qualitative study

Rising to the challenge: The motivation to champion routine intimate partner violence screening in rural emergency departments

OBJECTIVE

To understand the motivations of champions who worked to bring about system and practice change that supported routine screening for intimate partner violence (IPV) in two rural emergency departments (EDs).

INTRODUCTION

Practice changes are required to achieve routine and effective identification and response to IPV. Nurses play a significant role in affecting such practice change. This paper identifies the motivations of champions in the ED setting who successfully brought about such change.

SETTING

The EDs of two Level 5 tertiary hospitals within a rural Local Health District (LHD) of New South Wales, Australia.

PARTICIPANTS

Twenty-three individuals who identified as champions and worked to introduce routine IPV screening in two rural hospital EDs.

DESIGN

Qualitative longitudinal semi-structured interviews employing a process of constant comparison and an interpretive framework to analyse data thematically. Interviews were carried out between June and August 2017 and again between July and August 2019.

RESULTS

Over the period of the study, routine screening was established, and screening rates steadily increased from a low baseline to a significantly higher rate. Three aspects of champion motivation emerged from the analysis: formation of an identity as a champion, making a difference to a significant social justice issue and providing quality and community-relevant care.

CONCLUSIONS

This study is the first study to report on champions and their motivation as they supported IPV practice change in the ED. The findings highlight the capacity for innovation in rural health services, with important implications for other settings looking to translate similar programs. Understanding motivating factors may assist in improved utilisation and support for champions. This is vital if champions are to bring about required practice change within their service and ensure the needs of individuals experiencing IPV are effectively met.

Service evaluation of an independent domestic violence advocate post in a children's hospital

Domestic violence and abuse (DVA) has detrimental effects on the health and well-being of children and young people exposed to it, whether they witness or experience it. The introduction of independent domestic violence advocates in UK hospitals has enhanced the safety of victims of DVA. In 2020-2021 an independent domestic violence advocate post was piloted at a children's hospital for one year, the advocate's role being to train hospital staff and support women who had experienced DVA. A service evaluation showed that the training and support provided by the independent domestic violence advocate had benefits for women, children and staff. It also confirmed that the commissioning of services for children exposed to DVA is often underfunded and overshadowed by the provision of support to adults.

Nurses' experiences of perceiving violence and abuse of women in Saudi Arabia: A phenomenological study

AIM

To explore the practices, understanding, and experiences of nurses and nursing students about domestic violence and abuse in Saudi Arabia.

BACKGROUND

Domestic violence and abuse is a well-known public health issue and a clear violation of human rights resulting in detrimental effects on women's health.

INTRODUCTION

Societal and cultural barriers in Saudi Arabia limit women's rights and disclosure of violence within marriage and families, preventing access to health care and support. There are few reports of this phenomenon in Saudi Arabia.

METHODS

We used a hermeneutic phenomenological approach to acquire in-depth insights into nurses' perceptions and experiences regarding domestic violence and abuse. Eighteen nurses and student nurses were recruited from Riyadh, Saudi Arabia, using convenience sampling. Data were gathered between October 2017 and February 2018 through in-depth semistructured interviews, organized using NVivo 12 and analyzed manually to identify consistent themes. This study adhered to the consolidated criteria for reporting qualitative research.

FINDINGS

An overarching concept of "being disempowered" was identified, which was present at three levels: a lack of nurses' professional preparation, insufficient organizational structures and processes, and wider social and cultural components.

CONCLUSION

This study provides an in-depth account of nurses' practices, understanding, and experiences of domestic violence and abuse, highlighting the sensitivity and difficulties of addressing the problem in hospitals across Saudi Arabia and potentially other similar countries.

IMPLICATIONS

The study's findings will inform the development of nursing education and practice in Saudi Arabia, as well as pave the way toward formulating effective strategies with needed modifications in curriculum, organizations, policy, procedures, and laws.

Patient and Provider Emergency Care Experiences Related to Intimate Partner Violence: A Systematic Review of the Existing Evidence

Intimate partner violence (IPV) is a public health problem that has devastating physical, psychological, and economic consequences. The emergency department (ED) is an important point of contact for individuals experiencing IPV. However, there are few studies synthesizing interactions between patients experiencing IPV and providers. We aimed to summarize the existing evidence regarding (1) ED care experiences of patients with a history of IPV and (2) experiences of ED providers interacting with them. The secondary aim of this review was to evaluate high-quality care barriers and facilitators and to elucidate common causes of care avoidance. A literature search of peer-reviewed electronic databases was undertaken. Inclusion criteria consisted of studies detailing IPV-related patient or provider experiences surrounding ED visits. Articles published before 2000 or unavailable in English/French were excluded. A total of 772 studies were screened, yielding a final number of 41 studies. Negative patient experiences arose from individual-, institutional-, and system-level issues, commonly including adverse provider behavior. Negative provider experiences stemmed from individual-, institutional-, and system-level issues, such as a lack of knowledge and lack of infrastructure. Facilitators to positive patient experiences included interacting with empathetic providers, having privacy, and receiving timely specialized care. Facilitators to positive provider experiences included feeling well-equipped to manage IPV and having policies leading to appropriate care. Negative ED care experiences reveal inadequate care quality, ultimately leading to secondary victimization of individuals experiencing IPV. This review also uncovered important literature gaps regarding experiences of those who identify as equity-deserving.

Impact of the COVID-19 pandemic on emergency department team dynamics and workforce sustainability in Australia. A qualitative study

INTRODUCTION

The COVID-19 pandemic has challenged health care professionals and changed our approach to care delivery. The aim in this study was to explore nurses' experiences providing care in the ED during the COVID-19 pandemic in Australia and the impact of this on ED team functioning.

METHODS

A qualitative explorative descriptive study was conducted using thematic analysis strategies. Participants comprised: Registered Nurses (n = 18) working in clinical roles in the Emergency Department and Leadership Registered Nurses (n = 6) within the organisation. One on one interviews (n = 21) and one focus group interview were conducted utilising semi-structured, conversational style, in-depth interviews between January 2022 and April 2022.

RESULTS

Two major themes were identified that described the impact on ED team dynamics and longer-term impacts on the ED nursing workforce. The first major theme was: 'Changed Emergency Department team identity and dynamics' and included four sub-themes: i) PPE is a barrier to team camaraderie; ii) outsiders versus insiders - ambivalence to PPE spotter role; iii) personal safety comes first in a pandemic; and iv) using PPE depersonalises the whole patient experience. The second major theme was: 'This pandemic caught everyone off guard' and had three sub-themes. The associated sub-themes were: i) People outside ED have no understanding of what it has been like; ii) COVID-19 is here to stay - Permanent changes to care delivery and nursing practice; and iii) tenacity of a true profession.

CONCLUSIONS

Study findings illuminated the dynamics and functionality of ED nursing, encompassing the unique qualities of camaraderie, autonomy, resilience and tenacity.

Healthcare Professionals' Own Experiences of Domestic Violence and Abuse: A Meta-Analysis of Prevalence and Systematic Review of Risk Markers and Consequences

Background: Globally, healthcare professionals (HCPs) are increasingly asked to identify and respond to domestic violence and abuse (DVA) among patients. However, their own experiences of DVA have been largely ignored.Aim: To determine the prevalence of current and lifetime DVA victimisation among HCPs globally, and identify risk markers, consequences and support-seeking for DVA.Method: PubMed, EMBASE, PsycINFO, CINAHL ASSIA and ProQuest were searched. Studies about HCPs' personal experience of any type of DVA from any health service/country were included. Meta-analysis and narrative synthesis were adopted.Results: Fifty-one reports were included. Pooled lifetime prevalence was 31.3% (95% CI [24.7%, 38.7%] p < .001)) and past-year prevalence was 10.4% (95% CI [5.8%, 17.9%] p <.001). Pooled lifetime prevalence significantly differed (Qb=6.96, p < .01) between men (14.8%) and women (41.8%), and between HCPs in low-middle income (64.0%) and high-income countries (20.7%) (Qb = 31.41, p <.001). Risk markers were similar to those in the general population, but aspects of the HCP role posed additional and unique risks/vulnerabilities. Direct and indirect consequences of DVA meant HCP-survivors were less able to work to their best ability. While HCP-survivors were more likely than other HCPs to identify and respond to DVA among patients, doing so could be distressing. HCP-survivors faced unique barriers to seeking support. Being unable to access support - which is crucial for leaving or ending relationships with abusive people - leaves HCP-survivors entrapped.Conclusion: Specialised DVA interventions for HCPs are urgently needed, with adaptations for different groups and country settings. Future research should focus on developing interventions with HCP-survivors.

The Domestic Abuse Act 2021 England and Wales: implications for nurses

As the COVID-19 pandemic enveloped the globe there was a parallel increase in the incidence of domestic abuse (DA). This has been ascribed to the restrictions in movement and growing tensions during lockdown periods. The Domestic Abuse Act covering England and Wales was about to be passed prior to the COVID-19 outbreak, but progress halted as attention focused on managing infection control and treatment nationally. The unfolding DA 'shadow pandemic' led to pressure groups lobbying for specific changes to the Act which, in its revised form, became law in April 2021. This article sets out the changes in definition, statutory response and prevention of DA and relates these to nursing practice. Health education and promotion theory is considered and linked to nursing practice with those who are both victims/survivors and perpetrators of DA.

The elephant in the room: Intimate partner violence, women, and traumatic brain injury in sub-Saharan Africa

Background

Intimate partner violence (IPV) is a gendered form of violence that has been linked with traumatic brain injury (TBI). The prevalence of IPV in sub-Saharan Africa (SSA) is estimated to be one of the highest globally. Yet, little is known about the association between IPV and TBI in the SSA context. In this scoping review, we examine the intersection between IPV and TBI in SSA to identify gaps, as well as intervention opportunities.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Review (PRISMA-ScR) guidelines to guide our analyses and reporting, we searched for published articles indexed in the four largest and most comprehensive library databases: Pubmed, Embase, Web of Science and PsychInfo. Given the increasing attention that has been placed on gender disparities and health in recent years, we focused on studies published between 2010 and 2021.

Results

Our search yielded 5,947 articles and 1,258 were IPV and SSA related. Out of this, only ten examined the intersection between IPV and TBI. All focused on outcomes in female populations from South Africa (n = 5), Ghana (n = 3), Uganda (n = 1), and Cameroon (n = 1). They were a mix of qualitative studies (n = 3), neuro-imaging/biomarker studies (n = 3), case studies/reports (n = 2), quantitative surveys (n = 1) and mixed qualitative/quantitative study (n = 1). Six studies evaluated subjective reporting of IPV-induced TBI symptoms such as headaches, sleep disruptions, and ophthalmic injuries. Three examined objective assessments and included Hypothalamic-Pituitary-Adrenal (HPA) dysregulation detected by salivary cortisol levels, magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) to evaluate brain connectivity and white matter changes. One final study took a forensic anthropology lens to document an autopsy case report of IPV-induced mortality due to physical head and face trauma.

Conclusion

Our findings demonstrate that both subjective and objective assessments of IPV and TBI are possible in “resource-limited” settings. The combination of these outcomes will be critical for viewing IPV through a clinical rather than a cultural lens, and for substantiating the assertion that gender, is indeed, a social determinant of brain health.

Injury Patterns and Associated Demographics of Intimate Partner Violence in Older Adults Presenting to U.S. Emergency Departments

Intimate partner violence (IPV) is a global public health issue and occurs in intimate relationships regardless of age or sexual orientation. Several studies, most of them relying on small-scale samples, have explored the prevalence and risk factors of IPV in older adults. Still, none have focused on the demographics and injury patterns in older adult victims. Using the National Electronic Injury Surveillance System (NEISS) All Injury Program (AIP) data, we performed a retrospective analysis from 2005 through 2015 of the demographics and injuries of older adult IPV patients (>60 years old) presenting to emergency departments (EDs) compared to younger adult IPV patients (<60 years old). IPV accounted for 2,059,441 ED visits (.61%) with 37,534 (1.8%) visits in the older adults. Older adults were more frequently male (36.1% vs 16.8%), White (65.3% vs 52.8%), sustained fewer neck/head injuries (47.6% vs 59.4%), fewer contusions/abrasions (34.6% vs 47.2%), had more trunk fractures (38.4% vs 11.9%), trunk strains/sprains (39.5% vs 15.4%) and more hospital admissions (15.7 vs 4.2%), compared to younger IPV patients. Within the older adult cohort, females were more commonly White (71.2% vs 56.0%) while males were more commonly Black (36.3% vs 19.0%). Injuries in older adult males were more commonly lacerations (40.6% vs 14.2%%) and less commonly contusions/abrasions (33.8% vs 43.5%) compared to elderly females. Older adult females had more internal organ injuries than older adult males (18.9% vs 12.9%) and nearly all involved the head. Knowledge of these injury patterns in older adults can equip the health care providers when to be more suspicious of unexplained or suspicious injuries as the victim's symptoms at the presentation might not be directly related to violence.

Educational Needs of U.S. Emergency Nurses Related to Forensic Nursing Processes

BACKGROUND

Forensic nursing is a specialty deployed in patient care areas, including emergency departments, intensive care units, labor and delivery suites, and psychiatric units treating persons who have suffered trauma from a violent or criminal act. The recognition of violence-related injuries in patients presenting to health care facilities is critical to an appropriate care trajectory. These patients require specialized resources beyond the treatment of physical injuries to include psychosocial and legal care that supports patient recovery and pursuit of criminal justice.

OBJECTIVE

The purpose of this study is to obtain a broad view of current forensic knowledge and training for emergency nurses working in U.S. emergency departments and to identify gaps in nursing skills and practice such that appropriate education can be developed for this nursing specialty.

METHODS

The study was conducted using a quantitative exploratory, descriptive approach via an emailed cross-sectional survey sent to a convenience sample of U.S. emergency nurses.

RESULTS

A total of 43,775 emails were sent out to members of the Emergency Nurses Association. Of that group, 2,493 recipients opened the email, and 1,824 completed the survey, resulting in a total response rate of 4% and a 73% response rate from those who opened the email. Few respondents self-reported competence in the care of patients who experienced child abuse (13.1%), elder abuse (12.4%), interpersonal violence (17.6%), sexual assault (19.2%), human trafficking (7.4%), developmental challenges (7.2%), strangulation (12.5%), or who were suspected of committing a violent crime (11.4%).

CONCLUSIONS

There is a compelling need to expand forensic education to advance knowledge and skill acquisition in emergency nursing practice and provide staff with additional resources that support a holistic trauma-informed approach to patient care.

The role of champions in leading domestic violence and abuse practice improvement in healthcare: a scoping review

AIM

To describe and synthesize evidence for champions of domestic violence practice improvement in healthcare and highlight implications for leadership and nurse management.

BACKGROUND

Globally, healthcare leaders have been tasked with improving service responses to domestic violence. Evidencing the role of champions, and how managers may harness champions in improving responses to domestic violence, is an important factor in successfully leading change in this field.

EVALUATION

A scoping review was conducted using four electronic databases (Proquest, PubMed, Medline and PsycINFO).

KEY ISSUES

Eleven studies were included. Champion characteristics, roles, and factors influencing their impact were distilled. Barriers to the success of champions were identified as were four aspects of the champion role: mentor and expert advice; communication and engagement; strategic advocacy, coordination and project leadership; personal and emotional support.

CONCLUSIONS

The review highlighted that champions involved in domestic violence project implementation have unique aspect to their role, along with characteristics reported in the broader champion literature. As an emerging field, there is evidence that domestic violence champions play an important role in mentoring and supporting healthcare workers to effectively change their practice.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse managers and leaders need to understand the champion construct and the roles that champions enact to generate domestic violence and abuse system and practice change. Further research is required to provide guidance.

Silent Voices: Exploring Narratives of Women's Experiences of Health Care Professional Responses to Domestic Violence and Abuse

The impact of domestic violence and abuse (DVA) is far reaching not least in terms of both the immediate and longer term physical and mental wellbeing of those who have experienced abuse. DVA also exerts a considerable detrimental impact on the wider family including children. While professional perspectives of working with DVA survivors is increasingly well documented, there remains a paucity of accounts of encounters with healthcare services and/or healthcare professionals from survivors of DVA themselves. A central aim of this study was the exploration of women's experiences of healthcare encounters told purely as personal narrative rather than framed in more traditional research terms. The focus of this paper therefore is unedited personal stories of encounters with healthcare professionals. The position of narrative as research method and the presentation of narratives in this particular instance are also considered.

Case stories and Post-violence behavior of women seeking medical attention at the emergency department due to physical violence

SUBJECT

The objective of this study is to determine the violence experienced by women who presented to the Emergency Department (ED) due to Intimate Partner Violence (IPV) and their previous experiences of violence.

METHOD

The descriptive study was conducted with 96 women. The data was analyzed in SPSS 17.0 statistics package program.

FINDINGS

The average age of the women is X = 35.33 ± 11.72, 35.4% of them are in the 31-40 age group, 69.6% are married, 44.8% are high school graduates, 60.4% are unemployed. It was determined that women who were IPV victims were exposed to violence by being beaten (punching, kicking etc.) at the highest rate (82.3%), and nearly half of them (47.9%) were injured in the head and neck regions. The vast majority of women (86.5%) have been subjected to violence before, only %13.5 of them stated that they experienced violence for the first time. It was found that the majority of women (69.8%) continued to live with the perpetrator after violence. Only three of the women (3.4%) attempted to initiate legal action, and the majority (76.5%) did not intend to take legal action.

CONCLUSIONS

Healthcare professionals should be aware that most woman presenting to the ED with IPV has a history of violence before it, and that this will probably not be the last. Healthcare professionals should also consider the fact that the victims may be exposed to different types of violence at the same time. It is also recommended that healthcare professionals be trained on policies regarding IPV management and equipped to provide women with the right way out.

Violence against women: An observational study in an Italian emergency department

Violence against women is a pervasive phenomenon affecting one in three women aged ≥15 in the world that are more likely to visit an emergency department (ED) for the serious physical and psychological consequences of the abuse. The aim of this observational single-centre study is to describe the socio-demographic and clinical variables associated with violence against women. We enrolled 425 female patients who attended an Italian ED for trauma on 2019 and the patients' information was collected and analyzed with descriptive statistics. The average age of the patients was 41.5 (standard deviation = 14.2) years. 74.6% of the women were Italians, and 86.6% were of metropolitan origin. The reasons for the ED visit included aggression (67.5%), accidental trauma (29.0%) and unknown reasons (3.5%). Multivariate analysis confirmed that three factors were independently associated with violence: nationality (odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.09-0.77), head/face/neck injuries (OR = 7.32; 95% CI, 3.76-14.27) and multiple injuries (OR = 8.52; 95% CI, 1.03-70.47). Age over 25 was a protective factor. The study confirmed that being a foreigner and having head/face/neck injuries or multiple injuries are associated with violence against women.

What barriers prevent health professionals screening women for domestic abuse? A literature review

BACKGROUND

Domestic abuse is known to affect one in four women (although it is difficult to quantify) and has significant short- and long-term health implications. As people who often have regular contact with women in a variety of circumstances, including routine appointments, health professionals, particularly nurses and midwives, are in an ideal position to screen women for domestic abuse. However, it is recognised that there is a reluctance by some health professionals to undertake this important role.

AIM

To identify the potential barriers preventing health professionals from screening women for domestic abuse and to consider how these barriers could be overcome.

METHOD

A literature review of electronic databases using predetermined search terms and inclusion/exclusion criteria was undertaken. Seven studies were identified for review, consisting of five qualitative and two quantitative pieces of research.

CONCLUSION

Several barriers to screening by health professionals were identified, including lack of training, education, time, privacy, guidelines, policies and support from the employer, with the most prevalent of these being a lack of training and education. Further research is required, specifically within the UK, to provide more details about how these barriers might be addressed.

Health practitioners' readiness to address domestic violence and abuse: A qualitative meta-synthesis

Health practitioners play an important role in identifying and responding to domestic violence and abuse (DVA). Despite a large amount of evidence about barriers and facilitators influencing health practitioners' care of survivors of DVA, evidence about their readiness to address DVA has not been synthesised. This article reports a meta-synthesis of qualitative studies exploring the research question: What do health practitioners perceive enhances their readiness to address domestic violence and abuse? Multiple data bases were searched in June 2018. Inclusion criteria included: qualitative design; population of health practitioners in clinical settings; and a focus on intimate partner violence. Two reviewers independently screened articles and findings from included papers were synthesised according to the method of thematic synthesis. Forty-seven articles were included in the final sample, spanning 41 individual studies, four systematic reviews and two theses between the years of 1992 and 2018; mostly from high income countries. Five themes were identified as enhancing readiness of health practitioners to address DVA: Having a commitment; Adopting an advocacy approach; Trusting the relationship; Collaborating with a team; and Being supported by the health system. We then propose a health practitioners' readiness framework called the CATCH Model (Commitment, Advocacy, Trust, Collaboration, Health system support). Applying this model to health practitioners' different readiness for change (using Stage of Change framework) allows us to tailor facilitating strategies in the health setting to enable greater readiness to deal with intimate partner abuse.

"From taboo to routine": a qualitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse

Background

Health services are often the first point of professional contact for people who have experienced domestic violence and abuse. We report on the evaluation of a multi-site, hospital-based advocacy intervention for survivors of domestic violence and abuse. Independent Domestic Violence Advisors (IDVAs), who provide survivors with support around safety, criminal justice, and health and wellbeing, were located in five hospitals in England between 2012 and 2015 in emergency departments and maternity services. We present views about IDVAs’ approaches to tackling domestic violence and abuse, how the IDVA service worked in practice, and factors that hindered and facilitated engagement with survivors.

Methods

We adopted a convenience sampling approach and invited participation from all who offered to take part within the study timeframe. Sixty-four healthcare professionals, IDVAs, IDVA service managers, and commissioners at all sites were interviewed. Interviews were analysed using a thematic approach: familiarising ourselves with the data through repeated readings and noting initial ideas; generating initial codes through double coding notable features of the data across the dataset; collating codes into potential themes; and reviewing themes to ensure they captured the essence of the data.

Results

Two key themes emerged. The first was Hospital-based IDVAs fulfil several crucial roles. This theme highlighted that healthcare professionals thought the hospital-based IDVA service was valuable because it enhanced their skills, knowledge, and confidence in asking about domestic violence and abuse. It enabled them to immediately refer and provide support to patients who might have otherwise been lost along a referral pathway. It also reached survivors who might otherwise have remained hidden. The second theme was Success hinges on a range of structural factors. This theme illustrated the importance of ongoing domestic violence and abuse training for staff, the IDVA having private and dedicated space, and the service being embedded in hospital infrastructure (e.g. featuring it in hospital-wide policies and enabling IDVAs access to medical records).

Conclusion

Hospital-based IDVAs offer a unique and valued way to respond to domestic violence and abuse in a healthcare setting. Further work must now be done to explore how to implement the service sustainably.

Nurse education and understanding related to domestic violence and abuse against women: An integrative review of the literature

AIM

The aim of this study was to explore previous literature related to nurses understanding of Intimate partner violence (IPV) or domestic violence and abuse (DVA) against women and to identify the gaps in nursing education so as to use the findings as a baseline to inform potential intervention strategies, curriculum development and outline implications for future nursing practice.

DESIGN

An Integrative review of literature.

METHODS

Studies were extracted through a search of the electronic databases, such as Science direct, EBSCO host and PubMed, to identify relevant evidences published between January 2000-January 2017. "Joanna Briggs Institute (JBI) tool" was used to review primary research studies.

RESULTS

Seventeen empirical studies were analysed. Findings supported four themes including: educational and training experiences, identification of IPV/DVA, curriculum and communication skills of nurses. Continued efforts are further needed to highlight and address IPV/DVA in nursing education and training, to scale up nursing understanding to respond and identify IPV/DVA appropriately in a clinical environment.

Treatment for cases of violence by Brazilian emergency services focusing on family relationships and life cycles

This article analyzes data regarding cases of domestic violence treated by the emergency services through the following: the sociodemographic characteristics of the people who were treated; the events themselves; the evolution of care (from childhood to old age by gender); and the factors that differentiate cases of domestic violence compared to those committed by non-family members. Data from 24 Brazilian state capitals and the Federal District were analyzed, comprising 86 emergency services: a total of 4,893 individuals were surveyed. Of those people who were treated by emergency services, 26.6% suffered domestic violence: 40.0% were children/adolescents, 57.2% were adults and 2.8% were elderly. The adjusted model, which compared victims of violence committed by other family members with those who were not family members, showed that males were less likely to suffer from domestic violence; those that had fewer years of education were at increased risk; and that women were more likely to commit domestic violence compared to the category of "both genders". This study reinforces the fact that health sector professionals need to be able to deal with domestic violence by providing support, performing good practices, abiding by care protocols, taking care of injuries, and facilitating access to other services.

Supporting people who experience intimate partner violence

Intimate partner violence (IPV) is a significant issue in health and social care. Nurses may encounter individuals in healthcare settings who experience IPV, and they have an important role in supporting these people by providing person-centred care. It is important that nurses understand the complex issues involved in IPV, including those related to its presentation and effects on physical and psychological health. Nurses should also be aware of factors such as lack of knowledge among healthcare professionals and the challenge for some individuals of disclosing IPV, which can affect nurses' ability to identify and support those who experience IPV.

Understanding management and support for domestic violence and abuse within emergency departments: A systematic literature review from 2000-2015

AIMS AND OBJECTIVES

To identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of domestic violence and abuse who present at emergency department.

BACKGROUND

Domestic violence and abuse is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. Emergency department is widely recognised as one healthcare facility where domestic violence and abuse survivors will often disclose domestic violence and abuse. In the UK, National Institute of Clinical Excellence produced guidelines in 2014 requiring all sectors of health care and those they work alongside to recognise support and manage survivors of domestic violence and abuse. Whilst there is an increasing body of research on domestic violence and abuse, limited synthesised work has been conducted in the context of domestic violence and abuse within emergency department.

DESIGN

This review encompasses empirical studies conducted in emergency department for screening interventions, management and support for domestic violence and abuse patients including prevalence. This review included studies that included emergency department staff, emergency department service users and domestic violence and abuse survivors.

METHODS

A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000-2015.

RESULTS

From the 35 studies, four descriptive overarching themes were identified (i) prevalence of domestic violence and abuse in emergency department, (ii) use of domestic violence and abuse screening tools and emergency department interventions, (iii) current obstacles for staff working in emergency department and (iv) emergency department users and survivor perspectives.

CONCLUSIONS

Having knowledgeable and supportive emergency department staff can have a positive benefit for the longer-term health of the domestic violence and abuse survivor who seeks help. The physical characteristics of domestic violence and abuse are often easier to identify and manage, but emotional and psychological aspects of domestic violence and abuse are often more complex and difficult for staff to identify. This therefore raises questions as to what approaches can be used, within these busy settings, when often survivors do not want to disclose.

RELEVANCE TO CLINICAL PRACTICE

Domestic violence and abuse has been shown to have a direct impact on the health and well-being of survivors who will often access emergency department services with direct injuries and associated medical conditions. This article is relevant to those working in the emergency department in raising awareness in a number of areas of practice for example the prevalence of male intimate partner violence survivors. Furthermore, patients do not always disclose domestic violence and abuse even in cases where there is clear sustained injury thus requiring staff to be vigilant to repeat attendees and patient history. This requires a well-maintained and effective reporting system for instances of suspected and disclosed domestic violence and abuse in order that staff can provide the appropriate care and support. Emergency department staff often deal with complex cases, this includes different aspects of domestic violence and abuse including physical, emotional and psychological abuse. Continual support and guidance, including educational interventions, would assist emergency department clinical staff to manage and discuss instances of domestic violence and abuse in their workplace and their interactions with domestic violence and abuse patients. Whilst training for emergency department staff is welcomed, there also needs to be a greater awareness of the potential complexity of domestic violence and abuse presentations beyond physical injury in order for staff to remain observant throughout consultations. It is also suggested that clear domestic violence and abuse assessment and referral mechanisms should be embedded into clinical practice, including emergency department, as described in the UK National Institute of Clinical Excellence guidelines (2014). Overall improvements in reporting mechanisms in emergency department for the identification, management and support for domestic violence and abuse survivors would add to the collective and growing body of evidence surrounding domestic violence and abuse and their presentations within healthcare settings. Such measures would enable those working in emergency department to support disclosure of domestic violence and abuse more effectively.

Intimate partner violence screening in emergency department: a rapid review of the literature

AIMS AND OBJECTIVES

The aim of the review was to identify intimate partner violence screening interventions used in emergency departments and to explore factors affecting intimate partner violence screening in emergency departments.

BACKGROUND

Intimate partner violence against women is now clearly recognised as a global health and societal issue. Nurses working in emergency and urgent care settings can play a crucial role in identification, prevention and management of intimate partner violence. Research exploring optimal methods of intimate partner violence screening and factors affecting intimate partner violence screening in emergency departments are relatively limited.

DESIGN

Literature review: Rapid Evidence Synthesis.

METHODS

Literature published between 2000-2015 was reviewed using the principles of rapid evidence assessment. Six electronic databases: CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and Joanna Briggs Library.

RESULTS

Twenty-nine empirical studies meeting the eligibility criteria were independently assessed by two authors using appropriate Critical Appraisal Skills Programme Checklists. Intimate partner violence screening in emergency departments is usually performed using electronic, face to face or pen- and paper-based instruments. Routine or universal screening results in higher identification rates of intimate partner violence. Women who screen positive for intimate partner violence in emergency departments are more likely to experience abuse in subsequent months. Factors that facilitate partner violence screening can be classified as healthcare professionals related factors, organisational factors and patient-related factors.

CONCLUSIONS

Emergency departments provide a unique opportunity for healthcare professionals to screen patients for intimate partner violence. Competence in assessing the needs of the patients appears to be a very significant factor that may affect rates of intimate partner violence disclosure.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of appropriate domestic violence screening methods and factors affecting intimate partner violence screening in emergency can help nurses, and other healthcare professionals provide patient-centred and effective care to victims of abuse attending emergency department.

A scoping review of intimate partner violence assistance programmes within health care settings

Background: The lifetime prevalence of intimate partner violence (IPV) for women presenting to health care settings is estimated to be 38-59%. With the goal of providing help to victims of abuse, numerous IPV assistance programmes have been developed and evaluated across multiple health care settings. Objective: Our scoping review provides an overview of this literature to identify key areas for potential evidence-based recommendations and to focus research priorities. Methods: We conducted a search of MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and psycINFO. We used broad eligibility criteria to identify studies that evaluated the effectiveness of IPV assistance programmes delivered within health care settings. We completed all screening and data extraction independently and in duplicate. We used descriptive statistics to summarize all data. Results: Forty-three studies met all eligibility criteria and were included in our scoping review. Nine categories of assistance programmes were identified: counselling/advocacy, safety assessment/planning, referral, providing IPV resources, home visitation, case management, videos, provider cueing, and system changes. Characteristics of programmes amongst studies frequently reporting positive results included those in which one type of active assistance was used (77.8% of studies reported positive results), a counsellor, community worker, or case manager provided the intervention (83.3% of studies reported positive results), and programmes that were delivered over more than five sessions (100.0% of studies reported positive results). Conclusions: IPV assistance programmes are heterogeneous with regards to the types of assistance they include and how they are delivered and evaluated. This heterogeneity creates challenges in identifying which IPV assistance programmes, and which aspects of these programmes, are effective. However, it appears that many different types of IPV assistance programmes can have positive impacts on women.

First contact: acute stress reactions and experiences of emergency department consultations following an incident of intimate partner violence

AIMS AND OBJECTIVES

The aim of this research was to explore women's emotional and affective responses following an incident of intimate partner violence experienced during emergency department attendances.

BACKGROUND

A growing body of research has explored women's experiences of emergency departments following intimate partner violence still little remains known about the experience and impact of emotional and affective responses during these attendances.

DESIGN

A descriptive qualitative design was used, underpinned theoretically by critical realism and postmodern complexity theory to attend to multiple, intersecting mechanisms that lie behind events and experiences.

METHODS

Semistructured interviews with six women who had attended an emergency department directly following an incident of intimate partner violence. Interview data were transcribed and thematically analysed in nvivo9 using a coding framework.

RESULTS

There were three interconnected key findings. First, was the commonality of acute stress experiences among women attending an emergency department following partner violence, second was that these acute stress reactions negatively impacted women's consultations, and third was the need for specialist domestic violence services at the point of first contact to assist service users navigate an effective consultation.

CONCLUSIONS

Acute stress reactions were an important feature of women's experiences of emergency department consultations following intimate partner violence. Attending to psychological first aid; providing a safe and quiet space; and affording access to specialist violence advocacy services at the point of first contact will limit harm and improve health consultation outcomes for this population.

RELEVANCE TO CLINICAL PRACTICE

This research provides an account of emotional and affective responses experienced by women attending emergency departments following intimate partner violence and explicates how these acute stress reactions impacted their consultation. This research has relevance for practitioners in many first contact health services, such as urgent and emergency care, general practice, community public health and mental health.

Domestic violence and abuse: an exploration and evaluation of a domestic abuse nurse specialist role in acute health care services

AIMS AND OBJECTIVES

The aim of this study was to explore the experiences of clinical staff in responding to disclosure of domestic violence and abuse, and to evaluate the effectiveness of training and support provided by a dedicated Domestic Abuse Nurse Specialist across one acute National Health Service Trust in the UK.

BACKGROUND

The impact of domestic violence and abuse is well documented and is far reaching. Health care professionals have a key role to play in the effective identification and management of abuse across a range of settings. However, there is a paucity of evidence regarding the constituents of effective support for practitioners within wider nonemergency hospital-based services.

DESIGN

A qualitative approach semi-structured interviews (n = 11) with clinical staff based in one acute care Trust in the UK. Interviews were informed by an interview guide and analysed using the Framework approach.

FINDINGS

The organisation of the nurse specialist role facilitated a more cohesive approach to management at an organisational level with training and ongoing support identified as key facets of the role by practitioners. Time constraints were apparent in terms of staff training and this raises questions with regard to the status continuing professional development around domestic violence and abuse.

CONCLUSIONS

Domestic violence and abuse continues to exert a significant and detrimental impact on the lives and health of those who encounter abuse. Health care services in the UK and globally are increasingly on the frontline in terms of identification and management of domestic violence and abuse. This is coupled with the growing recognition of the need for adequate support structures to be in place to facilitate practitioners in providing effective care for survivors of domestic violence and abuse.

RELEVANCE TO CLINICAL PRACTICE

This study provides an approach to the expansion of existing models and one which has the potential for further exploration and application in similar settings.