Assisting patients experiencing family violence: A survey of training levels, perceived knowledge, and confidence of clinical staff in a large metropolitan hospital

Detecting and preventing child maltreatment in primary care and PHNs' role-a cross-sectional study

BACKGROUND

Child maltreatment is a global problem that puts children at risk of mental illness, substance abuse, and premature death. Interdisciplinary collaboration is important in preventing and detecting child maltreatment. In Norway, children undergo universal preventive health assessments and receive complimentary follow-up care from specialized public health nurses in child and family health clinics. These nurses conduct regular check-ups and home visits to monitor children for signs of maltreatment.

OBJECTIVE

The objective of this study is to describe how public health nurses at child and family health clinics follow the National Clinical Guidelines to prevent and detect child maltreatment, with a particular focus on clinical procedures and interdisciplinary collaboration. Furthermore, we aim to determine factors that are associated with identification of child maltreatment.

DESIGN

A cross-sectional online survey was conducted among public health nurses working in primary care between October 24th and December 31st, 2022. Public health nurses who worked with children aged 0-5 years and had consultations with families were eligible to participate, resulting in 554 responses. The study employed descriptive analysis, including frequency, percentage and mean, as well as a two-step logistic regression analysis. The study was approved by the relevant authority, and informed consent was obtained through questionnaire completion.

RESULTS

The public health nurses in this study displayed strong adherence to the guidelines and utilized various comprehensive assessment procedures to monitor child well-being, growth, and development. However, there was limited and infrequent collaboration with other professionals, such as child protection services, general practitioners, and hospitals. Most public health nurses reported occasional suspicion of child maltreatment, with age and years of experience in child and family clinics influencing these suspicions. Older public health nurses were more likely to suspect physical violence, while those with less than two years of experience reported less experience in suspecting maltreatment. Additional education increased the probability of suspecting sexual violence.

CONCLUSIONS

This study provides insights into the practices of public health nurses in Norway regarding the detection and prevention of child maltreatment in child and family clinics. While adherence to guidelines is strong, suspicion of maltreatment is relatively rare. Collaboration across agencies is crucial in addressing child maltreatment. Age and experience may influence the detection of maltreatment. Improved collaboration, targeted guidelines, and ongoing professional development are needed to enhance child protection.

Readiness of Exercise Physiologists, Physiotherapists and Other Allied Health Professionals to Respond to Gender-Based Violence: A Mixed-Methods Study

Experiencing gender-based violence (GBV) is associated with health conditions that are common indications for referral to exercise physiologists, physiotherapists and other allied health professionals (AHPs). The readiness of AHPs to identify and respond to GBV is currently unknown. This study aimed to determine the readiness of AHPs to respond to a person who had experienced GBV. Participants completed the modified Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) and/or an interview. The AHPs felt underprepared, had low perceived knowledge and lacked confidence to respond to and support people who have experienced GBV, despite recognition of the importance and agreement of the relevance to AHPs' practice.

Multifaceted training and readiness to respond to family violence: A prospective cohort evaluation

BACKGROUND

As frontline healthcare workers, there is a growing expectation that nurses should be able to respond to disclosures of family violence. However, the profession and hospital systems have been slow to respond with clear skills, knowledge and confidence deficits identified in existing research. There is limited research which has robustly evaluated the effectiveness of in-depth, multifaceted training on readiness to respond among nurses.

AIM

To longitudinally evaluate the effectiveness of an in-depth family violence training intervention on confidence, knowledge and clinical skills of nurses working in a large tertiary adult hospital.

DESIGN

Single-centre, longitudinal intervention study. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used.

METHODS

One hundred and ten nursing clinicians participated in this study to complete a comprehensive evidence-based model of healthcare workers response for assisting patients experiencing family violence. A mixed methods survey was used to assess change in knowledge, confidence and clinical skills among participants. Outcome assessment was electronically undertaken at baseline, 6-9 months and 12-15 months following intervention.

RESULTS

Statistically significant improvement was seen in self-reported knowledge, confidence and frequency of screening for family violence. Relative to baseline estimates, these improvements were identified 6-9 months and 12-15 months following intervention; albeit with consideration to the visually observed trend of skill reversion at follow-up. Quantitative findings were paralleled by qualitatively identified improvements in the recognition of the intersectional nature of violence, need for patient collaboration in screening and depth in considerations around how family violence is screened for.

CONCLUSIONS

Findings provide tentative support for the utility of a multidimensional training approach to improving nurses' readiness to respond to disclosures of family violence.

RELEVANCE TO CLINICAL PRACTICE

This study provides preliminary support for multidimensional, evidence-based training to effectively improve nurses' confidence, knowledge and clinical skills required for responding to family violence.

REPORTING METHOD

The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (SQUIRE) Statement: guidelines for reporting observational studies (see Table S1).

PATIENT CONTRIBUTION

Patients were involved in the initial design of the survey tool. This involvement came through the Allied Health Consumer panel and included input on the design and question wording of the survey items.

Preparedness to Respond to Family Violence: A Cross-Sectional Study Across Clinical Areas

Introduction

Family violence (FV) is one of the most urgent health issues of our generation. While nurses play a vital role in identifying and supporting victim/survivors of violence, little is known about nursing readiness to respond across clinical areas.

Objective

This study aimed to compare and contrast the knowledge, confidence, clinical skills, and perceived barriers of nurses across three clinical areas of a tertiary trauma hospital in Melbourne, Australia, in responding to FV.

Method

A prospective, mixed methods design was used. The nursing staff at a large trauma hospital were approached to participate. Participants completed a brief online survey to quantify clinician-reported knowledge, clinical skills, and barriers to managing FV.

Results

Two hundred and forty-two nursing staff electronically completed a brief survey to capture self-reported confidence, knowledge, clinical skills, and barriers to working effectively in the area. The descriptive analysis reflected service-wide deficits in knowledge, confidence, and self-reported clinical skills, irrespective of the work area. Deficits were identified on a background of limited structured training for FV among this cohort. Significantly higher rates of FV confidence and knowledge were identified among emergency department nurses relative to acute and subacute clinical counterparts.

Conclusion

Nurse respondents overall reported low rates of confidence, knowledge, and clinical skills in responding to disclosures of FV. Findings reinforce the need for imbedded training programs to support frontline responses.

Domestic and family violence knowledge and skills: A private mental health service survey of nurses, allied health, and medical clinicians

Mental healthcare services have an important role to play in recognizing and responding to domestic and family violence (DFV). This study aimed to evaluate staff knowledge, confidence, and clinical skills in family violence in an Australian private mental healthcare service. The methodology utilized was a cross-sectional, online survey of clinical staff. In total, 93 clinical staff participated (51 nursing, 37 allied health, and 5 medical), with a 29% response rate. Most clinicians reported working with patients who had disclosed experiencing family violence, but the majority of clinicians (63%) had received no training in the area, with nurses reporting the lowest training levels. Less than 20% reported definitive knowledge of important clinical skills including key family violence indicators, asking about family violence, and responding to disclosures. However, qualitative text response data indicated that many clinicians would provide responses that encompassed best-practice recommendations. Overall, the results indicated suboptimal clinician family violence knowledge, with further training needed, particularly in nursing staff. Stronger knowledge and skills in social workers and psychologists, relative to nurses, paralleled existing research in a medical hospital sample. The data from the study will be utilized to inform the implementation of a hospital-wide quality and service improvement project in the area of DFV clinical response.

Exploring the readiness of senior doctors and nurses to assess and address patients' social needs in the hospital setting

BACKGROUND

Adverse social circumstances are a key factor in health outcomes. Hospitals are an opportune setting for assessing and addressing the unmet social needs of patients, however, the readiness of healthcare workers in hospitals to undertake such tasks requires further exploration in the Australian context. This study aimed to generate a theory of doctors' and nurses' readiness to assess and address patients' social needs in a hospital setting.

METHODS

A constructivist grounded theory methodology was applied, with purposive and theoretical sampling used to gather diverse perspectives of readiness during semi-structured interviews with twenty senior doctors and nurses from a variety of clinical specialties working in hospitals serving communities experiencing inequitable social and health outcomes. Line-by-line coding, memo writing, and diagramming were used in analysis to construct an interpretive theory of readiness. Application of constant comparison analytic processes were used to test the robustness of the theory.

RESULTS

The readiness of doctors and nurses varies across individuals and departments, and is founded upon a state of being comfortable and confident to assess social need as determined by a range of personal attributes (e.g. knowledge of social need; skills to assess social need); a state of being willing and prepared to assess and address social need facilitated by supportive environments (e.g. departmental culture); and enabling characteristics of the clinical encounter (e.g. time, rapport).

CONCLUSIONS

We found that the readiness of doctors and nurses is dynamic and impacted by a complex interplay of personal attributes along with contextual and situational factors. These findings indicate that any efforts to strengthen the readiness of doctors and nurses to assess and address social needs must target personal capabilities in addition to characteristics of the working environment.

Evaluating the impact of a family violence transformational change project in a major trauma hospital: A three-year follow-up comparison study of knowledge, confidence, and family violence response skills in clinical staff

Family violence is a significant public health issue. Healthcare systems have an important role to play in recognising and responding to current family violence experiences in their patients. However, many healthcare workers and systems remain underprepared to fulfil this role. The current study evaluated the impact of a transformational change project in family violence clinical response at a major adult trauma hospital in Australia. Clinician self-rated knowledge, confidence, and family violence clinical skills were evaluated at three years post implementation of a family violence initiative at the Royal Melbourne Hospital, Melbourne. The three years post survey results (N = 526) were compared to baseline (N = 534) using Mann Whitney U and χ ² analyses. Self-reported clinician family violence knowledge, confidence and patient screening were all significantly improved from baseline. Specific family violence skills, including knowledge of key indicators, enquiry with patients and disclosure response were also all significantly improved. The most common clinician identified barriers to working effectively in the area were similar to baseline and included the presence of a suspected perpetrator during the clinical interaction, clinicians perceiving patients would be reluctant to disclose, and time limitations. However, significantly fewer staff endorsed a lack of knowledge or supporting policies and procedures as a barrier. The findings indicate that investment in a transformational change project comprised of the establishment of response policies and clinical work-flow, broad-scale training, a clinical champions program, a secondary consultation service and links with partner organisations, was effective at improving clinician self-rated rated family violence skills, across the hospital. However, one quarter of clinicians still reported having not received any family violence training, and half endorsed having little or no confidence in their skills to identify and respond to patient family violence experiences. This indicates ongoing and sustained work is required to optimise clinician skills in responding to family violence.

Responding to family violence: Variations in knowledge, confidence and skills across clinical professions in a large tertiary public hospital

Introduction

Healthcare workers play a vital role in assessing and appropriately responding to family violence. Discipline-specific differences in the readiness to respond have been indicated in the literature but no studies have directly compared multiple disciplines using the same measure. Given the imperative need for a hospital-wide, multidisciplinary approach to managing family violence, this study aimed to compare and contrast clinician perceived levels of knowledge, confidence and clinical readiness to manage disclosures of family violence across major professional groups in a tier 1, tertiary adult trauma hospital in Australia.

Methods

This prospective cross-sectional study implemented a brief questionnaire to explore self-reported knowledge, confidence and clinical skills in managing family violence. Data were analysed using non-parametric analyses. The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines for observational research were followed in the reporting of this study.

Results

Significantly greater self-reported clinical skills, knowledge and confidence were found among social work clinicians relative to all other disciplines. By contrast, allied health clinicians reported the lowest levels of clinical knowledge, confidence and skills relative to other discipline areas. No significant differences were seen between nursing and medicine.

Conclusion

There are significant differences across clinical professional groupings in knowledge and confidence levels, and clinical skills in assisting patients experiencing family violence. The findings have implications for facilitating a hospital-wide, multidisciplinary response to assisting clients experiencing family violence.

Family violence screening and disclosure in a large metropolitan hospital: A health service users' survey

OBJECTIVES

Assisting patients who are experiencing family violence is an important issue for health services. Rates of screening for family violence in general hospital settings in Australia are unclear. This study was conducted to obtain data on hospital family violence screening rates and health service users' perceptions of the screening process, in a large metropolitan hospital in Australia.

METHODS

Clients from the clinical caseloads of social work and psychology staff were invited to participate in a tablet administered, online survey of their family violence screening experiences, within the health service.

RESULTS

A total of 59 surveys were completed by hospital users, who had been treated in areas including the emergency department, acute inpatient wards, sub-acute and rehabilitation units, and outpatient clinics. Less than half the sample reported being screened for family violence at the health service. One-quarter of the respondents reported disclosing family violence concerns, with one-fifth wanting to disclose, but not feeling comfortable to do so. The majority of respondents who disclosed family violence felt supported by the response of the staff member and were provided with information they found helpful. However, further work could be done to improve screening rates, environmental and organizational factors to promote users feeling comfortable to disclose, and staff responses to disclosures.

CONCLUSION

The results of the survey will be used to inform the development of a hospital-wide family violence training initiative aimed to improve staff knowledge, confidence, rates of screening, and clinical responses to family violence.

Assisting clients experiencing family violence: Clinician and client survey responses in a child and family health service

AIMS AND OBJECTIVES

To determine the baseline levels of training, knowledge and confidence working in the area of family violence in staff at a public child and maternal health service in Melbourne, Australia, as well as perceived staff barriers to working effectively in this area. This study also aimed to explore the client perception of existing screening practices.

BACKGROUND

Family violence is a global concern with pregnancy and the postnatal period times of particularly high risk. Child and maternal health services are well placed to screen for violence, yet clinician and client perceptions of screening remain poorly characterised.

DESIGN

Thirty-five staff and 15 mothers participated in this cross-sectional, mixed-method study, via an online survey. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used.

RESULTS

The majority of staff screened clients for family violence, at least some of the time, with over 50% often or always screening. However, only half of staff respondents indicated that they believed they knew how to screen appropriately. Screening occurred most often over the phone or at the first service visit. The most commonly reported barriers to screening were suspected perpetrators being present during consultations and language barriers. Most clients reported being screened for physical violence and safety in the home with few being asking about financial and sexual abuse, or psychological violence and coercive control. Clients who disclosed violence reported being well supported.

CONCLUSION

While some baseline staff knowledge and skills have been identified, further support for clinicians is needed to ensure best practice and improve services and outcomes, particularly in regard to screening for different types of violence across the spectrum.

RELEVANCE TO CLINICAL PRACTICE

This study helps to inform clinical screening practices in maternal health services through an exploration of facilitators and barriers in the screening process.