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Midtsund AD, Henriksen L, Lukasse M, Valla L. Detecting and preventing child maltreatment in primary care and PHNs' role-a cross-sectional study. BMC PRIMARY CARE 2024; 25:218. [PMID: 38879472 PMCID: PMC11179210 DOI: 10.1186/s12875-024-02445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
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.
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Affiliation(s)
- Astrid Durdei Midtsund
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
- Oslo Municipality, Grünerløkka Child and Family Health Clinic, Oslo, Norway.
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Division of General Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Department of Nursing and Social Sciences, Institute of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Lisbeth Valla
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
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Wheatley L, Rosenbaum S, Mastrogiovanni C, Pebole M, Wells R, Rees S, Teasdale S, McKeon G. Readiness of Exercise Physiologists, Physiotherapists and Other Allied Health Professionals to Respond to Gender-Based Violence: A Mixed-Methods Study. Violence Against Women 2024:10778012241257245. [PMID: 38825701 DOI: 10.1177/10778012241257245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
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.
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Affiliation(s)
- Lauren Wheatley
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Chiara Mastrogiovanni
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michelle Pebole
- The Translational Research Centre for TBI and Stress Disorders, VA Boston Healthcare System, Boston, MA, USA
| | - Ruth Wells
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Susan Rees
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Scott Teasdale
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- Mindgardens Neuroscience Network, Sydney, NSW, Australia
| | - Grace McKeon
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
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Withiel TD, Sheridan S, Rushan C, Fisher CA. Multifaceted training and readiness to respond to family violence: A prospective cohort evaluation. J Clin Nurs 2023; 32:7740-7750. [PMID: 37477159 DOI: 10.1111/jocn.16827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/04/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
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.
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Affiliation(s)
| | - Simone Sheridan
- Nursing Education, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Catherine Rushan
- Allied Health, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Caroline Anne Fisher
- Allied Health, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Psychology, The Melbourne Clinic, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Withiel TD, Sheridan S, Rudd N, Fisher CA. Preparedness to Respond to Family Violence: A Cross-Sectional Study Across Clinical Areas. SAGE Open Nurs 2022; 8:23779608221126355. [PMID: 36245850 PMCID: PMC9557861 DOI: 10.1177/23779608221126355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- T. D. Withiel
- Allied Health, Royal Melbourne
Hospital, Melbourne, Australia,T. D. Withiel, Allied Health, Royal
Melbourne Hospital, Melbourne, Victoria, Australia.
| | - S. Sheridan
- Nursing, Royal Melbourne
Hospital, Melbourne, Australia
| | - N. Rudd
- Clinical Psychology, University of Melbourne and Royal Melbourne
Hospital, Melbourne, Australia
| | - C. A. Fisher
- Allied Health, Royal Melbourne
Hospital, Melbourne, Australia,The Melbourne
Clinic, Melbourne, Australia
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Fisher CA, Jones S, Smyth CB, Stokes L, Cairns G, Withiel TD. Domestic and family violence knowledge and skills: A private mental health service survey of nurses, allied health, and medical clinicians. Int J Ment Health Nurs 2022; 31:952-961. [PMID: 35535637 DOI: 10.1111/inm.13004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Caroline A Fisher
- The Melbourne Clinic, Richmond, Victoria, Australia.,Allied Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sue Jones
- The Melbourne Clinic, Richmond, Victoria, Australia
| | | | - Lisa Stokes
- The Melbourne Clinic, Richmond, Victoria, Australia
| | | | - Toni D Withiel
- Allied Health, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Fisher CA, Troy K, Rushan C, Felmingham K, Withiel TD. 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. FRONTIERS IN HEALTH SERVICES 2022; 2:1016673. [PMID: 36925808 PMCID: PMC10012647 DOI: 10.3389/frhs.2022.1016673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/18/2022] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Caroline A Fisher
- Allied Health, Family Safety Team, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Allied Health, Psychology, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Neuropsychology Service, The Melbourne Clinic, Melbourne, VIC, Australia
| | - Kirsty Troy
- Clinical Psychology, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Catherine Rushan
- Allied Health, Family Safety Team, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Kim Felmingham
- Clinical Psychology, Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Toni D Withiel
- Allied Health, Family Safety Team, Royal Melbourne Hospital, Melbourne, VIC, Australia.,Allied Health, Psychology, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Fisher CA, Rudkin N, Withiel T. Neuropsychology and family violence: a national survey of training and knowledge levels in clinical neuropsychologists. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1890978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Caroline A. Fisher
- Allied Health Psychology and Family Safety Team, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
- The Melbourne Clinic, Melbourne, VIC, Australia
| | - Nadine Rudkin
- Allied Health Psychology and Family Safety Team, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Toni Withiel
- Allied Health Psychology and Family Safety Team, The Royal Melbourne Hospital (RMH), Melbourne, VIC, Australia
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