Perceptions of intimate partner violence: a cross sectional survey of surgical residents and medical students

Lessons in Sexual Assault and Violence: A Scoping Review of Undergraduate Nursing Education

BACKGROUND

More than half of women and one third of men have experienced sexual violence in their lifetime. Nurses must be able to screen and treat patients who have experienced sexual assault, yet they may lack the knowledge and identification skills based on their exposure to content in their undergraduate nursing programs. This study examined the current state of the science regarding sexual assault and violence education in undergraduate nursing curricula.

METHOD

This scoping review was guided by Levac's five-step framework. Databases were searched using the key terms "nursing education" and "sexual assault education."

RESULTS

A total of 501 articles were identified; eight articles were included in the review. Themes of knowledge, confidence, and educational preparedness emerged.

CONCLUSION

Despite the importance and prevalence of sexual assault, limited educational content is provided in undergraduate nursing schools. Results urge implementing educational didactic, simulation, and clinical placement opportunities to improve nursing students' knowledge. [J Nurs Educ. 2024;63(10):665-670.].

Intimate partner violence: An updated review of prevalence, identification, and screening tools for orthopaedic surgeons and training in medical education

Intimate partner violence is an overlooked, underestimated, and under reported cause of musculoskeletal injury. This literature review aims to provide an updated overview of the prevalence of IPV, along with the identification and screening tools available to orthopaedic surgeons for early detection and intervention. Additionally, the review discusses the importance of training in medical education for orthopaedic surgeons to effectively recognize and address IPV. Through an analysis of current research and best practices, this review highlights the need for increased awareness, education, and collaboration among healthcare professionals to effectively address IPV as a public health issue.

"Boiling Water but There's No Pop-Off Valve": Health Care Provider Perceptions of the Effects of COVID-19 on Intimate Partner Violence

This study sought to understand the effects of COVID-19, including movement-related restrictions such as shelter-in-place, quarantine, and isolation orders, on intimate partner violence (IPV) from the perspective of health care providers (HCPs) working at a public hospital in Atlanta, Georgia. From November 2020 to May 2021, we conducted 12 interviews. Three themes emerged: (1) HCPs perceived that COVID-19 movement-related restrictions likely exacerbated IPV; (2) HCPs encountered many practice-oriented and community barriers in IPV care provision during COVID-19; and (3) HCPs suggested process and partnership improvements for IPV response. These findings can inform future pandemic preparedness including improved communication, improved IPV screening and follow-up, and strengthened hospital-community partnerships.

"And then the person sort of just drops off the radar…": barriers in the transition from hospital to community-based care among survivors of intimate partner violence in Metropolitan Atlanta

Introduction

Hospitals and community-based organizations (CBOs) provide the service-base for survivors of intimate partner violence (IPV), particularly those in acute crisis. Both settings face discrete challenges in meeting survivors' needs. In hospitals these challenges include the pressures of a fast-paced work setting, and a lack of trauma-informed and survivor-centered care. Connections to community care are often unmeasured, with relatively little known about best practices. Often IPV survivors who receive hospital care fail to connect with community-based services after discharge. Despite the critical role of CBOs in supporting IPV survivors, there is limited research examining the perspectives and insights of CBO staff on the challenges and opportunities for improving care coordination with hospitals. The purpose of this study was to address this knowledge gap by characterizing CBO staff perceptions of IPV care coordination between hospital and community-based organizations in Metropolitan Atlanta.

Methods

We used a qualitative study design to conduct a cross-sectional examination of the perceptions and experiences of staff working at CBOs serving IPV survivors in Metropolitan Atlanta, Georgia. The adapted in-depth interview (IDI) guide was used to explore: (1) IPV survivor experiences; (2) Survivors' needs when transitioning from hospital to community-based care; (3) Barriers and facilitators to IPV care coordination; and (4) Ideas on how to improve care coordination. Data analysis consisted of a thematic analysis using MAXQDA Analytics Pro 2022.

Results

Participants (N = 14) included 13 women and one man who were staff of CBOs serving IPV survivors in Metropolitan Atlanta. CBO staff perceived that: (1) IPV survivors face individual-, organizational-, and systems-level barriers during help seeking and service provision; (2) Care coordination between hospitals and CBOs is limited due to siloed care provision; and (3) Care coordination can be improved through increased bidirectional efforts.

Conclusion

Our findings highlight the multi-level barriers IPV survivors face in accessing community-based care following medical care, the limitations of existing hospital-CBO coordination, and opportunities for improvement from the perspectives of CBO staff. Participants identified silos and inconsistent communication/relationships between hospital and CBOs as major barriers to care connections. They also suggested warm handoffs and a Family Justice Center to support care connection.

Screening for Intimate Partner Violence in Trauma: Results of a Quality Improvement Project

INTRODUCTION

Intimate partner violence (IPV) is common, especially among patients presenting with traumatic injury. We implemented an IPV screening program for patients admitted after trauma. We sought to determine whether specific demographic or clinical characteristics were associated with being screened or not screened for IPV and with IPV screen results.

METHODS

Retrospective cohort study evaluating all patients admitted after trauma from July 2020-July 2022 in an Adult Level 1 Trauma Center.

RESULTS

There were 4147 admissions following traumatic injury, of which 70% were men and 30% were women. The cohort was 46% White, 20% Asian, 15% Black, and 17% other races. Twenty-three percent were Hispanic or Latino/a. Seventy-seven percent were admitted for blunt injuries and 16% for penetrating injuries. Thirteen percent (n = 559) of the cohort was successfully screened for IPV. Screening rates did not differ by gender, race, or ethnicity. After adjustment for demographic and clinical factors, patients admitted to the intensive care unit were significantly less likely to be screened. Of the screened patients, 30% (165) screened positive. These patients were more commonly Hispanic or Latino/a, insured by Medicaid and presented with a penetrating injury. There were no differences in injury severity in patients who screened positive versus those who screened negative.

CONCLUSIONS

There are significant barriers to universal screening for IPV, including injury acuity, in patients admitted following trauma. However, the 30% rate of positive screens for IPV in patients admitted following trauma highlights the urgent need to understand and address barriers to screening in trauma settings to enable universal screening.

Orthopaedic surgeons can play important role in identifying victims of domestic violence in the emergency department - narrative review of Brazilian literature

Over the last year, with the social isolation imposed by the coronavirus disease pandemic, there has been a significant increase in complaints associated with physical violence against women. In the present study, an exploratory literature review was carried out on the role of the on-call orthopedic surgeon when faced with a suspicion of domestic violence, in accordance with Brazilian legislation. The main objective of the study was to show the role of this specialist in identifying victims of domestic violence by recognizing their profiles and associated risk factors. The secondary objectives were to demonstrate the most common skeletal and non-skeletal injuries in this type of violence and to present a quick and practical guide on how to identify, approach, and manage cases of domestic violence against women. The findings revealed that the main aggressors were close partners, such as spouses and ex-spouses. Young adult women, black or multiracial, and low socioeconomic status are major risk factors for intimate partner violence. Head and neck injuries are the most frequently observed lesions in this population, with more than one-third of victims reporting falls. Musculoskeletal injuries are present in up to 42% of victims of domestic violence, occurring predominantly in the upper limbs and chest, and are the leading cause of death in women aged 1 to 34 years. A practical guide for orthopedic surgeons who work in emergency departments is proposed, with basic information about their role and responsibility in identifying potential victims of intimate partner violence.

Curricular Limitations and Recommendations for Training Health Care Providers to Respond to Intimate Partner Violence: An Integrative Literature Review

BACKGROUND

Intimate partner violence (IPV) is a well-known public health problem occurring worldwide. With a multisectoral approach being emphasized in addressing IPV, the health sector has a key role to play due to many IPV victims who appear in health facilities without their needs being met. A well-designed and implemented IPV curriculum is necessary for effectively training health care professionals to provide quality IPV care and related services. This integrative review was conducted to establish evidence for existing curricular limitations and recommendations for training health care providers to respond to IPV.

METHODS

A systematic literature search was conducted for studies published from 2000 to 2020 in five databases (PubMed, Science Direct, Cochrane Library, Google, and Scholar). As a criterion, studies that reported curricular limitations in training health care providers/professionals to address IPV were included. A total of 198 studies were identified for screening, with 16 studies meeting the inclusion criteria and included in the review.

FINDINGS

Curricular limitations for IPV response training for health care providers were reported in the following areas (themes): time allocated for the training, amount of content in the existing curricula, institutional endorsement for the content, IPV response teachers/facilitators, teaching and learning strategies, and funding to support curricular implementation. Various recommendations to improving IPV response training were provided including guaranteeing the training in all courses, increasing academic capability to teach the content, allocation of funding to improve infrastructure for curriculum development and implementation, comprehensive approaches to teaching, and continuing education for health care providers.

Socioeconomic disparities in rates of facial fracture surgeries for women and men at a regional tertiary care centre in Australia

BACKGROUND

Assault is the most common mechanism of injury in patients presenting with facial trauma in Australia. For women, there is a propensity for maxillofacial injuries to stem from intimate partner violence (IPV). Those with a low socioeconomic status have higher rates of IPV. This study examines variations in the proportion of surgical procedures that are due to facial trauma for Australian women and men by employment status and residential socioeconomic status.

METHODS

A single centre retrospective study was conducted (2008-2018). The proportion of operative patients presenting with facial fractures was examined. Multivariable logistic regression adjusting for year and age, was performed for women and men.

RESULTS

Facial fractures comprised 1.51% (1602) of all surgeries, patients had a mean age of 32, and 81.3% were male. Unemployed patients were more likely to require surgery for a facial fracture (OR 2.36 (2.09-2.68), P <0.001), and there were no significant variations by index of economic resources (IER). Unemployed males had higher rates of facial fractures (OR 2.09 (1.82-2.39), P <0.001). Unemployed and disadvantaged IER females had higher rates of facial fractures (OR 5.02 (3.73-6.75), P <0.001 and OR 2.31(1.63-3.29), P <0.001).

CONCLUSIONS

This study found disparities in rates of surgery for facial fractures; unemployment increased the rates for men and women, whereas disadvantaged IER increased rates for women. Studies have demonstrated higher rates of IPV for unemployed and low socioeconomic status women. Further research ascertaining the aetiology of these disparities is important both for primary prevention initiatives and to enable treating clinicians to better understand and address the role of IPV and alcohol consumption in these injuries.

Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning

INTRODUCTION

Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes.

MATERIALS AND METHODS

A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge.

RESULTS

Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women.

CONCLUSION

Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Effect of orthopaedic resident education on screening for intimate partner violence

BACKGROUND

Intimate Partner Violence (IPV) is prevalent in women presenting to orthopaedic fracture clinics. Rates of IPV have increased during the COVID-19 global pandemic. Our aim was to determine the effect of educational experiences on IPV knowledge and IPV screening to inform best-practices in resident education.

METHODS

Cross-sectional online survey of orthopaedic surgery residency programs in Canada. Demographics, IPV educational experiences, IPV knowledge, and frequency of IPV screening were collected via a modified version of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS). Descriptive statistics and regression modeling identified predictors of IPV knowledge and frequency of IPV screening.

RESULTS

Responses were obtained from 105 orthopaedic residents; 84% participated in classroom training, 39% underwent mentorship training, 32% received both classroom training and mentorship, and 10% reported neither. Classroom training had no statistically significant association with IPV knowledge or frequency of IPV screening. Residents who received mentorship were 4.1 times more likely to screen for IPV (95% CI: 1.72-10.05), older residents were more likely to screen for IPV (OR: 8.3, 95% CI: 2.64-29.84), and senior residents were less likely to screen for IPV than junior residents (OR: 0.29, 95% CI: 0.09-0.82).

CONCLUSIONS

Classroom training was not associated with any effect on IPV knowledge nor the frequency of IPV screening. Educational efforts should be targeted at increasing mentorship opportunities in order to improve IPV screening practices in Canadian orthopaedic residents.

Health Care Providers' Readiness to Identify and Respond to Intimate Partner Violence

Screening rates for intimate partner violence (IPV) among most health care providers are low; yet, positive interactions with providers can benefit people who experience IPV, with respect to increased safety, support, and self-efficacy. Missing is a broad assessment and comparison of knowledge, attitudes, and behavior across the range of providers who are likely to be involved in a response to IPV disclosure. The purpose of our study was to assess health care providers' IPV preparation, knowledge, opinions, and practices and examine differences across three types of health care providers (medical providers, nursing staff, and social/behavioral health providers). We used an anonymous online survey to gather self-reported information on preparation, knowledge, opinions, and practices around IPV. A random sample of 402 providers was drawn from 13 clinics in a large multispecialty outpatient practice setting. The respondents (N = 204) consisted of medical providers (n = 70), nursing staff (n = 107), and social/behavioral health providers (n = 27). Data analyses consisted of univariate, bivariate, and multivariate analyses. Social/behavioral health providers reported more preparation, knowledge, victim understanding, and less job-related constraints, yet they reported lower screening rates than medical providers and nursing staff. Overall, no provider group seemed well-equipped to work with patients who disclose IPV. Our findings identify unmet needs within our health system to better train health care providers and restructure care models to support IPV identification and response. A focus on interprofessional training and care collaboration would bolster competency and reduce constraints felt by the health care workforce.

Reproductive endocrinologists' knowledge and attitudes in the identification of intimate partner violence

OBJECTIVE

To assess reproductive endocrinologists' attitudes, beliefs, knowledge, and experiences with intimate partner violence (IPV).

DESIGN

Cross-sectional survey of US reproductive endocrinologists.

SETTING

The survey was disseminated via both direct mail and e-mail to a voluntary, semirandomized US national sample of reproductive endocrinologists. We randomly selected a maximum of six clinics per state using the Centers for Disease Control and Prevention Fertility Clinic Success Rates Report.

PATIENT(S)

None.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES

Clinician perceptions and knowledge regarding IPV and its relevance to the infertility setting.

RESULTS

A total of 95 reproductive endocrinology and infertility physicians practicing in either academic or private clinics in the United States completed the survey with an overall response rate of 46% (95/200). General knowledge of IPV was good among respondents. Intimate partner violence assessment was very relevant among 39% (37/95) of respondents and possibly relevant among 56% (53/95) of respondents. A history of IPV awareness training was associated with a decreased frequency of reported barriers, including fewer perceived time constraints, decreased knowledge regarding IPV community resources, and less discomfort asking about IPV. Most respondents estimated the prevalence of IPV in their practice to be rare (≤1%). However, 33% (31/95) reported identifying between one and five active victims of IPV over the prior year, and 63% (60/95) reported identifying a victim of IPV throughout their careers. Only 17% (16/95) of respondents were certain that their clinic had guidelines for detection or management of IPV.

CONCLUSION

Reproductive endocrinology and infertility physicians would benefit from education and training in IPV to enable them to better identify and assist patients who are victims of IPV.

Designing an Intimate Partner Violence Screening Program for Surgical Residents in Trauma

BACKGROUND

Intimate partner violence (IPV) commonly affects surgical patients, particularly trauma patients. However, baseline knowledge of IPV is poor among surgeons and screening is variable. We designed a project to educate surgical residents on IPV and standardize screening in all trauma patients.

MATERIALS AND METHODS

Quality improvement frameworks and the Modified Provider Survey were used to examine residents' attitudes and behaviors regarding IPV at a level one trauma center. An educational curriculum was designed with a trainee-led, multidisciplinary team to address knowledge gaps, barriers, and relevant reporting laws, and provide framing language that normalized screening.

RESULTS

Fifty-seven surgical residents (64% response rate) spanning post-graduate years 1-7 completed surveys. All respondents believed IPV was relevant to their patients, yet only 4% correctly identified the prevalence of IPV. Only 15% felt comfortable screening for IPV and 75% felt they had received inadequate training. The most common barriers to screening were insufficient knowledge of community resources and what to do if patients screened positive. Most residents grossly underestimated the incidence of IPV and 19% believe healthcare providers have a limited role in being able to help IPV victims. There were no significant differences in responses between male and female residents or among residents from different postgraduate levels.

CONCLUSIONS

Surgical residents believe IPV is relevant, but few feel they have adequate training. Residents vastly underestimated the societal prevalence of IPV and the majority never screened patients for IPV. A residency-wide curriculum can address common misperceptions and perceived barriers.

Longitudinal Curricular Assessment of Knowledge and Awareness of Intimate Partner Violence among First-Year Dental Students

BACKGROUND

Intimate partner violence (IPV) has previously been recognized as a major public health issue. Oral healthcare providers, such as dentists, are crucial to the screening and identifying of individuals experiencing IPV, since most injuries occur in the head and neck region. A lack of knowledge and awareness regarding teaching and learning about IPV in dental school curricula has been identified. Based upon the overall lack of knowledge, the objective of this study was to conduct a longitudinal assessment of knowledge, awareness, and beliefs regarding IPV among dental students in their first year of education.

METHODS

All students (n = 245) from three consecutive, first-year dental student cohorts (n = 81, n = 82, n = 82) were provided a brief and voluntary in-class survey in conjunction with an instructional workshop. The survey included questions designed to ascertain knowledge, awareness, and beliefs regarding IPV as a healthcare and dental issue before and after the instructional session. Differences in responses to the questions before and after the IPV educational workshop were measured using paired t-tests.

RESULTS

A total of n = 232 completed pre- and post-responses were received from all three first-year dental student cohorts (n = 76, n = 80, n = 76), representing an overall 94.6% response rate. Analysis of these data showed that the student population was predominantly male and white (non-minority), aged in their mid- to late twenties, with most students reporting no previous IPV education. The few students reporting previous IPV education were mainly younger (<25 years), which may represent more recent endeavors to increase awareness of IPV among students currently attending colleges and universities.

CONCLUSIONS

The results of this study may suggest that information-specific seminars within the curriculum might be adequate to provide dental students with awareness and knowledge of IPV and specific information regarding local resources and referrals for any patients experiencing IPV.

Difficult conversations: Navigating intimate partner violence with standardized patients

BACKGROUND

One in three women in the US experience intimate partner violence (IPV) in their lifetime. There are minimal opportunities for medical students to learn about responding to IPV.

METHODS

Students participated in a learning intervention about recognizing and addressing IPV, followed by a standardized patient session. Students filled out a seven-question survey before and after the session, which assessed comfort addressing IPV, discussing resources, and practicing trauma-informed care. Responses were compared using the Mann-Whitney U test.

RESULTS

Sixteen medical students participated, response rate of 100%. The median score for comfort recognizing signs of IPV increased from 2 to 3 (p < 0.01); for asking patients about IPV, from 1 to 3.5 (p < 0.01); in knowledge of IPV resources, from 1 to 3 (p < 0.01); in preparedness to practice trauma informed care, from 2 to 3.5 (ns). Comfort addressing IPV improved from 1 to 3 (p < 0.01).

CONCLUSION

After the session, student preparedness and comfort addressing IPV increased. The learning intervention addressed information not in standard medical curricula. This module can be easily adapted to any medical school curricula.

Top 10 Things Every Radiologist Needs to Know About Intimate Partner Violence [Formula: see text]

INTRODUCTION

Intimate partner violence (IPV) is considered to be the leading cause of nonfatal injury to women worldwide. Moreover, the need for effective training for health care professionals (HCPs) and protocol for addressing IPV in health care contexts are well-documented. This article addresses key questions that radiologists may have related to supporting patients who have experienced IPV.

METHODS

Peer-reviewed journal articles and other formal reports were located using Google Scholar and PubMed in order to assemble this review.

CONCLUSIONS

Radiologists are well-equipped to help identify possible instances of IPV if they are aware of the injury patterns commonly associated with IPV. Along with other HCPs, radiologists can also advocate for the implementation of protocols that will guide their responses to victims of IPV within their own health care institution.

Demographics and Fracture Patterns of Patients Presenting to US Emergency Departments for Intimate Partner Violence

Orthopaedic surgeons are in a position to assist in identifying intimate partner violence (IPV) patients. It was the purpose of this study to analyze the demographics and fracture patterns of IPV patients in the United States.

Mandatory reporting of child maltreatment when delivering family-based treatment for eating disorders: A framework analysis of practitioner experiences

BACKGROUND

Increasingly, evidence-based treatment guidelines emphasize the role of parents in first-line treatment approaches for child and adolescent psychiatric disorders. Yet there are no best practice guidelines for practitioners on the identification and reporting of suspicions and disclosures of child maltreatment to child protection services (CPS) in these circumstances. This is particularly concerning given that undetected and unreported child maltreatment may exacerbate the vulnerabilities of youth with mental illness.

OBJECTIVE

The objective of this study is to describe family-based practitioners' experiences of reporting child emotional abuse (CEA) and child exposure to intimate partner violence (CEIPV) to CPS.

PARTICIPANTS AND SETTING

Data from 30 practitioners based in five countries were included in this study.

METHODS

We use deductive framework analysis of qualitative interviews with practitioners providing family-based treatment to youth diagnosed with eating disorders. Interviews for the primary study elicited participants' perceptions and experiences of identifying and responding to CEA and CEIPV in practice. All transcripts were analysed by two authors using constructs identified by a qualitative meta-synthesis of mandatory reporting experiences among service providers.

RESULTS

Three participants identified as male, 27 as female. Practitioners described negative experiences when reporting CEA and CEIPV to CPS, as well as variable CPS responses to their reports. Findings confirm the need for additional training for mental health practitioners to recognize and report CEA and CEIPV.

CONCLUSIONS

Management of CEA and CEIPV while delivering family-based treatment remains an important area of practice that requires further inquiry.

Serious gaming: A tool to educate health care providers about domestic violence

Due to many adverse health effects, victims of domestic violence are frequently seen in the health care system. Yet, health care providers may lack the training to assist them. Online curricula can be an effective instructional tool. Our competency-based, serious video game, Responding to Domestic Violence in Clinical Settings, was designed to address health care providers' knowledge gaps through 17 modules, each a half hour in length. Nearly 9,000 participants completed at least one module; nursing students completed the most modules, approximately five hours of instruction. This serious video game-based curriculum is useful in helping health providers and students learn about Domestic Violence.

CE: Original Research: Intimate Partner Violence: The Knowledge, Attitudes, Beliefs, and Behaviors of Rural Health Care Providers

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BACKGROUND

Intimate partner violence (IPV) continues to be a pervasive health and social problem in the United States with serious short- and long-term consequences. Women in rural areas face particular challenges. Health care providers can play an important role in the lives of women who experience IPV; yet among providers, lack of knowledge, negative attitudes and beliefs, and low rates of screening are common.

OBJECTIVE

Though a large body of research exists regarding health care providers' IPV-related knowledge, attitudes, beliefs, and behaviors, little is known specifically with regard to rural providers. Given the challenges faced by rural women and the potential influence of their providers, it's important to understand rural providers' IPV-related knowledge, attitudes, beliefs, and behaviors. We conducted a study to learn more.

METHODS

Health care providers working in a large rural health network were asked to complete electronic surveys that examined their IPV-related knowledge, attitudes, beliefs, and behaviors. Descriptive and correlational statistical analyses of the data were conducted.

RESULTS

A total of 93 health care providers returned completed surveys. In general the respondents demonstrated good overall knowledge, judicious attitudes, and beliefs congruent with the available evidence related to IPV. Of concern were their knowledge and practice gaps regarding the prevalence of IPV, the higher risk of injury faced by women who leave their abusers, the ability of women to make appropriate choices about their situations, and what actions to take when someone discloses abuse.

CONCLUSION

The results of this study were encouraging with regard to the IPV-related knowledge, attitudes, beliefs, and behaviors of rural health care providers. But the findings also indicated important knowledge and practice gaps. Preparing providers to deliver compassionate, effective care to women who experience IPV is essential for the health and well-being of women and their families.

Addressing Intimate Partner Violence: Reducing Barriers and Improving Residents' Attitudes, Knowledge, and Practices

OBJECTIVE

This study aims to assess residents' attitudes, knowledge, practices, and barriers in addressing intimate partner violence and create a curriculum targeting self-identified deficits.

METHODS

The authors developed and distributed a survey to residents across multiple specialties at a large academic institution. A workshop was developed using obstetrics/gynecology residents' data, with post-intervention data collected to assess for changes.

RESULTS

One hundred forty-seven residents (41 %) completed the survey. Though all identified assessing intimate partner violence as physicians' responsibility, only 40 % reported consistent screening with new female patients, 36 % with pregnant patients, and 18 % with post-partum patients. Half reported inadequate training and felt unprepared to counsel patients regarding intimate partner violence. Post-intervention data suggest gains in knowledge and perceived preparedness.

CONCLUSIONS

Although residents appreciate the significance of intimate partner violence assessment, in this particular institution few consistently perform or feel comfortable screening. Development of comprehensive intimate partner violence curricula is therefore critical.

Student nurses' knowledge and attitudes towards domestic violence: results of survey highlight need for continued attention to undergraduate curriculum

AIMS AND OBJECTIVES

To gain a comprehensive understanding of undergraduate nursing student attitudes and views towards domestic violence, and employ the findings to inform undergraduate curriculum development.

BACKGROUND

Nurses have an important role in identifying people who are victims of domestic violence through screening and facilitating their access to assistance and support. Undergraduate nursing education is key to shaping attitudes and facilitating the development of a comprehensive understanding of domestic violence. Little research has been undertaken exploring nursing students' attitudes towards domestic violence.

METHODS

A cross-sectional survey of undergraduate nursing students enrolled in a three-year Bachelor of Nursing programme across three campuses of a regional university in NSW, Australia. Students completed a pen and paper survey during class time and descriptive and comparative analysis was undertaken.

RESULTS

The majority of respondents were female, first year students females aged 17-26 years. Many students understood the nature and consequences of domestic violence, yet others across the course of the programme demonstrate attitudes that reflect a lack of understanding and misconceptions of domestic violence. Stereotypical and gendered attitudes that normalise violence within intimate partner relationships and sustain victim-blaming attitudes were evident across the cohort.

CONCLUSIONS

It is important for nurses to understand the relationship between exposure to violence and women's ill health, and be able to respond appropriately. Undergraduate programmes need to highlight the important role of nurses around domestic violence and address stereotypical conceptions about domestic violence.

RELEVANCE TO CLINICAL PRACTICE

Continued effort is required to address domestic violence in undergraduate nursing education so that nursing graduates understand the association between violence exposure and poor health and are able to assess exposure and respond appropriately in the clinical environment.

Beliefs about intimate partner violence: A survey of the Swedish general public

Public interventions are considered to be an important means of preventing intimate partner violence (IPV). What people believe about the nature of IPV is likely to determine their propensity to intervene, but little is known at present about IPV beliefs among the general public. In a survey of 650 Swedish citizens, beliefs about the prevalence and causes of IPV, and viable means of intervention were assessed. Respondents estimated, on average, that IPV occurs in almost one quarter of all intimate relationships in Sweden, and that IPV is particularly prevalent in low-income groups, among non-European immigrants, in suburban areas, and in couples under the age of 50 years. Physical violence was believed to be the most frequent form of abuse in male offender-female victim cases, whereas psychological violence was considered most frequent in other combinations of offender and victim gender. Female respondents estimated a higher prevalence of IPV, attributed less blame to IPV victims, and suggested more means of intervention, than did male respondents. The findings are discussed in relation to empirical prevalence estimates, and implications are proposed.

Orthopaedic Trainees Retain Knowledge After a Partner Abuse Course: An Education Study

INTRODUCTION

Intimate partner violence (IPV) is a serious global issue that results in a large number of injuries and deaths among women. Educating clinicians about IPV can help providers identify, prevent, and treat victims, and, ultimately, improve care for victims of abuse. We sought to determine the effect of a half-day educational course on IPV for orthopaedic surgical trainees on knowledge and attitudes.

QUESTIONS/PURPOSES

We asked (1) whether a half-day educational course on IPV can improve orthopaedic surgical trainees' knowledge and (2) attitudes regarding IPV; and (3) whether a course on IPV can be accepted and viewed as valuable by trainees?

METHODS

Using published research on IPV in patients with musculoskeletal injuries, we developed a half-day educational course. The curriculum included lectures and discussion regarding the basics of IPV, the current state of IPV research, what to do when a patient is a victim or perpetrator, and the orthopaedic surgeon's role in recognizing, preventing, and assisting with IPV. All 33 course participants (30 men and three women), all orthopaedic surgical trainees, completed a questionnaire that included general true or false or agree or disagree statements regarding their knowledge, attitudes, and practices of IPV in the musculoskeletal setting; the questionnaire also included a knowledge test of 25 true or false statements. The questionnaire was administered immediately before, immediately after, and 3 months after the course; 76% (25 of 33) took the test immediately after the course and 82% (27 of 33) completed the test at 3 months. Participant knowledge scores were compared across the three different times to determine the effect of the course.

RESULTS

Participants increased their knowledge after the course, and the increased knowledge was retained at retesting at 3 months; the mean percentage of correct answers before the course was 57%, which increased to 73% after the course, and was 68% 3 months later (F = 9.505; p = 0.001). Before the course, most of the course participants (30 of 32; 94%) agreed that IPV is an important issue; agreement increased to 100% immediately after the course. The largest change in attitude was in response to the statement: "I am skeptical that the health care system has the resources to screen for IPV." Before the course, 53% (17 of 32) of trainees endorsed this statement, but the percent decreased to 36% (nine of 25) after the course and remained low at 33% (nine of 27), at the 3-month test.

CONCLUSIONS

Our findings show that a short course on IPV in patients with musculoskeletal injuries led to an improvement and retention of knowledge 3 months after the course. Based on our findings, we recommend that IPV education be integrated in training programs for orthopaedic surgeons. Future projects should focus on developing and implementing a sustainable education program that can affect practice for healthcare professionals and trainees in multiple clinical settings.

"I've never asked one question." Understanding the barriers among orthopedic surgery residents to screening female patients for intimate partner violence

BACKGROUND

Intimate partner violence (IPV) is a global public health problem. Orthopedic surgery residents may identify IPV among injured patients treated in fracture clinics. Yet, these residents face a number of barriers to recognizing and discussing IPV with patients. We sought to explore orthopedic surgery residents' knowledge of IPV and their preparedness to screen patients for IPV in academic fracture clinic settings with a view to developing targeted IPV education and training.

METHODS

We conducted focus groups with junior and intermediate residents. Discussions explored residents' knowledge of and experiences with IPV screening and preparedness for screening and responding to IPV among orthopedic patients. Data were analyzed iteratively using an inductive approach.

RESULTS

Residents were aware of the issue of abuse generally, but had received no specific information or training on IPV in orthopedics. Residents did not see orthopedics faculty screen patients for IPV or advocate for screening. They did not view IPV screening or intervention as part of the orthopedic surgeon's role. Residents' clinical experiences emphasized time management and surgical intervention by effectively "getting through clinic" and "dealing with the surgical problem." Communication with patients about other health issues was minimal or nonexistent.

CONCLUSION

Orthopedic surgery residents are entering a career path where IPV is well documented. They encounter cultural and structural barriers preventing the incorporation of IPV screening into their clinical and educational experiences. Hospitals and academic programs must collaborate in efforts to build capacity for sustainable IPV screening programs among these trainees.

Health sector responses to intimate partner violence: a literature review

BACKGROUND

Intimate partner violence (IPV) is a common and serious public health concern, particularly in South Africa, but it is not well managed in primary care.

AIM

This review aims to summarise the current state of knowledge regarding health sector-based interventions for IPV, their integration into health systems and services and the perspectives of service users and healthcare workers on IPV care, focusing on the South African context.

METHOD

PubMed, CINAHL, PsycINFO and Google Scholar were searched between January 2012 and May 2014. All types of study design were included, critically appraised and summarised.

RESULTS

Exposure to IPV leads to wide-ranging and serious health effects. There is sufficient evidence that intervening in IPV in primary care can improve outcomes. Women who have experienced IPV have described an appropriate response by healthcare providers to be non-judgmental, understanding and empathetic. IPV interventions that are complex, comprehensive and utilise systems-wide approaches have been most effective, but system- and society-level barriers hamper implementation. Gender inequities should not be overlooked when responding to IPV.

CONCLUSION

Further evaluations of health sector responses to IPV are needed, in order to assist health services to determine the most appropriate models of care, how these can be integrated into current systems and how they can be supported in managing IPV. The need for this research should not prevent health services and healthcare providers from implementing IPV care, but rather should guide the development of rigorous contextually-appropriate evaluations.

Implementing intimate partner violence care in a rural sub-district of South Africa: a qualitative evaluation

Background

Despite a high burden of disease, in South Africa, intimate partner violence (IPV) is known to be poorly recognised and managed. To address this gap, an innovative intersectoral model for the delivery of comprehensive IPV care was piloted in a rural sub-district.

Objective

To evaluate the initiative from the perspectives of women using the service, service providers, and managers.

Design

A qualitative evaluation was conducted. Service users were interviewed, focus groups were conducted amongst health care workers (HCW), and a focus group and interviews were conducted with the intersectoral implementation team to explore their experiences of the intervention. A thematic analysis approach was used, triangulating the various sources of data.

Results

During the pilot, 75 women received the intervention. Study participants described their experience as overwhelmingly positive, with some experiencing improvements in their home lives. Significant access barriers included unaffordable indirect costs, fear of loss of confidentiality, and fear of children being removed from the home. For HCW, barriers to inquiry about IPV included its normalisation in this community, poor understanding of the complexities of living with violence and frustration in managing a difficult emotional problem. Health system constraints affected continuity of care, privacy, and integration of the intervention into routine functioning, and the process of intersectoral action was hindered by the formation of alliances. Contextual factors, for example, high levels of alcohol misuse and socio-economic disempowerment, highlighted the need for a multifaceted approach to addressing IPV.

Conclusions

This evaluation draws attention to the need to take a systems approach and focus on contextual factors when implementing complex interventions. The results will be used to inform decisions about instituting appropriate IPV care in the rest of the province. In addition, there is a pressing need for clear policies and guidelines framing IPV as a health issue.

Intimate partner violence and musculoskeletal injury: bridging the knowledge gap in orthopaedic fracture clinics

Intimate partner violence (IPV) is a serious health issue. There have been widespread research efforts in the area of IPV over the past several decades, primarily focusing on obstetrics, emergency medicine, and primary care settings. Until recently there has been a paucity of research focusing on IPV in surgery, and thus a resultant knowledge gap. Renewed interest in the underlying risk of IPV among women with musculoskeletal injuries has fueled several important studies to determine the nature and scope of this issue in orthopaedic surgery. Our review summarizes the evidence from surgical research in the field of IPV and provides recommendations for developing and evaluating an IPV identification and support program and opportunities for future research.