Increasing Identification of Domestic Violence in Emergency Departments: A Collaborative Contribution to Increasing the Quality of Practice of Emergency Nurses

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ABSTRACT

This project was initiated to improve the quality of identifi cation and response practices of Emergency Department (ED) nursing staff dealing with possible victims of domestic violence (DV). Nursing staff were trained to identify three key actions in the pathway for domestic violence presentations in the ED. A survey of ED staff was taken pre-training to determine a base-line measure of self-reported knowledge regarding domestic violence policies and practices. The survey was re-administered 1 month and 6 months post-training. A fi le audit was also undertaken prior to and following the training. Results show the training improved the nurses' confi dence, practice and skills in the identifi - cation of, and response to, domestic violence, particularly in relation to children. ED nurses are well placed to identify and respond to domestic violence as the ED provides a gateway into health services for women and their children. This paper reports on a participatory action research project which aimed to improve quality and practice around DV for ED staff. The dissemination of the results in this paper are considered to be essential to health services due to dearth of information and research about best practice initiatives for responding to and recognizing domestic violence in the ED.

Keywords: domestic violence; emergency department; nursing; participatory action research; children; quality improvement

INTRODUCTION

This paper describes a quality improvement study (the project) developed to enhance the identifi cation of, and responses to, domestic violence1 in an Emergency Department (ED) within an Area Health Service. This collaborative project comprised of workers from the Violence, Abuse and Neglect Prevention Team and ED nursing staff. The Violence, Abuse and Neglect Prevention Team provide education, consultation, resources and project development on violence, abuse and neglect across the area health service. This project was aimed at improving staff awareness of domestic violence (DV) and encouraging practice developments so that nurses in the ED increased their capacity to identify women and children whose presentation may be related to these issues. The project is outlined in detail in this paper and includes information about the development of the learning materials, the training program and data collection methods. The data gathered from the ED nurses shows that as a result of their participation in this project that they felt more confi dent about their practice around working with presentations related to DV. The aim of the project was to improve staff awareness of domestic violence and encourage practice development for nurses in the ED to increase nurses' capacity to identify women and children whose presentation may be related to DV issues. The knowledge generated through this project provides opportunities to improve the quality of service in EDs to women and children who may have experienced DV. Furthermore, the ED provides an important opportunity for nurses to ask questions about DV when a woman presents to their services however, numerous researchers have found that identifi cation of DV is problematic and at most ineffective (Bonomi et al., 2006; Loxton, Schofi eld, Hussain, & Mishra, 2006). This paper therefore provides an overview of one project that provided an opportunity for nursing staff to participate in a project that increased their abilities to respond to DV. APPROPRIATENESS OF SCREENING FOR DV IN THE ED The defi nition of DV utilised for this project was derived from the NSW Health Policy which

APPROPRIATENESS OF SCREENING FOR DV IN THE ED

The defi nition of DV utilised for this project was derived from the NSW Health Policy which states 'Domestic violence is violent, abusive or intimidating behaviour carried out by an adult against a partner or former partner to control and dominate that person. It is most often violent, abusive or intimidating behaviour by a man against a woman. …