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...' Some of the forms of domestic violence are physical abuse, sexual abuse, emotional, psychological and verbal abuse, social abuse and economic abuse (New South Wales Health Department, 2006, p. 4). Other terms in the literature which describe similar behaviours may be found describe as family violence, or interpersonal violence. The similarity between all of the terms used is the use of violent, threatening, coercive or controlling behaviour by an individual against a family member(s), or someone with whom they have, or have an intimate relationship.
This project commenced with a literature search which identifi ed theoretical positions and frameworks to assist in the development of a best practice model (for example, Hegarty, Hindmarsh, & Gilles, 2000; Koziol-McLain, Giddings, Rameka, & Fyfe, 2008; McFarlane, Groff, O'Brien, & Watson, 2006; Plichta, 2007). The main concern when undertaking this phase of the project related to undertaking any project in the ED and the longstanding discussions about whether the ED is an appropriate place to screen for DV (for example, Bacchus, Mezel, & Bewley, 2003; Hillard, 1985; Ramsay, Richardson, Carter, Davidson, & Feder, 2002; Webster, 2006; Witting et al., 2006). This project acknowledged this controversy but worked according to the clear policy guidelines on this issue within the Area Health Service. The NSW Health Policy and Procedures for Identifying and Responding to Domestic Violence does not require routine screening in the ED (NSW Health, 2003). …