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Domestic Violence Screening by Nurses in the Primary Care Setting Karen Hetzel, PhD., PMHCNS-BC Rhode Island College Research & Evidence-Based Practice.

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Presentation on theme: "Domestic Violence Screening by Nurses in the Primary Care Setting Karen Hetzel, PhD., PMHCNS-BC Rhode Island College Research & Evidence-Based Practice."— Presentation transcript:

1 Domestic Violence Screening by Nurses in the Primary Care Setting Karen Hetzel, PhD., PMHCNS-BC Rhode Island College Research & Evidence-Based Practice Symposium Kappa Tau

2 Purpose of the Study To ascertain how nurses in primary care settings can adopt routine screening of their female patients for domestic violence into their practice.

3 Aim of the Study 1 st aim of this study was to identify barriers perceived by nurses that prevent them from routine screening of patients. Concurrently, identifying environmental facilitators as perceived by nurses in assisting them in screening for domestic violence occurred. 2 nd aim of this study was to deliver a structured educational program to primary care nurses on domestic violence and its screening and intervention.

4 Research Questions 1. What are the barriers identified in primary care settings by nurses that prevent them from effectively screening for domestic violence ? 2. What facilitates effective screening for domestic violence by nurses in the environment of primary care settings ? 3. What is the impact of a domestic violence educational program intervention delivered to nurses in primary care settings on decreasing the barriers identified by the nurses to screening for domestic violence ? 4. Does a domestic violence educational program intervention increase the identification and intervention of domestic violence by nurses in a primary care setting as compared to pre intervention conditions ?

5 Method The method was survey driven using focus groups and a structured educational program. The survey was given to ascertain a baseline of knowledge and awareness that nurses in primary care settings have about domestic violence in their practice. The focus groups explored the needs nurses have, to be able to effectively screen and intervene routinely in their daily practice.

6 Method (cont.) An established educational program was modified specifically to educate nurses in the outpatient setting derived from the survey and focus group results. The nurses who attended the program were interviewed by a research assistant following the program to evaluate the program’s effect and change in practice by the nurses related to screening, intervening and documenting domestic violence in their female patients.

7 Survey Participants n = 22 participants Sex 100% Female Race 100% White Age yo Marital Status 86% Married Education Level – 55% RNCS/NP/Midwife; 18%LPN;18% AD/Diploma; 9% BS Years in practice - 50% yrs. Practice Setting ~ 50% Pediatric; 23% Internal Medicine;18% Ob/Gyn; 9% Family Practice

8 Survey Results 68% of participants had suspected a female patient(s) to be a victim of domestic violence. 36% of participants had a female patient tell them they were a victim of domestic violence without being asked about it. 55% of participants had the opportunity to ask female patients about past or present day domestic violence and screened positive. 73% of participants had the opportunity to intervene with female patients that screened positive for domestic violence.

9 Survey Results (cont.) 50% of participants had domestic violence content in their nursing curriculum. 32% of participants had attended a CEU program on domestic violence. 73% of participants’ who had domestic violence content in their nursing curriculum or attended a domestic violence CEU program, acknowledged it influenced their practice. 45% of participants worked in facilities, presently or in the past, where screening measures for domestic violence were in place.

10 Survey Results (cont.) In order to screen routinely, the participants identified the following as essential elements within their practice sites: Questions to ask and how When and where to use them Local resources and referrals Signs and symptoms of domestic violence Office protocols for screening Outcomes for those who get help Patient rights regarding screening Teens and domestic violence Effect on children exposed to domestic violence

11 Focus Groups 2 Focus Groups were held with 5 nurses & nurse practitioners to discuss how they could adopt screening female patients for domestic violence into their daily practice. Several questions were posed regarding barriers and facilitators within their practices.

12 Focus Group Participants n = 5 participants Sex 100% Female Race 100% White Age yrs. old Marital Status 100% Married Education Level - 80% NP; 20% RN BS Years in practice - 60% yrs; 40% 6-10 yrs Practice Setting - 60% Pediatric; 20% Ob/Gyn ; 20% Internal Medicine

13 Focus Group Results In order to screen routinely, the participants identified the following as essential elements within their practice sites: Knowledge of the cycle of violence Awareness of signs & symptoms Knowledge of the best local resources Ability to stay nonjudgmental A prompt to ask ?s in patients’ charts A team approach within their practices Palm cards with information in rest rooms Available social supports for victims Knowledge of the legal process Awareness of staff as potential victims Informational literature in different languages for patient use

14 The Program Consisted of (3) one hour lunch sessions on 3 consecutive days at a pediatric practice site with lunch provided and continuing education credits given to the nurses and nurse practitioners Each of the 5 participants was given a packet of information on the domestic violence intervention program, which included the needs, suggestions and concerns from the surveys and focus groups and some content of the PVS Abuse Assessment Response Course and the AWOHNN Universal Screening for Domestic Violence

15 The Program (cont.) The content was presented in a multi-media format, with a 17- paged packet for each participant to follow, presentation of didactic content, video, role plays and question and answer periods. At the third session, environmental facilitators were given to the participants. The packet content included the following subheadings: Definition, Prevalence & Dynamics of Domestic Violence Impact on Health & Children Common Misconceptions & Presentations Barriers to Responding Screening Techniques & Guidelines Clinical Management with Referrals & Resources Documentation Medical-Legal Aspects

16 Post Intervention Interviews A research assistant individually interviewed each participant involved, one week later at the practice site. The research assistant utilized the Post- Intervention Interview Guide designed by the researcher. Five open ended & 5 closed ended questions were utilized - all related to the intervention program & domestic violence screening.

17 Themes from Post Intervention Interviews Changed practice to include screening of domestic violence with female patients More aware of domestic violence because of the education received in the intervention program Asking more appropriate questions in regards to domestic violence Being more keen in picking up warning signs & hints that domestic violence is occurring with a patient.

18 Quotes from Post Intervention Interviews “It has heightened my awareness” “I have tuned into how mom’s look, cues that are given… I’m more comfortable” “You don’t know unless you ask” “You leave the door open”

19 Research Question #1 Barriers Identified to Screening- Time constraints to screen/intervene Screening questions not on health forms Lack of knowledge of the cycle of violence Need for user-friendly domestic violence materials Lack of environmental facilitators Unawareness of local resources Language differences

20 Research Question #2 Facilitators identified for Screening- Female providers Supportive team approach to patient care Openness to learn about screening/intervening Readiness to try to incorporate it into daily practice Recognizing the need for environmental cues regarding domestic violence in primary care settings

21 Research Question #3 Impact of a domestic violence intervention program Surprise by the statistics of lifetime prevalence of domestic violence & how potentially lethal certain presentations of victims could be. Unaware of the increased danger a victim and her children is/are in when she/they decide to leave Unaware when a victim is pregnant, how the incidence of violence and homicide increases More comfortable with the knowledge of domestic violence and its components & consequently felt better prepared to screen & intervene with female patients.

22 Research Question #4 Increase identification & intervention of domestic violence by nurses in a primary care setting ~ No participants had been told by a patient that they were a victim of domestic violence by the time of the post intervention interviews. No interventions for domestic violence victims had occurred.

23 Recommendations Future studies be conducted with nurses and nurse practitioners in larger primary care settings with regard to domestic violence screening and intervention practices. Primary care settings screen all female patients for domestic violence and intervene as indicated. Protocols be adopted for domestic violence screening guidelines in individual primary care settings. All Schools of Nursing incorporate domestic violence content and development of skills into curriculums.

24 Implications for Practice If female patients are screened by nursing routinely for domestic violence in primary care settings, they may be able to end the cycle of violence and have a fresh start on life. Female patients who have been screened and provided with interventions by nursing will be safer, when they are ready to leave their abusive relationships. Screening female patients for domestic violence is an intervention in and of itself. Nursing can be a change agent and advocate its benefit and use in primary care settings.

25 References Association of Women’s Health, Obstetric and Neonatal Nurses (AWOHNN). (2003). Universal Screening for Domestic Violence, 2 nd edition. CD-ROM. Family Violence Prevention Fund (FVPF). Programs.(n.d.).Retrieved November 15, 2009, from Hetzel, K. (2004). Domestic violence screening by nurses in the primary care setting. (Doctoral dissertation, University of Rhode Island, 2004). Dissertation Abstracts International. McNutt, L., Carlson, B., Rose, I., & Robinson, D. (2002). Partner violence in the busy primary care environment. American Journal of Preventive Medicine, 22(2), Physicians for a Violent-Free Society (PVS). (2002). Abuse Assessment Response Course. CD-ROM.

26 Acknowledgements Massachusetts Nurse’s Foundation Theta Chapter at-Large Delta Upsilon Chapter at-Large Nursing Foundation of RI

27 Contact Information Karen Hetzel, PhD., PMHCNS-BC Associate Professor Rhode Island College School of Nursing 600 Mt. Pleasant Ave. FLS 134 Providence, RI


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