Implementing intimate partner violence (IPV) screening within emergency departments - Barriers, challenges and enablers experienced by intimate partner violence practice change champions.

AIM: To identify the barriers, challenges, and enablers that clinical champions experience whilst implementing Intimate Partner Violence (IPV) screening within Emergency Departments (EDs). BACKGROUND: Champions support the introduction of IPV screening within EDs. This paper shares new knowledge about IPV practice change champions: barriers, challenges and enablers they experienced in their efforts. DESIGN: Between 2017-2019, semi structured qualitative interviews were conducted with 23 individuals who identified as champions, working to introduce routine IPV in two rural tertiary hospital Emergency Departments. An interpretive framework and process of constant comparison was used to thematically analyse data from transcribed interviews. RESULTS: Champions identified barriers, challenges, and enablers that they experienced. Enablers included: support for the work of champions; champion leadership and collegiality; and training for the champion role. Challenges and Barriers included: resistance to a change in the focus of practice; and workflow and workload. CONCLUSIONS AND IMPLICATIONS: Nurse champions can effectively support IPV practice change but face certain barriers, challenges and enablers. Nurse managers can use this information to support champions to undertake their role effectively in order to better meet the needs of individuals experiencing IPV.

Emergency Department staff experiences of screening and response for intimate partner violence in a multi-site feasibility study: Acceptability, enablers and barriers.

BACKGROUND: Intimate partner violence is a lead cause of ill health and premature death among Australian women. Abused women are likely to present to Emergency Departments. Routine screening provides opportunities to identify and respond to intimate partner violence. METHODS: A six-month screening feasibility study was conducted in two rural and one urban NSW Emergency Departments. Surveys with participating nurses, medical officers and social workers, as well as focus groups with nurses and social workers were conducted at each site to understand their experience. RESULTS: Survey respondents (n = 198) agreed it was appropriate (87%) and acceptable (91%) to screen for intimate partner violence in Emergency Departments. Overall 62% of respondents suggested screening had positive impacts on womens' care. Focus group discussions with 39 nurses and social workers identified enablers of screening as: ease of use of the screening tool; availability of social work response within one hour (as per the study protocol); and executive support. Barriers were: high patient volume; lack of integration with existing processes; lack of privacy and brevity of training. CONCLUSIONS: Screening in Emergency Departments was strongly supported by health practitioners who responded to the survey. Work is needed to address competing demands, integration of screening processes, and staff training.

The role of champions in leading domestic violence and abuse practice improvement in health care: A scoping review.

AIM: To describe and synthesize evidence for champions of domestic violence practice improvement in health care and highlight implications for leadership and nurse management. BACKGROUND: Globally, health care leaders have been tasked with improving service responses to domestic violence. Evidencing the role of champions, and how managers may harness champions in improving responses to domestic violence, is an important factor in successfully leading change in this field. EVALUATION: A scoping review was conducted using four electronic databases (Proquest, PubMed, Medline and PsycINFO). KEY ISSUES: Eleven studies were included. Champion characteristics, roles, and factors influencing their impact were distilled. Barriers to the success of champions were identified as were four aspects of the champion role: mentor and expert advice; communication and engagement; strategic advocacy, coordination and project leadership; personal and emotional support. CONCLUSIONS: The review highlighted that champions involved in domestic violence project implementation have unique aspect to their role, along with characteristics reported in the broader champion literature. As an emerging field, there is evidence that domestic violence champions play an important role in mentoring and supporting health care workers to effectively change their practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers and leaders need to understand the champion construct and the roles that champions enact to generate domestic violence and abuse system and practice change. Further research is required to provide guidance.

Intimate partner violence screening and response in New South Wales emergency departments: A multi-site feasibility study.

OBJECTIVE: To test feasibility of a systematic approach to routine screening and response for intimate partner violence among women presenting to three New South Wales EDs. METHODS: This prospective feasibility study was conducted over 6 months in two rural and one major tertiary metropolitan ED in New South Wales. Women aged 16-45 years triaged category 3-5 (treat within 30 min/1 h/2 h), who could be approached privately, were screened for intimate partner violence using the validated HITS (Hurts, Insults, Threatens and Screams or Swears) tool. The follow-up protocol for patients who disclosed abuse, specified a social work/psychology (psychosocial) response within 1 h. Outcomes of interest were screening rates of eligible presentations, disclosures of abuse, psycho-social referral and responses. Interviews conducted with ED medical directors and nurse unit managers at each site explored barriers and facilitators. RESULTS: A total of 1047 women (11.4% of eligible presentations) completed screening at their first or subsequent presentation. Of 868 women screened on first presentation, 18% (n = 154) disclosed intimate partner violence, with no significant differences by age group, country of birth, triage category or time/day of arrival. Key barriers to screening were high patient volume, absence of electronic prompts and lack of privacy. Of those who screened positive 49% (n = 75) received an immediate, on-site psycho-social response. CONCLUSION: The present study demonstrates that it is both possible and relevant, given the 18% disclosure rate, to screen women in relation intimate partner violence in EDs and provide a psycho-social response within 1 h. More needs to be done to address barriers to screening to provide opportunities for early intervention.

Ready, willing and able? A survey of clinicians' perceptions about domestic violence screening in a regional hospital emergency department.

BACKGROUND: Domestic violence (DV) has significant health impacts for victims and their families. Despite evidence that routine screening increases the identification of DV and opportunities for support; routine screening is uncommon in Australian emergency departments (EDs). This study explored ED clinicians' level of support for DV screening; current screening practices; and perceived barriers and readiness to screen prior to a pilot intervention. METHODS: Census survey of 76 ED clinicians. A number of questionnaire items were generated through a review of the literature, with readiness to screen for DV assessed through the short version of the Domestic Violence Healthcare Provider Scale [1]. The confidential and anonymous online survey was hosted on the Qualtrics platform. Descriptive and comparative statistical analysis was performed using IBM SPSS version 22. RESULTS: Most clinicians supported screening for DV in the ED. In the absence of protocols, 72.3% (n=55) of clinicians reported currently engaging in case-based screening, which preferenced women with physical injury. The majority did not always feel comfortable screening for DV (79.7% n=59) and reported they had received insufficient training for this role (88.7% n=55). Lower perceived self-efficacy and fear of offending were statistically associated with discomfort or negative beliefs about DV enquiry (p=<0.05). CONCLUSION: Emergency department clinicians reported feeling ill-equipped and under-prepared to inquire about and respond to DV. These findings provide valuable insight about the training and support needs of ED clinicians prior to the commencement of routine screening in EDs.