Intimate partner violence screening in emergency department: a rapid review of the literature

DORIS study: domestic violence in orthopaedics, a prospective cohort study at a Swedish hospital on the annual prevalence of domestic violence in orthopaedic emergency care

BACKGROUND

Domestic violence (DV) is a major problem which despite many efforts persists globally. Victims of DV can present with various injuries, whereof musculoskeletal presentation is common.

OBJECTIVES

The DORIS study (Domestic violence in ORthopaedIcS) aimed to establish the annual prevalence of DV at an orthopaedic emergency department (ED) in Sweden.

DESIGN

Female adult patients with orthopaedic injuries seeking treatment at a tertiary orthopaedic centre between September 2021 and 2022 were screened during their ED visit.

SETTING

This is a single-centre study at a tertiary hospital in Sweden.

PARTICIPANTS

Adult female patients seeking care for acute orthopaedic injuries were eligible for the study. During the study period, 4192 female patients were provided with study forms and 1366 responded (32.5%).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was to establish the annual prevalence of injuries due to DV and second, to establish the rate of current experience of any type of DV.

RESULTS

One in 14 had experience of current DV (n=100, 7.5%) and 1 in 65 (n=21, 1.5%) had an injury due to DV.

CONCLUSIONS

The prevalence of DV found in the current study is comparable to international findings and adds to the growing body of evidence that it needs to be considered in clinical practice. It is important to raise awareness of DV, and frame strategies, as healthcare staff have a unique position to identify and offer intervention to DV victims.

The Relations Among Childhood Maltreatment and Later Intimate Partner Violence Victimization With and Without a Weapon in a Sample of Pregnant Black Individuals

Black pregnant and postpartum individuals are at risk for intimate partner violence (IPV), and those with a history of childhood maltreatment and IPV are even more likely to be re-victimized during pregnancy. However, it is unknown if specific types of child maltreatment predict later IPV with and without a weapon better than others. The current study sought to (i) document the prevalence of childhood maltreatment and IPV and (ii) examine the relations among types of childhood maltreatment and later IPV with and without a weapon within a sample of Black individuals seeking prenatal care at a large public hospital in the southeastern United States. Participants (n = 186; mean age = 27.2 years, SD = 5.3) completed measures assessing childhood maltreatment and IPV with and without a weapon. Approximately 68.5% of participants (n = 124) endorsed experiencing childhood maltreatment, while 42.6% (n = 78) endorsed experiencing IPV. The bivariate relations among five childhood maltreatment types (i.e., sexual, physical, and emotional abuse, physical and emotional neglect) and IPV with and without a weapon were assessed. All childhood maltreatment subtype scores-except childhood physical neglect-were significantly higher among participants who reported a history of IPV with or without a weapon compared to participants who denied a history of IPV with or without a weapon. Logistic regression models revealed childhood sexual abuse emerged as the only significant predictor of experiencing IPV with a weapon (B = 0.10, p = .003) and IPV without a weapon (B = 0.11, p = .001). For every point increase in childhood sexual abuse subtype score, the odds of experiencing IPV with and without a weapon increased by 10% (OR = 1.10, 95%CI [1.04, 1.18]) and 12% (OR = 1.12, [1.05, 1.20]), respectively. Findings suggest that screening for childhood sexual abuse may provide a critical opportunity for maternity care providers to identify individuals at increased risk for IPV victimization with and without a weapon.

Awareness of somatisation disorder among Swedish physicians at emergency departments: a cross-sectional survey

BACKGROUND

Somatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians' awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience.

METHODS

A web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 - January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi2 tests and Fisher's exact test.

RESULTS

Of the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness.

CONCLUSIONS

Awareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally.

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.

Stigma, social and structural vulnerability, and mental health among transgender women: A partial least square path modeling analysis

INTRODUCTION

Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring.

DESIGN/METHODS

Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress).

RESULTS

The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW.

CONCLUSION

Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts.

CLINICAL RELEVANCE

This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.

Workplace aggressions on hospital workers: A current and prevalent problem with a high demand for training

BACKGROUND

Workplace aggressions on hospital workers is a very frequent and under-reported problem.

OBJECTIVE

The novel objective of our study was to analyze the number of workplace aggressions per hospital worker. Other objectives of the study were to analyze the management knowledge and interest in receiving training on aggressions by hospital workers.

METHODS

An anonymous survey was handed out among all professionals in a university hospital.

RESULTS

A total of 1118 anonymous surveys were collected. The responders declared that throughout their working life they had suffered some sort of verbal aggression in the hospital in 766 cases (68.5%) and physical aggression in 393 cases (35.2%). Multiple logistic regression analyses found higher risk of receiving physical and verbal aggression in the nursing category and in the Emergency, Critical Care or Psychiatry Units, and a higher risk of receiving physical aggression in women. The score on the level of personal knowledge regarding the legal, physical, and psychological management of aggressions (score 0-10 for each of the 3 aspects) was 2.91±2.68 in legal management, 2.97±2.77 in psychological management and 2.91±2.76 in physical management. The opinion about the interest of receiving training (score from 0 to 10) on the legal management of hospital aggressions was 8.90±1.72, on psychological management was 8.85±1.78 and on physical management was 8.88±1.78.

CONCLUSIONS

Workplace aggression on hospital workers mainly affects women, the nursing category and the Emergency, Critical Care or Psychiatry Units. Hospital workers showed little knowledge on the topic but a great interest in receiving training.

Preparedness of Australian and British nurses and midwives about domestic violence and abuse

BACKGROUND

Domestic violence and abuse (DVA) is a major health problem that affects individuals across the world. Nurses, midwives and healthcare providers need to be confident and competent in identifying and responding to DVA.

AIMS

To measure current levels of knowledge, opinions and preparedness towards DVA and how it is managed by registered nurses and midwives residing in Australia and the UK.

METHODS

A cross-sectional study design was used. Data were collected using the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) measuring the perceived preparation and knowledge, actual knowledge, opinions and practice issues. Australian data were collected in 2018 and UK data were collected in 2017-2018. Descriptive and inferential statistics were used to analyse the data and differences in knowledge and attitudes of British and Australian nurses.

FINDINGS

Nurses and midwives (n = 368; 130 from Australia; 238 from the UK) responded to the survey. Minimal previous DVA training was reported by the participants. Participants had minimal knowledge about DVA, though had a positive attitude towards engaging with women experiencing DVA.

DISCUSSION

Most participants felt unprepared to ask relevant questions about DVA and had inadequate knowledge about available resources. Australian participants scored better than British participants; however, the mean difference in all aspects remained statistically insignificant.

CONCLUSION

Australian and British nurses and midwives have a positive attitude towards women experiencing DVA; however, the knowledge and skills to support women experiencing DVA are limited.

IMPLICATIONS FOR NURSING POLICY

Nursing institutions should develop strategic policies regarding mandatory preparation and training of nurses for domestic violence assessment and management.

A large health system's emergency department's evaluation of nurse triage questions about safe-at-home and abuse or neglect in traumatic ocular injuries

OBJECTIVES

Approximately 10 million Americans experience acts of physical violence by an intimate partner (IPV). Ocular injuries can present as a symptom of IPV in the emergency department, but IPV remains underreported in the literature. Understanding the incidence and trends in IPV-associated ocular injuries in the emergency department could increase the detection of at-risk patients otherwise overlooked.

DESIGN

Retrospective chart review.

PARTICIPANTS

Emergency department patients evaluated for traumatic ocular injuries between January 2018 and April 2023 at a large tertiary care health system.

METHODS

The study population was identified by ICD-10 code and their responses to being screened at triage for home safety and any nursing concerns for abuse or neglect. Patient screening consisted of a 2-part questionnaire inquiring first about whether the patient feels safe at home ("Yes" or "No") and second regarding nurses' concerns for abuse, neglect, domestic violence, sexual assault, or human trafficking.

RESULTS

There were 2,653,993 emergency department visits and 16,737 traumatic ocular injuries in the study period. Of them, 1.1% of patients (154 of 14,457) responded "No" to feeling safe at home. In only 0.6% of patients (82 of 14,457), a nursing concern was documented. Patients responding "No" to feeling safe at home presented with more severe ocular injuries such as maxillary fractures. On regression analysis, married, divorced, and widowed patients as well as patients on private insurance were less likely to report feeling unsafe at home than single patients on public insurance (p < 0.05).

CONCLUSION

Traumatic ocular injuries in emergency departments should raise concerns about IPV. Opportunity exists to improve education, screening, and management of these patients.

Intimate partner violence: A clinical update

ABSTRACT

Intimate partner violence (IPV) is a significant public health issue associated with substantial morbidity and mortality. NPs are ideally positioned to screen for and intervene in IPV, thereby mitigating the health risks IPV carries for women, infants, and young children. Safety planning and appropriate referrals to community-based resources are critical components of addressing IPV.

Assessment of Emergency Department Health Care Providers' Readiness for Managing Intimate Partner Violence and Correlation With Perceived Cultural Competence

INTRODUCTION

Intimate partner violence is a public health problem, and emergency departments are often a victim's only contact with health care providers. Despite this, recognition of intimate partner violence within emergency departments remains low owing, in part, to barriers experienced by providers. To better understand these barriers, this study examined relationships between readiness for managing intimate partner violence and cultural competence among emergency department health care providers.

METHODS

A cross-sectional, correlational study was conducted in 3 emergency departments. Eligible participants included registered nurses, physicians, physician assistants, nurse practitioners, and residents. Data were collected through an anonymous online self-report survey. Descriptive statistics and correlation analyses were conducted to answer study aims.

RESULTS

Our sample included 67 respondents. More than one-third (38.8%) reported no previous intimate partner violence training. Those with previous training had higher readiness scores. Physicians were found to have higher intimate partner violence knowledge scores than registered nurses. Cultural competence scores were generally positive across domains. Aspects of intimate partner violence readiness were associated with culturally competent behaviors, communication, and practices.

DISCUSSION

Overall, participants were found to have low perceived readiness scores. Those with previous intimate partner violence training were found to have greater readiness in practice, suggesting that standardization of screening practices and intimate partner violence-related training should be the standard of care. Our data also suggest that perception of culturally competent behaviors and communication are learned skills that can increase screening rates within the emergency department.

A review of the challenges of screening for domestic violence against women from the perspective of health professionals

BACKGROUND

Domestic violence has a significant effect on women's reproductive, physical, and mental health, and it is a significant threat to everyone's health, so that, it sometimes leads women to commit suicide. Although many of these women will refer to receive medical care due to domestic violence, few of them are identified by health care providers. The present study aimed to review the challenges of screening for domestic violence against women from the perspective of health professionals.

MATERIALS AND METHOD

This study is a scoping review. The study was performed in five stages, which include (1) designing the research question, (2) searching and extracting research-related studies in national and international databases such as PubMed, Scopus, Web of Science, Embase, Magiran, Scientific Information Database (SID), IranDoc and Google Scholar search engine, from inception to March 2021, (3) selecting related studies, (4) scheduling and summarizing data and information, and (5) reporting the results.

RESULTS

Out of 411 articles reviewed, 10 article met our inclusion criteria and were included. According to the results of the studies, barriers of screening for domestic violence can be classified into three areas, which include barriers related to employees (lack of knowledge and training, lack of time to conduct screening, lack of staff confidence, client judgment, and lack of security and comfort for asking related questions and forgetting employees), barriers related to the client and the prevailing culture in the society (tolerating and not reporting domestic violence, fear of spouse due to high power of men in society, fear of losing children and life, and racial and cultural issues) and barriers related to the organization (lack of necessary support from the organization, lack of funding from the organization, lack of protocol).

CONCLUSION

Considering the high number of barriers of detecting women affected by the domestic violence, this study could be used in program designation, and implementation of effective interventions to remove barriers of domestic violence screening. Health care providers can use the results of this review to prepare educational packages according to their cultural background to improve understanding and women's cooperation in the domestic violence prevention and screening programs.

Imaging of Intimate Partner Violence, From the AJR Special Series on Emergency Radiology

Intimate partner violence (IPV) is a highly prevalent public health issue with multiple adverse health effects. Radiologists are well suited to assessing a patient's likelihood of IPV. Recognition of common IPV injury mechanisms and resulting target and defensive injury patterns on imaging and understanding of differences between patients who have experienced IPV and those who have not with respect to use of imaging will aid radiologists in accurate IPV diagnosis. Target injuries often involve the face and neck as a result of blunt trauma or strangulation; defensive injuries often involve an extremity. Awareness of differences in injury patterns resulting from IPV-related and accidental trauma can aid radiologists in detecting a mismatch between the provided clinical history and imaging findings to support suspicion of IPV. Radiologists should consider all available current and prior imaging in assessing the likelihood of IPV; this process may be aided by machine learning methods. Even if correctly suspecting IPV on the basis of imaging, radiologists face challenges in acting on that suspicion, including appropriately documenting the findings, without compromising the patient's confidentiality and safety. However, through a multidisciplinary approach with appropriate support mechanisms, radiologists may serve as effective frontline physicians for raising suspicion of IPV.

Improving domestic violence screening practices in the emergency department: an Australian perspective

INTRODUCTION

Domestic violence (DV) is a major cause of morbidity worldwide. The ED is a location recommended for opportunistic screening. However, screening within EDs remains irregular.

OBJECTIVE

To examine intrinsic and extrinsic barriers to routine screening in Australian EDs, while describing actions taken after identification of DV.

METHODS

Emergency clinicians at nine public hospitals participated in an anonymous online survey. Factor analysis was performed to identify principal components around attitudes and beliefs towards screening.

RESULTS

In total, 496 emergency clinicians participated. Universal screening was uncommon; less than 2% of respondents reported screening all adults or all women. Although willing, nearly half (45%) reported not knowing how to screen. High patient load and no single rooms were 'very or severely limiting' for 88% of respondents, respectively, while 24/7 social work and interpreter services, and online/written DV protocols were top enablers. Factor analysis identified four distinct intrinsic belief components: (1) screening is not futile and could be done in ED, (2) screening will not cause harm, (3) there is a duty to screen and (4) I am willing to screen.

CONCLUSION

This study describes a culture of Queensland ED clinicians that believe DV screening in ED is important and interventions are effective. Most ED clinicians are willing to screen. In this setting, availability of social work and interpreter services are important mitigating resources. Clinician education focusing on duty to screen, coupled with a built-in screening tool, and e-links to a local management protocol may improve the uptake of screening and subsequently increase detection.

Intimate Partner Violence; Are Saudi Physicians in Primary Health Care Setting Ready to Identify, Screening, and Respond?

Introduction

Intimate partner violence (IPV) is a growing hot topic in Saudi Arabia and primary health care (PHC) physicians play a significant role in preventing it. Our objective was to assess the PHC Physicians' readiness and barriers to identify, screen, and respond to IPV in Saudi Arabia.

Methods

A cross-sectional study recruited physicians working in PHC centers in Saudi Arabia. Data was collected using a modified online self-administered questionnaire based on the PREMIS "The Physician Readiness to Identify and Manage IPV." The questionnaire consisted of respondent profile, perceived preparedness and knowledge, actual knowledge, practice issues, and opinion regarding barriers.

Results

Among 169 PHC physicians, 60.9% had never experienced any formal IPV training. Around one-fifth of participants have a good perceived and actual knowledge, whereas one-third have a good perceived preparedness. Nearly half of the participants (46.7%) do not screen for IPV and two-thirds of them (66.3%) have never identified an IPV case during the previous 6 months. The logistic regression model showed that family physicians were 2.27 times more likely to have a good knowledge than a general practitioner, and participants with IPV training were more likely to have a good level of perceived preparedness, perceived knowledge, and more likely to perform screening of IPV.

Conclusion

The low level of PHC physicians' readiness to identify and respond to IPV is worrisome. Findings emphasize the urgent need for an IPV training program, a supportive work environment, and a clear referral system in order to help the practitioner to provide comprehensive services and ensure safety plans for abused women.

Nursing students’ perception on their readiness to combat gender-based violence during the COVID-19 pandemic

Background: Gender-based violence (GBV) is a critical public health concern, demanding for global coordinated efforts. While nursing students form part of a healthcare team with significant roles in identifying and responding to abused victims, studies assessing their readiness to combat GBV are limited in Namibia.Aim: To assess undergraduate nursing students’ perceptions and to determine the relationship of the study variables to readiness to combat GBV during the coronavirus disease 2019 (COVID-19) pandemic in Namibia.Setting: This study was conducted at a university satellite campus in Namibia.Methods: A cross-sectional survey was used to collect data from 105 third and fourth-year undergraduate nursing students using ADKAR model. Data were analysed using Statistical Package for the Social Sciences, version 27.0, for descriptive statistics and logistic regression in determining relationships between study variables.Results: The study results show a mean readiness of 1.65 ± 0.19. Most respondents perceived themselves ready (73.3%), whereas 26.7% were not. Readiness was common with reinforcement (89.5%) and awareness (84.8%), knowledge (81.9%) and desire (76.2%) subscales. Predictors of readiness in this study were gender and age (R2 = 0.40; R2 = 0.37; p ≤ 0.05).Conclusion: The results of this study highlight that age and gender were significant predictors for readiness among the undergraduate students in Namibia. The results highlight the importance of GBV education in a nursing curriculum. A qualitative design is recommended for future studies.Contribution: The results of this study will support global efforts in strengthening the health system response on GBV incidences.

Preparedness to Respond to Family Violence: A Cross-Sectional Study Across Clinical Areas

Introduction

Family violence (FV) is one of the most urgent health issues of our generation. While nurses play a vital role in identifying and supporting victim/survivors of violence, little is known about nursing readiness to respond across clinical areas.

Objective

This study aimed to compare and contrast the knowledge, confidence, clinical skills, and perceived barriers of nurses across three clinical areas of a tertiary trauma hospital in Melbourne, Australia, in responding to FV.

Method

A prospective, mixed methods design was used. The nursing staff at a large trauma hospital were approached to participate. Participants completed a brief online survey to quantify clinician-reported knowledge, clinical skills, and barriers to managing FV.

Results

Two hundred and forty-two nursing staff electronically completed a brief survey to capture self-reported confidence, knowledge, clinical skills, and barriers to working effectively in the area. The descriptive analysis reflected service-wide deficits in knowledge, confidence, and self-reported clinical skills, irrespective of the work area. Deficits were identified on a background of limited structured training for FV among this cohort. Significantly higher rates of FV confidence and knowledge were identified among emergency department nurses relative to acute and subacute clinical counterparts.

Conclusion

Nurse respondents overall reported low rates of confidence, knowledge, and clinical skills in responding to disclosures of FV. Findings reinforce the need for imbedded training programs to support frontline responses.

More support, knowledge and awareness are needed to prepare emergency department nurses to approach potential intimate partner violence victims

BACKGROUND

Intimate partner violence is a global health issue. In the emergency department, patients seek help for health problems that may be related to exposure to physical, psychological or sexual violence, or controlling behaviour from a current or former partner. Of the many victims that seek care in an emergency department, few are identified, especially among those whose chief complaint is not clearly related to recent physical abuse. Not having all the facts about a patient can jeopardise patient safety and delay treatment. The aim of this study was to describe experiences of caring for adults, subjected to intimate partner violence, from an emergency nurse perspective.

METHODS

A qualitative semi-structured interview study of nine emergency care specialist nurses was conducted using content analysis.

FINDINGS

Two categories emerged: 'Subtle signs' and 'Not being enough'. The short encounters in emergency care do not allow for deep conversations. The informants highlighted the need for more knowledge about what and how to ask in that specific context. Some mentioned situations where the question had been avoided due to lack of time to handle the answer. The interviews revealed the importance of regular discussions to increase awareness of intimate partner violence and its prevalence among patients.

CONCLUSIONS

The organisation plays an important role in putting the question about intimate partner violence on the daily agenda and giving time to emergency nurses and other professions for training and reflection.

The elephant in the room: Intimate partner violence, women, and traumatic brain injury in sub-Saharan Africa

Background

Intimate partner violence (IPV) is a gendered form of violence that has been linked with traumatic brain injury (TBI). The prevalence of IPV in sub-Saharan Africa (SSA) is estimated to be one of the highest globally. Yet, little is known about the association between IPV and TBI in the SSA context. In this scoping review, we examine the intersection between IPV and TBI in SSA to identify gaps, as well as intervention opportunities.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Review (PRISMA-ScR) guidelines to guide our analyses and reporting, we searched for published articles indexed in the four largest and most comprehensive library databases: Pubmed, Embase, Web of Science and PsychInfo. Given the increasing attention that has been placed on gender disparities and health in recent years, we focused on studies published between 2010 and 2021.

Results

Our search yielded 5,947 articles and 1,258 were IPV and SSA related. Out of this, only ten examined the intersection between IPV and TBI. All focused on outcomes in female populations from South Africa (n = 5), Ghana (n = 3), Uganda (n = 1), and Cameroon (n = 1). They were a mix of qualitative studies (n = 3), neuro-imaging/biomarker studies (n = 3), case studies/reports (n = 2), quantitative surveys (n = 1) and mixed qualitative/quantitative study (n = 1). Six studies evaluated subjective reporting of IPV-induced TBI symptoms such as headaches, sleep disruptions, and ophthalmic injuries. Three examined objective assessments and included Hypothalamic-Pituitary-Adrenal (HPA) dysregulation detected by salivary cortisol levels, magnetic resonance imaging (MRI) including diffusion tensor imaging (DTI) to evaluate brain connectivity and white matter changes. One final study took a forensic anthropology lens to document an autopsy case report of IPV-induced mortality due to physical head and face trauma.

Conclusion

Our findings demonstrate that both subjective and objective assessments of IPV and TBI are possible in “resource-limited” settings. The combination of these outcomes will be critical for viewing IPV through a clinical rather than a cultural lens, and for substantiating the assertion that gender, is indeed, a social determinant of brain health.

Measuring Nurses' and Physicians' Attitudes and Perceptions of the Appropriate Interventions towards Intimate Partner Violence in Saudi Arabia

Background: Intimate partner violence (IPV) is considered the most common form of violence against women worldwide, concerning public health, safety, and human rights. However, little to no studies in Saudi Arabia have explored the attitude and perception of health care providers working in emergency departments toward IPV. This study aimed to measure the attitude and perception of Emergency Room (ER) health care providers towards the appropriate intervention for IPV. Methods: This is a cross-sectional quantitative study. Data was collected from a convenient sample of nurses (n = 88) and physicians (n = 18) working in ER, using Readiness to Manage Intimate Partner Violence Survey (PREMIS). Data was collected from two hospitals in Riyadh, Saudi Arabia, and descriptive analysis was used to analyze the data. Results: The majority of the respondents were aged 18−40 (n = 106, 78%), while 22% were 41−60 years old, 69% were female, and 31% were male. Eighty-five percent were nurses and 15% were physicians. The majority of the respondents did not have any training on IPV and had gained knowledge or skills mostly during their medical/nursing classroom and clinical training. The analysis revealed that the participants had moderate levels of overall preparedness, knowledge about IPV, and perceived knowledge, with a mean score of 2.30, 18.62, and 2.18, respectively. The respondents had low scores in practice issues in new diagnosis (0.91), current screening (1.69), and actions when IPV is identified (0.91). The perceived preparedness and knowledge have a significant positive correlation, as shown by an r value of 0.8476 and a p-value of <0.05. Conclusion: The study shows that participants stated minimal previous IPV knowledge and training. It is necessary to put in place adequate resources and specific training programs to overcome this issue for both ER nurses and physicians.

“The Average Counsellor Wouldn’t Know”: Exploring How General Health Practitioners Understand and Respond to Domestic Violence

Background

Individuals experiencing and perpetrating intimate partner violence (IPV) are frequently in contact with general health and mental health services. Health service providers, including nurses, thus have a key role in identifying and responding to initial indicators of IPV risk.

Purpose

The present study provides descriptive information about current assessment and intervention practices of health and mental health service providers when patients are presenting with concerns about IPV.

Methods

A secondary data analysis of interviews with general health practitioners (n = 17) were coded and dominant themes analyzed through thematic analysis.

Results

The present study uncovered ways in which IPV-related risks are, and are not, recognized and responded to. A metaphorical visual display in the form of a “domestic violence supply room” depicts the level of access and degree of competency described by practitioners in respective areas of practice. Within reach for all practitioners is the knowledge of factors that increase risk and vulnerability to IPV. Out of reach is a comprehensive understanding of the needs of children and perpetrators as well as the consistent ability to consider intersectionality and be reflexive when working with culturally and linguistically diverse populations. The step ladder to improved IPV response, including formal supports such as training and procedures, is frequently described as lacking.

Conclusions

A consistent and empirically supported approach to IPV assessment and response is rare to find across generalist service provision. Although service providers possess basic knowledge of risk factors, organizational direction is needed to allow providers to address IPV confidently and effectively.

The influence of an educational intervention on nursing students' domestic violence knowledge and attitudes: a pre and post intervention study

Background

Nurses, as the largest group of health professionals, have a key role in recognising, mitigating and preventing domestic violence. However, studies demonstrating effective undergraduate educational interventions are lacking. The research aim was to compare undergraduate nursing students’ knowledge and attitudes about domestic violence before and after an educational intervention on domestic violence and explore their views on the most useful teaching strategies.

Methods

A quasi-experimental pre and post design was used to determine the impact of an educational intervention. Australian nursing students enrolled in a first-year undergraduate subject were invited to participate. The educational intervention included a 40-min pre-recorded lecture on domestic violence, and a two-hour face-to-face workshop facilitated by an expert, supported by readings. Students completed a pre- and post-intervention online anonymous survey using a validated instrument, the Inventory on Beliefs and Attitudes towards Domestic Violence. Wilcoxon signed rank tests were used to compare pre and post intervention results.

Results

Approximately 400 students completed the voluntary workshop; 198 students completed the pre survey, 176 completed the post survey and 59 (13.1%) completed both. Post intervention, participants indicated stronger agreement on 15 of 22 items. The inventory score became significantly more positive (Z = -3.196, p = .001, CI -.206—-0.067) post intervention. Of the 173 students who indicated post intervention which forms of education they found useful, 38.2% considered face-to-face tutorials to be the most useful education modality.

Conclusions

This study demonstrates the effectiveness of even a small educational intervention in changing attitudes, and creating awareness and knowledge of the context, prevalence, perpetrators, and significant associated burden of illness related to domestic violence, and nurses’ responsibility to support victims.

Impact of mild traumatic brain injury on physical, mental and cognitive functioning of abused women admitted to emergency units

Limited studies exist on women's mild traumatic brain injury received from episode of intimate partner violence. This study aims to identify the occurrence of intimate partner violence-related mild traumatic brain injury in Chinese women admitted to emergency units; and examine the physical, mental, and cognitive functioning of abused women with mild traumatic brain injury related to violent episodes. Eighty-six Chinese abused women presenting at emergency units in four major local hospitals in Hong Kong between January 2014 and December 2016 were recruited. They were admitted for the treatment of intimate partner violence-related physical injuries and were screened for traumatic brain injury by the emergency unit nurses at triage. Participants were assessed for traumatic brain injury based on the definition from US Center for Disease Control and Prevention, post-concussion physical symptoms, anxiety and depression, health-related quality of life, and cognitive functioning. Structured multiphase regression was used to examine the impact of intimate partner violence-related mild traumatic brain injury on physical, mental, and cognitive functioning of participants. We found that 24.4% of participants had intimate partner violence-related mild traumatic brain injury. There were significantly more severe post-concussion physical symptoms in abused women with intimate partner violence-related mild traumatic brain injury than those without mild traumatic brain injury (estimate = 18.7, 95% CI = 10.9 to 26.6, p < 0.001). The Mental Component Summary was also significantly associated with intimate partner violence-related mild traumatic brain injury (estimate = -7.9, 95% CI = -13.8 to -2.1, p = 0.009). Regarding cognitive functioning, the mean total test scores indicated that both groups were cognitively abnormal and there was no significant impact from mild traumatic brain injury. This study provides evidence on the impact of mild traumatic brain injury and implications in screening for mild traumatic brain injury and early intervention for improving quality of life in abused women.

What Are We Missing?: Evaluating an Intimate Partner Violence Screening Program in a Pediatric Emergency Department

OBJECTIVES

Our study sought to explore and assess pediatric emergency department (ED) health care providers' knowledge, attitudes, and behaviors surrounding an existing intimate partner violence (IPV) screening program 4 years after initial implementation.

METHODS

We used anonymous electronic surveys and telephone interviews to obtain provider perspectives using a mixed-methods analysis. We used χ2 tests to analyze the quantitative survey results, and an unstructured qualitative approach to analyze the telephone interviews.

RESULTS

We analyzed 141 survey responses, which correlated to a response rate of about 35% of all the providers reached, and 20 telephone interviews. Our results demonstrate that pediatric ED providers have some knowledge of our existing caregiver IPV screening program in the pediatric ED and universally endorse routine caregiver IPV screening, which both are suggestive of postimplementation cultural shifts. However, reported provider behaviors still indicate selective/targeted screening. For example, many providers reported screening males and nontraditional caregivers less often compared with female caregivers. Reported barriers potentially explaining such screening habits mirror those in existing literature: patient acuity, time, multiple caregivers being present, and more.

CONCLUSIONS

Our study indicates that more research must be done to assess root causes of provider barriers to IPV screening in pediatric ED settings because trainings and a long-standing program do not seem to be changing screening practices. Addressing these issues may lead to truly sustainable and effective IPV screening programs in pediatric ED settings.

Intimate partner violence: analysis of current screening practices in the primary care setting

BACKGROUND

Intimate partner violence (IPV) is a largely undetected occurrence in the United States reported by 36-50% of women in their lifetime and associated with extensive physical and psychological implications. Currently, conflicting recommendations exist regarding screening practices with the United States Preventative Services Task Force (USPSTF) and the World Health Organization (WHO) advocating for and against universal screening, respectively. With research suggesting that women are seldom asked about IPV during clinic visits, further information is needed regarding current screening practices.

OBJECTIVES

To identify current IPV screening approaches in the primary care setting and factors that may impact screening completion.

METHODS

We retrospectively examined patients presenting for annual examinations at four university-associated primary care clinics in southeast Florida (n = 400). Patient demographics, screener demographics, screening completion, and screening results were collected from the medical record. Results were compared to depression and anxiety screenings due to comparable prevalence and screening recommendations. Pearson chi square and Fisher exact tests were utilized to compare screening rates by demographic characteristics.

RESULTS

IPV screening occurred at a much lower frequency (8.5%) compared to screenings for anxiety (37.3%) and depression (71.3%). Among documented IPV screenings, 64.7% of encounters resulted in patient refusal to be screened. Screening rates were found to be marginally impacted by patient ethnicity (P = 0.052).

CONCLUSIONS

Findings of both low screening rates and low screening success raise significant concerns for the shortcomings of advocating for universal IPV screening. Therefore, additional studies are necessary to identify covert barriers to screening completion before universal inquiry is advised.

Identifying domestic violence and sexual assault presentations at a regional Australian hospital emergency department: Comparative analysis of domestic violence and sexual assault cases

Objective:

To map the main characteristics of and differences between domestic violence and sexual assault cases presenting to a hospital emergency department in Australia.

Methods:

This retrospective observational cross-sectional study presents a snapshot of domestic violence and sexual assault cases presenting to the emergency department of a regional tertiary Australian hospital between 1 January 2018 and 31 December 2018. Data were extracted from the health district electronic information system for all eligible females. All data were checked for completeness and discrepancies by researchers before analysis.

Results:

42/105 (40%) sexual assault cases and 27/56 (48%) domestic violence cases reported mental health issues. More than half of the sexual assault and domestic violence cases had recurrent presentations to emergency department (51%; 54/105% and 52%; 29/56, respectively); most injuries were classed as severe. 92/105; 88% of sexual assault and 41/56; 73% of domestic violence victims were referred to related services.

Conclusion:

Clinical health staff, particularly those working in emergency department, can play crucial roles in identifying cases of domestic violence and sexual assault. Domestic violence training for clinicians and routine domestic violence screening in hospital emergency department is recommended to enhance early intervention.

Do You Believe Your Partner is Capable of Killing You? An Examination of Female IPV Survivors' Perceptions of Fatality Risk Indicators

Advocates in the field of intimate partner violence (IPV) have started to more actively engage survivors around their own perceptions of their lethality risk, as well as assist them in developing strategies for reducing and managing risk related to reassault and intimate partner homicide (IPH). Although research has examined the risk factors most associated with risk and utilized this information in the development and validation of risk assessment tools to be used with survivors, less is known about which indicators survivors most associate with lethality risk. This study aims to fill this gap by examining which risk indicators IPV survivors associate with fatality risk. Classification and regression tree analyses were used to differentiate between women who believed their partners were capable of killing them and those who did not. Data on a sample of 213 survivors of IPV used in this analysis were collected as part of a larger study in which a risk assessment instrument was piloted across four counties within New Jersey in 2016. More than three fourths of participants believed that their abuser was capable of killing them. Alhough the majority of survivors in the study felt as though their abusers were capable of killing them, there was variation in how survivors prioritized risk indicators. Factors associated with fatality risk included: (a) prior homicide threats; (b) whether the abusers had control over survivors' daily activities; (c) abusers' access to a gun; and (d) abusers' drug use. Findings suggest that IPV survivors need targeted intervention strategies around IPH, particularly those at higher perceived risk levels given the presence of risk indicators and their perceptions of lethality threat.

Design and Evaluation of a Curriculum on Intimate Partner Violence for Medical Students in an Emergency Medicine Clerkship

PURPOSE

Intimate partner violence (IPV) is a widespread public health issue that is relevant to all areas of medicine. Patients who suffer from IPV often contact the health care system via the emergency department, making this a particularly important but too often overlooked issue in this setting. Education on IPV varies in medical schools and emergency medicine (EM) educational programs, and evidence suggests that a barrier to assessing for IPV is a lack of adequate training of clinicians. In this study, we sought to design, implement and evaluate the efficacy of a curriculum on IPV geared towards medical students on an EM clerkship.

METHODS

We assembled a multi-disciplinary team of EM education faculty, a resident content expert on IPV, and social workers to design a two-part curriculum that was administered to medical students on an EM clerkship. The curriculum involved a 20-minute narrated slide presentation viewed asynchronously, followed by a 1-hour case-based discussion session. The curriculum was evaluated using a 13-item self-assessment survey on knowledge, comfort level and skill in managing victims of IPV, administered electronically before and after the curriculum. Survey results were compared pre- and post-curriculum using Wilcoxon signed-rank test.

RESULTS

Thirty-four students completed the curriculum and 26 completed both the pre and post self-assessment surveys. A statistically significant improvement in knowledge, comfort level and skills was observed in 11 of the 13 survey elements.

CONCLUSION

Based on the self-assessment survey results, this curriculum was well received and successfully increased participants' comfort, knowledge and skill level regarding assessment of patients for IPV. This is a focused and feasible curriculum that can be easily incorporated into an EM clerkship to provide effective education on a relevant but often overlooked topic.

Assault-injured youth in the emergency centres of Khayelitsha, South Africa: A prospective study of recidivism and mortality

INTRODUCTION

Violence is a major cause of death worldwide among youth. The highest mortality rates from youth violence occur in low and middle-income countries (LMICs). We sought to identify risk factors for violent re-injury and emergency centre (EC) recidivism among assault-injured youth in South Africa.

METHODS

A prospective follow up study of assault injured youth and controls ages 14-24 presenting for emergency care was conducted in Khayelitsha, South Africa from 2016 to 2018. Sociodemographic and behavioral factors were assessed using a questionnaire administered during the index EC visit. The primary outcomes were return EC visit for violent injury or death within 15 months. We used multivariable logistic regression to compute adjusted odds ratios (OR) and 95% confidence intervals (CI) of associations between return EC visits and key demographic, social, and behavioral factors among assault-injured youth.

RESULTS

Our study sample included 320 assault-injured patients and 185 non-assault-injured controls. Of the assault-injured, 80% were male, and the mean age was 20.8 years. The assault-injured youth was more likely to have a return EC visit for violent injury (14%) compared to the control group (3%). The non-assault-injured group had a higher mortality rate (7% vs 3%). All deaths in the control group were due to end-stage HIV or TB-related complications. The strongest risk factors for return EC visit were prior criminal activity (OR = 2.3, 95% CI = 1.1-5.1), and current enrollment in school (OR = 2.1, 95% CI = 1.0-4.6). Although the assault-injured group reported high rates of binge drinking (73%) at the index visit, this was not found to be a risk factor for violence-related EC recidivism.

DISCUSSION

Our findings suggest that assault-injured youth in an LMIC setting are at high risk of EC recidivism and several sociodemographic and behavioral factors are associated with increased risk. These findings can inform targeted intervention programs.

Screening for intimate partner violence in healthcare settings: An implementation-oriented systematic review

Background

Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. Screening for IPV within healthcare settings can identify women who experience IPV and inform counseling, referrals, and interventions to improve their health outcomes. Unfortunately, many screening programs used to detect IPV have only been tested in research contexts featuring externally funded study staff and resources. This systematic review therefore investigated the utility of IPV screening administered by frontline clinical personnel.

Methods

We conducted a systematic literature review focusing on studies of IPV screening programs for women delivered by frontline healthcare staff. We based our data synthesis on two widely used implementation models (Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] and Proctor's dimensions of implementation effectiveness).

Results

We extracted data from 59 qualifying studies. Based on data extraction guided by the RE-AIM framework, the median reach of the IPV screening programs was high (80%), but Emergency Department (ED) settings were found to have a much lower reach (47%). The median screen positive rate was 11%, which is comparable to the screen-positive rate found in studies using externally funded research staff. Among those screening positive, a median of 32% received a referral to follow-up services. Based on data extraction guided by Proctor's dimension of appropriateness, a lack of available referral services frustrated some efforts to implement IPV screening. Among studies reporting data on maintenance or sustainability of IPV screening programs, only half concluded that IPV screening rates held steady during the maintenance phase. Other domains of the RE-AIM and Proctor frameworks (e.g., implementation fidelity and costs) were reported less frequently.

Conclusions

IPV is a population health issue, and successfully implementing IPV screening programs may be part of the solution. Our review emphasizes the importance of ongoing provider trainings, readily available referral sources, and consistent institutional support in maintaining appropriate IPV screening programs.

Plain language abstract

Intimate partner violence (IPV) is a population health problem affecting millions of women worldwide. IPV screening and response can identify women who experience IPV and can inform interventions to improve their health outcomes. Unfortunately, many of the screening programs used to detect IPV have only been tested in research contexts featuring administration by externally funded study staff. This systematic review of IPV screening programs for women is particularly novel, as previous reviews have not focused on clinical implementation. It provides a better understanding of successful ways of implementing IPV screening and response practices with frontline clinical personnel in the context of routine care. Successfully implementing IPV screening programs may help mitigate the harms resulting from IPV against women. Findings from this review can inform future efforts to improve implementation of IPV screening programs in clinical settings to ensure that the victims of IPV have access to appropriate counseling, resources, and referrals.

Intimate partner violence (IPV) in male and female orthopaedic trauma patients: a multicentre, cross-sectional prevalence study

OBJECTIVES

Identify the proportion of patients attending fracture clinics who had suffered intimate partner violence (IPV) within the past year.

DESIGN

Powered cross-sectional study using validated participant self-reported questionnaires.

SETTING AND PARTICIPANTS

Adult trauma patients (no gender/age exclusions) attending one of three Scottish adult fracture clinics over 16-month period (from October 2016 to January 2018).

PRIMARY OUTCOME MEASURE

Number of participants answering 'yes' to the Woman Abuse Screening Tool question: 'In your current relationship over the past twelve months, has your partner ever abused you physically/emotionally/sexually?'

RESULTS

Of 336 respondents, 46% (156/336 known) were women with 65% aged over 40 (212/328 known). The overall prevalence of IPV within the preceding 12 months was 12% 39/336) for both male and female patients. The lifetime prevalence of IPV among respondents was 20% (68/336). 38% of patients who had experienced IPV within the past 12 months had been physically abused (11/29). None of the patients were being seen for an injury caused by abuse. Two-thirds of respondents thought that staff should ask routinely about IPV (55%, 217/336), but only 5% had previously been asked about abuse (18/336).

CONCLUSIONS

This is the first study worldwide investigating the prevalence of IPV in fracture clinics for both male and female patients. 12-month prevalence of IPV in fracture clinic patients is significant and not affected by gender in this study. Patients appear willing to disclose abuse within this setting and are supportive of staff asking about abuse. This presents an opportunity to identify those at risk within this vulnerable population.

Emergency department nurses experiences of female domestic violence presentations: A review of the qualitative literature

Domestic violence (DV) is a prominent social problem involving upwards of 30% of women and in most cases, it is often the emergency department (ED) that is the first point of call. This qualitative review aimed to explore and describe ED nurses experiences of DV presentations. A search of the qualitative literature was undertaken between 2000 and 2019. This review was performed using a three-stage process of thematic synthesis. For papers to be included each paper must have described a qualitative account of ED nurses' experiences of DV presentations. Ten papers met the inclusion criteria. Three themes emerged from the papers reviewed-feeling devastated in a world of helplessness and hopelessness; the anger of indifference; and grieving the pain and suffering. These included feelings of anger, rage, depression, guilt, helplessness, sadness, hopelessness, and cynicism. In conclusion, the emotional burden of care in supporting and protecting victims of DV can be immense for the nurses involved. This can lead to ED nurses distancing themselves from the patient as a means of emotional self-protection as well as increasing compassion fatigue as a result of secondary vicarious trauma.

Targeted HIV screening in the emergency department

Despite considerable improvement in human immunodeficiency virus (HIV) knowledge and treatment in the last 3 decades, the overall number of people living with HIV (PLHIV) is still rising with up to one quarter being unaware of their HIV status. Early HIV diagnosis and treatment prolongs life, reduces transmission, improves quality of life, and is a cost-effective public health intervention. The emergency department (ED) sees a large number of patients from marginalized and traditionally underserved populations in whom HIV is known to be more prevalent and who may not attend traditional services because of either cultural reasons or because of a chaotic lifestyle. This article discusses the two main approaches to screening; 'Opt-out' screening offers testing routinely in all clinical settings, and 'Targeted' screening offers testing to individuals presenting with indicator conditions. There are many studies of 'Opt-out' ED HIV screening in urban areas of high-HIV prevalence. However, little is known about the effectiveness of 'targeted' HIV screening, especially in areas of low prevalence. This review discusses the background to HIV screening in the ED and reviews the evidence around 'targeted' HIV screening in adult EDs in different HIV prevalence settings, concluding that targeted HIV screening at the ED can be impactful, cost-effective, and well accepted in the ED population, but its long-term implementation requires extra funding and increased staffing resource limiting its application in low resource setting. Despite most evidence being from areas of high-HIV prevalence, targeted screening might also be appropriate in low-HIV prevalence areas.

Sexist Myths Emergency Healthcare Professionals and Factors Associated with the Detection of Intimate Partner Violence in Women

This study analysed the capacity of emergency physicians and nurses working in the city of Granada (Spain) to respond to intimate partner violence (IPV) against women, and the mediating role of certain factors and opinions towards certain sexist myths in the detection of cases. This is a cross-sectional study employing the physician readiness to manage intimate partner violence survey (PREMIS) between October 2020 and January 2021, with 164 surveys analysed. Descriptive and analytical statistics were applied, designing three multivariate regression models by considering opinions about different sexist myths. Odds ratios and 95% confidence intervals (CIs) were considered for the detection of cases. In the past six months, 34.8% of professionals reported that they had identified some cases of IPV, particularly physicians (OR = 2.47, 95% CI = 1.14–5.16; OR = 2.65, 95% CI = 1.26–5.56). Those who did not express opinions towards sexist myths related to the understanding of the victim or the consideration of alcohol/drug abuse as the main causes of violence and showed a greater probability of detecting a case (NS) (OR = 1.26 and OR = 1.65, respectively). In order to confirm the indicia found, further research is required, although there tends to be a common opinion towards the certain sexual myth of emergency department professionals not having an influence on IPV against women.

The Role of Targeted HIV Screening in the Emergency Department: A Scoping Review

BACKGROUND

Human immunodeficiency virus (HIV) infection continues to expand worldwide, and a significant proportion of infection is still undiagnosed. Recent studies have addressed the impact and feasibility of 'opt-out' HIV screening in Emergency Departments (EDs) in urban settings at high HIV prevalence, whereas little is known about the yield of implementing 'targeted' HIV testing, especially in low-prevalence areas.

OBJECTIVE

The present study undertakes a scoping review of research carried out on the implementation of targeted HIV screening of adult in EDs to determine the impact, feasibility and acceptability of HIV testing in different HIV prevalence settings.

DESIGN

Online databases (EMBASE, MEDLINE) were used to identify papers published between 2000 to 2020. A three-concept search was employed with HIV (HIV, Human immunodeficiency virus infection, HIV infections), targeted testing (Target, screening or testing) and emergency medicine (Emergency Service, emergency ward, A&E, accident and emergency or Emergency Department) (28^th February 2020). Only full-text articles written in English, French, Spanish or Italian and using impact and/or feasibility and/or acceptability of the program as primary or secondary outcomes were analysed.

RESULTS

The search provided 416 articles. Of these, 12 met inclusion criteria and were included in the final review. Most of the included studies were carried out in the United States (n=8; 67%) and in areas of high HIV prevalence (n=11; 92%). Three (20%) were randomized control studies. While the rate of newly diagnosed HIV cases varied widely (0.03-2.2%), likely due to methodological heterogeneity between studies, the linkage of new HIV diagnosis was often high (80-100%) and median CD4+ cell count was always greater than 200 cells per microliter. Targeted HIV screening was found to be cost-effective (out of 2 studies) and well accepted by participants (out 2 studies).

CONCLUSIONS

Targeted HIV screening at the ED can be impactful, feasible and well accepted, but often requires extra funding and staff. Most previous work has focused on areas of high disease prevalence.

Investigating the prevalence of intimate partner violence victimisation in women presenting to the emergency department in suicidal crisis

OBJECTIVE

To investigate the prevalence of intimate partner violence (IPV) and frequency of victimisation questioning by hospital staff in women presenting to EDs for suicide-related complaints and injuries.

METHODS

A cross-sectional survey design was used to assess IPV and ED experiences among women with a recent (<18 months) suicide-related presentation to EDs within six Local Health Districts across New South Wales. Women aged 16 years and over, residing in participating health districts were recruited in-person by hospital staff, or via Facebook advertisements. Variables assessed included demographic characteristics, psychosocial assessment coverage and exposure to IPV (Composite Abuse Scale [Revised]-Short-Form). Binary logistic regression was used to test for independent associations between variables on victimisation questioning by hospital staff.

RESULTS

A total of 563 women completed questionnaires following presentation to the ED for a suicide attempt (n = 329; 58%) or suicide crisis (n = 234; 42%). Of these, 200 women (36%) reported IPV exposure in the 18 months prior and 141 women (25%) reported earlier lifetime victimisation. Of the 341 women with a history of IPV, 155 women (45%) were asked about victimisation by hospital staff. Younger age and lower socio-economic status were significantly associated with questioning (P = 0.03).

CONCLUSION

Findings suggest a large proportion of women seeking support for suicide in the ED are affected by IPV, although few are asked about abuse experiences. Victimisation is associated with complex health issues and heightened mortality risk, which carry important implications for patient-care. Findings support routine ED screening and can be applied to stratify risk within IPV responses.

A Brief Depression and Anxiety Rating Scale for Sexual Violence Victims

OBJECTIVE

This study aimed to develop a brief self-report measure of depressive and anxiety symptoms in victims of sexual violence.

METHODS

The sample, which consisted of 215 victims and 255 healthy controls, was recruited between December 2016 and November 2018 from eight Sunflower Centers. Eligible items were selected from existing scales of depression (CES-DC and CES-D) and anxiety (SAI-C and BAI) symptoms by item-total correlation coefficients and item response theory (IRT) analysis. Internal consistency coefficients were computed and the receiver operating characteristics curve was inspected to assess the validity of the brief scale and determine optimal cutoff scores.

RESULTS

The brief scales showed high internal consistency across all age groups. The optimal cutoff score of brief depression scale was 1.5 for children, 2.5 for adolescents, and 2.5 for the adults. That of brief anxiety scale was 8.5, 6.5, and 3.5, respectively.

CONCLUSION

The results underscore the need for age-appropriate screening measures of depressive and anxiety symptoms in victims of sexual violence.

Intimate Partner Violence Screening in the Emergency Department: A Quality Improvement Project

INTRODUCTION

Intimate partner violence is a serious public health issue that can be addressed through identification and early intervention. Although screening for intimate partner violence in health care settings is recommended by medical and nursing organizations, it is underperformed. The project objectives were to increase intimate partner violence screening rates, identification, and the referrals/resources provided.

METHODS

This project was a quality improvement intervention. Intimate partner violence screening training was provided to emergency nurses along with a computer prompt for screening in the emergency department, with a standard referral process to a social service agency. The project data included patient ED visits, partner violence screening rates, positive and negative screening rates, and the number of referrals/resources provided to the patients.

RESULTS

There was no increase in the screening rates (28%). Although the screening rates varied considerably from week to week, the highest rate of screening was during the intimate partner violence training week. Pre- and postintervention data showed a significant increase in the number of positive screens obtained per week after the nurse intimate partner violence training (7.80 vs 5.22, t = -4.33, P < 0.01). In addition, the referrals/resources provided to the patients doubled from 9 to 18 after the training, which is clinically significant for patient care.

DISCUSSION

This project demonstrates that nurse training along with a computer prompt intervention and standard referral process can contribute to intimate partner violence identification and the referrals/resources provided to the patients. Ultimately, the patients exposed to partner violence may benefit from increased identification and delivery of the referrals/resources.

Condições que interferem no cuidado às mulheres em situação de violência conjugal

Resumo Objetivo conhecer as condições que interferem no cuidado às mulheres em situação de violência conjugal. Métodos estudo qualitativo ancorado na Teoria Fundamentada nos Dados. Foram realizadas entrevistas, entre fevereiro e dezembro de 2019, com 31 profissionais de saúde atuantes em Unidades de Saúde da Família de um município do Nordeste brasileiro, as quais integraram um dos dois grupos amostrais (profissionais da Estratégia de Saúde da Família e Núcleo de Apoio à Saúde da Família). Resultados os elementos que interferem no cuidado à mulher em situação de violência conjugal foram representados nas categorias: Entendendo a importância da atuação profissional organizada; Reconhecendo a necessidade de preparo profissional para enfrentamento da violência conjugal; Percebendo a essencialidade do fluxo de atendimento intersetorial. Considerações finais e impactos para a prática o estudo revelou que o cuidado à mulher em situação de violência conjugal perpassa pelo preparo profissional, pela organização dos serviços de saúde e um fluxo de atendimento articulado e intersetorial. Nesse sentido, oferece subsídios que podem orientar gestores para a elaboração ações de identificação e enfrentamento da violência conjugal contra a mulher, pautadas na coparticipação e corresponsabilização das trabalhadoras da Estratégia de Saúde da Família, com fins em melhorias na assistência ofertada.

Process evaluation of a systemic intervention to identify and support partner violence survivors in a multi-specialty health system

BACKGROUND

Intimate partner violence (IPV) is highly prevalent in the United States and impacts the physical and mental health and social well-being of those who experience it. Healthcare settings are important intervention points for IPV screening and referral, yet there is a wide range of implementation of IPV protocols in healthcare settings in the U.S., and the evidence of the usefulness of IPV screening is mixed. This process evaluation investigates the facilitators and barriers to implementing Coordinated Care for IPV Survivors through the M Health Community Network ("M Health Network"), an intervention that aimed to standardize IPV screening and referral in a multi-specialty clinic and surgery center (CSC). Two validated IPV screens were introduced and mandated to be done by rooming staff at least once every 3 months with all clinic patients regardless of gender; the Humiliation Afraid Rape Kick (HARK) for presence of IPV and the shortened Danger Assessment (DA-5) for lethality of IPV. Upon a positive screen, the patient was offered immediate informational resources and, if willing, was referred to a social worker for care coordination with a community organization.

METHODS

Semi-structured, individual and group process interviews with clinic managers and clinic staff at 8 CSC clinics (N = 24) were undertaken at 3,12, and 27 months after intervention start. Semi-structured interviews were undertaken with the research team (N = 3) post-implementation. A Consolidated Framework for Implementation Research (CFIR) codebook was used to code data in two rounds. After each round, thick description was used to write detailed and contextual descriptions of each code. Facilitators and barriers to implementation were identified during the second round of thick description.

RESULTS

Facilitators to implementation were clinic staff support, dedication, and flexibility and research team engagement. Barriers were lack of prioritization, loss of intervention champions, lack of knowledge about intervention protocol and resources, staff and patient discomfort discussing IPV, and operational issues with screen technology.

CONCLUSIONS

The IPV protocol was implemented, but faced common barriers. CFIR is a complex, but comprehensive, tool to guide process evaluation for IPV screening and referral interventions in health systems in the U.S.

Physician attitudes on buprenorphine induction in the emergency department: results from a multistate survey

STUDY OBJECTIVE

Emergency Departments (ED) are rapidly becoming an important location for initiation of buprenorphine (EDBUP) for the treatment of opioid use disorder (OUD). Previous investigations of emergency medicine physicians' perceived barriers and attitudes toward EDBUP exclusively sampled from urban, academic-affiliated physicians. We administered a multistate survey to an institutionally and geographically diverse collection of emergency medicine physicians to better understand the professional opinions of EDBUP implementation across a variety of practice settings.

METHODS

This cross-sectional survey study used an online survey instrument to convenience sample emergency medicine physicians. In order to sample from various practice environments, participants were identified from (1) statewide ACEP chapters and (2) Facebook groups exclusive to emergency medicine physicians. The survey explored physicians' attitudes of EDBUP adoption and the perceived barriers to doing so.

RESULTS

162 emergency medicine physicians completed the survey. 76% of respondents agreed that emergency medicine physicians should offer EDBUP in the treatment of OUD. When stratified by practice setting and X-waiver status, 96% of X-waivered physicians, 73% of academic physicians, 49% of non-academic physicians, and 34% of non-X-waivered physicians felt comfortable initiating EDBUP. Lack of access to outpatient MOUD referral was the most frequently cited barrier to EDBUP across all practice settings.

CONCLUSIONS

An institutionally and geographically diverse group of emergency medicine physicians endorsed substantial support for EDBUP. Emergency medicine physicians practicing in different clinical environments endorsed similar barriers to EDBUP implementation.

The violence of men against women: Medico-legal and psychological issues

Violence against women breaches women’s human rights and is a global public health issue that can cause devastating life-long damage. This study considers the characters of victims, abusers and traumatic bonding in heterosexual couples from a medico-legal and psycological standpoint. After considering the devastating effects on women’s health, and with the objective of preventing future violence, it illustrates the weaknesses and strengths of new Italian guidelines related to violence against women in emergency departments including the use of “Brief Risk Assessment for IPV in the Emergency Department – DA5”.

Patterns of healthcare services utilization associated with intimate partner violence (IPV): Effects of IPV screening and receiving information on support services in a cohort of perinatal women

Background

While women experiencing intimate partner violence (IPV) face significant health consequences, their patterns of healthcare services (HCS) utilization are unclear, as are the effects of IPV screening and receiving information on these patterns.

Objectives

1. Compare utilization patterns of five HCS (visits to family physician, gynecologist, specialist and emergency room, and hospitalization) in a cohort of perinatal women who reported experiencing versus not experiencing any IPV and IPV types (physical and/or sexual; emotional and/or verbal; social and economic); 2. Examine whether IPV screening, receiving information on support services, or both, affect patterns; and 3. Compare these associations between ethnic groups (Arab and Jewish women).

Methods

We conducted a prospective study using registry data on HCS utilization obtained from Israel’s largest Health Fund (Clalit) in the year following a 2014–2015 survey of a cohort of 868 perinatal women in Israel (327 Arab minority, 542 Jewish) on their reports of experiencing IPV, IPV screening, and receiving information. Using multivariate analysis, we calculated adjusted odds ratios (AOR) and 95% confidence intervals (CI) for the five HCS utilizations in association with reports of any IPV and IPV types. We adjusted for IPV screening, receiving information about services, and both, in the total sample, and separately among ethnic groups.

Results

Any IPV and IPV types had significant associations with some HCS utilization variables, with different directions and patterns for the ethnic groups. Experiencing IPV was associated with higher HCS utilization among Arab women, lower utilization in Jewish women. Arab women experiencing IPV were twice as likely to visit a gynecologist than women not experiencing IPV (AOR (95% CI) was 2.00, 1.14–3.51 for any IPV; 2.17, 1.23–3.81 for emotional and/or verbal IPV, and 1.83, 1.04–3.22, for social and economic IPV). Among Jewish women, experiencing any IPV was associated with lower likelihood of emergency-room visits (0.62, 0.41–0.93); and experiencing physical and/or sexual IPV was associated with lower likelihood of family physician visits (OR = 0.20, 0.05–0.82). Both IPV screening and receiving information were associated with lower HCS utilization among Arab women only.

Conclusions

Different HCS utilization patterns among women who reported experiencing versus not experiencing IPV in different ethnic groups suggest complex relationships that hinge on how HCS address women’s needs, starting with IPV screening and providing information. This might inform tailored programs to tackle IPV at the HCS, particularly for minority women.

Intimate Partner Violence Documentation and Awareness in an Urban Emergency Department

Background

Domestic violence rates in smaller cities have been reported to be some of the highest in Canada. It is highly likely that the staff at emergency departments (ED) will come in contact with victims of intimate partner violence in their daily practice. The purpose of this study is to better understand current practices for detecting intimate partner violence, staff awareness and knowledge regarding intimate partner violence, and barriers to questioning about intimate partner violence in the ED.

Methods

A standardized retrospective chart review captured domestic violence documentation rates in patients presenting to the ED, and a cross-sectional online survey was distributed to the ED staff.

Results

We found documentation about intimate partner violence in 4.64% of all included patient charts. No documentation was noted in the domestic violence field. Significantly, 16.4% of the ED staff reported never questioning female patients about intimate partner violence; 83.6% enquired when they thought it appropriate, and none asked routinely. None of the staff used a structured screening tool, and 81.8% of the ED staff had not received any formal training. Partner presence was the most common barrier to asking about intimate partner violence, followed by a lack of access to domestic violence management information, and a lack of knowledge regarding intimate partner violence.

Conclusions

Our findings suggest that the current documentation tools are not being properly utilized. Low rates of intimate partner violence documentation in high-risk patients and lack of education indicate that there is a need to improve current practices. In order to improve identification of this important problem, appropriate training and education about intimate partner/domestic violence are required to increase staff comfort as well as knowledge about available community resources for the victims.

Intimate Partner Violence-Related Fractures in the United States: An 8 Year Review

BACKGROUND

Fractures associated with intimate partner violence (IPV) are devastating injuries that can have lifelong implications. With exception to the facial region, there are very limited epidemiological reports describing the types and location of IPV-related fractures. The objective of this study is to review a national database and describe trends associated with IPV-related fractures.

METHODS

An analysis of all adults was performed using the National Trauma Data Bank from 2007 through 2014.Data including demographics, age, location of fracture, and drug/alcohol use were described and analyzed.

FINDINGS

There were 1,352 records identified where the patient was diagnosed with an IPV-related fracture. Women accounted for 83% of the population and the mean age was 37.5 years. Approximately 30% of the population was diagnosed with vertebral, trunk, and rib fractures. Variances among fracture location were observed across age groups. Facial fractures were recorded more in the younger population (18-39 years) when compared to other age groups (40-59 years; 60+ years), p<0.0001. Alternatively, rib and femur fractures were more common among survivors aged 60+ when compared to the younger age groups, p<0.0001.

INTERPRETATION

The ability to identify and respond to survivors of IPV in the healthcare setting is critically important. While facial fractures are common, they are not the only type of fractures that are seen. In many cases, healthcare professionals are the first line of defense in identifying suspected IPV cases. The findings of this paper build upon existing literature while also describing IPV-related fractures across the age spectrum.

Healthcare Professionals' Perceptions and Concerns towards Domestic Violence during Pregnancy in Southern Italy

BACKGROUND

Literature on pregnancy highlighted a large number of women abused by their partners, especially among low-income teenagers attending hospital for pregnancy check-ups. Pregnancy represents a key moment for diagnosing domestic violence.

METHOD

This study explores health professionals' perceptions and concerns about domestic violence against women in services dealing with pregnant women. The twenty-four interviewees were from an Obstetrical-Gynecological walk-in Clinic in the south of Italy. The textual data has been complementarily analyzed by means of two different procedures: Symbolic-structural semiotic analysis and Thematic content analysis.

RESULTS

What emerges is that the interviewees of the clinic do not regard the issue of domestic violence as a matter of direct interest for the health service. The clinic is seen as a place for urgent contact, but one where there is not enough time to dedicate to this kind of patient, nor an adequate space to care for and listen to them. Obstetricians and health personnel expressed a negative attitude when it comes to including questions regarding violence and abuse in pre-natal reports. Training for health and social professionals and the empowering of institutional support and networking practices are needed to increase awareness of the phenomenon among the gynecological personnel.