The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study

Multifaceted training and readiness to respond to family violence: A prospective cohort evaluation

BACKGROUND

As frontline healthcare workers, there is a growing expectation that nurses should be able to respond to disclosures of family violence. However, the profession and hospital systems have been slow to respond with clear skills, knowledge and confidence deficits identified in existing research. There is limited research which has robustly evaluated the effectiveness of in-depth, multifaceted training on readiness to respond among nurses.

AIM

To longitudinally evaluate the effectiveness of an in-depth family violence training intervention on confidence, knowledge and clinical skills of nurses working in a large tertiary adult hospital.

DESIGN

Single-centre, longitudinal intervention study. Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional guidelines were used.

METHODS

One hundred and ten nursing clinicians participated in this study to complete a comprehensive evidence-based model of healthcare workers response for assisting patients experiencing family violence. A mixed methods survey was used to assess change in knowledge, confidence and clinical skills among participants. Outcome assessment was electronically undertaken at baseline, 6-9 months and 12-15 months following intervention.

RESULTS

Statistically significant improvement was seen in self-reported knowledge, confidence and frequency of screening for family violence. Relative to baseline estimates, these improvements were identified 6-9 months and 12-15 months following intervention; albeit with consideration to the visually observed trend of skill reversion at follow-up. Quantitative findings were paralleled by qualitatively identified improvements in the recognition of the intersectional nature of violence, need for patient collaboration in screening and depth in considerations around how family violence is screened for.

CONCLUSIONS

Findings provide tentative support for the utility of a multidimensional training approach to improving nurses' readiness to respond to disclosures of family violence.

RELEVANCE TO CLINICAL PRACTICE

This study provides preliminary support for multidimensional, evidence-based training to effectively improve nurses' confidence, knowledge and clinical skills required for responding to family violence.

REPORTING METHOD

The study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (SQUIRE) Statement: guidelines for reporting observational studies (see Table S1).

PATIENT CONTRIBUTION

Patients were involved in the initial design of the survey tool. This involvement came through the Allied Health Consumer panel and included input on the design and question wording of the survey items.

The psychological impact on perioperative healthcare workers during Victoria's second COVID-19 wave: A prospective longitudinal thematic analysis

The COVID-19 pandemic has had a profound psychological impact on our frontline healthcare workers. Throughout the entire second COVID-19 wave at one major tertiary hospital in Melbourne Australia, longitudinal qualitative data between perioperative staff members, and analyses of intrapersonal changes were reported. Inductive analysis of three open-ended questions generated four major themes: Organisational Response to the Pandemic, Psychological Impact, Changes in Feelings of Support Over Time and Suggestions for Changes. Understanding the challenges, perception and suggestions from this longitudinal study allows us to provide a range of support services and interventions to minimise the long-term negative psychological impact and be better prepared should another similar situation arises again.

Evaluating the impact of a family violence transformational change project in a major trauma hospital: A three-year follow-up comparison study of knowledge, confidence, and family violence response skills in clinical staff

Family violence is a significant public health issue. Healthcare systems have an important role to play in recognising and responding to current family violence experiences in their patients. However, many healthcare workers and systems remain underprepared to fulfil this role. The current study evaluated the impact of a transformational change project in family violence clinical response at a major adult trauma hospital in Australia. Clinician self-rated knowledge, confidence, and family violence clinical skills were evaluated at three years post implementation of a family violence initiative at the Royal Melbourne Hospital, Melbourne. The three years post survey results (N = 526) were compared to baseline (N = 534) using Mann Whitney U and χ ² analyses. Self-reported clinician family violence knowledge, confidence and patient screening were all significantly improved from baseline. Specific family violence skills, including knowledge of key indicators, enquiry with patients and disclosure response were also all significantly improved. The most common clinician identified barriers to working effectively in the area were similar to baseline and included the presence of a suspected perpetrator during the clinical interaction, clinicians perceiving patients would be reluctant to disclose, and time limitations. However, significantly fewer staff endorsed a lack of knowledge or supporting policies and procedures as a barrier. The findings indicate that investment in a transformational change project comprised of the establishment of response policies and clinical work-flow, broad-scale training, a clinical champions program, a secondary consultation service and links with partner organisations, was effective at improving clinician self-rated rated family violence skills, across the hospital. However, one quarter of clinicians still reported having not received any family violence training, and half endorsed having little or no confidence in their skills to identify and respond to patient family violence experiences. This indicates ongoing and sustained work is required to optimise clinician skills in responding to family violence.