Emergency Department care of women experiencing intimate partner violence: Are we doing all we can?

"You Can't Meet Everyone's Needs After-Hours": After-Hours Domestic and Family Violence Services in Rural and Remote Areas

Domestic and family violence is a significant issue in the Murrumbidgee region of New South Wales, Australia, mirroring national and international concerns about gender-based violence. Generally, there are known barriers associated with providing domestic and family violence (DFV) services in rural and remote communities; however, little research has considered the specific service needs and service barriers in the after-hours period. This is crucial. The already limited rural and remote services available during business hours are further constricted in the after-hours period. This article reports on research about after-hours service need and service challenges in six target communities in the Murrumbidgee region.

Intimate Partner Violence in the Orthopaedic Patient Population: What Surgeons Need to Know

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Intimate partner violence (IPV) is under-reported and pervasive in the orthopaedic surgical setting.

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Screening programs that could increase reporting and assist in treatment and prevention are commonly underutilized.

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There is little formalized education during orthopaedic surgery training for IPV.

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The incidence of IPV continues to increase in the setting of recent stressors, such as COVID-19, and the orthopaedic surgeon should play a role in the screening and identification of patients presenting with IPV injuries and provide resources and referral.

Family violence and its psychological management at the Emergency Department: A review

An Emergency Department provides emergency diagnosis and interventions, first clinical instrumental and laboratory examinations, actions needed to stabilize the patient. The purpose of this review was to evaluate the state-of-the-science focused on intimate partner violence. The review search period was from 2000 to 2019. The search was not restricted by language or geographical region, and was carried out by combining an exhaustive list of terms denoting intimate partner violence, domestic violence, emergency department care of women, women victims of violence, identifying abuse among women. Databases searched included MEDLINE, PsycINFO, Web of Science, Scopus, and Cochrane Library.

Two male nurses' experiences of caring for female patients after intimate partner violence: a South African perspective

BACKGROUND

South Africa is perceived to be one of the countries with the worst reputation regarding the occurrence of intimate partner violence. The women who suffer from serious physical injuries are admitted to emergency care units and their first contact with health care is through the nurses in these units. Emergency care nurses become secondary victims of violence due to their exposure to the pain of assaulted patients. Female nurses tend to identify with these patients as some nurses are in similar relationships. Not much research has been done on the challenges that male nurses face when they are confronted with abuse of women inflicted by males.

METHODOLOGY

In this case study with a phenomenological research methodology two African male emergency care nurses were interviewed.

FINDINGS

The participants experienced a dichotomy of being-in-nursing and being-in-society and had been confronted with the conflicting roles of being men (the same sex as the perpetrators) and being nurses (the carer of the victim). They tried to manage the situation by using the 'self' to care for the patient and to be a problem solver for the patient and her partner or husband.

CONCLUSION

The authors conclude that society expects men not to be in a caring profession and nursing is still a female-dominated caring profession that finds it difficult to move away from its engendered and caring image. The participants experienced role conflict when they took care of female patients who have suffered intimate partner violence.

Conditions and Patterns of Intimate Partner Violence among Taiwanese Women

PURPOSE

Intimate partner violence (IPV) is a serious public health issue among women. IPV victims usually seek help from hospitals, and emergency nurses are the frontline staff with whom the victims come into contact first. This study examined the conditions and patterns of IPV in southern Taiwan.

METHODS

From designated hospitals in Kaohsiung under the Department of Health Injury Assessment Clinic, data were collected on 497 women regarding their injury assessment for IPV reported to the Kaohsiung City Government.

RESULTS

Taiwanese survivors were older compared to immigrant survivors. Taiwanese survivors also had higher education levels compared to immigrant survivors. Taiwanese survivors had higher employment rate than immigrant survivors did. The time between IPV and medical help seeking was longer for divorced than married women.

CONCLUSIONS

These results can facilitate understanding of the conditions and patterns of IPV in Taiwan, increase the awareness of nurses, especially the emergency nurses for the prevention of IPV, and increase professional competency for the provision of appropriate healthcare services to survivors of IPV.

Intimate partner violence and communication of HIV diagnosis in Rakai, Uganda

Individuals who communicate their HIV diagnosis to sexual partners may be at increased risk of intimate partner violence (IPV). The authors examined past year self-reported IPV associated with communication of HIV diagnosis and other factors, in a sample of 679 sexually active; HIV-positive individuals age 18 to 49, who received HIV results and posttest counselling 12 months or more prior to the survey in Rakai, Uganda, using log-binomial multivariable regression. The rates of verbal and physical abuse among married individuals were significantly higher compared to unmarried persons, respectively. Physical abuse was significantly higher among women compared to men. IPV was not significantly associated with communication of HIV diagnosis. Interventions to prevent IPV among married HIV-positive individuals particularly women, at the community level, are needed.

Prevalence of Intimate Partner Violence Across Medical and Surgical Health Care Settings

Intimate partner violence (IPV) is a serious health problem and a leading cause of nonfatal injury in North American females. Prevalence of IPV has ranged from less than 20% to more than 50% across primary care, emergency medicine, and family medicine. We conducted a systematic review and meta-analysis of the literature to examine best estimates of IPV prevalence as opportunities for targeted interventions in health care specialties. We included 37 articles in this study. Based on our pooled data, best estimates of the lifetime prevalence of any type of IPV were 38% in family medicine and 40% in emergency medicine.

Nursing student's perceptions and understanding of intimate partner violence

Intimate partner violence (IPV) is a significant health issue in the Australian population and nurses have a role in assessment, intervention and support of families. World Health Organization Statistics indicate that as many as 61% of women, under the age of 50 have been physically abused by their partners. As nurses are in a unique position to identify, assist and support women living with IPV a greater understanding of student nurse's knowledge and attitudes may assist undergraduate programs to ensure better preparation of nurses for this role. A nurse's readiness to manage IPV may be influenced by their knowledge, attitudes, beliefs and behaviors, largely related to their self-efficacy in identifying these women (i.e. via screening procedures) and providing effective interventions. Students from all levels of the undergraduate program of an Australian regional university were invited to participate in focus groups and a subsequent survey that explored their perceptions, attitudes and knowledge of IPV. The results showed students had limited and stereotypical beliefs regarding what constitutes IPV and who perpetrates it. They indicated that they were under prepared to deal with IPV situations in clinical practice but did identify communication as a core skill required. Nursing students may not understand the significance of the issues of IPV nor fully understand the social, economic and health impacts at an individual and societal level. This may result in further under detection of the problem. The results of this study indicate a number of important implications for undergraduate nursing education curricula.

Nurses' role in caring for women experiencing intimate partner violence in the sri lankan context

Intimate partner violence has short- and long-term physical and mental health consequences. As the largest healthcare workforce globally, nurses are well positioned to care for abused women. However, their role in this regard has not been researched in some countries. This paper is based on a qualitative study that explored how Sri Lankan nurses perceive their role in caring for women who have experienced partner violence. Interviews with 30 nurses who worked in diverse clinical and geographical settings in Sri Lanka revealed that nurses' role involved: identifying abuse, taking care of patients' physical needs, attending to their safety, providing support and advice, and making referrals. Barriers to providing care included lack of knowledge; heavy workload; language barriers; threats to personal safety; nurses' status within the healthcare hierarchy; and lack of communication and collaboration between various stakeholder groups within the healthcare system. Nurses also identified a lack of appropriate services and support within hospitals and in the community. The findings reveal an urgent need for the healthcare system to respond to nurses' educational and training needs and help them function autonomously within multidisciplinary teams when caring for abused women. The findings also point to a need to address institutional barriers including the lack of appropriate services for abused women.

Normalizing policies of inaction--the case of health care in Australia for women affected by domestic violence

Domestic violence impacts on all aspects of affected women's lives and results in poor general, reproductive, and psychological health (World Health Organisation, 2010). Despite mounting evidence that current health care responses to women affected by domestic violence are problematic, policies have nevertheless been rolled out without addressing issues identified. Funding cuts, fragmentation of services, and failure to establish good practice has resulted in a discourse where women's needs are pushed to the outside and they are marginalized, lost in the language and discourse of policy, normalizing a discourse of incompletion at policy and bureaucracy levels.

"Why did it happen?" A review and conceptual framework for research on perpetrators' and victims' explanations for intimate partner violence

Although there is an extensive research literature on individual and cultural risk factors for intimate partner violence (IPV), much less is known about the factors that victims and perpetrators of IPV perceive as playing a role in violent events. In part, lack of systematic research on perceived reasons for violence is due to the lack of a clear conceptual model and comprehensive measures of perceived reasons why partner violence occurs. In this paper, we provide a conceptual model for domains of factors influencing IPV and use this model to frame our review of existing research on victims' and perpetrators' explanations for IPV. We discuss differences in explanations for IPV in terms of gender and whether explanations refer to the respondents' own or their partners' use of violence. Our review findings suggest a need for more standardization of measurement and larger representative samples in order to identify more systematically reasons that are perceived by victims and perpetrators to be most the important contributors to IPV. Further research on perceived reasons for IPV also needs to address gender differences as well as differences related to self-partner attributions.

PRevalence of Abuse and Intimate Partner Violence Surgical Evaluation (P.R.A.I.S.E.): rationale and design of a multi-center cross-sectional study

BACKGROUND

Intimate partner violence (IPV) is described by the American Medical Association as "a pattern of coercive behaviors that may include repeated battering and injury, psychological abuse, sexual assault, progressive social isolation, deprivation, and intimidation." The long-term consequences of IPV include health risks, posttraumatic stress disorder, depression, and staggering economic costs for health care of victims. Intimate partner violence is often underreported among women who seek medical attention. The current study seeks to address the issue of possible underreporting of IPV in orthopaedic fracture clinics by establishing prevalence rates of IPV among women seeking treatment for musculoskeletal injuries.

METHODS/DESIGN

We propose a cross-sectional multicenter study wherein 3,600 women will complete a self-reported written questionnaire across clinical sites in North America, Europe, and Australia. Recruitment of participants will take place at orthopaedic fracture clinics at each clinical site. The questionnaire will contain a validated set of questions used to screen for IPV, as well as questions that pertain to the participant's demographic, injury characteristics, and experiences with health care utilization. Female patients presenting to the orthopaedic fracture clinics will complete two validated self-reported written questionnaires (Woman Abuse Screening Tool (WAST) and the Partner Violence Screen (PVS)) to determine the prevalence of IPV in the past 12 months and in their lifetime. The two questionnaires were designed for rapid assessment of IPV status in emergency departments, family practice, and women's health clinics that we believe are similar to our intended setting of an orthopaedic clinic.

DISCUSSION

If the prevalence of IPV among women attending orthopaedic clinics is greater than the current perceptions of orthopaedic surgeons, this study will serve to advocate for the continued education of medical professionals to better recognize probable IPV cases and offer existing services to enhance the care of these patients.

Pattern of physical injury associated with intimate partner violence in women presenting to the emergency department: a systematic review and meta-analysis

OBJECTIVE

To examine patterns of physical injury associated with intimate partner violence (IPV) among women presenting to emergency room departments.

DATA SOURCES

Systematic searches of Medline, EMBASE, and CINAHL electronic databases from their earliest entries up to February, 2008. Reference lists from the studies included from the electronic database search were reviewed for published and unpublished studies. The authors contacted study authors regarding published and unpublished information.

REVIEW METHODS

After titles and abstracts were initially screened by a single reviewer, two reviewers screened the remaining full-text articles for inclusion into the review. Studies were included if they pertained in whole or in part to women who presented to an emergency department because of IPV and reported the location or type of injuries. Studies without comparison groups of non-IPV women and case series/case reports were excluded. The authors performed a meta-analysis of the available data using the random effects model.

RESULTS

The authors identified 262 potentially relevant titles and abstracts, of which 7 articles were included in the review. The association between head, neck, or facial injuries and IPV was higher among studies that excluded women with verifiable injuries such as witnessed falls or motor vehicle collisions (pooled odds ratio (OR) 24 (95% CI [15, 38]). Thoracic, abdominal, or pelvic injuries were nonspecific for IPV (pooled OR 1.07 (95% CI [0.89, 1.29]). Injuries in the upper extremities were suggestive of non-IPV etiology (pooled OR 0.51 (95% CI [0.41, 0.54]), as were lower extremity injuries (pooled OR 0.15 (95% CI [0.04, 0.56]).

CONCLUSIONS

Among women presenting to emergency room departments, unwitnessed head, neck, or facial injuries are significant markers for IPV. Conversely, extremity injuries are less likely to have been the consequence of IPV.