Paper Example on Prevalence and Support for Domestic Violence Survivors Presenting at Emergency Departments

Abstract

Aims and objectives - Our aim was to identify, review and critically evaluate published empirical studies concerned with the prevalence, management and support for survivors of DVA who present at ED.

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Background - DVA is a global phenomenon with a wealth of studies that explore the different aspects of the issue including the economic, social and health effects on survivors and on society as a whole. ED is widely recognised as one healthcare facility where DVA survivors will often disclose DVA. In the UK, NICE produced guidelines in 2014 requiring all sectors of healthcare and those they work alongside to recognise support and manage survivors of DVA. Whilst there is an increasing body of research on DVA, limited synthesised work has been conducted in the context of DVA within ED.

Design - This review encompasses empirical studies conducted in ED for screening interventions, management and support for DVA patients including prevalence. This review included studies that included ED staff, ED service users and DVA survivors.

Methods - A systematic approach across five electronic bibliographic databases found 35 studies meeting the inclusion criteria published between 2000 and 2015.

Results - From the 35 studies four descriptive overarching themes were identified (1) prevalence of DVA in ED, (2) Use of DVA screening tools and ED interventions, (3) current obstacles for staff working in ED and (4) ED users and survivor perspectives.

Conclusions - Having knowledgeable and supportive ED staff can have a positive benefit for the longer term health of the DVA survivor who seeks help. The physical characteristics of DVA are often easier to identify and manage but emotional and psychological aspects of DVA are often more complex, and difficult for staff to identify. This therefore raises questions as to what approaches can be used, within these busy settings, when often survivors do not want to disclose.

Relevance to clinical practiceDVA has been shown to have a direct impact on the health and well-being of survivors who will often access ED services with direct injuries and associated medical conditions. This paper is relevant to those working in the ED in raising awareness in a number of areas of practice for example the prevalence of male intimate partner violence (IPV) survivors. Furthermore, patients do not always disclose DVA even in cases where there is clear sustained injury thus requiring staff to be vigilant to repeat attendees and patient history. This requires a well maintained and effective reporting system for instances of suspected and disclosed DVA in order that staff can provide the appropriate care and support. ED staff often deal with complex cases, this includes different aspects of DVA including physical, emotional and psychological abuse. Continual support and guidance, including educational interventions, would assist ED clinical staff to manage and discuss instances of DVA in their workplace and their interactions with DVA patients.

Whilst training for ED staff is welcomed, there also needs to be a greater awareness of the potential complexity of DVA presentations beyond physical injury in order for staff to remain observant throughout consultations. It is also suggested that clear DVA assessment and referral mechanisms should be embedded into clinical practice, including ED, as described in the UK NICE guidelines (2014). Overall improvements in reporting mechanisms in ED for the identification, management and support for DVA survivors would add to the collective and growing body of evidence surrounding DVA and their presentations within healthcare settings. Such measures would enable those working in ED to support disclosure of DVA more effectively.

Summary box

What does the paper contribute to the wider global clinical community?

This systematic literature review uniquely provides the perspectives of DVA survivors, ED staff as well as describing DVA interventions used in ED settings

The review illustrates the complexities of providing support for survivors of DVA and provides a useful background for clinical staff and policy makers within ED settings

The paper provides a comprehensive review for the management of DVA and the experiences of survivors of DVA who present at ED adding to the current literature for DVA in other healthcare settings

Introduction

Domestic violence and abuse (DVA) is a global phenomenon with a wealth of studies and international reports (WHO 2005, 2011) that explore the different aspects of the issues around preventing, managing and supporting women and children who experience violence, including intimate partner violence (IPV), a term often used within the literature relating to sexual abuse between partners. The health implications for survivors of DVA is often difficult to capture economically but with synthesised pooling of UK evidence it is suggested that the prevalence of IPV ranges from 13% to 31% of the UK population (Feder et al., 2009). In the UK, the Home Office have revised the definition of DVA to reflect the complex and multi-faceted nature and includes...Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse: psychological, physical, sexual, financial, emotional [...] includes so called 'honour' based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group (UK Home Office, 2012).

The Emergency Department is widely recognised as one healthcare facility where DVA survivors will often disclose a history or prevalence of DVA (McGarry & Nairn, 2015, Olive 2007). In the UK the National Institute of Clinical Excellence (NICE) produced guidelines in 2014 requiring all sectors of healthcare to recognise support and manage survivors of DVA. Whilst there is an increasing body of research on DVA, limited synthesised work has been conducted in the context of DVA within ED. This review encompasses studies conducted in ED for screening interventions, management and support for DVA patients including rates of prevalence.

Aim:

Our aim was to identify, review and critically evaluate conducted and published empirical studies since 2000 concerned with the reported prevalence, management and support for survivors of DVA who present at ED. This review included studies that included ED staff, ED service users and DVA survivors and where it was clear that this was the overarching aim of the article. Our review research question "What approaches, including interventions, are used for the management of DVA survivors within ED settings, including staff perspectives and users of Ed services"

To undertake a systematic review of available empirical literature in order to evaluate the existing evidence with regard to the management and support for survivors of domestic violence and abuse (DVA) within an emergency room setting.

Methods:

The review, initially conducted in 2014 and updated in 2015, included a wide range of international publications, including qualitative, quantitative and mixed methods research. The review was conducted by 2 members of the research team (KHS, JM) and shared amongst the project steering group, in order to ensure consistency of approach. A systematic framework was applied to the search. A steering group, including specialists from an ED setting, safeguarding leads and ED educators for the local NHS Trust assisted with formation of the study aims and objective, and the review process.

Inclusion criteria:

• Work published and conducted between 2000 to 2015
• Empirical studies which sought the views of service users, DVA survivors or perpetrators of DVA accessing ED
• Studies that sought the views of staff working in adult ED settings
• Studies that demonstrate evidence of study approval
• Literature reviews that encompassed any of the above criteria
• Exclusion criteria
• Commentary papers, reports and discussion papers were excluded
• Studies not published in English or peer reviewed
• Studies relating to paediatric only ED settings

Data Extraction, review and synthesis

After removal of any duplicates (n=22), KHS & JM reviewed 852 titles from the search of five electronic bibliographic databases. Another 4 titles were found through the manual search for a total of 856 titles retained. Available abstracts for these titles were then screened using an agreed inclusion criteria. The abstracts were reviewed by the authors independently and agreement reached on those meeting the prescribed inclusion criteria. The remaining 53 sources were assessed for research congruity and aligning with the inclusion criteria, with a further 18 sources rejected at this stage (see Figure 1) providing 35 sources selected for this review. Data extracted was shared in a table format and key themes were discussed within the research team and steering group members as part of the thematic analysis of the findings.

Findings

The review identified 35 sources which met our inclusion criteria (see criteria). The inclusion date for empirical studies conducted and published from 2000 was chosen for pragmatic reasons. This included the view that any empirical studies are likely to represent current ED practices, including the reporting mechanisms, whilst ensuring the review provides a range of studies from different countries. Studies solely based in paediatric ED were excluded as this setting relates predominately with caring for minors (those under the age of 16) and their families and where cases of family violence or child abuse are identified...