Abstract
Objectives: Attempts to introduce assessment for exposure to domestic violence in health care settings have met with limited success, in spite of widespread knowledge of the prevalence of spousal abuse and its implications for women's health. We assessed the utility of Rogers' model of institutional change for the implementation of a universal screening program for domestic violence in postpartum clinical settings. Methods: We adapted Rogers' innovation–diffusion model to develop and implement a protocol for domestic violence assessment among 300 nurses working in two hospitals that together provide obstetrical care to the City of Vancouver, British Columbia, Canada. Our education sessions introduced new knowledge and addressed attitudes and beliefs. They were followed by “hands-on” demonstration and supervision of assessments. Our “Let's Talk” visual aids program added visibility to our initiative and provided cues as to how to undertake screening and response. Screening rates were monitored along with a process evaluation based on anecdotal reporting by nursing staff. Results: Following the initiation of educational sessions and supervision of assessment, the screening rate was 42%. Within 6 months, the screening rate had climbed to 60% and was sustained at that level. Major barriers to screening include difficulty in finding the opportunity to screen in privacy and overcoming language barriers. Conclusions: Application of Rogers' principles of diffusion of innovation in the implementation of a universal program for a domestic violence in two obstetrical care settings resulted in a screening rate of 60% which has been sustained for the first 18 months of the program.
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REFERENCES
Statistics Canada. The Daily 1993;November:1–9. Catalogue No. 11–001E.
Rodgers K. Wife assault: The findings of a national survey. Juristat Serv Bull 1994;5:1–21. Canadian Centre for Justice Statistics. Catalogue 85–002–ISSN 0715–271X.
Council on Ethical and Judicial Affairs, American Medical Association. Physicians and domestic violence: Ethical considerations. JAMA 1992;267:3190–3.
Buel S, Harvard J. Family violence: Practical recommendations for physicians and the medical community. Womens Health Issues 1995;5:158–70.
Sugg N, Innui T. Primary care physicians' response to domestic violence. JAMA 1992;267:3157–60.
Ellis J. Barriers to effective screening for domestic violence by registered nurses in the emergency department. Crit Care Nurs Q 1999;22:27–41.
Janssen P, Basso M, Costanzo R. Exposure to domestic violence among obstetrical nurses. Womens Health Issues 1998;8:317–23.
Lal S, Walker M, MacDonald S, Bala M. Spouse abuse in pregnancy: Asurvey of physicians attitudes and interventions. J SOGC 1999;May:565–71.
McFarlane J, Wiist W. Documentation of abuse to pregnant women: A medical chart audit in public health clinics. J Womens Health 1996;5:137–42.
Flitcraft A. Project SAFE: Domestic violence education for practicing physicians. Womens Health Issues 1995;5:183–88.
McLeer SV, Anwar RA, Herman S, Maquilling D. Education is not enough: A systems failure in protecting battered women. Ann Emerg Med 1989;18:651–3.
Roth D, Janssen P, Landolt M, Grunfeld A. Domestic violence education: From the classroom to the real world. Acad Med 2001;76:889–90.
Straus M. Measuring intrafamily conflict and violence: The Conflict Tactics (CT) scale. J Marriage Fam 1979;41:57–8.
Hudson W, McIntosh S. The assessment of spouse abuse: Two quantifiable dimensions. J Marriage Fam 1981;43:873–88.
Campbell J. Nursing assessment of risk of homicide with battered women. Adv Nurs Sci 1886;8:36–51.
Reid A, Carroll J, Wilson L, Stewart D. Using the ALPHA form in practice to assess antenatal psychosocial health. Can Med Assoc J 1998;159:677–84.
Feldhaus K, Koziol-McLain J, Amsbury H, Norton I, Lowenstein S, Abbott J. Accuracy of 3 brief screening questions for detecting partner violence in the emergency department. JAMA 1997;171:1357–61.
McFarlane J, Parker B, Soeken K. Assessing for abuse during pregnancy. JAMA 1992;267:3176–8.
Wood P, Schwass M. Cultural safety: A framework for changing attitudes. N Z Nurs J 1992;8:4–15.
Rogers E. Diffusion of innovations, 4th ed. New York: Simon & Schuster, 1995:1–35.
Jezierski M. Hospital-wide domestic violence education. Nurse Educator 1998;24:275–7.
Henderson A, Ericksen J. Enhancing nurses' effectiveness with abused women. J Psychosoc Nurs 1994;32:11–5.
Brandt E. Curricular principles for health professions education about family violence. Acad Med 1997;72:S51–8.
Canadian Nurses Association. Family violence: Clinical guidelines for nurses. Ottawa: National Clearinghouse on Family Violence, 1992. ISBN 1–55119–053–2.
Bullock L, McFarlane J. The birth-weight battering connection. Am J Nurs 1989;89:1153–5.
Parker B, McFarlane J, Soeken K, Silva C, Reel S. Testing an intervention to prevent further abuse to pregnant women. Res Nurs Health 1999;22:59–66.
Stewart D. Incidence of postpartum abuse in women with a history of abuse during pregnancy. Can Med Assoc J 1994;151:1601–4.
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Janssen, P.A., Holt, V.L. & Sugg, N.K. Introducing Domestic Violence Assessment in a Postpartum Clinical Setting. Matern Child Health J 6, 195–203 (2002). https://doi.org/10.1023/A:1019782230344
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DOI: https://doi.org/10.1023/A:1019782230344