Practice Issue
Identifying and responding to domestic violence in the emergency department is a chosen practice issue. The topic is important to me because nurses are not provided with proper training on how to identify violence as an issue for their patients. Even though nurses can identify domestic violence as a problem, they are not empowered to respond to it due to a lack of information regarding community services. Nurses are not able to provide immediate assistance to victims of domestic violence and are not able to make proper referrals because of insufficient information. The study titled “Increasing Nurses’ Knowledge and Skills for Enhanced Response to Intimate Partner Violence” by Yolanda Davila is focused on researching the need of nurses to enrich their knowledge regarding domestic violence issues. In particular, the American Nurses Association and the American Association of Colleges of Nursing have issued statements recommending initiatives to provide all nurses with intimate partner violence content and clinical experiences within their nursing education programs. Nurses represent the largest group of healthcare professionals and they are the first to interact with victims of domestic violence. Therefore, there is an extreme need to investigate the current level of nurses’ knowledge in this field and ensure the availability of educational resources.
Study Synopsis
The study starts with the overview of general information on the role of nurses in providing care to survivors of intimate domestic violence. Yolanda Davila provides a short synopsis of the physical and psychological effects of intimate partner violence. The author notes that in-service training for nurses has been identified as an effective strategy to bridge the gap between the need for clinical competence in this field and the lack of content and skills training within formal educational programs. The government puts identification of domestic violence as a healthcare priority; however, there is an evident lack of planned clinical learning experiences within most nursing programs. For this reason, domestic violence remains undetected and untreated. The study was conducted using adult learning theory and the training program was developed to build upon nurses’ intimate partner violence knowledge and skills required through previous workshops. A two-phased design was used: Phase 1 was aimed at answering the question “What are the intimate partner violence learning needs of the public health department’s nursing staff?” and Phase 2 was aimed at answering the question “Does the developed intimate partner violence training program influence the intimate partner violence knowledge and skills of the nursing staff”.
Only 29% of all respondents reported having received a formal domestic training within nursing programs and all agreed that continuing education is an effective method of obtaining domestic violence information and training. One of the important results achieved in the study is that staff nurses indicated having a basic understanding of domestic violence as well as a need to enhance their intervention skills. The lack of interviewing skills on sensitive information, danger assessment, safety planning, increased referring to local communities and services was found to be directly related to the inadequate education and training with the professional healthcare educational programs. The study concludes with the note that violence information and prevention resources should be made readily available.
Research Paradigm
The author has used a qualitative theoretical research paradigm. Davila hypothesized that there was a gap in the formal education of nurses related to helping victims of domestic violence. Then, using the theory of adult learning, she conducted research to prove this hypothesis through qualitative measures. Questionnaires and specific training sessions were developed to find the answer to the questions raised in the opening section.
Detailed Critique
Research Design
The research problem is directly related to the actual practice of nursing. The lack of knowledge in the field of domestic violence reduces the ability of nurses to help victims of intimate partner violence. Moreover, insufficient knowledge slows down the identification and prevention of domestic violence incidents. The study focus can be considered one of the top priorities in nursing research because nurses are the first to encounter victims of domestic violence and lack of adequate skills makes nurses unable to provide first psychological help and conduct targeted interviews. The research covered in the article is qualitative and its purpose is exploration and explanation. The fact of problem existence has already been proved; however, no research was conducted previously aimed at exploration of skills’ lack from nurses’ standpoint. The main concept under investigation is a self-evaluation and self-assessment by nurses regarding their knowledge on domestic violence and skills gained through formal education and training. The relationship among variables and concepts is clearly presented and the key concepts are clearly defined both conceptually and operationally.
Ethical aspects of a study
There is no indication whether the study has been approved and monitored by a Research Ethics Board or other similar ethics review committee. The study participants were not subjected to any physical harm, discomfort, or psychological distress. Researchers did not need to take appropriate steps to remove or prevent the harm because the chosen method of information collection was a questionnaire. Informed consent was obtained prior to the nurse being interviewed in a private area within their clinics. Descriptive data were collected through a demographic form and qualitative data were collected in the form of audio-taped responses to interview. Informed consent to gather this type of information was obtained prior to interview and audio-taping.
Theoretical Framework
The research was conducted using adult learning theory as a foundation. The choice of theory is justified because it is directly related to the study objectives. In particular, the basic premise of this theory is that learning occurs when a learner recognizes that existing knowledge is either defective or deficient. Recalling the research objective, the aim was to investigate whether nurses had enough knowledge on domestic violence and first aid delivery to victims of intimate partner violence. The adult learning theory was integrated into development of training program designed to meet nurses’ needs for enhancement of intervention skills. The problem solving technique was integrated though the use of case studies with more attention paid to the application of new knowledge into clinical practice situations.
Research problems and hypotheses
The research problem is easily located and clearly stated. The chosen research problem is lack of knowledge and intervention skills of nurses in the field of domestic violence. The problem is significant for nursing and the given research contributes to the nursing practice, administration, education, and policy. Moreover, the study results can be used a foundation for further research. There is a good fit between the research problem and the paradigm within which the research was conduction. The research was purely qualitative and aimed at practical application of results. The adult learning theory used for a theoretical framework, questionnaire development and training sessions is appropriate tool to gather information on the raised problem. However, there is no formal presentation of statement of purpose, research questions, and hypothesis. It is necessary to read the whole report first to understand the problems and hypothesis. Information is communicated clearly and is placed in a logical sequence. Nevertheless, the displacement of research problem and hypothesis decreases the overall value of research. In addition, the key concepts and variables are not identified, as well as population of interest in not specified. The only defined concept is “intimate partner violence”. There is no direct indication for whom the report is written, even though it is clear that it is furnished for nurses and healthcare representatives. Hypotheses do flow from the previous research and there is a justifiable basis for predictions. In is noted in the opening section that many organizations have already recognized the need to enhance knowledge in the field of domestic violence intervention, however, no research was previously done to investigate the problem from nurses’ perspective.
Literature review
There is no literature review section in the report. Nevertheless, the major relevant studies on the topic of domestic violence are included. The bibliography list contains more than 30 entries: these are the recent publications on the topic. The majority of referenced and consulted articles are not older than 5 years, therefore, the studies are appropriate to include. Even though the supporting literature is mostly secondary, it is used to back the primary information gathered in the result of this research. Taking into account that there is no literature review section, the gaps in literature are not identified aw well as there is no critical appraisal and comparison of the studies. Nevertheless, numerous references are made throughout the report and the reader is enabled to locate supporting information easily.
Clinical Relevance
As the final section of report states, the findings of the study have several implications for nursing education, research, and practice. Intimate partner violence is recognized as healthcare system concern, however, violence-related content in not included within the formal nursing curricula. The study revealed that if intimate partner violence is not provided or inadequately covered within the formal professional educational programs, nurses will not be prepared to provide relevant care to victims of violence. The inclusion of intimate partner violence programs is essential to enable nurses to provide effective and safe nursing care. Moreover, the study is highly relevant for nursing students as well as for practicing nurses. As the result support, the opportunity to regular debrief should be made available to students and employees who are responsible to provide care to survivors of violence. One of the main study implications related to clinical practice is that informational sources and opportunity to continuously update knowledge in the field of domestic violence treatment and intervention should be available at no-cost in clinics, within school, and employment settings.
In conclusion, the study titled “Increasing Nurses’ Knowledge and Skills for Enhanced Response to Intimate Partner Violence” has high informational value, is properly conducted and appropriately presented. The lack of literature review section, failure to provide the definitions of the key terms, and lack of clear hypothesis and research questions presentation in the opening section are compensated with relevant theoretical framework, detailed discussion, appropriate methodology, and applicable results. Lack of knowledge in the field of providing care to the survivors of domestic violence is caused by the insufficient programs at schools and unavailability of informational resources. Even though the research sample is rather small, the results of the study can be applied in the wide context.
The study contributed to my personal knowledge on the subject “Identifying and Responding to Domestic Violence in the Emergency Department”. While most of the nurses are capable of identifying the instance of domestic violence, many of them are trained on how to respond to domestic violence. Insufficient training reduces the effectiveness of primary care delivery to the victims of intimate partner violence and decreases the efficiency of emergency department. Nurses need to receive more formal education on domestic violence and be offered an opportunity to update their knowledge regularly. The information resources should be available to ensure timely response to domestic violence. Currently, nurses have to act intuitively or enrich their knowledge by their own initiative, while introduction of domestic violence prevention courses into formal education setting will significantly improve the quality of delivered help.
References
Davila, Y. (2006). Increasing Nurses’ Knowledge and Skills for Enhanced Response to Intimate Partner Violence. The Journal of Continuing Education in Nursing, 37 (4), 171-177.