Violence Training Research Articles

Domestic Violence Is a Significant Public Health and a Health Administration Issue in the U.S.

This paper discusses domestic violence as a public health concern and a health administration issue. People affected by domestic violence, such as physical, mental, sexual, and financial abuse, experience higher rates of trauma leading to PTSD. This study explored healthcare interaction with victims of domestic violence. Effective communication, proper domestic violence training, and screening should be used and implemented in healthcare settings to support victims regardless of where they may be within the abuse cycle. This paper adds to the dialogue on domestic violence by pulling together other previous research and by offering tools that can be implemented in emergency rooms, urgent care facilities, and medical practices to recommend standard processes focused on identifying dangerous situations and giving victims the support they need.

Impacts of an Intervention to Improve the Identification, Referral and Safety of Those Experiencing Domestic Violence: A Mixed Methods Study in the UK

This study is the first evaluation of the impacts on long-term health issues (and associations with ethnicity and poverty) of a domestic violence intervention, Identification and Referral to Improve Safety (IRIS). IRIS is a domestic violence training, support and referral programme based mainly in primary care settings. This was a convergent, parallel, mixed methods UK study. In the quantitative phase, we matched the health records of 294 patients who had a marker for domestic violence with records from a domestic violence support service to track the health conditions of participants before and after referral to IRIS. In the qualitative phase, we conducted semi-structured telephone interviews with 21 women who had received IRIS support and thematically analysed the data. Descriptive statistics indicated that, at the point of referral to IRIS, participants had a variety of health conditions, with a reduction on a number of mental and overall physical health conditions post-IRIS. Qualitative data are reported under five prominent themes: life before, driving forces for help-seeking, experiences of support, perceived impacts and recovery as a journey. Overall, we found that IRIS support was associated with a positive impact on participants. The study highlights the benefits of improved identification and referral of domestic violence survivors.

Hairdos and Help-seeking: Mandatory Domestic Violence Training for Salon Workers

Traditional methods to prevent and respond to domestic violence include criminal laws, national hotlines, and community programming to promote healthy relationships. Despite these methods, domestic violence continues to be a prevalent public health issue. In recent years, some states began to focus prevention and intervention efforts on the beauty industry. States including Arkansas, Illinois, Tennessee and Washington enacted laws that mandate domestic violence training for salon workers and other beauty professionals. The laws largely require salon workers to attend an informational training on domestic violence before obtaining or renewing their license. However, they do not require any affirmative action on the part of the salon worker if the client discloses that he or she is experiencing domestic violence. This paper investigates how the legislation uses the historically close relationship between hairdressers and their clients in order to achieve a unique way of reaching domestic violence victims, as well as the drawbacks to the legislative structure and atypical public health approach.

"Figuring it out on our own": exploring family medicine residents' sexual assault and domestic violence training.

Family physicians are uniquely able to provide comprehensive and longitudinal care to those experiencing sexual assault and domestic violence (SADV). To date, we know little about how Canadian family medicine (FM) residents learn about SADV. This study explored SADV teaching in residency from the perspectives of FM residents. This qualitative study took place in the Western University FM residency program. We conducted semi-structured interviews with first- and second-year FM residents (n = 8). We analyzed data using thematic analysis. We identified three inter-related themes: (1) Inconsistent training for SADV, (2) Attitudes towards SADV and (3) Learner hesitancy. Quality and quantity of SADV learning opportunities were inconsistent across learners, fuelling feelings of incompetence and lack of confidence around providing SADV care.This led to hesitant behaviours by learners when encountering SADV clinically. Understanding FM residents' experiences and ideas regarding SADV education is critical in order to graduate physicians equipped to care for this vulnerable population. This research highlights the relationship among learners' and teachers' experiences, attitudes and behaviours; targeting this behavioural cycle may improve SADV learning.

Domestic violence screening in a public mental health service: A qualitative examination of mental health clinician responses to DFV.

WHAT IS KNOWN ON THE SUBJECT?: Mental health clients experience higher estimated rates of domestic violence, yet mental health services are less likely to screen for domestic violence. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper qualitatively explores the perspectives and experiences of mental health practitioners in inpatient and community teams in a publicly funded hospital and health service (i.e. public mental health service). Mental health practitioners described a lack of domestic violence training, as well as a lack of knowledge of domestic violence and support mechanisms for victims, when domestic violence is disclosed by clients. The paper highlights the unique difficulties and barriers experienced by clinicians in screening for domestic violence while also dealing with clients suffering a mental health crisis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The paper sheds more light on the issue of domestic violence in mental health in terms of screening, and identifies avenues for improvement in mental health services; particularly the need for staff training and education. ABSTRACT: Introduction Domestic violence is particularly prevalent within mental health client groups, though screening for domestic violence within mental health services is often overlooked. Aim To investigate the experiences and opinions of domestic violence screening by mental health clinicians in a publicly funded hospital and health service. Methods Semi-structured interviews were conducted with twelve clinicians working in publicly funded mental health services in Queensland, Australia. Transcripts were thematically analysed. Results Four main themes emerged from the data: staff training and experience; prioritizing domestic violence screening; attitudes to domestic violence; and victim support. Participants discussed a lack of training for, or expectations of, domestic violence screening in mental health services. They also highlighted a lack of resources enabling them to appropriately respond when domestic violence was identified. Discussion Education, attitudes and resources relating to domestic violence are major factors that should be addressed for the successful screening and treatment of clients in mental health. Implications for Practice This paper informs services of the gaps in knowledge and care around domestic violence and mental health. A less medicalized approach to the treatment of mental health should be adopted, and domestic violence training introduced for all healthcare practitioners, to improve client outcomes.

Interpersonal violence education: An analysis of the Spanish oral health school's curricula and future requirements.

Interpersonal violence results in injuries that frequently affect oral, head and neck structures, the treatment of which must be carried out by Oral health practitioners with sufficient training to detect the problem and manage the victim's lesions and need for referral. The objective of this study is to know the academic preparation that Spanish dentistry students receive in learning outcomes related to interpersonal violence during undergraduate academic training. A survey was conducted through an online form with 9 questions (Survey Monkey platform). The link was sent by email to the deans of the 23 Spanish universities (public and private) offering dentistry degrees. The analysis of the results was carried out using Fisher's test and a chi-squared test. 95.63% of the deans (n= 22) responded. 85.7% of the universities report to carry on training in violence, according with Spanish legislation. Currently 33.3% dedicate less than 5 h to this training, whereas in the future study plans only 19% would dedicate less than 5 h to these learning outcomes. 85.7% of the respondents agree in consider this training as mandatory. The subjects in which learning outcomes on interpersonal violence were reported to be included were: legal and forensic dentistry (78%), psychology (55%), medical ethics (33.3%), paediatric dentistry (39%), surgery (5.5%) and 22% respondents cited other specialties. In future curricula, the competence areas in which such training is proposed to be imparted are: legal and forensic dentistry (80.9%), psychology and medical ethics (57.1%), paediatric dentistry (38.1%), surgery (14.2%) and in 23.8% also in other specialties. Significant differences were found between public and private universities only in the number of hours that would be dedicated to interpersonal violence learning outcomes in the future. Interpersonal violence encompasses situations of abuse and neglect inflicted to different patients (women, children, elderly) that are perceived both by Oral Health students and practitioners to require a comprehensive training. Most of the respondent deans consider that in the future curricula both the hours and areas that teach interpersonal violence learning outcomes must be increased. To respond to victim's need for help and care, the future requirements for the Oral health workforce education must encompass interprofessional undergraduate as well as postgraduate training in interpersonal violence.

Intimate Partner Violence Training and Readiness to Respond among Students, Staff, and Faculty in Three Institutions in the United States.

Intimate partner violence (IPV) is a significant public health concern; however, limited studies have explored perceptions and experiences towards IPV among students, staff, administrators, and faculty across diverse disciplines at institutions of higher education. The purposes of this study were to (1) assess experiences of IPV among a sample of students, staff/administrators, and faculty and (2) examine the relationship among attitudes, actual and perceived knowledge, awareness, training, readiness, and personal experiences with IPV in this sample. Participants were recruited from an urban university and two university-affiliated medical institutions to participate in an online survey. Bivariate and multivariate associations were assessed. Structural Equation Modeling (SEM) was used to examine direct and indirect effects of perceived and actual knowledge and personal experiences with IPV. Of the 216 respondents, 42.6% reported personally experiencing IPV and 34.3% reported having witnessed IPV. Over 34% of participants never received training on IPV. The sub-sample with training received between one and more than 15 hours of training. Standardized total effect of training on attitudes and awareness was β = 0.42 (95% confidence interval [CI] = 0.30-0.51), the combined indirect effects was β = 0.18 (95% CI = 0.10-0.27) and the direct effects of β=0.23 (95% CI = 0.12-0.34), indicating that hours of training was highly associated with the participants' perceived knowledge and actual knowledge, which improved their attitudes and awareness towards IPV survivors. Our findings suggest the need for campus-wide formal training on IPV to better prepare members in higher education to accurately identify, assess, and intervene to protect victims of abuse. Interprofessional approaches are needed that focus on the multiple and intersecting needs of victims of violence and should also enhance professional self-efficacy and increase readiness to respond to IPV survivors.

Facilitators and barriers to routine intimate partner violence screening in antenatal care settings in Uganda

BackgroundUganda clinical guidelines recommend routine screening of pregnant women for intimate partner violence (IPV) during antenatal care (ANC). Healthcare providers play a critical role in identifying IPV during pregnancy in ANC clinics. This study explored facilitators and barriers for IPV screening during pregnancy (perinatal IPV screening) by ANC-based healthcare workers in Uganda.MethodsWe conducted qualitative in-depth interviews among twenty-eight purposively selected healthcare providers in one rural and an urban-based ANC health center in Eastern and Central Uganda respectively. Barriers and facilitators to IPV screening during ANC were identified iteratively using inductive-deductive thematic analysis.ResultsParticipants had provided ANC services for a median (IQR) duration of 4.0 (0.1–19) years. Out of 28 healthcare providers, 11 routinely screened women attending ANC clinics for IPV and 10 had received IPV-related training. Barriers to routine IPV screening included limited staffing and space resources, lack of comprehensive gender-based violence (GBV) training and provider unawareness of the extent of IPV during pregnancy. Facilitators were availability of GBV protocols and providers who were aware of IPV (or GBV) tools tended to use them to routinely screen for IPV. Healthcare workers reported the need to establish patient trust and a safe ANC clinic environment for disclosure to occur. ANC clinicians suggested creation of opportunities for triage-level screening and modification of patients’ ANC cards used to document women’s medical history. Some providers expressed concerns of safety or retaliatory abuse if perpetrating partners were to see reported abuse.ConclusionsOur findings can inform efforts to strengthen GBV interventions focused on increasing routine perinatal IPV screening by ANC-based clinicians. Implementation of initiatives to increase routine perinatal IPV screening should focus on task sharing, increasing comprehensive IPV training opportunities, including raising awareness of IPV severity, trauma-informed care and building trusting patient-physician relationships.

Workplace violence among home healthcare workers in KSA: Prevalence, predictors, action, and response 2021

ObjectivesThis study aims to identify the prevalence and predictors of workplace violence among home healthcare workers in KSA. MethodsHome healthcare workers employed by government sectors in KSA are invited to fill an electronic questionnaire, covering background information, exposure and response to workplace violence, documentation, and the availability of workplace violence policies and training. ResultsA total of 1,054 Home healthcare workers completed the questionnaire. Approximately 68% and 50% reported no training and lack of workplace violence policies, respectively. The overall prevalence of workplace violence was 67.7%. The prevalence rates of verbal aggression, workplace aggression (non-physical), and workplace violence (physical) were 61.6%, 41.6%, and 31.1%, respectively. Sexual harassment and sexual aggression was experienced by 3.6% and 5.7% of the respondents, respectively. Exposure to workplace violence was higher among the younger age groups (p = 0.010), nurses (p < 0.001), and those with intermediate (1–7 years) working experience (p = 0.003). In approximately 20% of those who were exposed to workplace violence, the incident was not reported, and in 33.1% of the cases, action was not taken. ConclusionsWorkplace violence is prevalent among home healthcare workers, necessitating the development of policies related to workplace violence in the home healthcare setting, and escalating the training of workers.

The Association between Treatment Components and Mental Health Outcomes Among Young Children Exposed to Violence.

When treating violence-exposed children, clinicians often modify psychotherapy protocols or use only a subset of treatment components (e.g., a clinical technique, strategy). However, there is little evidence of the effectiveness of individual treatment components. Our study aimed to determine: i) the best fitting factor structure of individual treatment components; ii) the association of child characteristics (i.e., demographics, treatment dosage, environmental risk factors) with mental health outcomes (i.e., post-treatment internalizing and externalizing symptoms); and iii) the association of individual treatment factors (i.e., sets of treatment components) with mental health outcomes. A sample of 459 violence-exposed children aged 1.5-5 years was examined. Principal component analyses were conducted to factor-analyze 22 child treatment components and 18 caregiver treatment components, respectively. Multiple linear regression analyses were conducted to determine the relationship between child and caregiver treatment factors and outcomes. Children who received grief work showed significant improvement in externalizing symptoms. Children of caregivers who received parent training, attachment skills building, psychoeducation about domestic violence, safety planning, and anger management training showed significantly less externalizing symptom improvement. Gender, race/ethnicity, and treatment dosage were also associated with outcomes. This is the first study to examine treatment components in a sample of young children exposed to violence with a standardized quantitative measure. Our findings suggest that acknowledging children's loss and sorrow expressed through externalizing behavior and helping them process bereavement may help alleviate their symptoms. Clinical recommendations are discussed.

Identifying domestic violence and sexual assault presentations at a regional Australian hospital emergency department: Comparative analysis of domestic violence and sexual assault cases.

Objective:To map the main characteristics of and differences between domestic violence and sexual assault cases presenting to a hospital emergency department in Australia.Methods:This retrospective observational cross-sectional study presents a snapshot of domestic violence and sexual assault cases presenting to the emergency department of a regional tertiary Australian hospital between 1 January 2018 and 31 December 2018. Data were extracted from the health district electronic information system for all eligible females. All data were checked for completeness and discrepancies by researchers before analysis.Results:42/105 (40%) sexual assault cases and 27/56 (48%) domestic violence cases reported mental health issues. More than half of the sexual assault and domestic violence cases had recurrent presentations to emergency department (51%; 54/105% and 52%; 29/56, respectively); most injuries were classed as severe. 92/105; 88% of sexual assault and 41/56; 73% of domestic violence victims were referred to related services.Conclusion:Clinical health staff, particularly those working in emergency department, can play crucial roles in identifying cases of domestic violence and sexual assault. Domestic violence training for clinicians and routine domestic violence screening in hospital emergency department is recommended to enhance early intervention.

Implementing Violence Training to Reduce Workplace Violence amongst Registered Nurses and Healthcare Professionals

Workplace violence (WPV) is highly prevalent across the healthcare system, but there is a higher incidence of violence within the emergency department. Healthcare workers have either experienced or witnessed workplace violence such as physical assault, verbal assault, sexual assault, or other discrimination while working. In recent years, workplace violence has gained some potential to identify what can be done to address the issue at hand. This mini literature review is aimed to understand how implementing violence training can benefit emergency nurses' confidence in their training against workplace violence. The need for change and implementation of educational programs is vital for safety of the healthcare staff.

Improving Policy and Legislation Related to Healthcare Workplace Violence

Abstract Our group conducted the first known New Hampshire survey on healthcare staff experience of workplace violence. Study questions focused on experiences of workplace violence, incident reporting mechanisms, and the availability and benefit of workplace violence training programs. Results were consistent with recently published literature: violence against healthcare workers remains a serious public health problem that is under-reported, understudied, “tolerated and largely ignored.” We will discuss the aspects of policy and legislative responses to workplace violence that have been insufficient to address this problem. We also will present some strategies that, if implemented, could lead to improved policy and legislation that may be more proactive in reducing such violence.

Reframing Older Adults’ Violence Toward Staff as Self-Protection

One of the first studies on workplace violence in nursing homes was published in 1985. Forty-five (45) years later, resident violence against staff continues to increase in incidence and severity. At the request of a state senator, a New Hampshire psychiatrist formed a research group to conduct the first New Hampshire survey on staff experience of workplace violence. Study questions focused on experiences of workplace violence and incident reporting, and the availability and benefit of workplace violence training programs. Results were consistent with recently published literature: violence is an expected, normalized element when providing care; potential repercussions and perceived resident lack of intent were major reasons for incident non-reporting. Analysis of study results and review of the literature led to the question: Are older residents’ violent behaviors towards staff an act of self-protection?

Effects of Indirect Experience of Client Violence on Social Workers' Posttraumatic Stress Disorder.

Objective This study aims to empirically determine if indirect exposure to client violence has significant negative effects on social workers’ posttraumatic stress disorder (PTSD) the same way direct victimization does. Methods Using a sample of 1,359 social workers drawn from the data collected by the Seoul Association of Social Workers, this study employs descriptive statistics to examine the prevalence of indirect experiences with client violence, and utilizes a series of hierarchical regression analyses to demonstrate the potential impact of indirect exposure to client violence on PTSD. To assess the severity of PTSD symptoms in participants, the Korean version of the Impact of Events Scale-Revised (IES-R-K) was employed. Results A descriptive analysis shows that 12.4% of the sample indirectly experienced client violence by witnessing it or hearing about a violent incident, whereas 6.0% were directly victimized. Hierarchical regression analyses indicate that direct experience (B=4.548, p<0.05) and indirect experience (B=7.297, p<0.001) of client violence have a significant association with the scores on IES-R-K. An investigation of the interaction terms between experiences of client violence and violence-prevention training illustrates that such training significantly moderates the influence on the scores on IES-R-K from indirect exposure to client violence (B=-8.639, p<0.01). Conclusion Social workers who are indirectly exposed to client violence experience PTSD symptoms comparable to their colleagues who were directly victimized. Further, violence-prevention training has greater ameliorative effects with regard to indirect experience of client violence than for direct victimization.

Pedagogies of Discomfort and Care: Balancing Critical Tensions in Delivering Gender-Related Violence Training to Youth Practitioners

This reflective paper explores the emotions, ethics, and challenges of facilitating training for youth practitioners to tackle gender-related violence (GRV). This paper draws on insights from a training intervention that emerged from an EU-funded feminist project (UK GAPWORK project), which sought to bring together approaches to tackle violence against women and girls with challenging heteronormativity and homophobia. Drawing on accounts from facilitators and participants, the aim of this paper is to identify tensions, opportunities and strategies in developing training to support critically engaged practice around sensitive topics such as GRV, and to consider the significance of working with discomfort within any such training intervention. We reflect on how discomfort presented within the training space and the challenges presented. This paper examines how Boler’s theoretical work on pedagogy of discomfort can be operationalised to think productively about designing and delivering training for informal educators on sensitive issues with ethical integrity.

Perceptions of Australian paramedicine students on a novel multi-modal, skills-based intimate partner violence training: A qualitative, exploratory study

BackgroundIntimate partner violence is a global problem with significant adverse sequelae. Healthcare education in this area is limited, and healthcare students and professionals generally lack the confidence to communicate with, and clinically manage patients experiencing intimate partner violence. ObjectivesThis study aimed to examine the perceptions of undergraduate paramedicine students about intimate partner violence and its management, and intimate partner violence education. DesignA qualitative, exploratory study. SettingAn Australian undergraduate paramedicine program. ParticipantsSecond- and third-year paramedicine students. MethodsSecond-year paramedicine students were provided with intimate partner violence information in the form of relevant literature, a lecture and an online educational package, and a group clinical scenario session. Third-year students were not offered this information or experience. Both 2nd and 3rd year students then participated in a one-on-one clinical scenario with a standardised patient. The students interviewed the patient regarding health concerns, with appropriate questioning eliciting intimate partner violence disclosure. Subsequently, focus groups examined students' views regarding intimate partner violence management and education. Focus group transcripts were thematically analysed. ResultsTwelve students participated in a standardised patient one-on-one clinical scenario and nine of these students took part in focus groups. Four major themes were identified from the focus groups: i) confidence, ii) uncertainty-what to do now? iii) value of intimate partner violence education, and iv) future of intimate partner violence education. The discourse around lack of confidence appeared to be more pronounced in the students who had not received the intimate partner violence educational package. ConclusionThe inclusion of a multi-modal intimate partner violence education package, including the utilisation of a standardised patient can be useful in improving paramedicine student confidence to interact with and manage patients impacted by intimate partner violence. Students value this education and are supportive of its incorporation in undergraduate paramedicine programs.

A Systematic Review: Effectiveness of Interventions to De-escalate Workplace Violence against Nurses in Healthcare Settings.

Workplace violence (WPV) is an increasing cause of concern around the globe, and healthcare organizations are no exception. Nurses may be subject to all kinds of workplace violence due to their frontline position in healthcare settings. The purpose of this systematic review is to identify and consider different interventions that aim to decrease the magnitude/prevalence of workplace violence against nurses. The standard method by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2009) has been used to collect data and assess methodological quality. Altogether, twenty-six studies are included in the review. The intervention procedures they report on can be grouped into three categories: stand-alone trainings designed to educate nurses; more structured education programs, which are broader in scope and often include opportunities to practice skills learned during the program; multicomponent interventions, which often include organizational changes, such as the introduction of workplace violence reporting systems, in addition to workplace violence training for nurses. By comparing the findings, a clear picture emerges; while standalone training and structured education programs can have a positive impact, the impact is unfortunately limited. In order to effectively combat workplace violence against nurses, healthcare organizations must implement multicomponent interventions, ideally involving all stakeholders.

Obstetric violence: Comparing medical student perceptions in India and the UK

Objective(s)Obstetric Violence refers to professional deficiencies in maternity care, which can occur in both low and high resource settings. Examples include non-dignified care, lack of respect when giving care, discrimination and abandonment of care. The objective of this study was to assess knowledge and attitudes towards obstetric violence in a cohort of medical students in India and the UK. Study designAn online survey was sent to 240 UK and 280 Indian medical students. This incorporated a video showing a dramatized scenario of obstetric violence. The survey assessed participant’s demographics and prior knowledge of obstetric violence. Participants scored their perceptions of eight behaviours in the video on visual analogue scales. Participants were asked to reflect on their own practice and score this. Comparisons of survey responses between UK and Indian participants were made using chi squared/Student’s t-test. Results62 Indian medical students and 58 UK medical students completed the survey. Indian medical students were significantly more likely to be male (p < 0.001). 26 % of UK participants had previously heard the term obstetric violence, compared to 34 % of Indian participants (p = 0.15). Both were able to correctly define obstetric violence at similar rates (32 % versus 34 %). Indian medical students were significantly less critical (p < 0.001) of all eight scored behaviours in the video of obstetric violence compared to their UK counterparts. UK medical students were significantly less likely to agree that the video had changed their perception on how teams should behave and act in this context (p < 0.001).90 % of UK participants and 38 % of Indian participants had received training in professional behaviours. 14 % of UK participants had seen examples of obstetric violence in clinical practice compared to 49 % of Indian participants. ConclusionsUK and Indian medical students were able to identify behaviours associated with obstetric violence, although the majority were previously unaware of the term. Indian medical students in this study were less critical of obstetric violence in the video, which may be because of cultural reasons, greater numbers of male students, greater exposure to obstetric violence or less training on professional behaviours. Standardised training to prevent obstetric violence should be part of undergraduate medical training internationally.

Percepciones del personal sanitario sobre la violencia de género

IntroductionHealth professionals are sometimes the main support for battered women. However, some obstacles have been identified, related to the lack of training among professionals, which complicate healthcare. The aim of this study was to learn about health professionals’ opinions and attitudes towards gender violence. MethodsA descriptive survey research was carried out in healthcare areas of A Coruña, Santiago de Compostela and Vigo. ResultsA total of 124 completed surveys were obtained. 12% of professionals reported training in gender violence, 87% of them in the medical community. 37,1% stated that they know the national protocol for health assistance or resources available to help victims. Primary care professionals showed greater training and familiarity with the protocol. ConclusionThis research highlights the need to improve the training of health professionals in the field of gender violence to offer an appropriate answer to battered women.