Teaching about violence and abuse: lessons learned from nursing

1
Teaching about violence and abuse lessons
learned from nursing

• Janice Humphreys, RN, NP, PhD, FAAN
• Associate Professor
• Vice-Chair for Faculty Practice
• UCSF School of Nursing

2
Evolution of Nursing Knowledge on Family Violence

• Early 1970s - violence and abused were not
  viewed within the context of human health
• Instead as a criminal problem for the judicial
  system
• 1970s-80s Nursing research was instrumental is
  changing from violent human behavior to
  interpersonal violence family system
  dysfunction within societal context

3
Evolution of Nursing Knowledge on Family Violence

• Burgess Holstrom (1974)
• rape trauma syndrome
• Child sexual assault
• Parker Schumacher (1977) 1st domestic
  violence research in nursing
• 1st to address womens response to battering
• Emphasized the significance of family roles

4
Evolution of Nursing Knowledge on Family Violence

• 1983
• Department of Justice Task Force
• Surgeon Generals Workshop on Violence Public
  Health
• Influence of nursing research evident in Healthy
  People 2000 Report
• Helton, McFarlane, Anderson, Bullock others
  (1986-7) association between abuse and
  complications of pregnancy

5
Evolution of Nursing Knowledge on Family Violence

• Campbell (1980s)
• Domestic homicide
• underscored the social context
• interpersonal relationship basis for abuse
• Dangerousness of abuse for women
• Campbell, J., Humphreys, J. (1984). Nursing
  care of victims of family violence. Reston, VA
  Reston Publishing Company, Inc.
• 1992 Annual Review of Nursing Research
• Battered women and their children

6
Development of Nursing Education on Family
Violence

• 1995-American College of Nurse-Midwives Domestic
  Violence Education Module (Paluzzi Quimby)
• developed to serve as an education tool for
  student nurse-midwives as well as Certified
  Nurse-Midwives on the issue of domestic
  violence.
• intent is to promote universal screening
• Clinical content
• Readings
• Evaluation
• Appendices (tools, images, documentation
  guidelines, legal information, resources,
  articles)

7
Nursing Network on Violence Against Women
International

• 2000 (and ongoing!)
• Excellence in Nursing Education
• Christine King

8
Levels of Competency for Addressing Family
Violence
From Brandt 97
9
Exemplars in nursing across educational levels
10
Basic Core Competencies Needed for Addressing
Family Violence (from AACN 99)

• Identify, assess document abuse
• Intervene to secure safety reduce vulnerability
• Recognize cultural value factors influencing
  family violence
• Recognize legal ethical issues in treating
  reporting family violence
• Engage in activities to prevent family violence

11
Educational Activities in Nursing

• Woodtli Beslin (1996) (2002)
• 2-4 hours of content
• 46 taught sexual elder abuse in hour or only
  in readings
• Only coincidental clinical experiences
• 63 No faculty development in area despite
  identified need
• IOM (2005)
• Majority (90) of BSN schools of nursing include
  
• IPV child abuse content
• Less on elder abuse
• However, a few hours of lecture is the norm!

12
Professional Requirements in Nursing

• 1995-ACNM
• 1997- AACN
• Generalized professional competencies
• 2006-IOM recommended that all qualified health
  professionals query veterans about wartime
  experiences symptoms (PTSD)

13
What does it take? A persistent presence

• Requirements commitment
• Prepared programs
• Prepared faculty
• A champion
• Dedicated
• Knowledgeable
• Respected
• Didactic content
• Clinical experiences

14
Electives Senior Seminars

• Family violence (1-3 credits) Johns Hopkins
  University Jacquelyn Campbell
• Classroom setting
• Content, theories, reading, discussion
• AND
• Clinical experiences in community agencies

15
Masters students

• Guest lectures
• Health Promotion Disease Prevention
• Screening
• Physiologic consequences
• Qualitative Research Methods
• I What kinds of situations or things interfere
  with your sleep?R My worrying about my future,
  worrying about myself and what I need to do to
  take care of all my problems. Worrying about the
  kids. Worry interferes with my sleep. Or,
  things uncomfortable in the house. Waiting for
  someone to come home or someone just left and I
  was close to them, that I miss them. I share
  this huge bed with the kids so, they interfere
  with my sleep.

16
Forensic Nursing

• Currently 24 programs
• Online
• 6 certificate
• 2 degree

• Onsite
• 6 certificate
• 11 degree

• Length of programs vary
• Approximately 12-24 months

17
Clinical Nurse Specialist Forensic Nursing
Focus

• Prepares specialists to work in
• ED
• acute care
• sexual assault exam programs
• protective services
• forensic tx evaluation units
• death investigation teams

Dan Sheridan Johns Hopkins University
18
Doctoral Students

• Guest lectures
• Health Promotion Disease Prevention
• High risk perinatal neonatal care
• Health disparities
• Related courses
• Seminar on Symptom Management
• Specialty courses
• Advanced Nursing Seminar on Violence Health

19
American Academy of Nursing Expert Panel on
Violence

• Provide a forum for Fellows with shared
  expertise
• Expert panels review the current research and
  needs within their field to make recommendations
  on projects and/or initiatives the Academy should
  undertake to transform health care policy and
  practice.
• The expert panels are intended to address
  emerging issues within the nursing profession and
  the health of the public.

20
CURRICULAR CONTENT TEACHING STRATEGIES

• IOM CONCLUSIONS
• Existing education theories about behavior change
  suggest useful teaching approaches to planning
  educational interventions for health
  professionals tailored to FV.
• Ways of changing behavior practice in health
  care delivery systems,
• Use of techniques to address practitioners
  biases about victims,
• Not didactic - rather skill-building, practice
  enabling, interactive, guided clinical
  experience, evaluative feedback

21
Recommendations

• Evidence of core competencies for nursing
• Education at the appropriate level across all
  levels
• Nursing programs should address competencies at
  the appropriate level
• Ideal Content clinical experiences both
  integrated focused
• Innovative approaches
• Didactic content alone does not have the same
  impact as personal encounter!
• Others have led before. You dont have to start
  from scratch.

22
Recommendations-continued

• In curriculum development practice
• Family violencenot just the direct effects
• Acknowledged as a potentially influential with
  every patient
• Complex health problem
• Multidisciplinary

23
Thank you