TEACHING ABOUT VIOLENCE AND ABUSE LESSONS LEARNED FROM

TEACHING ABOUT VIOLENCE AND ABUSE: LESSONS LEARNED FROM NURSING Janice Humphreys, RN, NP, Ph. D, FAAN Associate Professor & Vice-Chair for Faculty Practice UCSF School of Nursing

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

Evolution of Nursing Knowledge on Family Violence Burgess & Holstrom (1974) “rape trauma syndrome” Child sexual assault Parker & Schumacher (1977) – 1 st domestic violence research in nursing 1 st to address women’s response to battering Emphasized the significance of family roles

Evolution of Nursing Knowledge on Family Violence 1983 Department of Justice Task Force Surgeon General’s Workshop on Violence & Public Health Influence of nursing research evident in Healthy People 2000 Report Helton, Mc. Farlane, Anderson, Bullock & others (1986 -7) – association between abuse and complications of pregnancy

Evolution of Nursing Knowledge on Family Violence Campbell (1980 s+) 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”

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)

Nursing Network on Violence Against Women International 2000 (and ongoing!) Excellence in Nursing Education Christine King

Levels of Competency for Addressing Family Violence LEADERSHIP From Brandt ‘ 97 ADVANCED BASIC Applies to all health care professionals Applies according to role or position requirements, interest, complexity of cases & advanced practice roles Applies to those in family violence specific positions, opinion makers, delivery system architects, & directors, & family violence researchers.

Exemplars in nursing across educational levels Doctoral Applies to those in family violence specific positions, Masters opinion makers, Applies according delivery system to role or position architects, & Undergrad requirements, directors, & family interest, complexity Applies to all violence nursing students of cases & researchers. advanced practice roles

Basic Core Competencies Needed for (from AACN ’ 99) Addressing Family Violence 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

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!

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)

What does it take? : A persistent presence Requirements & commitment Prepared programs Prepared faculty A champion Dedicated Knowledgeable Respected Didactic content Clinical experiences

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

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.

Forensic Nursing Currently 24 programs Online 6 certificate 2 degree Onsite 6 certificate 11 degree • Length of programs vary • Approximately 12 -24 months

Clinical Nurse Specialist: Forensic Nursing Focus Prepares specialists to work in Dan Sheridan Johns Hopkins University ED acute care sexual assault exam programs protective services forensic tx & evaluation units death investigation teams

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

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.

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

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 don’t have to start from scratch.

Recommendations-continued In curriculum development & practice Family violence—not just the direct effects Acknowledged as a potentially influential with every patient Complex health problem Multidisciplinary

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