Fisher Caroline A, Troy Kirsty, Rushan Catherine, Felmingham Kim, Withiel Toni D
Allied Health, Family Safety Team, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Allied Health, Psychology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Front Health Serv. 2023 Jan 6;2:1016673. doi: 10.3389/frhs.2022.1016673. eCollection 2022.
Family violence is a significant public health issue. Healthcare systems have an important role to play in recognising and responding to current family violence experiences in their patients. However, many healthcare workers and systems remain underprepared to fulfil this role. The current study evaluated the impact of a transformational change project in family violence clinical response at a major adult trauma hospital in Australia. Clinician self-rated knowledge, confidence, and family violence clinical skills were evaluated at three years post implementation of a family violence initiative at the Royal Melbourne Hospital, Melbourne. The three years post survey results ( = 526) were compared to baseline ( = 534) using Mann Whitney and analyses. Self-reported clinician family violence knowledge, confidence and patient screening were all significantly improved from baseline. Specific family violence skills, including knowledge of key indicators, enquiry with patients and disclosure response were also all significantly improved. The most common clinician identified barriers to working effectively in the area were similar to baseline and included the presence of a suspected perpetrator during the clinical interaction, clinicians perceiving patients would be reluctant to disclose, and time limitations. However, significantly fewer staff endorsed a lack of knowledge or supporting policies and procedures as a barrier. The findings indicate that investment in a transformational change project comprised of the establishment of response policies and clinical work-flow, broad-scale training, a clinical champions program, a secondary consultation service and links with partner organisations, was effective at improving clinician self-rated rated family violence skills, across the hospital. However, one quarter of clinicians still reported having not received any family violence training, and half endorsed having little or no confidence in their skills to identify and respond to patient family violence experiences. This indicates ongoing and sustained work is required to optimise clinician skills in responding to family violence.
家庭暴力是一个重大的公共卫生问题。医疗保健系统在识别和应对患者当前的家庭暴力经历方面可发挥重要作用。然而，许多医护人员和医疗系统仍未做好履行这一职责的准备。本研究评估了澳大利亚一家大型成人创伤医院开展的一项变革性项目对家庭暴力临床应对的影响。在墨尔本皇家墨尔本医院实施家庭暴力倡议三年后，对临床医生的自评知识、信心和家庭暴力临床技能进行了评估。使用曼-惠特尼检验和t检验将三年后的调查结果（n = 526）与基线（n = 534）进行比较。自我报告的临床医生家庭暴力知识、信心和患者筛查情况均较基线有显著改善。包括关键指标知识、与患者询问及披露应对等特定家庭暴力技能也均有显著提高。临床医生确定的在该领域有效工作的最常见障碍与基线相似，包括临床互动期间有疑似施暴者在场、临床医生认为患者不愿披露以及时间限制。然而，认可缺乏知识或支持性政策及程序作为障碍的工作人员明显减少。研究结果表明，对一个由制定应对政策和临床工作流程、大规模培训、临床支持项目、二级咨询服务以及与合作伙伴组织建立联系组成的变革性项目进行投资，对于提高全院临床医生自评的家庭暴力技能是有效的。然而，四分之一的临床医生仍报告未接受过任何家庭暴力培训，一半的临床医生认可自己在识别和应对患者家庭暴力经历方面几乎没有信心或完全没有信心。这表明需要持续不断的工作来优化临床医生应对家庭暴力的技能。
