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 1970�s - 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 women�s response to battering Emphasized the significance of family roles

4. 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, 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) 2000 Canada Conference � Awards Recipients Excellence in Nursing Practice Nancy Glass Excellence in Nursing Education Christine King Excellence in Nursing Research Jacqueline Campbell 2000 Canada Conference � Awards Recipients Excellence in Nursing Practice Nancy Glass Excellence in Nursing Education Christine King Excellence in Nursing Research Jacqueline Campbell

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

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 Task force of AACN which represents more than 530 members of baccalaureate and higher degree schools of nurisng in public and private colleagues and universities. Here are the 5 competenciesTask force of AACN which represents more than 530 members of baccalaureate and higher degree schools of nurisng in public and private colleagues and universities. Here are the 5 competencies

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! Child � typically during pediatric rotation in medical school Dependent on residency PA�s � little info on training available � curricula at Nova in Fla � 3 hrs of lecture Dentistry � Of the 64 dental schools � 96% taught to recognize child maltreatment, PANDA (Prevent Abuse & Neglect through Dental Awareness- pioneer program in Missouri � coalition of schools social service to address abuse) Medical School Child Abuse � 95% some content (Alpert �98) IPV � increase in education (AAMC-2000) Elder Maltreatment � least included Residency-Peds, Ob-Gyn, Fam Practice, EM, IM, psych Social Work � most programs Psychology � CAN in most programs, IPV in less Child � typically during pediatric rotation in medical school Dependent on residency PA�s � little info on training available � curricula at Nova in Fla � 3 hrs of lecture Dentistry � Of the 64 dental schools � 96% taught to recognize child maltreatment, PANDA (Prevent Abuse & Neglect through Dental Awareness- pioneer program in Missouri � coalition of schools social service to address abuse) Medical School Child Abuse � 95% some content (Alpert �98) IPV � increase in education (AAMC-2000) Elder Maltreatment � least included Residency-Peds, Ob-Gyn, Fam Practice, EM, IM, psych Social Work � most programs Psychology � CAN in most programs, IPV in less

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

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

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. The primary goals of this work are to: explore of trends and issues important to health care delivery and policy; recommend actions to the Board of Directors and the Fellowship; provide expert opinion on issues critical to the provision of health care and the well-being of the American people; support the mission and strategic priorities of the Academy and Board designated priorities; and, prepare Board approved and/or requested products and documents that reflect the synthesis of philosophic and scientific knowledge aligned with the strategic directions of the Academy, producing tangible outcomes. The primary goals of this work are to: explore of trends and issues important to health care delivery and policy; recommend actions to the Board of Directors and the Fellowship; provide expert opinion on issues critical to the provision of health care and the well-being of the American people; support the mission and strategic priorities of the Academy and Board designated priorities; and, prepare Board approved and/or requested products and documents that reflect the synthesis of philosophic and scientific knowledge aligned with the strategic directions of the Academy, producing tangible outcomes.

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 don�t have to start from scratch.

22. 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

23. Thank you