“What now?: Exploring the emergency healthcare response to domestic violence": A grounded theory study within regional Queensland hospitals

Background: Domestic violence is a form of violence that has become an internationally recognised problem with high prevalence rates globally (WHO, 2013). It is a form of gendered violence in that it disproportionately affects the lives of women, causing serious adverse outcomes for their health and wellbeing. Frontline healthcare professionals such as medical professionals, nurses, and social workers within Emergency Departments are often the first point of contact with healthcare services for women experiencing domestic violence. It is essential that these healthcare staff and services prioritise and meet the needs of these victims and survivors of domestic violence. Study Objective: The purpose of this study was to explore emergency healthcare professionals’ responses to patients experiencing domestic violence in regional hospitals in Queensland, Australia. Research Design: This qualitative study employed semi-structured interviews within a Straussian grounded theory methodology. Participant Population: The target participant population for this study was male and female emergency medical professionals, nurses and social workers who were employed in the Emergency Departments of two regional Queensland hospitals within Australia. Participant Screening: Participants within this study were screened using a developed self-assessment screening protocol. Participants were screened for two main reasons. Firstly, there remains a high prevalence of domestic violence experienced by healthcare professionals. Secondly, domestic violence may cause both physical and psychological harm. The use of this screening protocol ensured that no participant would be unduly distressed by their participation in this study. Data Collection: The study collected data in two forms. Firstly, demographic data was collected through anonymous paper-based surveys. Secondly, data on the care provided to patients experiencing domestic violence was collected through audio-recorded semi-structured interviews. Data Analysis: The demographic data collected from the anonymous paper-based surveys was analysed employing descriptive statistics. The audio-recorded semi-structured interviews were transcribed, then analysed utilising Straussian grounded theory; a form of constant comparative analysis. Results: This study found several areas of concern around the care provided to domestic violence victims in regional Emergency Departments. It found there was a lack of clinical guidance for healthcare professionals surrounding the identification, management and referral of patients. Referral options and pathways were not clearly established or utilised, and a lack of service availability hindered ongoing patient healthcare. A lack of education and training further contributed to the provision of suboptimal care. The physical design of the Emergency Department, models of care that prioritise physical trauma, and the demand for bed space resulted in decreased identification, and therefore inadequate health management. Finally, ill-informed and entrenched attitudes about why women do not leave abusive relationships reflected a lack of knowledge and negatively affected care. Conclusions: There are considerable and significant gaps in the care provided in regional Emergency Departments to victims of domestic violence. These gaps in care compromise the safety of the patient and result in inadequate healthcare being provided. These gaps in care may lead to further deterioration of the patient’s health and wellbeing and an increased risk of morbidity and mortality. Therefore it is imperative that further research is undertaken, and this knowledge translated into processes and initiatives which may improve health outcomes for patients. Specifically, a much stronger focus on DV is required for all healthcare professionals in the Emergency Department environment. There needs to be a health workforce comprehensively educated in DV and violence against women. Emergency healthcare professionals need to demonstrate a significant depth of knowledge surrounding the signs, symptoms and identification of domestic violence in order to initiate appropriate healthcare and promote the safety and wellbeing of women and their children. In order to facilitate this healthcare, there needs to be well-developed clinical practice guidelines, protocols, policies and procedures to support Emergency Department healthcare professionals to recognise, respond and refer patients who present with injuries consistent with domestic violence, particularly those with non-lethal strangulation which has long-term adverse health outcomes for victims.