When Victims Seek Help
For women who have been victimized by domestic violence, visiting a hospital emergency department can be an agonizing experience due to the problems in opening up to emergency staff. A study published in the November 2007 issue of Annals of Internal Medicine examining how female patients interact with emergency providers focuses on this issue. The study is based on an analysis of audio taped conversations made during a randomized, controlled trial of computerized screening for domestic violence in two emergency department (one urban and one sub-urban). Using a sample of 1281 English-speaking women age 16 to 69 years and 80 providers (30 attending physicians, 46 residents, and 4 nurse practitioners), 871 audiotapes, including 293 that included provider screening for domestic violence, were analyzed. Results indicated that providers typically asked about domestic violence in a routine manner during questioning concerning patient social history. Communication strategies that encouraged women to disclose abuse more openly included probing (defined as asking one or more additional topically related question), providing open-ended opportunities to talk, and being generally responsive to patient clues (any mention of a psychosocial issue). Chart documentation of domestic violence was present in one third of cases. While non-verbal communication was not directly examined, the results indicated that hectic and crowded clinical settings may obstruct candid reporting of domestic violence. Specific strategies designed to encourage meaningful discussion helped victims to open up about abuse. The researchers also identified common pitfalls and good practices in screening for domestic violence.
Comments