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Project title

An exploration of what enables NSW Health emergency department staff to treat and support domestic and family violence victims who have experienced non-fatal strangulation

Background

Non-fatal strangulation (NFS) is an indicator of serious risk in domestic and family violence (DFV). NFS is a predictor of lethality however it is frequently minimised by both victims and health workers due to a lack of awareness regarding the potential injuries. It is medically dangerous with a risk of brain injury, an arterial dissection or death from unseen injuries. Health services need to assess and respond to both the medical and psychosocial risks when victims present to emergency departments.

Aim

This study aims to explore what enables emergency department staff to respond to and support domestic violence victims who have experienced non-fatal strangulation. This study provides an avenue for emergency department staff to share their knowledge and experience to inform the development of service improvements required for this challenging work.

Methods

This study utilises a qualitative appreciative inquiry approach, collecting data through semi-structured interviews with a range of NSW Health emergency department staff including medical, nursing and social work staff.

Significance

Findings from this study will have practical implications to inform the development of training, education and resources to support emergency department staff to do this work and will inform redesign processes to integrate crisis responses to domestic and family violence victims.

Funding body

Health Education and Training Institute (HETI); NSW Health

Funding budget

$29,430

Project start date

January 2021

Expected completion date

October 2022

Report abstract

Semi structured interviews were conducted with a range of emergency department (ED) health professionals, to explore what enables them to treat and support people who have experienced non‐fatal strangulation in the context of domestic and family violence (DFV). Health professionals shared how they do this work, ‘what works’ and what else could support the ED response to people who have experienced non‐ fatal strangulation (NFS) in the context of domestic and family violence.   Purposive sampling resulted in the recruitment of 12 doctors, nurses, and social workers from eight emergency departments across three New South Wales Local Health Districts. Appreciative inquiry methodology informed the study design. Inductive coding of the data was conducted, followed by deductive analysis using a social ecological framework. Participants’ insights show tensions between key factors within and between the policy, community, organisational, interpersonal, and individual levels of the social ecological framework. The results suggest that whilst clinical guidelines assist with medical assessment and treatment, local ‘champions’ delivering organisationally supported education on the nuanced responses needed to address the complexities and risks for victims in domestic violence situations, is also crucial. Integrated, multidisciplinary collaborative responses enables positive engagement with victims/survivors and social workers are key to linking victim/survivors to ongoing supports. Organisational recognition and encouragement of the informal support networks amongst emergency department staff enables staff to debrief and cope with intensity of this work.   Organisational support for education, clarification around risk reporting responsibilities and enhanced resourcing for domestic violence champions and social workers in EDs, would support staff to implement clinical guidelines for the management of non‐fatal strangulation.