ACADEMIC EMERGENCY MEDICINE • February 2001, Volume 8, Number 2
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ter initial procedures, after the sense of crisis had improving attitudes and knowledge of nurses and
passed), as well as our anonymity decision.3 How- physicians about battered women and can change
ever, this decision resulted in an inability to link the culture of the ED so that protocols, training
the patient surveys with medical records directly. regimens, and information available for battered
Therefore, we could not determine exactly which women are significantly improved. These changes
women who reported abuse on the PSSS were were achieved even with limited technical assis-
identified as battered in the medical record and tance, scarce resources, and inconsistent adminis-
had to rely on proportional comparisons. We had tration support. Yet even though the protocols of
based our original estimates of power and, there- the experimental hospitals were significantly bet-
fore, sample size on the literature available at the ter than those of the controls, the study suggested
time of study design, which suggested as many as that actual practice change is more difficult to
18–30% (at least 10% prior to training and 20% achieve. In order to identify all battered women
post-training) of the women would be in the ED who present in the ED, universal rather than
with trauma from abuse.4,5 Unfortunately, our de- symptom (or trauma)-based screening is needed.
sign included only women at the ED due to injuries Routine screening needs reminders such as form
from abuse, not women who were in the ED for prompts and administration support to achieve
other IPV-related health problems, for the final change in forms and maintain change in practice.
outcome analysis. Our sample size of 83 women
References
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also originally hypothesized that better documen-
tation and medical record indication of improved
interventions would occur in the experimental hos-
pitals, but we did not have enough power to detect
significance and therefore were unable to test
those hypotheses.
According to the process evaluation, these hos-
pitals also found it difficult to truly partner with
local shelters without dedicated resources and pri-
orities for the initiative on both sides. They also
needed external prods and support (and/or internal
administrative goal setting and legitimization) to
get implementation started once they returned
home from the training. This kind of ‘‘kick start,’’
as one of the interviewees described, could be pro-
vided by shelter personnel and/or internal admin-
istration, but it was essential that both these play-
ers (along with nurses and physicians) be part of
the initial team for training in order to forge long-
term relationships.
These lessons learned from this evaluation are
reflected in the revised model of training being im-
plemented by the FVPF in its new ten-state initia-
tive that will also be rigorously evaluated. Even so,
in order to establish the rationale for routine
screening and ED interventions for domestic vio-
lence, further research is needed to document that
this kind of secondary prevention intervention can
actually improve the long-term health and safety
of battered women.
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CONCLUSIONS
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