THE FRONT LINE OF CARE: A QUALITATIVE STUDY OF DOMESTIC VIOLENCE INTERVENTION IN THE EMERGENCY DEPARTMENT

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Abstract

ABSTRACTUniversity of Manchester – Olufolakemi Adebimpe Tokode – Degree of Doctor ofPhilosophy in the Faculty of Medical and Human Sciences - 2012THE FRONT LINE OF CARE: A QUALITATIVE STUDY OF DOMESTICVIOLENCE INTERVENTION IN THE EMERGENCY DEPARTMENTThis study qualitatively explored the practice of domestic violence (DV) intervention in the emergency department (ED) from the distinct perspectives of service users, service providers and co-ordinators of DV voluntary organisations. The research participant group was made up of eight survivors of domestic abuse, fourteen staff members from an ED (including their manager) and eight co-ordinators from a voluntary organisation offering services for DV issues. The study was informed by the dearth of evidence regarding pragmatic intervention for the specific context of emergency departments (EDs), a need to develop system level interventions and a solid theoretical base to inform implementation of a more effective interventional strategy (Feder et al., 2009; Thurston and Eisener, 2006; Ramsay et al., 2002).The study utilised constructivist grounded theory and feminist perspectives to elicit unique viewpoints from interviews with the three separate groups. A range of meanings and conceptualisations were found which contribute to a more complex understanding of the issues involved and the responses to them. These included how women experience DV, the way DV is rendered invisible by ED culture and, perhaps most importantly, how a lack of policy implementation has influenced the practice of ED staff with regard to DV. Adopting a perspective that takes into account the sensitivity and gendered nature of DV made visible the socio-political and personal influences that affect both health providers’ and health users’ attitudes to seeking help. System-wide barriers to intervention ranged from personal to situational levels within the context of EDs. They included deep-seated ambivalence, fear and trust issues located within the constructs of both service users and providers regarding identifying and assessing the problem, seeking help, and providing support.Three overarching concepts were identified: 1) meanings and complex realities relating to DV and its intervention 2) barriers to seeking and providing help and 3) strategies for overcoming barriers and developing DV intervention within ED. Using rigorous, inductive, comparative and interpretive attributes of grounded theory procedures, conclusions were reached about the development of DV interventions in the department. These informed the propositions made for a comprehensive and integrated DV intervention including universal interventions which can be helpful irrespective of service user’s disclosure and stage of abuse, providing resources within the ED to enhance DV intervention; improving the ED environment so that it is more favourable for DV intervention; implementing policies that make the experience of psychological abuse visible; and promoting DV awareness. Areas of concern were highlighted for practice, policy, and research relevant to DV intervention in EDs.

Keyword(s)

Domestic violence; Emergency Department; Women

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