Pocket Guide to Midwifery Care (Crossing Press Pocket Guides)

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Nevertheless, nurses are the largest group of employees among healthcare professionals and are most often the first healthcare professional who provides care to women at Emergency Departments ED and high risk clinics. These clinical guidelines were designed to be used for the development of policies, procedures, protocols and educational programmes, and as an assessment and documentation tool, but the authors suggest that it can be used as a resource tool and adapted to each practice setting or environment.

Further, only one new study was found in which the impact of a nursing intervention when women had experienced abuse was tested.

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Nevertheless, little is known about how and in what ways nurses working in ED and midwives working in high risk prenatal clinics can intervene with women who have experienced abuse, and no study was found that focused on the use of clinical guidelines for these healthcare professionals regarding best practice initial response when women disclose to them that they are victims of gender violence.

The aim of this study was to identify the incidence of violence against women seeking healthcare services and evaluate the use of clinical guidelines to identify interpersonal violence. All the nurses and midwives who participated in the data collection gave written consent. The guidelines were originally developed in Ontario, Canada RNAO , but had been modified based on new information from the literature and adapted to fit the Icelandic culture.

The inclusion criteria were that the women were a 18—67 years of age; b were seeking healthcare services from the ED or the HRPCC and c were able to read and write Icelandic or English. Women who were under the influence of alcohol or drugs were excluded from the study. Although the Icelandic version of the guidelines was based on the Canadian clinical guidelines, new research findings were integrated into the Icelandic version.

The guidelines were organized differently and divided into two versions, a long version 21 pages , and a short version two pages. Information for Icelandic women who have experienced or are experiencing physical, emotional or sexual abuse, such as lists of institutions or organizations, was also added to the guidelines. This version includes a flow chart that is intended to help to identify abuse among women.

In addition, violence is defined and an example is given on how to open a discussion about violence with a client. The importance of a caring attitude towards victimized women is emphasized, as well as the importance of confidentiality. Electronic information sources are given and there is a list of important phone numbers and institutions to turn to. Before they introduced the study to the women the nurses and midwives in the study were encouraged to read the longer version of the guidelines first and then the shorter version to review the main emphases in the longer version.

In both versions, the most important information was extracted and presented in grey boxes for ease of use. The content of both versions and their applicability to clinical practice were critically discussed at the seminars held for the nurses and midwives participating in the study.

Identifying abuse among women: use of clinical guidelines by nurses and midwives

Data were collected with women seeking health care for a variety of reasons at the ED from January to May Questions posed to the women included age, ethnicity, education and employment status. The nurses and midwives were asked about length of work experience as a healthcare professional and length of employment at the current healthcare institution. The interview framework consists of nine broad questions, with each question having many subcategories. The healthcare professionals asked the women each question and filled in the questionnaire, e. This study was approved by the appropriate ethics committee and service managers.

The nurses, midwives and women participating in the study received oral and written introductions to its purpose and procedures before being recruited. If women were interested in participating, they received an introduction letter about the study. Those who agreed to participate and gave written consent received a package of questionnaires.

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After having filled in the questionnaires, they were offered the interview with the nurse or midwife. Their experiences of offering the women participation in the study was generally good:. I was a bit worried in the beginning but then I was OK, I found this a little difficult at first, It was a positive experience, I was embarrassed to start with, but I got used to it, It depended on whether the women had experienced abuse or not. It was not difficult, except for asking about sexual abuse in the beginning, The experience was good, It was not a problem, It varied, It took a lot out of me to ask about sexual abuse, It was a difficult experience, I was a bit hesitant at first, It was a positive experience, I was insecure in the beginning, It is a sensitive topic, I felt uncomfortable asking about this, At first it was uncomfortable then it was normal, It was not a problem after having asked the first woman.

I read the guidelines carefully in the beginning, I read the long version twice, then the short version, The guidelines were very helpful, They were good, I used them to prepare myself and in the beginning, They were a solid base to build on, They were OK, they guided me, They were useful but they were too long. A general limitation of the study was the small number of ED nurses who participated. Further, the use of the instrument Abuse of women: Screening and First Response.

The findings, therefore, need to be interpreted with caution and cannot be generalized outside of study ED or high risk prenatal clinic.


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However, the frequency of sexual abuse varied greatly between the two groups of women. Twelve of the 20 sexually abused women visiting the ED had been abused more than 10 times each, compared with only one woman at the HRPCC. Although the frequency of sexual abuse varied between the two groups, nearly half of the 21 women visiting the HRPCC who reported sexual abuse had experienced abuse by a close family member between two and five times, and seven of the sexually abused women at the HRPCC had experienced sexual abuse by a family member once.

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This finding is of particular concern for healthcare professionals working in these settings and supports the importance of routine screening for abuse against women by first response nurses and midwives. However, despite their relatively long work experience as healthcare professionals, many of them admitted that it had been difficult in the beginning to discuss abuse with their clients.

All stressed, however, that as they became more familiar with the topic, and after having gone through the first one or two evaluation interviews with the women, they became more secure and relaxed with the screening process. Further, a majority recommended that the guidelines both the long and short versions be used and implemented into clinical practice without any changes. These findings are encouraging and emphasize the importance for nursing managers and clinicians to implement routine screening for abuse against women at ED and high risk pregnancy clinics.

The guidelines that were developed and applied in this study are promising with regard to detection of and first response to abuse among women visiting ED and high risk healthcare settings. However, further research is needed to test the effectiveness of the guidelines as an intervention in other cultures and healthcare systems.

We would like to thank all the women, nurses, and midwives who participated in the study. EKS was responsible for the study conception and design. EKS performed the data analysis. EKS was responsible for the drafting of the manuscript. Products of this store will be shipped directly from the US to your country. Products of this store will be shipped directly from the UK to your country. Products of this store will be shipped directly from China to your country.

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