Understanding family violence assessment practices of pediatric emergency department nurses and physicians

Abstract

Despite recommendations from professional nursing and other health organizations, including the Institute of Medicine the frequency of routine assessment for intimate partner violence and other forms of family violence remains low among emergency department healthcare providers. The aim of this study was to use a theory-driven approach to understand the reasons why pediatric emergency department providers do not routinely assess for family violence, both child abuse and intimate partner violence. This is the first study to use the Theory of Planned Behavior (TPB) to explore family violence assessment behaviors. This study used a cross-sectional design and a convenience sample of emergency and urgent care nurses and physicians (n = 132) from a large Midwestern pediatric emergency department and two urgent care centers. TPB constructs of attitude, subjective norm, perceived behavioral control, and intention to perform routine family violence assessment were explored, as well as self-reported assessment behaviors. Multiple regression analyses were performed to explore the predictive power of TPB constructs and family violence assessment intentions and assessment behaviors. Independent t-tests were performed to compare nurse/physician groups. Frequency analyses were performed to evaluate two additional yes/no questions related to participants personal experience with family violence. The predictor variables of attitude, subjective norm, and perceived behavioral control made a significant contribution to the prediction of intentions to assess for child abuse; with subjective norm being the most significant (β = .52, p < .00). Only subjective norms and perceived behavioral control contributed significantly to the prediction of intention to assess for IPV; again, subjective norms was the most significant (β = .54, p < .00). Only the predictor variable of intention to assess was significant for both child abuse and IPV self-report assessment behaviors (β = .43, p < .00; β = .44, p < .00). No significant differences between nurses and physicians were found. Personal experience with family violence was reported by 26.2% of participants and 63.1% reported knowing someone personally who has experienced family violence. Thus, exposure to family violence is a common experience in this population of healthcare providers.