Domestic violence screening in maternal & child health nursing practice: a scoping review
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Faculty of Health Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC
Faculty of Health Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC
Faculty of Health Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC
This scoping review explores the breadth of literature on domestic violence (DV) screening by nurses, within the well child setting. The review followed the introduction of universal DV screening into the Victorian Maternal & Child Health (MCH) service, in Australia.
A scoping review provides a panoramic overview of a chosen topic that may be later used to influence policy and practice. This review explored the literature in the well child area, with a view to identifying further research priorities.
The ‘Arksey & O'Malley (2005) framework' was used to ensure methodological rigor. There was little relevant research on DV screening in the well child setting. Emergent themes included barriers and enabling factors associated with DV screening and children at risk. From this research we can conclude that further research is required on the appropriateness of DV screening, risk assessment and referral in MCH practice.
scoping review, violence, child health, nurse, screening, postnatal, well child
Domestic violence (DV) is a major public health issue globally (Campbell, 2002; Garcia-Moreno, Jansen, Ellsberg, Heise & Watts, 2006; Krug, Mercy, Dahlberg & Zwi, 2002) and within Australia, one in three Australian women will be subjected to physical and /or sexual violence in their lifetime. Greater prevalence rates exist within indigenous women's groups, women with disabilities and women from culturally and linguistically diverse backgrounds (Australian Bureau of Statistics, 2005). The aim of this research was to explore the breadth of literature on DV screening in Maternal & Child Health (MCH) practice by undertaking a scoping literature review. This was initiated following the introduction of routine DV screening into the Victorian MCH service.
Violence against women comes at an enormous cost to the individual, family and community (Department of Families, Housing, Community Services & Indigenous Affairs (FaHCSIA), 2009). This cost is growing, with government estimates stating that violence against women costs the nation $13.6 billion annually. This figure is expected to rise to $15.6 billion by 2021 (FaHCSIA, 2009). In Victoria, Australia, DV is responsible for an estimated 9 per cent of the total disease burden for women under 45 years, with the greatest proportion of the disease burden associated with mental health problems (60%). DV has the greatest impact on the health of Victorian women between the ages of 15-44 than any other known risk factor (VicHealth, 2004).
Individual health costs include significant mental and physical health problems, including loss of life. Common physical health symptoms associated with DV include gynaecological symptoms and poor reproductive health outcomes (Gazmararian et al., 2000; Taft, Watson & Lee, 2004). Violence often occurs or escalates during times of pregnancy, with the estimated prevalence during pregnancy being between 4-8% (Campbell, 2002). DV has also been associated with higher rates of unplanned pregnancy, abortion, miscarriage, low birth weight, premature birth and foetal injury (Gao, Paterson, Carter & Iusitini, 2008; Gazmararian et al., 2000; Taft Watson & Lee, 2004; Walsh, 2008). Less direct physical health outcomes include headaches, irritable bowel syndrome, sexually transmitted infections and self harming behaviours such as drug abuse or unprotected sex (Campbell, 2002; VicHealth, 2004). The most prevalent mental health outcomes from DV are depression and post traumatic stress disorder, with associated behaviours including substance abuse, suicide or attempted suicide (Golding, 1999; Hegarty, Gunn, Chondros & Small, 2004). These effects also impact on women's parenting abilities, with poor outcomes for children (Carpenter & Stacks, 2009; Department of Planning and Community Development (DPCD), 2007).
Recent data from the National Homicide Monitoring Program (Australian Institute of Criminology) report an increase in female victimisation, with 112 women murdered in 2007-2008 compared to 81 the previous year (Virueda & Payne, 2010). This data revealed that intimate partner homicides comprised 60% of domestic homicides. However historical trends suggest that femicide rates remain consitent with previous years. The exception to this are indigenous women, who have had consecutive increases in the rates of homicide since 2003-2004 (Virueda & Payne, 2010).
A strategy to reduce the burden of DV in Victoria has been to introduce routine DV screening into the MCH service (Department of Education and Early Childhood Development (DEECD, 2009b). The Victorian MCH Service is a comprehensive primary health care service for families with children from birth to 6 years (school age). The service aims to provide a focused approach for the promotion, prevention, early detection, and intervention of the many factors affecting young children and their families (DEECD, 2009c). This is a similar role to public health nurses and health visitors in other countries, who provide primary health care in the immediate postnatal period (birth to 6 weeks), with ongoing support until school age.
Maternal and Child Health nurses provide home visits within one week of birth. This potentially places them in an ideal position to identify early and refer, women and children who are at risk, for ongoing support and safety. This service and unique role allows women to access nurses at a time when they may be vulnerable, with evidence indicating an increased prevalence rate of DV in the child bearing years, especially associated with pregnancy (Bowen, Heron, Waylen & Wolke, 2005; Burch & Gallup, 2004; Gazmararian et al., 1996; Gazmararian et al., 2000; Goodwin et al., 2000; Webster, Sweett & Stolz, 1994).
Although DV awareness and its subsequent management are not new for MCH nurses, the Victorian service only introduced a policy on DV screening in late 2009 (DEECD, 2009b). Considering the significant burden of disease from DV (VicHealth, 2004), screening may provide early detection and intervention through appropriate counselling and referral. However this practice remains controversial, with evidence from systematic reviews suggesting that DV screening does not improve health outcomes for women and children (MacMillan et al., 2009; Nelson, Nygren, McInerney & Klein, 2004; Ramsay, Richardson, Carter, Davidson & Feder, 2002; Wathen & MacMillan, 2003).
Despite this, the new MCH Service: Practice Guidelines (DEECD, 2009b) and the MCH Service: Key Ages and Stages Framework (DEECD, 2009a) require nurses to routinely ask women about DV at the 4 week postnatal visit and then at any other visit if professional judgement warrants. The Common Risk Assessment Framework (CRAF) for MCH nurses has been developed to assist nurses in undertaking further risk assessments, safety planning and referral (DPCD, 2008).
Given the prevalence and disease burden associated with DV, a better understanding of the practice of DV screening within MCH nursing is needed. The aim of the scoping review was to map the international evidence on DV screening within MCH practice (or similar well child services). Gaps in the literature and future research opportunities were identified by examining the range, extent and nature of the literature with a view to improve decision-making and policy direction within MCH services.
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