Exemplar of Creative Practice: Using Evidence-based Nursing to Address Family Violence

Whitireia Nursing Journal, 2007 by Horua, Maraea

Sara's story

I was working as a graduate nurse in a clinic that was part of a local medical centre. My role was to provide primary and acute nursing care. Clients attending the clinic had 15 minute appointments, and I was responsible for procedures such as dressing, cryotherapy, cervical screening (smear tests), childhood immunisations and anything else that may present. It was a busy practice - my days were fully booked and sometimes double booked.

Sara came in for a cervical screening appointment. She had been recalled many times and was now well overdue. Before the procedure the clinic nurse uses a screening tool to ask routine questions about the woman's present and previous health: I began my usual routine questions. One of these asks whether the client has a partner. When I asked, Sara looked at me and then she said 'no, I have left him.' Then she looked down. I asked whether everything was okay. Sara looked at me and then described what she had been through for the past 15 years. She was a middle aged Pakeha woman with two grown children who had recently left home to study. She told me how she had left an abusive husband several months ago. I took this opportunity to explore the issue with her, asking what her support networks were and if there was anything I could do to support her. She told me that she was well supported and that Women's Refuge had been advocating for her.

During this consultation, I was interrupted three times, because I had been with Sara for over half an hour and had not yet done the cervical screening. I felt that letting her discuss her situation was more important, and I knew that she would come back and see me again if I could build a rapport with her.

I did not charge Sara for my services and did not do the smear test -1 felt it was more important to respond in the therapeutic moment than provide the intended clinical services. This brought about tension in the clinic, as I had to justify not having charged Sara to my supervisors.

Family violence - increasing awareness

Domestic violence or family violence is when one partner or person in a relationship uses different ways to gain power and control. The Family Violence Intervention Guidelines (Faslow, 2002) definition is straightforward: 'Violence or abuse of any type, perpetrated by one family member against another family member. It includes child abuse, partner abuse and elder abuse' (p. 84).

For my assignment I focused on family violence and explored the evidence for primary health nursing practice. One of the key issues for me was to relate my nursing experiences to the available literature much of which is published internationally to make sure that it related to a New Zealand context. My research made me wonder what we can do as primary health care professionals to increase awareness and support in the area of family violence.

Raising public awareness is a positive way that family violence can be addressed (Fanslow, 2002). This can offer the chance of prevention and action. The Ministry of Health's Family Violence Intervention Guidelines (Fanslow, 2002) is an excellent resource and should be openly available in every medical centre. Through the implementation of this nurses can adhere to the New Zealand Primary Health Strategy and the New Zealand Health Strategy. They can also contribute to the well-being of women and families. Through utilising evidence-based practice and using a holistic framework, nurses can develop policies and protocols that enhance their practice.

From my experience with Sara and the insight into family violence this provided me with, I have now introduced a screening question in all cervical screening or well-woman checks: I now ask 'Do you feel safe at home?' Increasingly (as I am growing in confidence) I will routinely ask this question in other consultations with women. If health professionals don't ask about family violence, there is no opportunity to respond to it. I have a passion for supporting those who are affected by family violence and it will be an area that I continue to research and support. Although I am a new nurse in primary health care, I believe that in the case of Sara I maintained professional nursing care and utilised evidence-based practice to supporting a woman who had experienced family violence.

Tears and troubles are all behind

Time to grow and cheer

Fear has gone and I am here

Lucky to be alive

Children laugh and play

No more crying in the dark

Here to live another day

Lucky to be alive

(Anonymous)

References

Fanslow, J. (2002). Family violence intervention guidelines, child and partner abuse. Wellington: Ministry of Health.

Maraea Horua RN, Postgraduate Certificate in Primary Health Care Specialty Nursing. As part of the Postgraduate Certificate in Primary Health Care Specialty Nursing paper, I wrote an assignment exploring evidence-based decision making in nursing practice. This is an excerpt from that paper.