http://informahealthcare.com/jic ISSN: 1356-1820 (print), 1469-9567 (electronic) J Interprof Care, 2015; 29(3): 281–283 ! 2015 Informa UK Ltd. DOI: 10.3109/13561820.2014.955913
Greater commitment to the domestic violence training is required Tuija Helena Leppa¨koski1,2, Aune Flinck2,3 and Eija Paavilainen1,2 1
Disctrict Hospital of Southern Ostrobothnia, Seina¨joki, Finland, 2Department of Health Science (Nursing Science), University of Tampere, Tampere, Finland, and 3National Institute for Health and Welfare, Helsinki, Finland Abstract
Domestic violence (DV) is a major public health problem with high health and social costs. A solution to this multi-faceted problem requires that various help providers work together in an effective and optimal manner when dealing with different parties of DV. The objective of our research and development project (2008–2013) was to improve the preparedness of the social and healthcare professionals to manage DV. This article focuses on the evaluation of interprofessional education (IPE) to provide knowledge and skills for identifying and intervening in DV and to improve collaboration among social and health care professionals and other help providers at the local and regional level. The evaluation data were carried out with an internal evaluation. The evaluation data were collected from the participants orally and in the written form. The participants were satisfied with the content of the IPE programme itself and the teaching methods used. Participation in the training sessions could have been more active. Moreover, some of the people who had enrolled for the trainings could not attend all of them. IPE is a valuable way to develop intervening in DV. However, greater commitment to the training is required from not only the participants and their superiors but also from trustees.
Evaluation research, interprofessional education, qualitative method
Introduction Domestic violence (DV) is a global health and social problem in close relationships. It increases the health problems among the population and the burden on the service system. The objective of our project was to improve the preparedness of social and healthcare professionals to manage DV (Leppa¨koski, Flinck, & Paavilainen, 2014). Our baseline staff survey indicated that health care workers find it difficult to identify and intervene in DV (Leppa¨koski, Flinck, Paavilainen, & Ala-aho, 2012). A major barrier is lack of education and training. Second, there were no commonly agreed interprofessional practices and written guidelines to help the different parties of DV. Third, training on DV issues was incidental and the staff expressed a very clear need for it. The interprofessional education (IPE) approach was chosen to recognise and respond to DV and to develop and integrate commonly agreed guidelines to be used in social and health care settings. An IPE intervention is defined as an occasion where two or more professions learn from, with and about each other to improve collaboration and the health and wellbeing of patients (Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013; WHO, 2010a).
Background The focus of IPE was driven by evidence emerging from earlier national and international studies and the results of the initial survey (Leppa¨koski et al., 2012). The themes of the IPE sessions
History Received 26 February 2014 Revised 26 June 2014 Accepted 14 August 2014 Published online 10 September 2014
were as follows: (1) training events orientation, (2) DV from an ethical and legal perspectives and (3) service networks for DV. The purpose of the third session was to find out the views of the central collaborative parties, i.e. the emergency unit of the hospital and the health centre, child protection, social and crisis centre employees, the police and the city management, regarding the following issues: how to prevent DV and how to arrange DV work in the area, and how to proceed towards the goals? Therefore, apart from collaboration partners who encounter DV in their work, city trustees were also invited to the training day and panel discussion. The participating units in the IPE programme were as follows: emergency clinics both in primary health care and in specialised health care, an orthopaedic ward and an acute psychiatry emergency unit. The staff profile of the training programme included nurses with varying education levels (80%), and additionally, e.g. physicians and social workers (20%). The main principle of IPE, interactivity, requires active learning participation and exchange between learners from different professions (Reeves et al., 2013). The first two training sessions were conducted with the researchers working in pairs. During the sessions, the teachers discussed the topics in dialogue that included the participants. The reciprocal and equal discussion between the teachers and learners enabled to search for different solutions, question one’s own operating practices and reflect together. The other experts represented regional and local supporting parties: the police, social and crisis workers, child protection units and shelters.
Methods Correspondence: Mrs Tuija Helena Leppa¨koski, Disctrict Hospital of Southern Ostrobothnia, Seina¨joki, Finland; Department of Health Science (Nursing Science), University of Tampere, Tampere, Finland. E-mail: [email protected]
We evaluated the extent of the achieved purposes of the IPE intervention. A process evaluation approach was used at it ensures a focus on the content of the programme, training activities or
T. H. Leppa¨koski et al.
J Interprof Care, 2015; 29(3): 281–283
Table I. Overview of IPE sessions, participants and main evaluation results. Sessions
Participants and main results
Session 1: orientation (2 4 h)
Ninety-nine participants, of whom 46% completed feedback. Main results: The training was close to practice (33%) The training afternoon ‘‘made me think again about violence issues’’ or ‘‘raised thoughts about my profession or responsibility’’ or ‘‘encouraged me to intervene in DV in client situations’’ (25%) The teachers ‘‘were able to talk about DV issues in a broad context, from many viewpoints and taking different professions into account’’ (48%) More information was needed on how to act in real situations, such as where to refer the patients for follow-up care, more information about the collaborative partners and activities, and more information about getting help in creating a ‘‘treatment path’’ in their own units Respondents (n ¼ 46) graded the whole session in the following way: very good (n ¼ 9), good (n ¼ 33), satisfactory (n ¼ 3) and poor (n ¼ 1)
Session 2: DV from an ethical and legal point of view and bringing the topic up for discussion (2 7 h)
Forty-nine participants, of which 22% completed feedback. Main results: The compact and versatile training package (38%) The speech by the police (25%), the lecture by the child protection expert (19%), and case exercises (18%) A deeper discussion was hoped for the legislation regarding DV, the view of the lawyer in their own hospital district regarding, for example, patient confidentiality Respondents (n ¼ 11) graded the whole session in the following way: very good (n ¼ 3) and good (n ¼ 8).
Session 3: Service networks for intervening in DV and solving problems + panel (7 h)
Seventy-one participants, of which 23% completed feedback. Main results: The panel discussion (45%), the speeches of the different help providers and discussions (55%) More practical examples of how to cooperate in violent situations: ‘‘What I can actually do to help the patient?’’ or ‘‘Who will care for what, what things to take care of and in what situations?’’ Participants praised the training as being well organised and said the session held their interest throughout. Respondents (n ¼ 16) graded the whole session in the following way: very good (n ¼ 6), good (n ¼ 7), satisfactory (n ¼ 2) and poor (n ¼ 1)
practical support to find out whether it has been delivered as planned and to identify gaps between its intended and actual delivery (Seppa¨nen-Ja¨rvela¨, 2004). In addition, the use of such an approach means that unpredicted issues can be highlighted (Seppa¨nen-Ja¨rvela¨, 2004; WHO, 2010b). Data collection and analysis Data were collected from the participants orally and in the written form. At the end of every training day, the participants were asked to answer the following questions: What was the best part of the session? Was there any content information/experience that was missing or lacking? Is there anything further you would like to tell us? What grade (very good, good, satisfactory or poor) would you give for the whole session? Moreover, both the participants and the teachers had a discussion with each other after each training session. Less than a third (31%) of all participants (n ¼ 239) returned the questionnaire. Qualitative content analysis was used based on open questions. Direct citations were also used to describe the participants’ experiences. Ethical considerations Ethical approval (R12857H) for the project was granted by the Ethical Committee of Pirkanmaa Hospital District. No personal data of the staff were recorded. Quotes have been used in such a way that the informants were not recognisable.
Results It was found that IPE was a useful framework for improving interprofessional collaboration in the treatment of victims of DV. After orientation days, 48% of the participants expressed that DV issues were widely elaborated and/or discussed and taking different professions into account. After second training session, about 50% of participants regarded the speeches of the different help providers and case exercises in multidisciplinary groups as
the best offering of the training. In addition, the participants were satisfied with the content of the training programme (see Table I). However, participation in the training session could have been more active. Unfortunately, some of the participants who had enrolled for the training could not participate in all sessions. Contrary to what had been commonly agreed, some also discontinued due to work with patients. This fact, at least partly, hindered the realisation of the goals of the IPE programme – to provide and to improve collaboration on a local and regional level.
Discussion Intervention in DV is difficult because there is no available enough services where to refer the parties involved in DV. Because the prevention of violence and the responsibility for organising services belongs to municipalities, we wanted official support from decision makers for starting the network operations. The first unpredicted issue happened when the trustees did not attend the session because of their duties. Moreover, some of the people who had enrolled for the trainings could not attend all of them. This means that administrative support is needed. Second, managers should take care of the resource allocation as well as making sure that DV training is included in annual training plans like Leppa¨koski et al. (2014) have highlighted earlier. Some limitations of this study must be considered. The designing phase of the IPE did not include anyone involved in practical work or their superior. The functionality of the training programme has not been tested and no outside evaluator was used. Only a little over one-third returned the written feedback. What the rest of the participants thought of the training programme remained a mystery.
Declaration of interest The authors declare that they have no conflict of interests. The authors alone are responsible for the content and writing of this article.
References Leppa¨koski, T., Flinck, A., & Paavilainen, E. (2014). Assessing and enhancing health care providers’ response to domestic violence. Nursing Research and Practice, 2014, 759682. Article ID 759682. Leppa¨koski, T., Flinck, A., Paavilainen, E., & Ala-aho, S. (2012). The role of interprofessional collaboration for intimate partner violence in psychiatric care: A research and development project. Journal of Interprofessional Care, 27, 344–346. Reeves, S., Perrier, L., Goldman, J., Freeth, D., & Zwarenstein, M. (2013). Interprofessional education: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 28, CD002213.
Greater commitment to DV is required
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