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4. Select, tailor, and suggest guidelines for adaptation to your population
Tailoring
Screening & Responding: Domestic Violence in the Acute Setting
Summary
By: Zoe, Shani, Kendra & Darrah
A Clinical Guideline
Barriers & Facilitators
3. Assess barriers and facilitators to knowledge use
2. Adapt knowledge to the local context
Adaptation
Date 1
Guidelines
1. Identify the knowledge to action gaps
This is an audio-visual presentation, please ensure that you have speakers or headphones ready.
Why the iceberg?
The child's presenting concern
Coping
Socioeconomic status
Domestic abuse
Welcome!
Adverse childhood experiences
Health literacy
Social supports
Throughout this presentation, consider the role of the RN in uncovering the underside of the iceberg, and how implementing adapted clinical guidelines can facilitate this process
What is Domestic Violence?
Preidt, Robert. (2014). Domestic Violence Affects Children. [Photograph]. Retrieved March 13, 2020 from http://www.graysoncrisiscenter.org/domestic-violence-affects-cjodrem
In a relationship which holds intimacy or trust, it is the act or intent of using physical force or threats against another
(Alberta Health Services. (2017). Domestic violence: Universal education, direct questioning and intervention. Retrieved from https://insite.albertahealthservices.ca/Main/assets/Policy/clp-calgary-womens-health-clin-support-domestic-violence-3-dv-1.pdf#search=domestic%20violence
Video
(Best experienced with lower volume audio)
https://www.facs.org/-/media/files/quality-programs/trauma/tqip/abuse_guidelines.ashx
What are the guidelines talking about?
Our Guidelines
1. USA - Best Practice Guidelines for Trauma Centre Recognition of Child Abuse, Elder Abuse, and Intimate Partner Violence
(2019)
2. AHS - Domestic Violence: Universal Education, Direct Questioning and Intervention
(2017)
https://insite.albertahealthservices.ca/Main/assets/Policy/clp-calgary-womens-health-clin-support-domestic-violence-3-dv-1.pdf
Why do we need these guidelines?
- Family Centered Care
- Improving child health outcomes
- Minimizing harmful impacts of domestic violence on children
- Trauma Informed Practice
- Keeping our patients safe
Why do we need them?
Crawford, C. (2019). CDC: Preventing ACEs may mitigate chronic health issues. [Photograph]. Retrieved March 19, 2020 from https://www.aafp.org/news/health-of-the-public/20191113mmwraces.html
So What?
- Healthier and safer children
- Reducing impact of adverse childhood experiences
- Avoiding cases of domestic violence going undetected
How will these guidelines impact our practice?
Time to adapt!
Local Adaptation
Informing Practice
USA vs AHS guidelines
Similarities
- Definition of domestic violence
- Instructions on how to recognize and respond
- Provision of screening tools
- Provision of emergency resources
- Clearly outlined role of each discipline
Similarities
Differences?
Fine-Tuning the Guidelines to Our Setting
Diving in Deeper
Alberta Children's Hospital: What do we need to adapt?
We MUST:
- Address development and communication strategies
- Explore cultural impacts
- Recognizing the inter-professional team available at ACH
- Stay within our scope as RN's
UPDATE, UPDATE, UPDATE!
Why update guidelines?
- Clarify our roles for better & safer practice
- New changes in the communities
- Best practice, if not updated could hinder screening
Assessing Barriers and Facilitators to Implementing the Guideline
Write down 3 potential barriers you foresee with this implementing these guidelines around Domestic Violence?.
Your thoughts?
Overview
Barriers that We Identified in Our Guidelines:
Barriers
- The RN may have personal biases that impact ability to carry out response
- The guidelines do not address all cultural impacts to screening for and responding to domestic violence
- Communication break down
Your thoughts?
Write down who you think should be the key players in the implementation of these guidelines?
Overview
Key Stakeholders Involved in our Guidelines
Facilitators
- Alberta Health Services
- Nurses
- Doctors
- Unit clerks
- Unit managers
Integrating the Guidelines and Policies into practice
Legal
Social Work
Resources
Family
Education
The Health Care Team
Guideline Adaptation
AHS Guideline:
- Screen at admission
- Completed flow sheet in chart
- Documented answers and referrals
Adapting Guidelines:
AHS
Example: Adapting a tool from the AHS guideline to fit our population
Video
Guideline Adaptation
Adapting Guidelines:
USA
US Guideline:
- Taking a history at first point of contact
- Physical assessment for traumatic injury
- Communication techniques
[Photograph of nurse assessing child]. (n.d.). National Children’s Advocacy Centre.
Retrieved on March 23, 2020 from https://www.nationalcac.org/medical-services/
Integrating into the unit. . .
- Education
- Workshops or simulated labs
- Auditing
- Feedback from stakeholders
Plan for Integration
[Photograph of simulated lab]. (n.d.). University of Portland. Retrieved from
https://nursing.up.edu/about/learning-resource-center.html.
Summary
Implementing these clinical guidelines could significantly improve child health outcomes (Bradbury-Jones et. al, 2020).
In summary, we suggest the following adaptations to the guidelines:
- Considering barriers such as culture and communication
- Rewording screening questions to fit the peds population
- Making it clear what do do if parent is not present
- Making the guideline more accessible by creating education/modules when introducing it to health care workers
What strategy has been proven to facilitate smooth implementation of adapted guidelines in the clinical setting
A) Focus groups
B) Mandatory webinars
C) Educational modules
D) Reading a study on the guidelines
Take-Away Question
Which of the following would be an appropriate way to adapt a clinical guideline to address the barrier of culture
A) Treat every case the same
B) Provide tools with language-inclusive options (eg. in Mandarin)
C) Just use the child as a cultural liaison or translator
What strategy has been proven to facilitate smooth implementation of adapted guidelines in the clinical setting
A) Focus groups
B) Mandatory webinars
C) Educational modules
D) Reading a study on the guidelines
Answer
Which of the following would be an appropriate way to adapt a clinical guideline to address the barrier of culture
A) Treat every case the same
B) Provide tools with language-inclusive options (eg. in Mandarin)
C) Just use the child as a cultural liaison or translator