Specialist domestic abuse training for emergency department clinical staff: A review of the literature

Abstract

Aim: Emergency departments are often the first point of contact for women suffering from domestic abuse and identifying how healthcare staff can support women is important to tackle missed opportunities for timely intervention.

Method: A review of research studies was undertaken between 2012 and 2024 using electronic databases AMED, CINAHL Ultimate, MEDLINE, EBSCO, and the RCNi. The search words “emergency department, ED, accident and emergency, A & E, domestic abuse, domestic violence, intimate partner violence, family violence, staff- training education, development, learning” were used and retrieved n=93, reduced n=18, and finally n=7.

Findings: The findings identify a training and role-specific issue related to emergency department nursing, and the need to have a supportive environment for positive action to be taken on behalf of the victim and their families. Four themes were identified; “don’t ask,” “stereotyping,” moral distress” and “systemic support.” In ‘don’t ask’ the thread of conscious incompetence ensures staff reluctance to talk to women in case it opens a ‘can of worms.’

Discussion: The difficulties experienced by emergency nurses were compounded by staff being unaware of their departments policy on dealing with domestic abuse. Contrary to WHO recommendations, the evidence identified domestic abuse screening in most emergency departments happens on an ad-hoc basis and is subject to the experience and confidence of the individual clinician.

Conclusion: Training is required to myth bust the factors related to domestic abuse, yet training is not enough, there needs to be a shift in attitudes toward domestic abuse, and in an institutional context, staff should feel supported and empowered to respond to women appropriately.