IPV Lesson Plan for Rural ER Nurses

Intimate Partner Violence Lesson Plan for Rural Nurses

Title of Health Intervention: Intimate Partner Violence Education for the Rural ER Nurse

Need for Health Topic

The Centers for Disease Control and Prevention (2014) reported one in three women have been victims of intimate partner violence (IPV). IPV victims are more likely to suffer from chronic physical and mental illness signifying a need for early identification and intervention. Rural areas experience increased rates of intimate partner violence (IPV) from immediate family members and casual or well-known acquaintances when compared to urban and suburban residents (Bureau of Justice Statistics [BJS], 2012). The United States Preventive Services Task Force (2013) reported that early intervention may decrease IPV and the long term consequences to physical and mental health for women of reproductive age. Rural emergency room (ER) nurses are in a unique position to identify the risk factors and physical or psychosocial signs of IPV. Educating rural nurses about IPV will increase their ability to identify and refer victims of IPV to the appropriate agencies.

Intended Audience

            Rural ER nurses (licensed vocational nurses and registered nurses) employed at Mitchell County Hospital (MCH) emergency room in Colorado City, Texas. Ten full time nurses and four part time nurses work in the ER. Seven are registered nurses (RN) with an associate degree and seven are licensed vocational nurses (LVN). The age range of the intended audience is 22-58. All nurses have been employed at the MCH emergency room for more than two years.

Setting

            The Mitchell County Hospital conference room (in the hospital) in Colorado City, Texas will be reserved for the educational intervention. The room has a large conference table that seats eight people with comfortable chairs and enough room for participants to take notes. The room also has a projector and screen for presentations. The room will be reserved from 7:30am to 8:30am on one Monday and from 7:30pm- 8:30pm on a different Monday to allow both rotating shifts to participate in the education. This also allows the shift to choose an am or pm participation per their preference.

Estimated Time

1.      Preliminary Set-up (5min)

2.      Pre-intervention questionnaire (10min) – adapted from Gutmanis, Beynon, Tutty, Wathen, and MacMillan’s (2007) questionnaire (Appendix)

3.      Introduction (3min)

4.      Importance of Topic (5min)

5.      Game (5min)

6.      Lecture (10min)

7.      Short Video about IPV (5min)

8.      Post-intervention questionnaire completion (10min) - adapted from Gutmanis et al., (2007) questionnaire (Appendix)

9.       Speaker evaluation survey (5min)

Materials Needed

Laptop Computer with projection capabilities

Projection screen

Remote control for slide advancement on laptop

20 pencils

20 Brochures – “A Guide for Nurses”

20 handouts of the power-point slides

20 Green pre-intervention questionnaire

20 Red post-intervention questionnaire

20 Speaker evaluation questionnaires

1 conference table

10 chairs (not all participants will attend at once due to shiftwork)

Guiding Health Education Theory or Model

            The guiding health education theory of this intervention will be the Social-Ecological Model. According to the Centers for Disease Control (2009) the Social-Ecological Model is a framework for prevention and uses four key constructs to conduct change through the social environment. The first construct identifies the individual factors that contribute to IPV (i.e. IPV risk of individual in rural community) and prevention strategies that focus on individual education and life skills. The second construct identifies relationship factors that play a role in increasing the risk of experiencing IPV (i.e. increased IPV risk from family or acquaintances in rural areas) with prevention strategies that focus on mentoring relationships and promoting problem solving skills within relationships. The third construct involved community settings and identifies characteristics within the settings that increase the likelihood of victimization (i.e. rural tight knit community where everyone is known). The prevention strategies at the community level include local policies, local climate and social marketing. The last construct is the societal level which either promotes or inhibits IPV. The prevention strategies at the societal level include enacting education and social policies to inhibit IPV (i.e. change social or cultural norms). This particular educational intervention will focus on the societal level to influence rural nurses to screen and provide effective interventions to IPV victims in order to inhibit continued victimization.

Goals

            The overall goal of this program is to educate rural ER nurses about IPV to help rural nurses develop preparedness and self-confidence in IPV screening, identification, and referral.

1.      Increase rural nurse’s knowledge and preparedness to screen and intervene in IPV.

2.      Prepare rural nurses to routinely ask about intimate partner violence.

3.      Increase rural nurse’s knowledge and preparation to share local resources for IPV victims.

4.      Increase nurse’s self-confidence to identify and manage IPV victims.

Outcome Objectives & Learning Domains

1.      Compared to a pre-intervention baseline assessment, participants will report they are at least 10% more prepared to ask about intimate partner violence and intervene on the post-intervention assessment. (Cognitive Domain-knowledge)

2.      Compared to a pre-intervention baseline assessment, participants will report they are at least 10% more self-confident to ask about intimate partner violence and intervene on the post-intervention assessment. (Affective Domain-feel/believe)

Process Objectives

1.      To provide the IPV program to a minimum of 80% of the rural nurses from Mitchell County Hospital ER during the scheduled interventions. (participation)

2.      To solicit feedback about the IPV program from the participants through use of a speaker evaluation questionnaire. (participant satisfaction)

 Procedures

1.      Preliminary setup (5 min) – distribute brochures, green pre-intervention questionnaires, and power-point handouts to each participate. Place the handouts and brochures on the conference table where the participants will be sitting.

2.      Pre-intervention questionnaire completion (10 min) - As the participants enter the room welcome them and ask them to complete the pre-intervention questionnaire while they are waiting. Have the participants complete and turn in the pre-intervention questionnaire prior to beginning the introduction.

3.      Introduction (3 min) – Briefly introduce yourself and describe how you developed an interest in IPV. Thank the participants for their participation.

4.      Importance of Topic (5 min)

a)      Intimate partner violence is violence committed by an intimate partner which can be defined as a boyfriend, girlfriend, husband, wife, or partner. In rural areas there is increased risk of intimate partner violence from immediate family members and casual or well-known acquaintances when compared to urban and suburban residents (Bureau of Justice Statistics [BJS], 2012).

b)      Have every third person stand up to illustrate the incidence rate of IPV.  Then say: Those standing illustrate how often IPV occurs and women are affected most often. In fact one in three women have been victims of IPV (Centers for Disease Control and Prevention, 2010).

c)      The United States Preventive Services Task Force (2013) reported that early intervention may decrease IPV and the long term consequences to physical and mental health for women of reproductive age. Rural emergency room (ER) nurses are in a unique position to identify the risk factors and physical or psychosocial signs of IPV. Let’s learn more about IPV.

5.      Game (5 min) - We are going to play a game called Myth versus Fact about IPV– I am going to place some information on the projector screen and I want you to tell me if it is myth or fact.

a)      Intimate partner violence is rare. Myth: Answer: Millions of women, men, and children are impacted by IPV (United States Department of Agriculture [USDA] n.d.).

b)      Intimate partner violence accounts for 21% of violent crimes. Fact: (Bureau of Justice Statistics [BJS], 2012).

c)      Intimate partner violence only occurs in the poor or lower class. Myth: IPV exists equally in all socioeconomic classes regardless of race or culture (USDA, n.d.).

d)     Intimate partner violence can result in adverse health conditions. Fact: chronic headaches, chronic pain, trouble sleeping, decreased activity, and poor physical and mental health are just a few problems resulting from IPV (Centers for Disease Control and Prevention, 2014).

e)      Intimate partner violence only occurs along with drug or alcohol abuse. Myth: Drugs and alcohol give a batterer an excuse for the behavior, but the IPV does not stop when the perpetrator is sober (USDA, n.d.). In fact, the batterer usually still chooses to commit the violence privately to avoid detection (USDA, n.d.).

f)       Injuries occur to 45% of intimate partner victims. Fact: (BJS, 2012).

g)      Intimate partner victims usually report their injuries to the police. Myth: Only 55% report the violent incidents to police (BJS, 2012).

h)      Intimate partner victims want to be hit or abused or else they would leave. Myth: The reason women do not leave is the economic impact, lack of childcare, lack of support from family or friends, and the potential to lose her job. Additionally there may be increased risk of physical harm or death if she leaves (USDA, n.d.).

6.      Lecture (10 min) – What rural ER nurses should do to identify IPV.

a)      Routinely ask about IPV when you assess the patient. The injuries you see may be from IPV. Interview the patient alone if possible because the perpetrators may be with the victim. Be creative. Tell the partner you need to take them to x-ray so you can ask in a private location.

b)      Encourage your facility to develop training and screening protocols for IPV.

c)      Know your state laws about reporting IPV. In Texas it is NOT mandatory reporting unless the injury is a GSW or stabbing. It is mandatory referral. Have a list of shelters and resources for the patient.

d)     Hang posters with the hotline numbers in areas where the patients can see them.

e)      Know early identification and intervention prevents disability and death. 30 out of 3,032 female homicide victims were murdered by an intimate partner (BJS, 2012).

How do you address IPV if you identify a victim?

a)      Validate it is a real problem and can happen to anyone

b)      Allow the patient to talk about their experience and tell them they are not alone.

c)      Tell them they do not deserve this and help is available.

d)     Encourage and reinforce actions to improve the health and safety of the victim. For example-tell them to form a safety plan, to save money, to get together important documents, and to inform a friend or family member of their situation.

e)      Know you do not have to be the solution and the victim knows their situation best.

f)       Educate the patient about the health consequences of abuse.

g)      Be a good referral source and give the National Domestic Hotline number which is available in your brochure and know the locations of local shelters. The closest local shelter or resource is Nolan County Family Services  325-235-1552  or Taylor County Noah Project  1-800-444-3551

h)      Know the victim may return to their abuser many times before leaving and that does not mean you should not provide ongoing support.

(Family Violence Prevention Fund, n.d.)

7.      Short Video about IPV (5min) – “Nurse’s Role in IPV Screening”

8.      Post-intervention questionnaire completion (10min)

9.      Speaker evaluation questionnaire (5 min)

Outcome Objective Evaluation Measures

1.      Conduct a pre and post-intervention questionnaire of preparedness using a modified version of the questionnaire created by Gutmanis et al., (2007).

2.      Conduct a pre and post-intervention questionnaire of self-confidence using a modified version of the questionnaire created by Gutmanis et al., (2007).

Process Objective Evaluation Measures

1.      Determine the extent of participation during program implementation by measuring the number of participants in the program.

2.      Administer a speaker questionnaire to determine program appropriateness, participant satisfaction, appropriateness of setting, and speaker competency

 Anticipated Problem and Solution

1.      Problem: Laptop computer does not work. Solution: Bring back up computer.

2.      Problem: ER may be busy and participants may not arrive on time. Solution: Schedule conference room for two hours to allow for a late start if needed.

3.      Problem: Power-point may not work. Solution: Bring handouts of the power-point.

4.      Problem: The nurses may want extra brochures to share with other coworkers. Solution: Bring extra brochures.

5.      Problem: ER nurses will not be able to leave the ER because there is no shift relief. Solution: Arrange with director of nurses to have shift coverage during scheduled intervention times.