Promoting Emergency Care provider responsiveness to domestic violence patients through simulation training

Abstract

Domestic violence is a complex healthcare burden for South Africa and the world over. In 2013, the Health Professions Council of South Africa endorsed a domestic violence-screening guideline for Emergency Care providers. It is unknown if any accredited Emergency Care training facility has implemented these guidelines so as to improve the prehospital emergency care management of domestic violence victims. The probable absence of its wide-scale implementation suggests the prehospital identification and management of domestic violence victims continues to be at the discretion of the attending emergency care provider. To bridge the gap between theory, policy, and practice of domestic violence response, simulation training is proposed as a method of sensitising emergency care students and providers to manage cases which they may encounter in the “real world”. This study aimed to position emergency care students and providers as advocates for the interests of adult domestic violence victims’ during the (simulated or real) emergency care interaction so as to improve the emergency care provider responsiveness to victims of domestic violence. The primary research question was: How does the scripting of evidence-informed simulations of domestic violence cases enhance practitioner responsiveness and patient safety among prehospital emergency care students? The paradigm and methodology for this qualitative study was social constructivism and grounded theory respectively. A literature review preceded pre-simulation focus group discussions, participant observation during patient simulations, and post-simulation focus group discussions. Each data collection method helped strengthen and focus the proceeding data collection, honing in on the emerging theory. Through the process of constant comparative analysis, four categories of understanding emerged: ‘The need for Emergency Care provider role definition in DV intervention’; ‘Impediments to prehospital Domestic violence response’; ‘Emergency Care provider empathy during domestic violence response’ and ‘Conducting effective domestic violence-based simulations’. The finding is that: scripting of evidence-informed simulations can improve the responsivity to domestic violence cases by highlighting the theoretical gaps in knowledge, and help participants to meaningfully engage with the relevant content (laws, regulations, screening protocol for abuse, and referral agencies). Furthermore, the scripted simulations made vivid the need for an empathic and patient-centred approach in clinical practice (in addition to the commonly used skill-orientated approach). Scripting of simulations with the use of peer-based training may be an effective method of achieving improved responsivity to domestic violence. Traditional EMS training with mannequins may not be as effective for this purpose as students require a level of feedback and fidelity through which they can convey their empathy and history-taking skills. To make future domestic violence simulations effective they need to have clear and achievable outcomes. The study findings are of relevance to health professions educators, emergency care education centres, the professional regulator and civil society organisations involved in domestic violence crisis intervention.