title: Family violence intervention within an emergency department: achieving change requires multifaceted processes to maximize safety.
abstract: BACKGROUND
  Family violence is common with significant long-term negative health effects. Health professionals are recognised as key providers of family violence intervention. In 2002, the Hawke's Bay District Health Board launched a Family Violence Intervention Programme in its emergency department. The intervention programme involved staff training, the development of resources and routine questioning for partner abuse within the social history for all women 16 years and over. The aim was to identify the barriers and enablers to routine questioning one year after the programme was launched to inform programme improvements.
  
  
  METHODS
  Evaluation research using semi-structured interviews; eleven staff participated in either a single or a group interview. Content and thematic analysis, with triangulation of findings was used.
  
  
  RESULTS
  The interviews revealed that routine questioning for partner abuse is difficult in the emergency department. Some staff screened routinely while others only offered intervention when overt abuse was identified. Barriers, enablers and solutions revealed by participants were either personal or organisational; all had the common theme of safety.
  
  
  CONCLUSIONS
  Routine questioning for partner abuse is challenging and its introduction into practice requires a systems approach to achieve change. Barriers to questioning exist and by simultaneously addressing these and implementing enablers, at an organisational and personal level, barriers are eliminated or at least minimised. A link was evident between nurses' level of comfort and their rate of questioning. A multifaceted approach focusing on safety of all concerned can support change resulting in implementation of family violence intervention in the health sector.
authors.affiliation: Hawke's Bay District Health Board, Private Bag 9014, Hastings, New Zealand. Miranda.Ritchie@hawkesbaydhb.govt.nz
authors.forename: Miranda
authors.initials: M
authors.lastname: Ritchie
authors.forename: Katherine
authors.initials: K
authors.lastname: Nelson
authors.forename: Russell
authors.initials: R
authors.lastname: Wills
mesh_terms: D017579:Domestic Violence / Q000517:prevention & control / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods; D016529:Emergency Nursing / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D008297:Male; D020380:Needs Assessment; D009520:New Zealand; D024802:Nurse's Role; D016272:Occupational Health; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires