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Forensic care for victims of violence and their family members in the emergency department
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Forensisk vård för våldsutsatta personer och deras familjemedlemmar på akutmottagningen (Swedish)
Abstract [en]

Aim: To explore forensic care in EDs for victims of violence and their family members from the perspectives of ED department heads, ED nurses, and a family member of a victim of violence.

Methods: Study I consisted of a questionnaire to all heads of EDs in Sweden, data were analyzed with descriptive statistics. Study II consisted of a similar questionnaire which also included the instrument Families’ Importance in Nursing Care-Nurses’ Attitudes. It was sent to all nurses at 28 EDs and data were analyzed using descriptive statistics, multiple linear and ordinal regression analysis. Study III comprised of individual interviews with twelve nurses from seven EDs and data were analyzed with content analysis. Study IV was a single case study with two interviews with a family member of a victim of violence. Data were analyzed with a Gadamer-inspired hermeneutic approach.

Results: ED preparedness for forensic care varied and was often limited to women and children. Nurses played a key role, but most of them had no training for this task and felt uncertain (I, II, III). Creating a caring encounter was the main challenge for providing forensic care and nurses perceived hindering factors to overcome this challenge (III). Family members were rarely included in forensic care and nurses perceived that family members were offered little help (I-III). Having ED documents that included family members, was associated with a more positive attitude to family members, which in turn was associated with involving them in care (II). For the family member, perfunctory encounters and caring alliances had a major impact and the experience reframed life (IV).

Conclusion: Lack of preparedness in EDs to care for all types of victims of violence and differences between individual nurses may prohibit the provision of equal care. Hindering factors for a caring encounter can result in forensic care being unaddressed, which may limit possibilities for alleviated suffering and legal justice. Family members were rarely included in forensic care, but caring encounters can be crucial for the family member in the aftermath of violence.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2018. , p. 63
Series
Linnaeus University Dissertations ; 337
Keywords [en]
interpersonal violence, family member, forensic care, emergency department, nurses, experiences
National Category
Health Sciences Nursing
Research subject
Health and Caring Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-78757ISBN: 978-91-88898-18-0 (print)ISBN: 978-91-88898-19-7 (electronic)OAI: oai:DiVA.org:lnu-78757DiVA, id: diva2:1262268
Public defence
2018-12-07, V159, Storken, Kalmar, 10:00
Opponent
Available from: 2018-11-14 Created: 2018-11-10 Last updated: 2018-11-14Bibliographically approved
List of papers
1. Preparedness to care for victims of violence and their families in emergency departments
Open this publication in new window or tab >>Preparedness to care for victims of violence and their families in emergency departments
2013 (English)In: Emergency Medicine Journal, ISSN 1472-0205, E-ISSN 1472-0213, Vol. 30, no 3, p. 198-201Article in journal (Refereed) Published
Abstract [en]

Objective To describe the preparedness to provide care for victims of violence and their families in emergency departments (EDs) in Sweden.

Methods A web-based questionnaire was sent to all hospital EDs in Sweden (N=66).

Results A total of 46 out of 66 (70%) heads of EDs completed the questionnaire. The results show that most of the EDs are prepared to care for women and children who are victims of violence. However, there seems to be a lack of preparedness to care for other groups of patients, such as victimised men. Very few EDs have routines to identify victims of violence among patients. Results also indicate that nurses play a key role in the care for victims of violence; however, family members are rarely included in care.

Conclusions A lack of general preparedness in EDs to care for all victims of violence, regardless of gender and age, can lead to many patients not receiving appropriate care and treatment. To correct this there is a need to implement guidelines and routines about the care for victims of violence. Further research can shed more light on which measures are needed to improve quality of care for these patients and their families.

Keywords
emergency department, guidelines, interpersonal violence, family
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Caring Sciences, Caring Science
Identifiers
urn:nbn:se:lnu:diva-18092 (URN)10.1136/emermed-2012-201127 (DOI)000314922100018 ()22433592 (PubMedID)2-s2.0-84874668064 (Scopus ID)
Projects
Omhändertagande av våldsdrabbade och deras närstående på akutmottagningen - forensisk omvårdnad
Available from: 2012-03-22 Created: 2012-03-22 Last updated: 2018-11-10Bibliographically approved
2. Nurses' views of forensic care in emergency departments and their attitudes, and involvement of family members
Open this publication in new window or tab >>Nurses' views of forensic care in emergency departments and their attitudes, and involvement of family members
2015 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 1-2, p. 266-274Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. To describe nurses' views of forensic care provided for victims of violence and their families in EDs, to identify factors associated with nurses' attitudes towards families in care and to investigate if these attitudes were associated with the involvement of patients' families in care. Background. Interpersonal violence has serious health consequences for individuals and family members. Emergency departments provide care for victims of violence, and nurses play a key role in forensic care. However, there is limited knowledge of their views and their involvement of family members. Design. A cross-sectional design was used with a sample of all registered nurses (n = 867) in 28 emergency departments in Sweden. Methods. A self-report questionnaire, including the instrument Families' Importance in Nursing Care Nurses' Attitudes, was used to collect data. Descriptive statistics, multiple linear regression and ordinal regression were used to analyse data. Results. Four hundred and fifty-seven nurses completed the questionnaire (53%). Most nurses provided forensic care, but few had specific education for this task. Policy documents and routines existed for specific patient groups. Most nurses involved family members in care although education and policy documents rarely included them. Being a woman, policy documents and own experience of a critically ill family member were associated with a positive attitude towards family. A positive attitude towards family members was associated with involving patients' families in care. Conclusion. Many emergency department nurses provided forensic care without having specific education, and policy documents only concerned women and children. Nurses' positive attitude to family members was not reflected in policies or education. Relevance to clinical practice. These results can inspire clinical forensic care interventions in emergency departments. Educational efforts for nurses and policies for all groups of victims of violence are needed. Emergency departments may need to rethink how family members are included in their organisation.

Keywords
association, attitude, emergency medical services, family, forensic nursing, nurses, victims of violence
National Category
Nursing
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-41973 (URN)10.1111/jocn.12638 (DOI)000350347300026 ()2-s2.0-84926201534 (Scopus ID)
Available from: 2015-04-09 Created: 2015-04-09 Last updated: 2018-11-10Bibliographically approved
3. Challenges of caring for victims of violence and their family members in the emergency department
Open this publication in new window or tab >>Challenges of caring for victims of violence and their family members in the emergency department
2018 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction

Interpersonal violence causes illness and suffering for victims and their family members. Emergency nurses are often given responsibility for forensic patients and their family members, but there is limited knowledge of their experiences regarding this task. This study aimed to describe nurses' experiences when caring for victims of violence and their family members in the emergency department.

Methods

Individual interviews were conducted with twelve nurses from seven emergency departments. Data were analyzed using qualitative content analysis.

Results

The analysis resulted in the theme: a challenge to create a caring encounter. Hindering factors comprising this challenge are described under four categories: struggling to intervene and talk about violence; contradictions when caring for family members; being helped by forensic guidelines but needing more knowledge; and dealing with one’s own strong emotions towards violence.

Discussion

Creating a caring encounter is perceived as a prerequisite to providing forensic care. Nurses often felt hindered to act and forensic issues were left unaddressed. Family members are offered little or no support in the aftermath of violence. The hindering factors must be overcome to ensure forensic care for victims of all types of violence.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Victims of violence, Family, Emergency, Nursing, Forensic care, Experiences
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-78753 (URN)10.1016/j.ienj.2018.10.007 (DOI)
Available from: 2018-11-10 Created: 2018-11-10 Last updated: 2018-11-15
4. Vicarious victimization in the aftermath of violence: a family member´s experience in the emergency department
Open this publication in new window or tab >>Vicarious victimization in the aftermath of violence: a family member´s experience in the emergency department
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Health and Caring Sciences, Nursing
Identifiers
urn:nbn:se:lnu:diva-78754 (URN)
Available from: 2018-11-10 Created: 2018-11-10 Last updated: 2018-11-15Bibliographically approved

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Doctoral Thesis (Comprehensive Summary)(2597 kB)8 downloads
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Rahmqvist Linnarsson, Josefin

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