Educational Program for Obstetric Nurses: How to Effectively Screen for Intimate Partner Violence

Intimate Partner Violence (IPV) is a longstanding concern of health professionals caring for women (AWHONN, 2015). The definition of IPV is the physical, sexual, or psychological harm done to an individual by a current or former partner or spouse (AWHONN, 2015). The incidence and severity of IPV increase during pregnancy (ACOG, 2012). The American College of Obstetrics and Gynecology reports that up to 20% of women are at risk of abuse during pregnancy. However, actual prevalence is unknown due to women being afraid to discuss episodes of violence (ACOG, 2012). Such abuse can lead to adverse pregnancy and birth outcomes. Pregnant women can experience poor weight gain, stillbirth, placental abruption, fetal injury, preterm delivery, low birth weight infants, and even death (ACOG, 2012).

The American College of Obstetrics and Gynecology (2012), Association of Women's Health, Obstetrics, and Neonatal Nurses (2015), and the American College of Nurse Midwives (2013) recommend screening for IPV multiple times during pregnancy. Screening recommendations include the first prenatal visit and upon admission to labor and delivery for any reason (ACOG, 2012; AWHONN, 2015). Due to the delicate nature of the topic, lack of preparedness or education, and lack of organizational support, providers often do not complete or ineffectively complete IPV screens (AWHONN, 2015). Nurses are in a unique position to encourage increasing rates of screening, provide education and support, offer community resources, and advocate for women experiencing abuse (AWHONN, 2015). Obstetric nurses must be fluent in accurately screening their patients for IPV in order to identify those suffering from abuse, provide appropriate care and resources, decrease risk, and improve pregnancy and birth outcomes.

An education program was developed and implemented in the Maternity Center of a community hospital in Southeast Georgia. The purpose of the program was to increase staff nurses' knowledge, comfort, and attitude toward screening pregnant patients for IPV. Before development, the program coordinator completed a needs assessment with the nurses in the Maternity Center to identify areas of weakness and need. The data obtained from the needs assessment was used to create the education program, taking interest to include identified needs. Content included forms of IPV, statistics regarding incidence, effects on pregnant women and their fetuses, professional practice guidelines, methods for screening, and resources available for both nurses and women experiencing IPV.

The program was developed in an online format using the SoftChalk application to make the training more flexible for staff nurse participants. Once nurses completed the online didactic component, they had the opportunity to practice screening techniques. There were two options for practice. The first was online using VoiceThread technology. The online option again allowed for greater flexibility in the training. Participants could record questions. The program coordinator could answer the questions or leave feedback on the participants recorded practice screens. The second option was to attend an online interactive session where nurses could practice screening techniques on a standardized patient. The live, interactive session allowed for discussion, questions, and immediate feedback.

Participants were given a pretest before the education session to determine knowledge-base and attitudes toward IPV and IPV screening. After the education session, the nurses completed a post-test that matched pretest questions. One month after the education session, the participants will complete a second post-test. The questions match those on the pretest and initial post-test. Additionally, there are two qualitative questions about IPV screening practice change.

Data collection is ongoing, and the program coordinator will administer the second post-test in April. Results are not known until the collection is complete and data is analyzed.