Resea ch A icle
Assessing and Enhancing Heal h Ca e P o ide s’ Response o
Domes ic Violence
Tuija Leppäkoski,1,2 Aune Flinck,1,2,3 and Eija Paa ilainen1,2
1School o Heal h Sciences, (Nu sing Science), Uni e si y o Tampe e, Finland
2The Dis ic Hospi al o Sou he n Os obo hnia, Finland
3Na ional Ins i u e o Heal h and Wel a e, Finland
Co espondence should be add essed o Tuija Lepp¨
akoski; [email p o ec ed]
Recei ed 11 Decembe 2013; Accep ed 13 Ma ch 2014; Published 22 Ap il 2014
Academic Edi o : Ma ia Helena Palucci Ma ziale
Copy igh © 2014 Tuija Lepp¨
akoski e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion
License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly
ci ed.
This s udy aimed o examine possible changes om 2008 o 2012 in he skills o heal h ca e s a in iden i ying and in e ening in
domes ic iolence (DV). A longi udinal desc ip i e s udy design wi h olun ee samples (baseline; 𝑛=68, ollow-up;𝑛 = 100)
was used o acqui e in o ma ion ega ding he p esen s a e and needs o he s a in p ac ices ela ed o DV. The esul s o he
baseline su ey we e used as a basis o planning wo in e en ions: s a aining and d a ing p ac ical guidelines. In o ma ion
was collec ed by ques ionnai es om nu ses, physicians, and social wo ke s and supplemen ed by esponses om he in e iews.
The da a we e analysed using bo h quan i a i e and quali a i e me hods. A chi-squa e es was used o es he s a is ical signi icance
o he da a se s. In addi ion, pa icipan s’ quo es a e used o desc ibe speci ic phenomena o issues. The compa ison showed ha
o e all a small posi i e change had aken place be ween he s udy pe iods. Howe e , he pa icipan s we e awa e o hei own
sho comings in iden i ying and in e ening in DV. Changes happen slowly, and adminis a i e suppo is needed o sus ain such
changes. The e o e, his pape o e s ecommenda ions o imp o e heal h ca e p o ide s’ esponse o DV. Mo eo e , he e is a g ea
need o e alua ing he aining p og amme used.
1. In oduc ion
Domes ic iolence (DV) is globally ecognised as a majo
bu unde epo ed public heal h and social p oblem among
he e osexual and same-sex couples [1,2]. I esul s in inju ies
and o he nega i e sho - and long- e m e ec s on he heal h
o all he amily membe s [3,4]. Child en and young people
in amilies whe e DV has aken place a e a isk o abuse and
associa ed de imen al heal h ou comes [5–7]. Nu ses and
physicians play a i al ole in add essing hese p oblems. Ea ly
iden i ica ion o DV can educe i s consequences and may
help o p e en u he iolence.
Un o una ely, heal h ca e p o essionals do no engage
wi h hese issues and hey do no ou inely sc een o heal h
isks such as DV o child abuse (CA) and neglec . In a Swedish
s udybySundbo ge al.,onlyhal o henu seswo kingin
p ima y heal h ca e always asked women abou DV and did
so mos ly when he pa ien was physically inju ed [8]. Heal h
p o essionals do no ask abou o iden i y DV, e en in cases
whe e i is ob ious [9–12]. Acco ding o a Finnish s udy by
Husso e al., i seems ha he e is a endency o heal h ca e
s a o ocus on ixing he inju ies and consequences o DV
while dismissing he iolence ha is he cause o symp oms
and inju ies [13]. Consequen ly, asking abou iolence is
undesi able. On he o he hand, pa ien s gene ally ind being
asked abou iolence accep able [7,8,11,12].
Va ious s udies ha e shown ha nu ses and doc o s
asc ibe hei eluc ance o o discom o wi h inqui ing abou
DV o ac o s such as lack o ime, beha iou s a ibu ed o
women li ing wi h abuse (e.g., denial), lack o aining and
e ec i e in e en ions, he complexi ies o p o iding whole
amily ca e, and pa ne p esence [10,11,14–16]. A lack o
knowledge o he causes and e ec s o DV o en leads o
eelings o inadequacy and us a ion [13]. Fo example,
auma caused by DV is no always ecognized by heal h
ca e p o essionals. The ic im’s auma may a ec he ic im’s
Hindawi Publishing Co po a ion
Nu sing Resea ch and P ac ice
Volume 2014, A icle ID 759682, 8 pages
h p://dx.doi.o g/10.1155/2014/759682
2Nu sing Resea ch and P ac ice
abili y o discuss he p oblem. Fu he mo e, nu ses who wo k
in a as -paced en i onmen may be used o seeing immedia e
esul s when hey in e ene wi h pa ien s, whe eas DV is a
complex issue and no he one ha can be sol ed in one isi
[17]. O e all, awa eness o one’s own a i udes, my hs, and
s e eo ypes (e.g., men a e always o ende s; iolence is only
physical; iolence only conce ns ma ginal g oups) plays an
impo an ole in one’s eadiness o deal wi h in ima e pa ne
iolence (IPV) [8,11,17,18].
The mos equen ly epo ed acili a o s o ask abou DV,
alongside aining communi y esou ces and p o essional
ools, a e p o ocols and police [7,15]. Mul i ace ed and
in e sec o al app oaches ha add ess he indi idual, in e -
pe sonal, wo kplace, and sys emic issues aced by nu ses and
physicians when inqui ing abou DV a e equi ed [15]. I has
also been men ioned ha s ong leade ship and p io i iza ion
o he issue ha e acili a ed he de elopmen o he ca e
p ocess o de ec and manage DV p esen a ions [19]. T aining
and o ganiza ional change wi hin heal hca e sys ems can
inc ease he iden i ica ion and knowledge o DV, as well as
heal h p o essionals’ eadiness o ask ic ims abou i [16,19–
21]. Howe e , so a , he e ec o sys ema ic sc eening o
DV has emained somewha unclea . Randomized con olled
ials ha e shown ha he e is insu icien e idence o
ecommend ou ine sc eening o DV [22,23].
The Finnish na ional publica ion “Recommenda ions
o he p e en ion o in e pe sonal and domes ic iolence”
(2008) s esses local and egional wo k and he impo ance
o s a egic planning, in addi ion o aining [24]. A “Na ional
clinical nu sing guideline o iden i ying and in e ening in
child mal ea men wi hin he amily in Finland” has also
been d awn up based on p ac ical wo k [25].
Du ing his esea ch p ojec , he s a pa icipa ing in
he s udy was ained o ecognise and add ess DV. Finally,
he ollow-upsu eywasconduc ed.Thes udysea ched o
answe s o he ollowing ques ions. (1) How did he s a ’s
abili y ode ec iolencechangedu ing he esea chpe iod
o 2008–2013? (2) How did he s a ’s eadiness o in e ene
in iolence change du ing his ime pe iod?
2. Pa icipan s and Me hods
2.1. Pa icipan s. The s udy began in 2008 wi h an ini ial
su ey o heal h ca e p o essionals in a la ge cen al hospi al
and in one local p ima y heal h ca e o ganiza ion. The pa -
icipa ing uni s we e an eme gency clinic and a doc o s’ o ice
in p ima y heal h ca e, an eme gency clinic, an o hopaedic
wa d, and an acu e psychia y eme gency uni in specialized
heal h ca e. The s a p o ile o he s udy included physicians,
nu ses, and social wo ke s. The idea was o enhance no only
he knowledge, skills, o a i udes o indi iduals wi h espec
o domes ic iolence bu also in e disciplina y unde s anding
and collabo a ion.
2.2. S udy Design. Thisisalongi udinals udywi hap e-
/pos es design. An ini ial su ey was used o gain in o ma-
ion o he p esen s a e and needs o he heal h ca e wo ke s
in p ima y and specialized heal h ca e wi h espec o DV.
The esul s o he su ey we e used as a basis o planning
ollow-up in e en ions: s a aining and d a ing p ac ical
guidelines.
The ques ionnai e asked o he ollowing in o ma ion:
he pa icipan s’ demog aphic da a (gende , age, occupa ion,
leng h o ime in cu en occupa ion, and employmen
s a us), he p e alence and/o ea men o DV (e.g., “Can
you es ima e how o en you mee o ea women o men
who a e ic ims o DV?” “Can you es ima e how o en you
mee o ea women o men a wo k who a e pe pe a o s
o DV?” “A wo k, ha e you me o ea ed men who ha e
expe ienced DV?”), he iden i ica ion o and in e en ion in
DV(e.g.,“Doyoubelie eyouwouldiden i yapa ien whois
expe iencing o has expe ienced DV?” “Do you belie e you
would iden i y a pa ien who is o who has been iolen in
hei ela ionship?” “Is he e an ope a ions model in you
wo k uni o in e ening in DV?” “Do you collabo a e wi h
di e en suppo au ho i ies when mee ing he ic im and
he pe pe a o ?” Fu he mo e, he pa icipan s we e asked
o iden i y issues ha may be a ba ie o he ecogni ion o
DV and he ac ions o he heal h ca e pe sonnel wi h a pa ien
who has expe ienced iolence o who has used iolence.),
he quali y o he DV aining ecei ed (e.g., “Has DV been
discussed in you p o essional basic aining?” “Ha e you
pa icipa ed in aining o ganized by you employe ?”), and
oneopen-endedques ioncomp ising heDVwo kin he
pa icipan ’s uni wi hin he las wo yea s (see Tables 1and
2).
In addi ion, quali a i e da a we e ga he ed by in e iew-
ing heal h ca e p o essionals, du ing wo g oup in e iews,
police, a social wo ke , and c isis wo ke s abou hei expe-
iences ega ding coope a ion in p ac ice, including ba ie s
and possibili ies, sha ed esponsibili ies, and mo i a ion o
eac o DV.
The ou come e alua ion da a we e collec ed in May
2012 wi h he same ins umen as a he beginning o he
p ojec , in 2008. In addi ion, quali a i e da a we e ga he ed
by in e iewing heal h ca e p o essionals (𝑛=6).
2.3. In e en ions. The educa ional in e en ion was planned
on he basis o he esul s o he ini ial su ey [26]and
esea ch e idence om ea lie s udies (e.g., [9,27,28]) and
was comple ed o e a ou -mon h pe iod, om Janua y 2008
o May 2008. The aining was ca ied ou o e h ee aining
sessions. The sessions we e epea ed wice wi h he same
con en so ha asmanyshi wo ke saspossiblecould
pa icipa e. The hemes o he sessions we e o ien a ion (2×
4h), DV om an e hical and legal poin o iew and aising
he p oblem in discussion (2×7h), and local, egional, and
na ional se ice ne wo ks in DV and sol ing p oblems.
A he same ime o he aining sessions, a de elopmen
p ocess was s a ed o c ea e p ac ical guidelines o be used
as a ool o de e mining how o iden i y, espond, and
in e enein he ollowingsi ua ions:whe e he ea emo e
easons o suspec DV, when DV is b ough up by he pa ien ,
andwhen hesymp omsandsignso hehappenedDV
a e no iceable. The idea was ha he s a can immedia ely
Nu sing Resea ch and P ac ice 3
Table 1: Demog aphic da a on pa icipan s.
Va iable Ca ego y Ini ial su ey 2008 (𝑛=68)Follow-up su ey
2012 (𝑛 = 100)
Gende Male 15% 14%
Female 85% 86%
Age (yea s)
Mean 42 41
Median 45 43
Range (24–59) (21–60)
S anda d de ia ion 10 12
Age g oup
≤29 16% 29%
30–39 23% 14%
40–49 37% 23%
50–59 24% 32%
≥60 2%
Occupa ional s a us
Nu se 65% 62%
P ac ical nu se 25% 28%
Social wo ke 4%
Doc o 6% 2%
O he s 8%
Occupa ion ime
Mean 16 16
Median 15 15
Range (0.5–37) (0.3–40)
S anda d de ia ion 11 12
Employmen Pe manen 71% 76%
Tempo a y 29% 24%
apply he knowledge gained om he cou se in o p ac-
ice. A mul idisciplina y eam ha comp ised s a nu ses,
social wo ke s, and physicians wo ked oge he wi h he
esea che s. O e he yea s 2011–2013, he de ised guidelines
[29] ha e been in eg a ed and implemen ed in p ac ice o
help and encou age he heal h ca e s a o iden i y and
in e ene in DV. So a , a o al o 14 in o ma ion e en s ha e
been held wi h 237 pa icipan s. In addi ion, a p ojec wo ke
has isi ed di e en uni s o alk abou he issue.
2.4. Da a Analysis. F equency ables we e used o examine
all a iables. Pea son’s chi-squa e es was used o es he
changes in opinions be ween 2008 and 2012. S a is ical
signi icancewasse a hele elo 5%(𝑃 < 0.05). Because o
he low numbe o answe s o some ques ions, he da a we e
combined in o wo g oups.
Di ec quo es we e used o desc ibe he pa icipan s’
expe iences and a i udes ega ding he DV in e en ions ha
hey had made.
2.5. E hical Issues. E hical app o al (R12857H) o he p ojec
was g an ed by he E hical Commi ee o Pi kanmaa Hospi al
Dis ic . No pe sonal da a o he s a we e eco ded. Quo es
ha e been used in such a way ha he in o man s a e no
ecognizable.
3. Resul s
3.1. The Pa icipan s’ Demog aphic Da a. The 2008 sample
consis s o 68 esponden s and he esponse a e was 35%.
The 2012 sample consis s o 100 esponden s and he esponse
a ewas50%.The eha ebeennosigni ican di e encesin he
esponden demog aphics (gende dis ibu ion, occupa ional
s a us, leng h o ime in cu en occupa ion, and ull- o pa -
ime employmen ) du ing he s udy yea s o 2008 and 2012. In
bo h yea s,less han one-six h o he esponden s we e men.
Nine y pe cen o he esponden s a e nu ses wi h a ying
le els o educa ion and 10% a e o he pe sonnel, such as social
wo ke s and doc o s (Table 1).
In con as , he age o he pe sonnel di e s o some ex en
be ween he s udy yea s. In he 2008 da a, he median age
o he esponden s is 45 yea s. In he 2012 da a, he median
age o he esponden s is 43 yea s. Howe e , he di e ence is
no signi ican . In he 2008 da a, esponden s be ween 40 and
49 yea s o med 37% o all esponden s, whe eas, in he da a
om 2012, hey o m less han a qua e o all he esponden s
(Table 1).
3.2. Iden i ica ion o a Vic im o DV and a Pa ien Who Has
Used Violence. The esul s o he ini ial su ey (26) e ealed
ha he s a had di e en kinds o ba ie s o iden i ica ion
o and in e en ion in DV, o example, a lack o men o ing
and olemodellingandape cei edlacko p i acyand
4Nu sing Resea ch and P ac ice
Table 2: Changes o opinions o he esponden g oups o manage DV.
Ques ions Ini ial su ey 2008 Follow-up su ey 2012 Signi icance es
𝜒2d 𝑃 alue
Can you es ima e how o en a wo k you mee o
ea women o men who a e ic ims o DV?
A leas once a mon h (22) 33% (28) 29% 0.558
Once a mon h o less (45) 67% (70) 71%
Can you es ima e how o en a wo k you mee o
ea women o men who a e pe pe a o s o DV?
A leas once a mon h (15) 23% (25) 26% 0.684
Once a mon h o less (51) 77% (73) 74%
A wo k, ha e you me o ea ed men who ha e
expe ienced DV?
No (40) 60% (39) 39% 6.897 1 0.009
Yes (27) 40% (61) 61%
Do you belie e you would iden i y a pa ien who is
expe iencing o has expe ienced DV?
Always o o en (29) 43% (54) 55% 0.155
Once o ne e (38) 57% (45) 45%
Do you belie e you would iden i y a pa ien who is
o who has been iolen in hei ela ionship?
Always o o en (13) 19% (34) 34% 4.227 1 0.040
Once o ne e (54) 81% (66) 66%
Do you hink ha iden i ica ion o DV is di icul o
easy?
Di icul (60) 88% (82) 86% 0.747
Easy (8) 12% (13) 14%
Do you hink ha in e en ion in DV is di icul o
easy?
Di icul (63) 97% (86) 90% 0.475
Easy (2) 3% (10) 10%
Is he e an ope a ions model in you wo k uni o
in e ening in DV?
No (34) 51% (12) 13% 35.761 2 <0.000
Yes (4) 6% (34) 35%
Canno say (29) 43% (50) 52%
Do you collabo a e wi h di e en suppo ing
au ho i ies when mee ing he ic im and he
pe pe a o ?
No (32) 51% (47) 49% 0.821
Yes (31) 49% (49) 51%
Has DV been discussed in you p o essional basic
aining?
No (49) 77% (53) 55% 7.577 1 0.006
Yes (15) 23% (43) 45%
Has you cu en employe o ganized supplemen a y
aining ela ed o DV?
No (37) 56% (29) 30% 22.585 2 <0.000
Yes (10) 15% (5 0) 52%
Canno say (19) 29% (18) 18%
Ha e you pa icipa ed in aining o ganized by you
employe ?
No (60) 92% (54) 57% 23.014 1 <0.000
Yes (5) 8% (40) 43%
ime a ailable. Fu he mo e, he e we e no commonly ag eed
mul ip o essional p ac ices o iden i y and help he pa ies o
DV. By he esul s o he ini ial su ey he aining was seen
as inciden al and he s a needed i .
In bo h s udy yea s, nea ly all esponden s (>90%) had
me women who had expe ienced iolence. The pa icipan s
epo ed ha hey had me mo e men who had expe ienced
iolence in 2012 when compa ed o he 2008 da a (40% e sus
60%; 𝑃 = 0.009). Acco ding o he su eys, app oxima ely
one- hi d o he esponden s epo ed ha a leas once
a mon h hey me o ea ed women and men who had
expe ienced DV. The pa icipan s also epo ed oughly equal
numbe s o bo h male and emale pe pe a o s o iolence
du ing bo h s udy yea s. App oxima ely one- ou h o he
esponden s epo ed ha hey mee pe pe a o s o iolence
a leas once a mon h (Table 2).
In he2012s udy,wello e hal o he esponden s
belie ed ha hey always o mos ly iden i y a pa ien who
expe iences and/o has expe ienced DV. This is app oxi-
ma ely10%mo e hanin2008,bu hedi e enceisno
s a is ically signi ican . On he o he hand, he numbe o
esponden s who epo ed ha hey a e able o iden i y a
pa ien who has used iolence in hei in ima e pa ne ship
inc eased om less han one- i h in 2008 o o e wo- hi ds
in 2012 (𝑃 = 0.040)(Table 2).
The pa icipan s we e asked o name 1–6 hings ha
aise he suspicion o iolence, e en i he pa ien did no
men ion i . In bo h s udy yea s, he mos suspicious poin s
we e he pa ien ’s physical inju ies (e.g., ypical inju ies such
as b uises a ound he body o he na u e o he inju ies
no ma ching wha he pa ien epo s ha has happened)
and he pa ien ’s beha iou (e.g., he pa ien canno gi e an
explana ion o he inju ies; he pa ien canno say whe e he
inju ies o igina e; he pa ien declines ollow-up ea men ;
i s he pa ien admi s and hen denies iolence). Bo h poin s
co e al oge he app oxima ely 60% o all men ions o poin s
ha aisesuspicion.The emaining40%we e ela ed o ague
symp oms epo ed by he pa ien (e.g., s omach pain, ches
pain, and a headache) wi hou a co esponding cause, he
wo ke ’s in ui ion becoming a oused, and he beha iou o
he pe pe a o o iolence i hey a e accompanying he
pa ien . In bo h s udy yea s, >80% hough ha iden i ica ion
Nu sing Resea ch and P ac ice 5
o iolence is di icul ( e y o ai ly di icul ) (Table 2). In
bo h s udy yea s, nea ly ou - i hs o he esponden s (77%)
hough ha hei eadiness o iden i y DV was mode a e.
The pa icipan s we e asked o iden i y issues ha may be
a ba ie o he ecogni ion o DV. I was possible o ci cle
se e al gi en al e na i es (1–13). The la ges g oup consis s
o he ollowing: “ he pa ien s a e eluc an o say ha DV
happened” and “when asked, a pa ien exposed o DV does
no admi i ” ( wo- hi ds o all al e na i es). Ma e s ela ed
o he iden i ica ion o acu e iolence o symp oms, a lack o
ime o ask abou iolence, o he wo k en i onmen lacks
a peace ul place whe e o ask iolence we e men ioned he
leas .
Fu he mo e, he esponden s we e asked o name hings
ha hey hink would p e en in e en ion in DV. In
his ask, he esponden s had he possibili y o check
all sui able op ions, wi h al oge he 16 op ions gi en in
he su ey o m. In bo h s udy yea s, he p o ec ion o
he pe pe a o o iolence, he pa ien no admi ing o
ha ing expe ienced iolence when asked, and he pa ien s
being unwilling o discuss he ma e i he pe pe a o
is p esen du ing he appoin men we e men ioned he
mos . These poin s co e ed 60% o all esponses. The lack
o imeo spacewasno anobs acle oin e en ionin
iolence and e y ew nu ses el ha hey would be in e -
e ing in he pa ien ’s pe sonal ma e s when asking abou
iolence.
In 2008, apa om a couple o esponden s, 97% o he
esponden s hough ha in e en ion in DV is di icul ( e y
o ai ly di icul ). Acco ding o he 2012 su ey, 90% hough
ha in e en ion is di icul and 10% o he esponden s
hough ha i waseasy(Table 2).
The pa icipan s explained he di icul y as being caused
by he pa ien denying he iolence, he phenomenon o
iolence being a sensi i e issue, and he pa ien epo ing
he eason o coming o heal h ca e o be some hing o he
han he iolence heyha eexpe ienced.Thecommen ha
“in e en ion in iolence is no seen as impo an ” made
by one esponden e lec s he a i ude o how o deal wi h
DV. In bo h s udy yea s, app oxima ely wo- hi ds o he
esponden s (70%) hough ha hei eadiness o in e ene
in DV was a leas mode a e.
The demog aphic ac o s p esen ed in Table 1 (gende ,
age, ull- o pa - ime employmen , and du a ion o wo king
in he p o ession) we e no obse ed o ha e a connec ion
be ween he iden i ica ion o and in e en ion in iolence.
3.3. The Ac ions o he Heal h Ca e Pe sonnel wi h a Pa ien
Who Has Expe ienced Violence o Who Has Used Violence.
A mul iple-choice ques ion was used o inqui e abou he
ac ions o he heal h ca e pe sonnel wi h a pa ien who is
a ic im o iolence. This ques ion o e ed he possibili y o
choose all sui able op ions (1–12). In bo h s udy yea s, he
ollowing ac ions we e men ioned he mos : “I ask he pa ien
di ec ly,”“Iencou agemypa ien o epo heo encei i
is physical iolence,” and “I discuss he issue wi h he pa ien
and ollow up on he ma e , wi h he pa ien ’s pe mission, by
con ac ing suppo ing pa ies.”
Fu he mo e, he su ey o m inqui ed abou he pa ic-
ipan s’ ac ions wi h a pa ien who has used iolence. This
ques ion also included he possibili y o check all sui able
op ions (1–10). In bo h s udy yea s, app oxima ely one- ou h
o he esponden s’ opinions a e conce ned wi h he pe son-
nel’s in e communica ion and how o ac wi h a pe pe a o
o iolence.
A s a is ically signi ican di e ence was seen be ween he
esponden g oups o he wo s udy yea s when inqui ing
abou whe he he esponden ’s wo k uni had an ope a ions
model o p ac ical guidelines o in e en ion in DV. In 2008,
51% o he esponden s hough ha he e was no such model.
Fo 2012, he equi alen igu e was 12.5% (𝑃 < 0.000).
Howe e , in 2012, app oxima ely hal o he esponden s
could no say whe he he wo k uni had an ope a ions model
o no (Table 2).
The esponden s we e also asked abou he p ac ice in
hei wo k uni o asking hei clien s sys ema ically abou
DV. In 2008, wo- hi ds o he esponden s hough ha DV
was no asked abou sys ema ically and 23% could no say
whe he i wassys ema icallyaskedabou o no .Fo 2012,
he equi alen igu es we e 63% and 33%, bu he di e ence
is no s a is ically signi ican .
3.4. Se ice Ne wo ks and Mul ip o essional Ac i i y. The e
was no change o e ime wi h espec o collabo a ion
be ween local suppo ing au ho i ies. In bo h esponden
g oups, app oxima ely hal o he esponden s epo ed ha
hey collabo a e wi h local suppo ing au ho i ies (Table 2).
The esponden s we e asked o desc ibe he cen al col-
labo a i e pa ies and p ac ices. In bo h s udy yea s, he
esponden s men ioned he police, social se ices, and c isis
and eme gency se ices as he closes collabo a i e pa ies.
The na u e o he con ac wi h he collabo a i e pa ies
was desc ibed in ai ly gene al e ms, such as a phone call,
con ac wi h he a o emen ioned suppo ing pa ies, o gi ing
in o ma ion o he pa ien abou he di e en suppo ing
pa ies. A couple o esponden s desc ibed he ma e in mo e
de ail: “I mos ly ask abou shel e s,” “I con ac he social
eme gency se ices i he e a e child en a home,” o “I ollow
up on he ma e wi h he pa ien ’s pe mission by con ac ing
he police, o ins ance.”
3.5. T aining. A s a is ically signi ican di e ence was ound
be ween he esponden g oups o he ques ion ha asked
whe he DV has been discussed in p o essional basic aining.
In 2008, less han one- ou h o he esponden s epo ed
ha hei aining had discussed DV. Acco ding o he 2012
su ey, 45% o he esponden s hough ha ma e s ela ed
o iolence had been discussed in p o essional aining
(𝑃 = 0.006). A s a is ically signi ican di e ence be ween he
esponden g oups was also ound ega ding how awa e he
esponden s we e o aining o ganized by hei employe .
In 2008, app oxima ely one-six h o he esponden s hough
ha hei employe had o ganized aining ela ed o DV,
and, acco ding o he second su ey, app oxima ely hal o
he esponden s we e awa e o aining o ganized by hei
employe (𝑃 < 0.000). Mo eo e , 57% o he esponden s

6Nu sing Resea ch and P ac ice
had also pa icipa ed in he aining (Table 2). Pa icipa ion
in aining o ganized by some o he pa ies was ma ginal. In
bo h s udy yea s, only abou 8% o he esponden s epo ed
ha ing pa icipa ed in such aining.
In bo h s udy yea s, aining needs we e conce ned wi h
he iden i ica ion o and in e en ion in DV and helping
bo h ic ims and pe pe a o s o DV. Ma e s o legisla ion in
si ua ions o DV we e he leas in e es ing opics o aining.
In bo h s udy yea s, a couple o esponden s (2%) hough ha
hey did no need any aining.
Las ly, one- ou h o he esponden s desc ibe wi h a
couple o wo ds he de elopmen wo k ela ed o iolence in
hei own uni . Posi i e hings we e ela ed o an awa eness o
aining ha ing been o ganised and he exis ence o w i en
guidelines on how o ac in DV si ua ions. Acco ding o a
couple o esponden s, “ he ma e is discussed qui e well
i he e is a suspicion o iolence,” “in acu e si ua ions we
aim o ind ou he pa ien ’s si ua ion holis ically,” and “ he
issue o iolence is discussed mo e o en hese days.” The
esponden s men ioned he ollowing as nega i e aspec s:
“ he de elopmen wo k did no a ec p ac ical wo k in
any way and he whole hing emained heo e ical,” “ he
de eloped model does no wo k in p ac ice,” “ hey could no
i all he employees in he aining who wan ed o a end,”
and “ he e has only been aining o a couple o employees.”
A couple o esponden s had ecen ly s a ed wo k a he uni
and we e no awa e o he exis ence o he w i en guidelines.
4. Discussion
In bo h s udy yea s, o e 90% o all esponden s had me
and ea ed women who had expe ienced DV. Howe e , a di -
e ence was seen in ques ions ega ding he ecogni ion and
ea ing o men who ha e expe ienced iolence. In 2012, he
esponden s epo ed o ha e me o ea ed app oxima ely
20% mo e men who ha e expe ienced DV han in 2008. This
kindo s udy esul canbeasigno he ainingha ing
had an impac on he sensi i i y o he pa icipan s owa ds
iden i ying hese men, e en hough a s a is ical di e ence
was no seen be ween he aining and he mee ing o male
ic ims o DV. Acco ding o a na ional epo by Heiskanen
and Ruuskanen [30], equal numbe s o women and men
expe ienced ic ims o pa ne abuse and o e hal o he
men ha e had physical o psychological consequences om
he iolence. In addi ion, men may ha e mo e ecu ing
expe iences o iolence [30]. As he consequences o iolence
a e a eaching and complex, i is likely ha hese men
seek ea men also in he uni s pa icipa ing in he ongoing
esea ch p ojec , and awa eness o his ac could help
p ac i ione s o iden i y and ea hem.
The iden i ica ion o and in e en ion in DV we e s ill
conside ed di icul in he su ey o 2012, and he aining
ecei ed was no obse ed o ha e a signi ican connec ion
o hese ma e s. Mo eo e , no signi ican changes ha e
happened in he ac ions o he heal h ca e pe sonnel wi h
ic ims and pe pe a o s o iolence be ween 2008 and 2012.
O e he ou yea s, he e we e no di e ences in he numbe
o in e en ions o help ic ims and pe pe a o s o iolence.
In 2012, sligh ly mo e in e en ions we e made wi h pa ien s
who ha e pe pe a ed iolence. The esponden s also hough
ha heyiden i ypa ien swhoha eused iolencemo eo en
han hose in 2008. The lack o ime o space was no an
obs acle o in e en ion in iolence. This is an opposi e esul
compa ed o he p e ious s udies [7,8,10,14–16]. Ins ead, he
pa icipan s explained he di icul y as being caused by he
pa ien denying he iolence and he phenomenon o iolence
beingasensi i eissue.This esul ispa allel o heea lie
s udies [7,9,11].
The pa icipan s acknowledged hei weaknesses, as hey
named iden i ica ion and in e en ion as he mos impo an
opics o supplemen a y aining. A sys ema ic u he ain-
ing plan o all s a should be de eloped in o de o enhance
p o essionals’ skill and knowledge o all ypes o DV and
how o iden i y and in e ene in DV and CA. O ganisa ional
suppo , o example, guidelines o collabo a ion wi h o he s,
has been men ioned as a sho coming in ea lie s udies [8,15].
Some nu ses we e unawa e o he w i en guidelines and he
legal poin s o iews. Fo some esponden s, he ope a ions
model de eloped had emained heo e ical and hey hough
ha i did no ansla e o p ac ical wo k. “The ma e is easily
iled away and o go en,” as one employee no ed, bu hey
also added ha “i is also an issue o wo k managemen .”
McCloskey e al. ha e concluded ha he con en o
he aining ecei ed was mo e impo an han he amoun
o aining ecei ed [31]. In he u u e, i is impo an o
emphasizemo e heuseo in e ac i eme hods,suchas ole
playing,and oin ol e hesuppo ingpa ies( hesuppo ing
ne wo k) in he aining p og ammes. Fu he , he ea lie
esul s e ealed ha he s a lacked men o ing and ole
modelling [15,24]. Thus, a men o ing ac ion plan migh help
heheal hca es a wi hDVwo k.
Al hough mo e han one- hi d o he esponden s in
he second su ey hough ha he ope a ions model o
in e en ion in iolence exis ed in hei wo k uni , o e
hal o he esponden s s ill did no know whe he one
exis ed o no . This kind o s udy esul may be a ec ed
by he ac ha he su ey was conduc ed app oxima ely
one yea a e he ope a ions guideline had been adop ed
and o ien a ion was s ill un inished in he uni s. Wha e e
he eason is, he ac emains ha no all esponden s had
been amilia ized wi h hei use o e en hei exis ence.
The s udy esul suppo s he idea ha i is necessa y o
conduc a hi d su ey in 2014 be o e ending he p ojec .
The e ha e also been o ganiza ional changes du ing he s udy
pe iod and ope a ions and unc ions ha e been eo ganized.
Due o his, he e ha e been pe sonnel ans e s be ween
uni s. Fu he mo e, in he 2008 da a, nea ly one- hi d o he
esponden s we e empo a y eplacemen wo ke s, and, in
2012, nea ly one- ou h o he esponden s we e empo a y
eplacemen wo ke s. This kind o s udy esul emphasizes
he ac ha supplemen a y aining mus be sys ema ic
and con inuous. Mo eo e , he ope a ion model o p ac ical
guidelines will also be a ool o he o ien a ion o new s a .
Acco ding o his s udy, he uni s do no sys ema ically
ask abou iolence. This s udy esul is consis en wi h ecen
in e na ional esea ch esul s [8,11,18]. In 2008, less han one-
ou h o he esponden s and one- hi d in 2012 did no know
Nu sing Resea ch and P ac ice 7
whe he iolence is asked abou in hei uni o no . A he
momen , he guidelines do no include he idea o adop ing
a sc eening ool, bu he issue is wo h conside ing in he
nea u u e. Fu he , i lacks e idence whe he DV sc eening
educes iolence o imp o es heal h ou comes o ic ims
[22,23]. This demands u he esea ch.
Like ea lie s udies ha e s a ed, collegial and o ganisa-
ional suppo a e needed [8,15,19]. Pe haps heal h ca e s a
s ill lacks eal collegial and o ganiza ional suppo , hough in
his case i would appea o be due o indi idual di e ences
be ween uni s. One in e iewee s a ed ha “we ha e been
suppo ed by employees and ou manage and we ha e made
a iolence olde wi h my wo k pa ne ,” while ano he one
s a ed ha “ he uni managemen is no commi ed o he
ma e .” Fu he mo e, i eme ged om he open esponses
ha only some o he pe sonnel we e able o pa icipa e in
he aining p og ammes. This means ha , in he u u e,
esou ces ha e o be alloca ed o supplemen a y aining.
Manage s should ake ca e o he esou ce alloca ion as well
as making su e ha iolence aining is included in annual
aining plans.
Limi a ions. Some limi a ions o he p esen s udy mus be
conside ed. Fi s , hese include he small sample sizes in bo h
su ey yea s. Second, he ins umen used is based on he
pa icipan s’ epo da a. Thi d, he guidance implemen a ion
ook place in 2011, one yea be o e he ollow-up su ey.
Fou h, pe haps hose who pa icipa ed in he su eys a e
indi iduals who a e willing o ake pa in wo k agains
iolence, husc ea ingselec ionbias.Weno ed ha many
amilia people ook pa in bo h aining sessions and
many o he ac i i ies du ing he s udy pe iod. Some o hem
wo ked as con ac pe sons o hei uni s. Fu he mo e,
he esponden s o he 2012 su ey may no necessa ily be
hesameas hosein he2008su ey,due opa o he
pe sonnel being empo a y wo ke s and some o hem may
ha e changed o a di e en wo ks a ion. Thus, i is a li le
bi di icul o cla i y he deg ee o cong uence be ween he
epo ed da a and he ac ual si ua ion o iden i ying and
in e ening in DV. Because he esea ch esul s migh be
biased, i is a li le bi di icul o cla i y whe he he change
was eal o no .
5. Conclusions
Fu u e esea ch needs o e alua e ou aining p og amme as
a p ocess (p ocess e alua ion) and go h ough all he w i en
eedback ecei ed. In his case, we will pay a en ion o,
among o he hings, aining ac i i ies o p ac ical suppo ,
o ind ou i i is being deli e ed as planned and o iden i y
gaps be ween i s in ended and ac ual deli e ies. A e ha
we mus change he key poin s in he aining p og amme.
Fu he , we mus coope a e wi h he nu sing manage s o he
s a so ha con inuing educa ion on DV issues is included in
he annual aining plans. We also need o con inue o o ien
and amilia ize he p ac i ione s wi h using he guidelines
because some o he esponden s hough ha he guidelines,
w i en in collabo a ion, had emained heo e ical. I is also
necessa y o conside o he kinds o suppo ools such as
sc eening ools. Na u ally, he e iciency o hese sc eening
oolsshouldalsobee alua edand hei adop ion equi es
o ien a ion o he p ac i ione s. Because he implemen a ion
o heguidelineswill ake ime,anewsu eyshouldbe
conduc edinacoupleo yea sino de oseede elopmen
o e a longe ime pe iod.
Con lic o In e es s
The au ho s decla e ha he e is no con lic o in e es s
ega ding he publica ion o his pape .
Acknowledgmen s
The au ho s acknowledge Ms. Elina Sellg en and M . Duncan
Ju onen o hei linguis ic e ision o he pape . This wo k
was suppo ed by he Na ional Ins i u e o Heal h and
Wel a e (140/THL/TE/2011–2013) and he Dis ic Hospi al o
Sou he n Os obo hnia, Finland.
Re e ences
[1] E.G.K ug,J.A.Me cy,L.L.Dahlbe ge al.,The Wo ld Repo
on Violence and Heal h, Wo ld Heal h O ganiza ion, Gene a,
Swi ze land, 2002.
[2] N. L. Bake , J. R. Buick, S. R. Kim e al., “Lessons om examining
same-sex in ima e pa ne iolence,” Sex Roles, ol.69,no.8,pp.
182–192, 2013.
[3] M.P.JohnsonandK.J.Fe a o,“Resea chondomes ic iolence
in he 1990s: making dis inc ions,” Jou nal o Ma iage and
Family, ol.62,no.4,pp.948–963,2000.
[4] J. C. Campbell, “Heal h consequences o in ima e pa ne
iolence,” The Lance , ol.359,no.9314,pp.1331–1336,2002.
[5] S. Hol , H. Buckley, and S. Whelan, “The impac o exposu e o
domes ic iolence on child en and young people: a e iew o he
li e a u e,” Child Abuse and Neglec , ol.32,no.8,pp.797–810,
2008.
[6] E. Nicklas and M. J. Mackenzie, “In ima e pa ne iolence and
isk o child neglec du ing ea ly childhood in a communi y
sample o agile amilies,” Jou nal o Family Violence, ol.28,
pp.17–29,2013.
[7] P. Oli e, “Ca e o eme gency depa men pa ien s who ha e
expe ienced domes ic iolence: a e iew o he e idence base,”
Jou nal o Clinical Nu sing, ol.16,no.9,pp.1736–1748,2007.
[8] E. M. Sundbo g, N. Saleh-S a in, P. W¨
andell, and L. T¨
o nk is ,
“Nu ses’ p epa edness o ca e o women exposed o In ima e
Pa ne Violence: a quan i a i e s udy in p ima y heal h ca e,”
BMC Nu sing, ol. 11, a icle 1, 2012.
[9] T. Lepp¨
akoski, Women exposed o acu e physical in ima e
pa ne iolence seeking ca e a eme gency depa men s—
Iden i ica ion o and in e en ion in iolence [Ph.D. hesis],
Ac a Uni e si a is Tampe ensis 1231. Uni e si y o Tampe e,
Tampe e, Finland, 2007.
[10] L. Robinson and K. Spilsbu y, “Sys ema ic e iew o he pe -
cep ions and expe iences o accessing heal h se ices by adul
ic ims o domes ic iolence,” Heal h and Social Ca e in he
Communi y, ol.16,no.1,pp.16–30,2008.
[11] M. Ben Na an, G. Ben A i, T. Bade , and M. Hallak, “Uni e sal
sc eening o domes ic iolence in a depa men o obs e ics
8Nu sing Resea ch and P ac ice
and gynaecology: a pa ien and ca e pe spec i e,” In e na ional
Nu sing Re iew, ol.59,no.1,pp.108–114,2012.
[12] F. B adley, M. Smi h, J. Long, and T. O’Dowd, “Repo ed e-
quency o domes ic iolence: c oss sec ional su ey o women
a ending gene al p ac ice,” B i ish Medical Jou nal, ol.324,no.
7332, pp. 271–274, 2002.
[13] M.Husso,T.Vi kki,M.No koe al.,“Makingsenseo domes ic
iolence in e en ion in p o essional heal h ca e,” Heal h and
Social Ca e in he Communi y, ol.20,no.4,pp.347–355,2012.
[14] A. Ta , D. H. B oom, and D. Legge, “Gene al p ac i ione
managemen o in ima e pa ne abuse and he whole amily:
quali a i e s udy,” B i ish Medical Jou nal, ol.328,no.7440,pp.
618–621, 2004.
[15] C.E.Beynon,I.A.Gu manis,L.M.Tu y,C.N.Wa hen,andH.
L. MacMillan, “Why physicians and nu ses ask (o don’ ) abou
pa ne iolence: a quali a i e analysis,” BMC Public Heal h, ol.
12, a icle 473, 2012.
[16] K. Bai d, D. Salmon, and P. Whi e, “A i e yea ollow-up
s udy o he B is ol p egnancy domes ic iolence p og amme
o p omo e ou ine enqui y,” Midwi e y, ol.29,pp.1003–1010,
2013.
[17] C. K. S inson and R. Robinson, “In ima e pa ne iolence: con-
inuing educa ion o egis e ed nu ses,” Jou nal o Con inuing
Educa ion in Nu sing, ol.37,no.2,pp.58–62,2006.
[18] R. Robinson, “My hs and s e eo ypes: how egis e ed nu ses
sc een o in ima e pa ne iolence,” Jou nal o Eme gency
Nu sing, ol.36,no.6,pp.572–576,2010.
[19] S. Basu and G. Ra cli e, “De eloping a mul idisciplina y
app oach wi hin he ED owa ds domes ic iolence p esen a-
ion,” Eme gency Medicine Jou nal, ol.31,pp.192–195,2014.
[20] G. Fede , R. A. Da ies, K. Bai d e al., “Iden i ica ion and
Re e al o Imp o e Sa e y (IRIS) o women expe iencing
domes ic iolence wi h a p ima y ca e aining and suppo
p og amme: a clus e andomised con olled ial,” The Lance ,
ol. 378, no. 9805, pp. 1788–1795, 2011.
[21] M. Papadakaki, E. Pe idou, M. Koge inas, and C. Lionis, “Mea-
su ing he e ec i eness o an in ensi e IPV aining p og am
o e ed o G eek gene al p ac ice,” BMC Medical Educa ion, ol.
13,no.46,2013.
[22] H. L. MacMillan, C. N. Wa hen, E. Jamieson e al., “Sc eening
o in ima e pa ne iolence in heal h ca e se ings: a andom-
ized ial,” Jou nal o he Ame ican Medical Associa ion, ol.302,
no. 5, pp. 493–501, 2009.
[23] J.Kle ens,R.Kee,W.T icke al.,“E ec o Sc eening o pa ne
iolence on women’s quali y o li e,” Jou nal o he Ame ican
Medical Associa ion, ol.308,no.7,pp.681–689,2012.
[24] “Recommenda ions o he p e en ion o in e pe sonal and
domes ic iolence. Recognise, p o ec and ac ,” How o guide
and lead load and egional ac i i ies in social and heal h
ca e se ices, Publica ions o he Minis y o Social A ai s
and Heal h, Helsinki, Finland, 2008, h p://p e20090115.s m
. i/ka1210341082447/pass h u.pd .
[25] E. Paa ilainen and A. Flinck, “Na ional clinical nu sing guide-
line o iden i ying and in e ening in child mal ea men
wi hin he amily in Finland,” Child Abuse Re iew, ol.22,pp.
209–220, 2013.
[26] A. Flinck, T. Lepp¨
akoski, and E. Paa ilainen, “Iden i ica ion
o and In e en ion in In ima e Pa ne Violence and Mul-
ip o essional Educa ion,” An in e im epo o he esea ch
and de elopmen p ojec . Publica ion se ies B o he Hospi al
Dis ic o Sou he n Os obo hnia, 2009.
[27] E. Paa ilainen, [Child mal ea men in he amily]. Pe heen
oimin a ja yh eis y¨
ope he ¨
a hoi a an e eydenhoi ajan kanssa
[Ph.D. hesis], Ac a Uni e si a is Tampe ensis 604. Uni e si y o
Tampe e, Tampe e, Finland, 1998.
[28] A. Flinck, In ima e pa ne iolence as expe ienced by women
and men— om Bed o Roses o C own o Tho ns [Ph.D. hesis],
Ac a Uni e si a is Tampe ensis 1169. Uni e si y o Tampe e,
Tampe e, Finland, 2006.
[29] “Guidelines o ea men si ua ions wi h pa ien s who ha e
encoun e ed amily iolence,” Uni e si y o Tampe e, 2013,
h p://www.u a. i/hes/s oppia/index.h ml.
[30] M. Heiskanen and E. Ruuskanen, “Tuhansien iskujen maa.
Mies en kokema ¨
aki al a Suomessa,” The Eu opean Ins i u e
o C ime P e en ion and Con ol, a ilia ed wi h he Uni ed
Na ions (HEUNI), Repo no. 66, 2010, h p://www.heuni. i.
[31] L. McCloskey, E. Lich e , M. G anz e al., “In ima e pa ne
iolence and pa ien sc eening ac oss medical speciali ies,”
Academic Eme gency Medicine, ol.12,pp.712–722,2005.
Submi you manusc ip s a
h p://www.hindawi.com
Endoc inology
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Gas oen e ology
Resea ch and P ac ice
B eas Cance
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hema ology
Ad ances in
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Scien i ica
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Pedia ics
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Ad ances in
U ology
Hepa ology
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
In lamma ion
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
The Scien i ic
Wo ld Jou nal
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Compu a ional and
Ma hema ical Me hods
in Medicine
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
BioMed
Resea ch In e na ional
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Su ge y
Resea ch and P ac ice
Cu en Ge on ology
& Ge ia ics Resea ch
Hindawi Publishing Co po a ion
h p://www.hindawi.com
Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Nu sing
Resea ch and P ac ice
E idence-Based
Complemen a y and
Al e na i e Medicine
Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com
Hype ension
In e na ional Jou nal o
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
P os a e Cance
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Hindawi Publishing Co po a ion
h p://www.hindawi.com Volume 2014
Su gical Oncology
In e na ional Jou nal o