Classificatory multiplicity: intimate partner violence diagnosis in emergency department consultations

Aims and Objectives The aim of this research was to explore the naming, or classification, of physical assaults by a partner as ‘intimate partner violence’ during emergency department consultations. Background Research continues to evidence instances when intimate partner physical violence is ‘missed’ or unacknowledged during emergency department consultations. Methods Theoretically this research was approached through complexity theory and the sociology of diagnosis. Research design was an applied, descriptive and explanatory, multiple-method approach that combined: qualitative semi-structured interviews with service users (n=8) and emergency department practitioners (n=9), and qualitative and quantitative document analysis of emergency department health records (n=28). Results This study found that multiple classifications of intimate partner violence were mobilised during emergency department consultations and that these different versions of intimate partner violence held different diagnostic categories, processes, and consequences. Conclusion The construction of different versions of intimate partner violence in emergency department consultations could explain variance in people’s experiences and outcomes of consultations. The research found that the classificatory threshold for ‘intimate partner violence’ was too high. Strengthening systems of diagnosis (identification and intervention) so that all incidents of partner violence are named as ‘intimate partner violence’ will reduce the incidence of missed cases and afford earlier specialist intervention to reduce violence and limit its harms. Relevance to Clinical Practice This research found that identification of and response to intimate partner violence, even in contexts of severe physical violence, was contingent. By lowering the classificatory threshold so that all incidents of partner violence are named as ‘intimate partner violence’, practitioners could make a significant contribution to reducing missed intimate partner violence during consultations and improving health outcomes for this population. This research has relevance for practitioners in any setting where service-user report of intimate partner violence is possible.   SUMMARY BOX What does this paper contribute to wider global community? • Identification of and response to intimate partner violence, even in contexts of severe physical violence was found to be contingent. • Classification of intimate partner violence was connected to: legal duty to respond statutory frameworks of risk of harms; socio-cultural discourses about what counts as intimate partner violence; and health care practitioners’ perceptions of usual modes of disclosure. • Connecting all reports of partner perpetrated violence to intimate partner violence identification and intervention will reduce missed cases in health consultations and mobilise earlier intervention to reduce violence and limit its harms. • The sociology of diagnosis is a valuable conceptual tool for examining variance in identification and response for a wide range of determinants of health of concern for nurses and allied professions

A national survey of services for the prevention and management of falls in the UK

Background: The National Health Service (NHS) was tasked in 2001 with developing service provision to prevent falls in older people. We carried out a national survey to provide a description of health and social care funded UK fallers services, and to benchmark progress against current practice guidelines. Methods: Cascade approach to sampling, followed by telephone survey with senior member of the fall service. Characteristics of the service were assessed using an internationally agreed taxonomy. Reported service provision was compared against benchmarks set by the National Institute for Health and Clinical Excellence (NICE). Results: We identified 303 clinics across the UK. 231 (76%) were willing to participate. The majority of services were based in acute or community hospitals, with only a few in primary care or emergency departments. Access to services was, in the majority of cases, by health professional referral. Most services undertook a multi-factorial assessment. The content and quality of these assessments varied substantially. Services varied extensively in the way that interventions were delivered, and particular concern is raised about interventions for vision, home hazard modification, medication review and bone health. Conclusion: The most common type of service provision was a multi-factorial assessment and intervention. There were a wide range of service models, but for a substantial number of services, delivery appears to fall below recommended NICE guidance