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Each month, HospitalSoup.com will feature a health care professional in our monthly series: "A Day in the Life." The series aims to provide readers with a realistic view of what working as a health care professional entails, and provides an inside view and opportunity to get to know some extremely talented and dedicated health care professionals.

A Day in the Life.....
An Interview with Laura Stats, Emergency Room Nurse
Written by: L. Powers, RN, BSN

Background: Laura's career as a nurse began in Columbus, Ohio back in 1978 on an oncology unit. Moving to Alaska in 1981, Laura first cared for patients on a medical/surgical unit for a few years, and accepted employment in the Emergency Room at Bartlett Regional Hospital in 1984. Since that time, Laura has continued her career as an Emergency Room Nurse and has been involved in developing and implementing a Domestic Violence Screening program at Bartlett Regional Hospital

Q. Laura, Can you tell our readers how and why you became involved in domestic violence issues and explain the steps taken by Bartlett Regional Hospital to address domestic violence?
LS: Back in 1996, administration decided that our hospital should participate in a domestic violence task force. The hospital administrator asked my emergency room department head to appoint someone to serve on the task force, and I was selected. At that time, I learned about the effects of domestic violence on individuals, families, and communities. The National Institute of Justice and the Centers for Disease Control and Prevention estimates that women made 693,933 visits to the health care system last year as a result of injuries inflicted by physical violence. It is estimated that 20 to 30 percent of women in this country are being abused by an intimate partner at some time in their adult life.

In September of 1998 Alaska was invited by the Family Violence Prevention Fund, a national non-profit organization which focuses on domestic violence prevention, to participate in a 10-state health initiative. Participating states would develop model programs and improve their response to domestic violence in the health care environment through training, policy reform, and public education. Bartlett Regional Hospital was one of 15 healthcare sites chosen to participate from Alaska. Our hospital sent a team of six to Anchorage in April of 1999 for a training session on domestic violence. The team was composed of a physician, social worker, nurse, victim's advocate, and the hospital administrator. I was the nurse representative and team leader for the group. The training provided participants with an overview of the dynamics of domestic violence and prepared us with resources on how to design and implement protocols for domestic violence programs in each team's respective facility.

Bartlett Regional Hospital introduced the new routine screening protocols and domestic violence education program to the community on February 12, 2000. In the first quarter of 2000 Bartlett held 12 separate 4 hour training programs, educating over 130 members of our community, including 85 clinical staff. Our training opportunities are open to both employees and community members. Hospital employees showed the strongest attendance followed by staff from area clinics. Hospital policy requires training sessions on domestic violence be offered at least three times a year.

Q. How have your professional practices at Bartlett been affected in implementing the domestic violence program and screening protocols?
LS: I think we've made great strides towards educating staff and community members on the importance of screening for domestic violence. Our goal is to screen all of our female patients and we've incorporated screening questions into a nursing assessment form. Screening is now a mandatory component of our Hospital's admissions process.

Q: What are/were the major challenges you faced introducing the program?
LS: Anne L. Ganley, Ph.D., a domestic violence training facilitator, told us that it takes hours of training on a given subject before a medical professional will change their practice skills. Prior to attending training, some medical professionals may have felt that the issue of violence was a private one, and was best left to the individual to work out on their own. However, once we provide education about the dynamics of domestic violence, and the impact that violence has on the health of individuals and on communities, health care professionals were very receptive towards incorporating screening into their practices.

Changing the way we perform our jobs and incorporating new behaviors into our practice definitely takes commitment. As an ongoing effort to ensure that our staff remains informed on domestic violence issues, Bartlett Hospital includes the educational component of our domestic violence program as a curriculum element in the hospital's annual educational day. During this annual training, we educate clinical and non-clinical staff on topics like fire standards, OSHA requirements, etc, and include a 40 minute session on Domestic Violence issues.

Q: You mentioned the regularly scheduled training-sessions (4 hours in duration), that your hospital provides on a regular basis throughout the year for staff and community members. Can you explain who facilitates this training and how it works in terms of your process?
LS: We have an remarkable women's advocacy group here which is called Aiding Women Against Rape Emergency (AWARE). Annette Coggins is the Executive Director and was the individual who initiated the citywide task force on Domestic Violence in our area. Ms. Coggins and AWARE have given freely of their time and expertise to assist us providing no cost facilitators for portions of our domestic violence periodic training-sessions.

Q: Laura, are Bartlett Hospital employees paid to attend the four hour domestic violence training-sessions, or are employees volunteering their time to attend?
LS: I attribute the success of the program in part to the support of our hospital and administrative staff. Bartlett is a wonderful employer and furnishes employees with 24 hours of paid educational leave annually, and it's up to the individual employee to use that paid time however they choose. Many employees attending our training sessions, use their paid educational leave time. I think that one has to note that another piece to the success of the program lies in the high numbers of our clinical staff that participate in the trainings. I think it shows both open mindedness and professionalism on the part of our staff.

Q: What has been the response of the patients and has there been any increased utilization of resources since you've implemented this program?
LS: A Quality Assurance (QA) program that we have yet to implement will measure our success. But in general, I have never had a woman be offended by asking the screening question. For instance, it is very common for a woman to say something like, 'I'm glad you ask that, I know someone who has a relationship like that.' Or, 'I'm glad you asked that, I don't have that in my life now, but I used to.' Most importantly, even in the event that someone answers "no" to our screening question, it sends a message that domestic violence is an issue which we, as health care professionals take seriously, and this message ripples out into the community. Because we've asked women about an abuse history, they know there is a safe place they can come to for help, should they need assistance in dealing with violence in the future.

Q. What type of screening tools do you use, in your domestic violence program?
LS: In the Emergency Room setting, our clinicians use a certain screening question, which is asked in the following manner: "Because violence is common in many patient's lives we are now screening all of our patients for domestic violence. Are you in a relationship where you feel hurt or threatened?" All patients over the age of 16 are screened using the question I mentioned above. If patients answer in the affirmative, the nurse has follow up questions that will be asked, and safety assessments/referrals will be made as appropriate (Click Here for Example Screening Tools)

Q .Laura, I want to thank you for taking the time today to talk to us about your work as an ER nurse, and your contributions towards educating health care professionals on domestic violence issues. Is there anything else that you want to add before we finish today?
LS: The real importance of the issue of domestic violence and screening, I think, goes way beyond identifying one individual through screening. The effects of domestic violence bleed out into our society, and our children and entire communities are influenced by violence every day. We are just now beginning to understand how children are impacted when they observe violence within their own households while growing up, and how this affects a child's development. The whole point of screening is to get the victim of domestic violence out of a situation as early as she/he thinks she/he can! When children become immersed in the cycle of domestic violence, the cycle continues and these children are at high risk of becoming either victims or perpetrators of domestic violence themselves. We know that violence is a learned behavior, and children exposed to violence become very troubled, and it's extremely confusing for a child to witness a parent being beaten, or exposed to constant verbal abuse, night after night. Furthermore, imagine how it must be for a child to try to make sense in their mind, of a situation in which one parent is abusing another parent. The effects of domestic violence spiral out into the community. Children who witness and experience domestic violence become troubled because of the conflicting and disturbing environment in which they live. The problems continue throughout the life span for children from domestic violence homes. Difficulties may be experienced for children in classrooms, while dating, and finally, as they begin their own families.

The goal at Bartlett Regional Hospital is to be an example for other communities, and to let the public know that domestic violence is a community and public health issue. Working together, we can make our communities healthier places to live. Most importantly, we want to be known as a resource where domestic violence victims can come for help. Our focus is on helping the victim get out of a violent situation as soon as the victim thinks they can do so safely.

This concludes HospitalSoup.com's interview with Laura Stats, RN. HospitalSoup would like to thank Laura for contributing her time, knowledge and experience for this article!

Special thanks also to Bartlett Regional Hospital, The Alaska Network on Domestic Violence & Sexual Assault, The Family Violence Prevention Fund, and the State of Alaska Council on Domestic Violence and Sexual Assault for their assistance in contributing resources for our feature this month.

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