The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the "Major Recommendations" field.
Practice Recommendations
Recommendation 1.0
Nurses implement routine universal screening for woman abuse in all health care settings.
(Level of Evidence = IIb)
Recommendation 2.0
Routine universal screening be implemented for all females 12 years of age and older.
(Level of Evidence = IV)
Recommendation 3.0
Nurses develop skills to foster an environment that facilitates disclosure.
This necessitates that nurses know:
- how to ask the question
- how to respond
(Level of Evidence = IV)
Recommendation 4.0
Nurses develop screening strategies and initial responses that respond to the needs of all women, taking into account differences based on race, ethnicity, class, religious/spiritual beliefs, age, ability, or sexual orientation.
(Level of Evidence = III)
Recommendation 5.0
Nurses use reflective practice to examine how their own beliefs, values, and experiences influence the practice of screening.
(Level of Evidence = IIa)
Recommendation 6.0
Nurses know what to document when screening for and responding to abuse.
(Level of Evidence = IV)
Recommendation 7.0
Nurses know their legal obligations when a disclosure of abuse is made.
(Level of Evidence = IV)
Education Recommendations
Recommendation 8.0
Mandatory educational programs in the workplace be designed to:
- increase nurses' knowledge and skills
- foster awareness and sensitivity about woman abuse
(Level of Evidence = Ib)
Recommendation 9.0
All nursing curricula incorporate content on woman abuse in a systematic manner.
(Level of Evidence = III)
Organization & Policy Recommendations
Recommendation 10.0
Health care organizations develop policies and procedures that support effective routine universal screening for and initial response to woman abuse.
(Level of Evidence = IV)
Recommendation 11.0
Health care organizations work with the community at a systems level to improve collaboration and integration of services between sectors.
(Level of Evidence = Ib)
Recommendation 12.0
Nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational, and administrative support, as well as appropriate facilitation.
Organizations may wish to develop a plan for implementation that includes:
- An assessment of organizational readiness and barriers to education.
- Involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process.
- Dedication of a qualified individual to provide the support needed for the education and implementation process.
- Ongoing opportunities for discussion and education to reinforce the importance of best practices.
- Opportunities for reflection on personal and organizational experience in implementing guidelines.
In this regard, Registered Nurses Association of Ontario (RNAO) through a panel of nurses, researchers and administrators) has developed the Toolkit: Implementation of Clinical Practice Guidelines based on available evidence, theoretical perspectives and consensus. The Toolkit is recommended for guiding the implementation of the Registered Nurses Association of Ontario guideline Woman Abuse: Screening Identification and Initial Response.
(Level of Evidence = IV)
Definitions:
Levels of Evidence
Ia Evidence obtained from meta-analysis or systematic review of randomized controlled trials
Ib Evidence obtained from at least one randomized controlled trial
IIa Evidence obtained from at least one well-designed controlled study without randomization
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study, without randomization
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies, and case studies
IV Evidence obtained from expert committee reports or opinions and/or clinical experiences of respected authorities
