Scripting of domestic-violence simulations to improve prehospital emergency-care diagnostic probity and healthcare responsiveness in low- to middle-income countries

Abstract

The global occurrence of domestic violence is a disturbing problem which leaves both victims and interventionists with a sense of helplessness. Emergency-care providers have been identified as a critical contact point for victims. The interlude between the act of violence and the victim’s hospitalisation provides opportunities for screening, medical care and appropriate referral (primary, secondary and tertiary prevention). Both the current training of emergency-care providers and research on the domestic-violence response are unjustifiably minimal. Simulation training is not foreign to prehospital emergency care. However, the use of domestic-violence-related scripted scenarios (to promote diagnostic probity) is novel. Therefore, the primary research question was: How does the scripting of evidence-informed simulations of domestic-violence cases enhance practitioner responsiveness and patient safety among prehospital emergency-care students?

The paradigm and methodology for this qualitative study was social constructivism and grounded theory respectively. The data collection comprised a literature review, focus-group discussions and participant observation during patient simulations. The data was analysed through the method of constant comparative analysis.

It was found that the scripting of simulations with the use of peer-based training may be an effective method of achieving improved responsivity to domestic violence. Traditional EMS training with expensive manikins may not be as effective for this purpose, as students require a level of feedback and fidelity through which they can convey their empathy and history-taking skills. Further research should be conducted to determine the most effective methods for assessing standardised domestic-violence patient simulations.