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Confronting Chronic Neglect: The Education and Training of Health Professionals on Family Violence
In a few cases, competency domains specific to family violence are addressed. For example, one review notes that competence in family violence “is now part of the expected standard of care for graduating and practicing physicians” (Alpert et al., 1998, p. 278). It describes the goal of curricula on family violence as competence in screening (how to ask the right questions), assessment (how to listen to the patient’s responses and concerns), intervention (offering information, advice, and support), and referral for services. It also addresses some important interpersonal competencies, such as to “efficiently, yet compassionately, evaluate patients’ concerns in the context of evolving life circumstances” (p. 277), appreciation for diversity, and awareness of one’s own attitudes, beliefs, values, and history.
Another report identifies some traits for ethics consultations, including tolerance, patience, compassion, honesty, courage, prudence, humility, and integrity as being important and closely related to such skills as active listening and the communication of interest, respect, support, and empathy (Auslisio et al., 2000). These appear to be quite applicable to family violence as well. The complexity of addressing rights for individual autonomy while at the same time ensuring patient safety is a formidable task to be achieved in the family violence arena. However, competence here is necessary for all health care professionals encountering all forms of family violence (NRC and IOM, 1998). The American College of Nurse Midwives similarly supplemented knowledge, skill, and behavior competencies with the “hallmarks of midwifery” (1997), which include, for example, skillful communication, guidance, and counseling. In these and other cases, those proposing competencies acknowledge that practice involves not only science but also the artful application of knowledge in interpersonal relationships and ethical issues with clients. In family violence, this need to attend to interpersonal, ethical, and cultural competencies is considered crucial (American Nurses’Association, 1995; Ryan and King, 1998).
The foregoing review of the literature does not provide a scientific foundation for core competencies on family violence for health professionals. The committee struggled with the lack of a scientific evidence base from which to propose core competencies for health professionals and the need for such competencies. What and how much each type of health professional needs to know about family violence remains a matter of debate. However, the literature does suggest important elements and common themes. In the committee’s judgment, the overlap it found in the literature, as well as the literature describing curricular development by consensus processes (e.g., Brandt, 1997), suggests some agreement in the field regarding the appropriate areas for educational intervention. The consensus opinions and products of the formal consensus panels that have developed core competencies provide a very valuable starting point from which to launch evaluative research.
Based primarily on the work of the American Association of Colleges of Nursing (1999), Alpert et al., (1998), Brandt (1995, 1997), Heise et al. (1999),