Educating emergency department staff on the signs of strangulation

According to the Training Institute on Strangulation Prevention, strangulation is one of the most lethal forms of intimate partner violence (IPV). Within seconds, a victim can fall unconscious. Within minutes, they can die. Of the 10 million women who suffer IPV each year, over 8% have been choked or strangled.

Even though many of these women visit an emergency department (ED), the signs of strangulation are difficult to detect and many health care professionals have not received training in this area. Failure to diagnose strangulation can, however, lead to severe consequences – including succumbing to death days or weeks after the assault has occurred.

When and how to screen patients

Enter Doctor of Nursing Practice (DNP) alumna Susan Graham (DNP ’19), who, over the past 15 years, has worked as an ED, medical-surgical and intensive care unit nurse.

For her final research project, Graham used the Institute’s free assessment tool as the basis for educating ED staff at a small, 40-bed rural Oklahoma hospital about when and how to screen patients for strangulation and to use the correct radiographic imaging test to rule out life-threatening injuries. As Graham points out, “Oklahoma is a particularly apt place in which to carry out such training, as we are one of only 12 states that is not currently mandated to use strangulation screening tools or algorithms.”

Graham said her study “initially started out as a research project but quickly became also a quality improvement project.” All 25 participants – nurses and physicians – were given a pre-test, then formal education on detecting strangulation, followed by a post-test. When Graham compared her subjects’ pre-test and post-test knowledge, she discovered “a significant change, a drastic improvement. Scores went up 37.6% related to the dangers and signs of strangulation.”

 

Giving victims of violence a voice

Reflecting on the outcomes of her work, Graham noted that “there is a great need for this education and assessment tool in EDs. When women who have been the victim of assault present, they typically don’t want to talk about it. So, as health care providers, we need ways to improve our assessment capabilities. My project was geared toward improving both patient satisfaction and patient outcomes, to be helpful for those women who didn’t feel able to tell their stories.”

And one of those stories, Graham revealed toward the end of our conversation, was her own. “One of the things I would like people to know is that I was a statistic,” she said. “The reason why this project was so important to me was because I was one of those girls before I was a nurse. I thought, how could I help another person who was in my shoes?”