To celebrate International Nurses Day, we are taking a closer look at one of our biggest champions, Louise Knight.
Louise is a nurse practitioner at the Kingskerswell and Ipplepen Medical Practice and is also the IRIS Clinical Lead for South Devon and Torbay.
IRIS is a specialist domestic violence and abuse (DVA) training, support and referral programme for general practices. It has been running in the South Devon and Torbay area for just under a year. It is a partnership between health and the specialist DVA sector, providing in-house, DVA training for general practice teams and support from a named advocate educator, a specialist DVA worker, to whom patients can be referred for support. The programme has been available to be commissioned in the UK since 2010. At the centre of the programme is the local clinical lead, in this case Louise. The clinical lead not only provides training, but also supports practices and advocate educators in identification and referral of patients affected by DVA .
IRIS launched in Devon and Torbay July 2018 and the service is divided into three geographical clusters: South Devon and Torbay, Exeter and East Devon, and North Devon. Louise joining as clinical lead for South Devon and Torbay in autumn of the same year. In Devon and Torbay, for the first time, the IRIS Programme has been broadened to encompass sexual violence as well as domestic abuse. The training provided to general practice teams covers both sexual violence and domestic abuse, and patients affected by either form of violence and abuse can be referred for specialist support from the local advocate educators. As of end March 2019, 8 practices in South Devon and Torbay were fully trained and 52 referrals had been received by the advocate educator.
“I first heard about IRIS when I saw the position for clinical lead for Torbay advertised in a local nurse bulletin” explains Louise. “I have always been passionate about women’s health and welcomed the opportunity to try and improve the services offered in our area for patients who are experiencing or have experienced domestic violence and abuse or sexual violence”
Louise found her own training not only hugely educational, but also inspiring and motivating.
“I really enjoyed the training” says Louise. “The signs that a patient is a victim of DVA are not always physical. The training showed us that there is a lot more to identification than what is presented physically by the patient. That then raises the question ‘is she experiencing domestic violence and abuse or sexual violence’? The training included periods of roleplay which are vital in this setting. Roleplay allows you to develop the words and language that you feel easily able to use with a vulnerable patient within a ten minute consultation to get to the root of the matter.”
In South Devon and Torbay there are now 8 surgeries fully trained in the IRIS programme. There are a further 7 surgeries that are part trained, with more being trained this year. This equates to access to specialist SV and DVA service support for nearly 145,000 patients.
But there is still work to do. With 112 GPs and clinicians now trained in the area, as well as 94 ancillary and reception staff, referrals have gone up to 74 since January 2019 and continue to rise.
“For me the post positive experience has been the responses from the clinicians that I have trained” says Louise.
Many GPs feel like they don’t have the time to take on the training in practice, the reality being that with specialist trained staff, return visits to surgeries are actually less frequent, freeing up the staff to see more patients.
Louise explains “I was asked to speak about IRIS to a local group of GPs, to try and persuade them to get on board with the programme. It was a lively discussion and I faced some difficult questions. But the response afterwards was amazing.”
“The lead GP, and organiser of the event said that in all the years he has been organising, they have never had a speaker prompt so much discussion and debate. I also had a GP tell me that until that point, he had advised his surgery they did not need to take on the IRIS programme but had now 100% changed his mind”
“When we know better, we do better, and raising awareness of the scale of the problem of DVA and SV is so important.”
Specialist DVA service providers rarely receive referrals from primary care, and historically, general practice has been absent from community domestic violence partnerships. Women report wanting health services and professionals to have a duty to identify and respond to violence against women and girls, but healthcare professionals are largely unaware of appropriate interventions and have not received effective training.
Some of the IRIS training sessions provide ‘lightbulb’ moments, for even the most experienced GPs. “I had an email the day after training from a GP who had asked the question to a long- term patient who had fibromyalgia” says Louise “The patient had disclosed she was a DVA victim and he was then able to signpost her to support. These conversations are now taking place all over the country, raising awareness and changing lives for so many women.”
Feedback from the practice supports this, with one patient reporting “I have seen that there were agencies that could support people with abuse, but I would never have called or seen anyone if it wasn’t for my GP referring me to see someone in my surgery, what a difference this has made to my life & future”
The IRIS programme relies on solid teams of clinical leads, advocate educators and third sector, specialist DVA agencies to be able to make a difference. It is nurses like Louise who champion our cause and are passionate and committed to recognising gender-based violence as a health issue that we applaud on International Nurses Day. Their continued enthusiasm and passion will mean that more women and children are given the opportunity to live happier, safer lives.
“We all have a role to play in educating our society, both as individuals and clinical professionals” says Louise “We need more advocate educators to help with referrals and more training across the board”
Medina Johnson is CEO of IRISi, a social enterprise established to promote and support the health care response to gender based violence. She was one of the two original IRIS advocate educators and IRISi now supports sites delivering the IRIS programme and encourages new sites to sign up to and fund the programme.
“We know that our nurse colleagues in primary care are pivotal to the change in practice we need to see to ensure better support in primary care for patients affected by DVA. It is great to hear the positive feedback from both clinicians and patients in the Devon and Torbay area. The response to DVA is everyone’s responsibility and our nurse colleagues are great advocates.”