Document Type
Article
Publication Date
4-12-2025
Degree Name
Doctor of Nursing Practice
Faculty Advisor
Kerry A. Milner, DNSc, APRN, FNP-BC, EBP-C
Practice Mentor
Shivanna Subramani-Gonzalez DNP, FNP-C
Abstract
Background: Intimate partner violence (IPV) is a significant public health crisis, disproportionately affecting individuals identifying as women, with lifelong physical and psychological consequences. Despite recommendations from the U.S. Preventive Services Task Force (USPSTF) for routine IPV screening, many primary care settings lack standardized tools to perform this screening. The Modern Woman Health and Wellness Center (MWHWC), a women’s only primary care clinic in Connecticut, identified the need for a validated screening tool to increase detection of IPV, improve patient outcomes and align with national screening guidelines.
Objective: This quality improvement (QI) project aimed to implement the HARK (Humiliation, Afraid, Rape, Kick) tool to enhance IPV identification, ensure timely referrals, and integrate screening into existing clinical workflows.
Methods: Guided by the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles, the HARK tool was introduced over a 12-week period. The tool was used during all annual gynecological and primary care appointments. Staff training, workflow integration, and EHR documentation were emphasized while surveys were used to assess staff perception. Process measures included staff education and screening adherence, while outcome measures included tracking screening rates, positive results, and follow-up actions.
Results: Of 272 eligible visits, 188 (69.12%) patients were screened using HARK, with 13 (6.91%) positive screens. Positive cases received referrals to in-house therapists or external resources. Staff surveys indicated high comfort (100%) and confidence (100%) in using HARK, with seamless workflow integration. Screening rates peaked at 85.37% during one of the implementation months, indicating strong adherence. However, the clinic’s transition to a new EHR system during the implementation period adversely impacted adherence, contributing to a decline in screening rates.
Discussion: The HARK tool is feasible and effective for use in a primary care setting, enhancing early identification and support for affected patients. Sustainability plans include integrating the screening into the EHR, incorporating training on the screening workflow into new hire onboarding, and data-based reminders in huddles. This project underscores the importance of standardized IPV screening to improve patient safety and align with national guidelines. Although the target of 90% compliance was not reached, positive trends in staff engagement and patient outcomes support the scalability and sustainability of the intervention.
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Recommended Citation
Senu, A. (2025). Implementing a validated screening tool for intimate partner violence in a women’s primary care setting: A quality improvement project [Unpublished DNP project]. Sacred Heart University. https://digitalcommons.sacredheart.edu/dnp_projects/96
Comments
A DNP project submitted in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice, Sacred Heart University Davis & Henley College of Nursing.