Didn't put a label on it: Examining intimate partner strangulation within a diagnostic framework

Aims: The aim was to examine and describe women's emergency department visits and care-seeking experiences, including recognition, evaluation and communication of symptoms, injuries and health risks after non-fatal intimate partner strangulation. Design: Using a diagnostic process framework, this mixed-methods study explores concordance and discordance of interview and medical records data to highlight opportunities for clinical diagnostic improvement. Methods: In-depth, semi-structured interviews with women after an emergency department visit for non-fatal intimate partner strangulation, concurrent with medical records reviews, were conducted between March 2018 and January 2019. A constant comparative approach was used to analyse interview and medical record data using an a priori codebook designed based on the National Academies of Science, Engineering and Medicine's conceptual model of the diagnostic process and prior intimate partner violence research. Results: Interviews reflected participants did not have a sense of long-term health risks from their strangulation beyond addressing emotional trauma. Women noted that forensic and emergency nursing support was treatment in and of itself that allowed them to be heard and validated. Medical record clinical impressions and final diagnoses included domestic violence, domestic abuse or sexual assault, but not specifically strangulation. Conclusion: This study contributes to the growing literature regarding strangulation diagnosis and care. Our findings provide new details of women's emergency department care-seeking experiences which, whilst overall aligned with medical records documentation, were not reflected in final diagnostic impressions nor in patient recollection of long-term health risks. Impact: Nurses are strongly positioned as clinical practice leaders and policy advocates to improve collective responses to this dangerous violence mechanism. Actions such as improving patient education, referral and follow-up options to better communication and address long-term strangulation risk are one example. Further research on non-fatal intimate partner strangulation and care-seeking is warranted to expand this knowledge, particularly in longitudinal cohorts and varied geographical areas.