Brenda K. Binder

TESTING THERAPEUTIC LIFE REVIEW OFFERED BY HOME CARE WORKERS TO DECREASE DEPRESSION AMONG HOME-DWELLING OLDER WOMEN

The purpose of the study was to test a psychosocial intervention, therapeutic life review, offered by home care workers to decrease depression among home-dwelling older women. A quasi-experimental, one-group time-series design measured the effect of a once-a-week, 40-minute therapeutic life review intervention, delivered for six weeks by home care workers, on the depression scores of women 65 years and older, compared to their scores during the ten weeks prior to the intervention. Over time, depression scores improved with a significant decrease in depression immediately following the six-week intervention. Based on these findings, we concluded that home care workers can deliver a community-based psychosocial intervention that decreases depression in their home-dwelling clients.

Children in Distress: Functioning of Youngsters of Abused Women and Implications for Child Maltreatment Prevention

Intimate partner violence (IPV) is a global health problem impacting millions of women each year. Children of these women are exposed to the violence and are at high risk for significant behavioural problems. To protect children and promote healthy families, assessment of child functioning, by age and gender, is critical to identify “red flags” that trigger immediate child/family support services for abused women seeking assistance. The present study is the first to describe the behavioural dysfunction by age and gender of children of mothers experiencing IPV who reach out for assistance for the first time. This information is a part of a seven-year prospective research project evaluating the treatment efficacy of two models of care for abused women: safe shelter and justice services. Study findings indicated that boys of abused women, particularly younger boys, are more likely to exhibit clinically significant behaviour problems placing them at high risk for delinquency, hostility, and aggression. The child malfunctioning behaviour when viewed in the context of a family experiencing chronic stress (IPV) has the potential for child abuse. Implications for child health practice to minimise the risk for child maltreatment include awareness and education for child health professionals and advocates, implementing the mother–child unit of care when providing services to children, behavioural screen or assessment of the child when the mother screens positive for IPV, and the development/implementation of intergenerational programmes to address the mental and physical health needs of the abused mother and the behavioural function of the child.

The meaning of adolescents' eating experiences during bone marrow transplant recovery.

Bone marrow transplant (BMT) is a common treatment option for adolescents with various diseases; however, the aggressive therapy often causes significant side effects that can lead to poor eating. There is little documentation of eating experiences and necessary support needed after the initial BMT hospitalization. This phenomenological study, guided by Martin Heidegger’s philosophical influences, revealed the meaning of adolescents’ eating experiences, eating strategies, and the impact of eating on the adolescents’ quality of life during the first 100 days post-BMT. Individual interviews were conducted at 50 and 100 days post-BMT. Data analysis used the hermeneutic circle and revealed 5 themes. Adolescents discussed the slow return of eating, barriers that affected their eating, personal eating strategies, significance of eating, and feelings regarding eating. Eating issues do not end when a BMT patient is discharged from the hospital, and caregivers need to have a better understanding of the ongoing issues affecting adolescents throughout the BMT recovery phase.

THE FEASIBILITY OF HOME CARE WORKERS DELIVERING AN INTERVENTION TO DECREASE DEPRESSION AMONG HOME-DWELLING, OLDER WOMEN: A QUALITATIVE ANALYSIS

Depression is associated with poorer functioning and may even increase the risk of dying. Home-dwelling frail older women with depression often receive inadequate treatment or no treatment at all. Therapeutic life review, an intervention based on Eriksons developmental stages, delivered by home care workers (HCWs) with three hours of training, is a cost effective way to enhance mood in these women. Nine HCWs who had implemented therapeutic life review participated in one of two focus groups and reported enhanced moods among their frail older clients.

Modeling the intergenerational impact of partner abuse on maternal and child function at 24 months post outreach: Implications for practice and policy

OBJECTIVE Many women are exposed to partner violence during their lifetime which affects mental health and child development. This study revalidates an intergenerational model connecting partner violence to poor functioning for mothers and children using structural equation techniques. METHOD A longitudinal design collected data on 300 mother-child pairs. Comparisons between the model, tested at study entry and again at 24 months, are reported. Maternal measures included childhood experiences of abuse, partner abuse, chronic pain, and mental health. The Child Behavior Checklist measured child function. RESULTS Comparison of both models revealed that maternal chronic pain, maternal mental health, and child witnessing of mothers abuse remain strong predictors of child dysfunction. Maternal social support and self-efficacy are significant predictors of more positive maternal mental health with a conduit effect on child behavior. CONCLUSION Intimate partner violence directly impacts the victim and also has a secondary impact on the children of abuse victims.

Behavioral functioning of children of abused women who seek services from shelters or the justice system: new knowledge for clinical practice.

Millions of women worldwide are victims of partner violence annually and their children are at-risk for psychological and physical dysfunctions. A total of 300 children (ages 18 months to 16 years), whose abused mothers sought safe shelter or a protection order for the first time, were studied. Data revealed internalizing behaviors, such as depression and externalizing behaviors, such as bullying decreased 4 months after mothers obtained help. Children’s scores from the shelter group indicated more dysfunction. Although no direct program was offered to the children studied, routine child care presents opportunities for nurses in pediatric settings to assess mothers for abuse and intervene with guided referrals and safety information that may promote better child functioning.

The simulated hospital environment: a qualitative study applying space industry techniques.

Patterned after the integrated simulation approach utilized in the space industry, we report results of an innovative simulation in nursing, a 96-hour continuous simulated hospital environment. Training objectives for our study emphasized the integrative and critical thinking skills needed by new graduate nurses. The purpose of this study was to determine the process for development and the experience of participating in a simulated hospital environment. We sought to (a) translate space industry-integrated simulation techniques into development of a simulated hospital environment and (b) determine the experience of participating in an integrated simulation experience among undergraduate (UG) and graduate nursing students and nursing faculty. We used a qualitative mixed-methods design. Data were collected from participant focus groups, debriefing sessions, research team field notes, and electronic health record documentation. The sample, 72 student focus group participants, consisted of 12 baccalaureate-level soon-to-graduate students and 60 graduate nurse practitioner students as patient actors and providers. Important themes emerged from the project. We were able to design a simulated hospital environment that was true to life. Notably, student knowledge-practice gap was a major theme of the study, consistent with studies of employer concerns of new graduate nurses.

Storytelling by community-dwelling older adults: perspectives of home care workers.

The purpose of this exploratory, qualitative study was to investigate storytelling by home care clients to their home care workers (HCWs). Specific research questions were: (a) When does storytelling by a care recipient occur during usual care?; (b) How do HCWs engage older clients in storytelling?; (c) How do HCWs respond to the stories told by clients?; and (d) What is the perceived effect of storytelling by older clients on the relationship between the client and the HCW? Two focus groups consisting of 10 HCWs each were conducted. Verbatim transcripts of both focus groups were analyzed using the constant comparative analysis method. Categories and concepts were identified. Characteristics of the HCW and client set the stage for storytelling. The process of storytelling included context, triggers, and temporal aspects. HCWs also shared the content of stories, the impact on their relationship with the client, and the perceived effect on each individual. A visual model depicting the nature of storytelling in association with the care of older clients is presented.

Youth Exposed to Parental Intimate Partner Violence and Bullying at School

Millions of children globally are exposed to multiple forms of violence in their homes, neighborhoods and schools, making it difficult to quantify cumulative exposures. These children are at increased risk for poor health outcomes, such as internalizing and externalizing mental and behavioral symptoms. Objective: The aim of this analysis are to examine the frequency of bullying experiences in the lives of children who have experienced parental intimate partner violence and to examine the association between health outcomes and being bullied, specifically internalizing and externalizing symptoms. Method: This study considers sex roles and divides the children by ages over 12 and under 12; however, only the victim role is assessed. For this analysis 52 months data were collected as part of a 7 year prospective study. To our knowledge, this is the first prevalence and health outcomes data reported for this population of children (N=274, average age 11.2) exposed to parental intimate partner violence (IPV) and bullying. Results: Children experienced higher than national rates of bullying victimization, ranging from 22% to 47.4%, with physical bullying at 35.6% to 45.1%. Indirect bullying was higher in the under 12 age group (32.4%-46%). The only significant gender difference was that boys experienced physical bullying more than girls. Children who scored in the borderline/clinical range on the Child Behavior Checklist experienced significantly higher levels of bullying. Conclusion: Children who experience higher levels of bullying tend to also have significantly greater internalizing and externalizing problems. This study demonstrates that negative mental and behavioral health outcomes are associated with youth who experience both bullying and parental intimate partner violence.