Carole W. Pearce

Graduate students' experiences with standardized patients as adjuncts for teaching pelvic examinations

Purpose: To explore graduate nurse practitioner students’ perceptions of their experiences when learning to perform pelvic examinations in the laboratory and performing them in subsequent clinical rotations. One group was taught by faculty with voluntary peer examination, and the other two groups were taught by standardized patients (SPs). Data sources: Surveys with open‐ and closed‐ended (responses on Likert scales) items administered twice during 3 consecutive years to students enrolled in an advanced health assessment course. Conclusions: All groups reported feeling anxious while learning pelvic exam techniques and in subsequent clinical experiences. SPs provided immediate feedback to students, decreased their feelings of anxiety, and increased their confidence in performing examinations. Students who were taught pelvic examination techniques by SPs rated their learning experiences more positively and reported a better understanding of exam techniques than students who learned to perform exams by voluntary examination of classmates. Implications for practice: Graduate nursing programs should consider locating and using SP programs for teaching pelvic examinations in advanced health assessment courses. Although more cost‐effective, voluntary peer examination was a less effective teaching method.

SCREENING FOR ABUSE: BARRIERS AND OPPORTUNITIES

Domestic abuse is the leading cause of injuries and death among women of childbearing age in the United States. The broad purpose of this research is to discover how pregnant womens psychological and behavioral responses to abuse affect birth outcomes. To select a diverse sample of women, we identified 8 prenatal care sites and completed the human subjects approval process with each. Rates of screening for abuse range from all but 12 women over a 2-1/2-year period at one site to no screening for abuse at another site. In this article, we will review pertinent literature and discuss the supports and barriers we observed when implementing an abuse screening program using the Abuse Assessment Screen, a well-tested and valid clinical instrument. Suggestions will be made for improving the screening rates at those sites where screening is absent or inconsistent.Domestic abuse is the leading cause of injuries and death among women of childbearing age in the United States. The broad purpose of this research is to discover how pregnant womens psychological and behavioral responses to abuse affect birth outcomes. To select a diverse sample of women, we identified 8 prenatal care sites and completed the human subjects approval process with each. Rates of screening for abuse range from all but 12 women over a 2-1/2-year period at one site to no screening for abuse at another site. In this article, we will review pertinent literature and discuss the supports and barriers we observed when implementing an abuse screening program using the Abuse Assessment Screen, a well-tested and valid clinical instrument. Suggestions will be made for improving the screening rates at those sites where screening is absent or inconsistent.

Translation of Domestic Violence Instruments for Use in Research

The Abuse Assessment Screen, Severity of Violence Against Women Scales, and Appraisal of Violent Situations scales were translated into versions for women originating from Brazil, Haiti, the Dominican Republic, and Puerto Rico. The procedure of back translation was chosen as the most reliable method for translation of these three instruments. The translated instruments were used to screen women for abuse during pregnancy and to determine the prevalence and severity of that abuse. This article discusses the translation process and illustrate with versions of the instruments for use with pregnant women from Puerto Rico.

Children who witness violence: what services do they need to heal?

Children are witnesses to violence far too often in their daily lives. To elicit information on the needs of children and adolescents living in the United States who have witnessed violence in their homes, neighborhoods, or communities, we held focus groups with mothers who have survived interpersonal violence and whose family included child witnesses to violence (CWV), professionals who work with families affected by violence, and with adolescents who have witnessed violence. Based on four separate focus group discussions held in Massachusetts, involving a total of 45 participants, recommendations for screening, programming, and the development of healing interventions are offered to mental health professionals.

Health Disparities Among Health Care Workers

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

Creating a community coalition to address violence

Building a community-wide coalition to address violence evolved out of a five-year federally funded project on abuse during pregnancy. The setting for this coalition building is Haverhill, Massachusetts, a city of about 60,000, located northeast of Boston in the Merrimack River Valley. For nearly eight years, representatives of more than 30 agencies and institutions have been meeting monthly and creating programs and strategies to address violence in homes, schools, and neighborhoods, and designing interventions for children witnessing this violence. The purpose of this article is to describe the process of coalition building and provide an analysis of this work.

Comprehensive interdisciplinary care: making a difference in pregnancy outcomes for Hispanic women.

Hispanic women constitute one of the fastest growing and most diverse groups in the United States, representing many countries of origin and cultural practices. The purpose of this evaluation study, using an ex post facto design, was to examine well-being during pregnancy and pregnancy outcomes for a cohort of 113 Hispanic women receiving perinatal care at the clinic of a community hospital in an old industrial city in the Northeast. The received adequacy of prenatal care for the study sample women was very high. The low-birthweight rate was lower than for the study hospital, the study city, the state, and the entire United States. The results of this study demonstrate the favorble effects of a comprehensive, interdisciplinary, and culturally sensitive model of prenatal care on these womens well-being and birth outcomes. Findings also support the need for an outreach program targeted at hard-to-reach women in the inadequate, received-care group and women with later initiation of care.

Adapting and testing the Appraisal of Violent Situation scales.

The purpose of this study was to test the psychometric properties of a vertical version of horizontally oriented three Appraisal of Violent Situation scales that elicit womens subjective appraisals of severity, dangerousness, and controllability of violence. Construct validity of the vertical scale eliciting 64 abused womens perceptions of severity of violence experienced was supported by a low to modest correlation between that scale and the Severity of Violence Against Women Scale. Concurrent validity between the horizontal and vertical versions of the scales was demonstrated with a subsample of 26 abused women completing both. Results provide preliminary support for the revised scales.