Cynthia D. Connelly

Mother's age and risk for physical abuse

It is widely believed that young mothers are at greater risk of engaging in physical abuse. However, this relationship is not clearly supported by previous empirical research. This study reexamines the issue using a nationally representative sample of 1,997 mothers. All analyses controlled for family income, race, number of minor children in the home, age of abused child, mothers education, and whether mother was a single parent. Physical abuse was measured with the Conflict Tactics Scales. Using mothers age at time of birth of the abused child, the younger the mother, the greater the rate of child abuse; however, there was not a significant relationship when mothers age was measured at age at time of abuse. Large families and minority group children were also found to be at greater risk of abuse. The paper discusses implications for further research and for prevention of child abuse.

A Psychometric Examination of English and Spanish Versions of the Revised Conflict Tactics Scales

The psychometric properties of the Revised Conflict Tactics Scales (CTS2) are examined for English-speaking (n = 211) and Spanish-speaking (n = 194) Latino women. Internal consistency of total scale scores is satisfactory (Cronbach’s alpha of .70 to .84). However, subscale alphas range from .46 to .80. Confirmatory factor analyses support five factors of negotiation, minor and severe psychological aggression, and minor and severe physical assault. In unconstrained two-group models, loadings are of similar magnitude across language of administration, with the exception of the Physical Assault scales. Unconstrained and constrained model comparisons show scale structure varied by language group for physical assault. Although results of this study show some comparability for English-speaking and Spanish-speaking Latinas, simply combining results across language groups may obscure important differences in rates of endorsement and patterns of responses reflecting cultural, educational, and economic differences.

Substance involvement among youths in child welfare: the role of common and unique risk factors.

This study examines risk factors for substance involvement for youths involved with the child welfare (CW) system. In addition to common risk factors examined in general population studies; this research examines risk factors unique to youths in the CW system, including age at entry into CW and number of out-of-home placements. Participants included 214 youths ages 13 to 18, randomly sampled from youths active to CW in San Diego County, California. Severity of substance involvement was assessed through structured diagnostic interviews determining lifetime substance use, abuse, and dependence. Hierarchical regression analyses including demographics, psychosocial variables, maltreatment history, CW placement variables, and the interaction of age at entry into CW and number of out-of-home placements revealed that both common and CW-specific risk factors were associated with the severity of youth substance involvement. Multiple-placement changes, later entry into the CW system, and multiple-placement changes at an older age are associated with higher risk for more serious substance involvement for youths in CW.

Moral distress, compassion fatigue, and perceptions about medication errors in certified critical care nurses.

The primary purpose of this study was to examine the previously untested relationships between moral distress, compassion fatigue, perceptions about medication errors, and nurse characteristics in a national sample of 205 certified critical care nurses. In addition, this study included a qualitative exploration of the phenomenon of medication errors in a smaller subset of certified critical care nurses. Results revealed statistically significant correlations between moral distress, compassion fatigue, and perceptions about medication errors in this group. Implications for critical care nurses seeking to create work environments conducive to the reduction of medication errors are explored.

Child Maltreatment Profiles and Adjustment Problems in High-Risk Adolescents

The purpose of this article is to identify profiles of maltreatment experiences in a sample of high-risk adolescents and to investigate the relationship between the derived profiles and psychological adjustment. Participants are 1,131 youth between the ages of 12 and 18 years involved with publicly funded mental health and social services. Information on physical, sexual, and emotional maltreatment and psychological symptoms are obtained in interviews with adolescents and their primary caregivers. Using latent profile analysis, three maltreatment profiles are identified: “sexual + physical + emotional maltreatment,” “physical + emotional maltreatment,” and “low maltreatment.” Adolescents in the two maltreatment profiles generally have significantly higher scores on symptom scales compared with those in the “low maltreatment” profile, but scores in the two maltreatment profiles do not differ. Findings highlight the need for agencies to identify and provide appropriate intervention for youth who experience multiple types of maltreatment.

Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women.

BACKGROUND The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women. METHOD Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants. RESULTS A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms. CONCLUSION In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.

Intimate Partner Violence and Psychological Functioning in Latina Women

In this study, the researchers examined the associations among intimate partner violence and psychological functioning in 282 Latina women between 18 and 45 years. Participants were interviewed about demographic characteristics, experiences with physical, sexual, and psychological intimate partner violence, psychological symptoms, stressful life events, and childhood maltreatment. Physical violence was associated with symptoms of depression and hostility, and psychological abuse was related to depression, hostility, and somatization. Sexual violence was generally not associated with psychological functioning. The different types of intimate partner violence were not related to participants’ self-esteem. Implications for interventions with Latina women are discussed.

Trajectories of maternal harsh parenting in the first 3 years of life.

OBJECTIVE Despite the high prevalence rates of harsh parenting, the nature of developmental change in this domain early in life and the factors that contribute to changes in harsh parenting over time are not well understood. The present study examined developmental patterns in maternal harsh parenting behavior from birth to age 3 years and their related longitudinal risk factors (contextual and intrapersonal). Partner aggression was also tested as a time-varying predictor to examine its time-specific influence on maternal harsh parenting. METHODS Longitudinal data from 4 assessments of a community sample of 488 at-risk mothers were analyzed using latent growth curve modeling. Maternal risk factors and harsh parenting behaviors were assessed at birth and at ages 1, 2, and 3 years. RESULTS There was a significant increase in maternal harsh parenting from birth to age 3, particularly between ages 1 and 2. There was a significant direct effect of maternal alcohol use and abuse history on maternal harsh parenting at age 3, and maternal age was positively associated with change in maternal harsh parenting over time. In addition, partner aggression was significantly and positively associated with maternal harsh parenting at each time point. CONCLUSIONS The findings suggest possible developmental trends in the emergence of maternal harsh parenting during infancy and toddlerhood. Further investigation is needed to elucidate individual differences in the developmental patterns and to differentiate predictive factors that persist across time and factors that are unique to specific developmental stages. PRACTICE IMPLICATIONS The overall high prevalence rates of harsh parenting behavior and growth of such behavior in infancy and toddlerhood support the need for developmentally sensitive early intervention programs.

Interdisciplinary collaboration: The role of the clinical nurse leader

AIMS   To explore the feasibility and acceptability of a clinical nurse leader (CNL) role to improve interdisciplinary collaboration (IC) within a fragmented acute-care microsystem. BACKGROUND   Fragmented patient care is associated with preventable adverse healthcare outcomes. IC decreases fragmentation and improves patient care quality. The CNL role is theorized to provide the necessary leadership and competency skill base to impact IC at the optimal organizational level, the point of care where most healthcare decisions are made. METHODS   This study used a descriptive non-experimental design. CNL daily workflow was developed to target empirical determinants of IC. Descriptive data were collected from multiple stakeholders using an investigator-developed survey. RESULTS   Findings indicate the integration of the role is feasible and acceptable to the microsystem healthcare team. CONCLUSIONS   Preliminary evidence suggests the CNL role may be an effective intervention to facilitate IC. More research is needed to support the CNL roles association with microsystem IC. IMPLICATIONS FOR NURSING MANAGEMENT   The CNL role presents an innovative opportunity for clinical and administrative leadership to partner together to redesign a healthcare delivery system and improve patient care quality.

Work-related burnout, job satisfaction, intent to leave, and nurse-assessed quality of care among travel nurses.

Objective: This research study examines work-related burnout, job satisfaction, nurse-assessed quality of care, and intent to leave in travel nurses, a population that has not been studied previously. Background: Travel nurses are frequently used to supplement nursing staff in acute care hospitals, especially in times of shortage-understanding their satisfaction with the job may further illuminate the problem of nurse job dissatisfaction in general. Methods: Ordinary least-squares regression analyses were used to examine the influence of nurse and workplace characteristics on work-related burnout, job satisfaction, intent to leave, and perceived quality of care. Results: Quality of care and job satisfaction were significantly influenced by whether a hospital held Magnet® designation. As the number of patients cared for increases, there was a significant increase in work-related burnout. Work-related burnout was also significantly lower for nurses working in California. Conclusion: The results of this study suggest that different workplace characteristics influence the perceptions of quality of care provided at a hospital facility and the degree to which a nurse is either burned out or satisfied with his/her job.