Ellen Taliaferro

Family Presence During Invasive Procedures and Resuscitation: Hearing the Voice of the Patient

How do patients react to the presence of family during invasive procedures (IPs) or cardiopulmonary resuscitation (CPR)? Until recently, surprisingly little research had addressed the issue of family presence at all, and to our knowledge, no other studies have been published that delineate patients’ perspectives.In February 2000, we first reported in this journal findings from our pioneering study, which demonstrated numerous benefits that bedside visitation confers on the families of patients undergoing these procedures. This article presents our further investigation—aimed at describing the experiences of the patients—using a qualitative research approach to analyzing data collected during that study.The study took place in the emergency department (ED) of a university-affiliated, regional, level-I trauma center. The protocol for family presence was adapted from guidelines developed by the Emergency Nurses Association (ENA). Nine patients (eight who had IPs and one who underwent CPR) were also interviewed approximately two months after the emergency event. A semistructured questionnaire was used to determine their perceptions of the family presence experience.Seven themes emerged from the data. Three of these relate to the positive effects that family presence had on patients: it comforted them; provided help; and served, the patients believed, to remind providers of a patient’s “personhood”—he wasn’t just a patient; he was a person and had a family. Two themes involve how family presence reflects the reciprocal nature of patient–family bonds and the patient’s right to have family members present. The remaining two themes characterize how patients perceived the effects of the experience on their family members and on the health care environment. Patients saw both positive and negative effects on those who were present but believed the benefits to families outweighed the potential problems. Although further study is needed, family presence indeed appears to deliver many benefits, with apparently few drawbacks or adverse effects, to patients, their families, and their providers. In 1999, our institution, Parkland Health & Hospital System, approved a hospital-wide protocol for family presence during IPs and CPR.Corresponding author:Theresa MeyersPresbyterian Hospital of Dallas, Emergency Department8200 Walnut Hill LaneDallas, TX 75231TheresaMeyers@texashealth.org

SURVEY RESULTS OF WOMEN WHO HAVE BEEN STRANGLED WHILE IN AN ABUSIVE RELATIONSHIP

Few studies attempt to examine individual methods of domestic abuse. The objectives of this study are to evaluate strangulation as a method of domestic violence abuse: to determine the incidence of strangulation occurrence within the cycle of domestic violence, the subjective medical symptoms experienced by victims of intimate partner strangulation, and the elective utilization of health care following a strangulation incident. Sixty-two women were surveyed at two womens shelters in Dallas, Texas and Los Angeles, California and the Parkland Health & Hospital (PHHS) Violence Intervention Prevention (VIP) Center in Dallas, Texas. Each patient was individually interviewed and verbal responses were recorded. Statistics were performed using the SPSS program. Of the 62 surveyed, 42 (68%) had been strangled by their intimate partner who was a husband (23, 55%), boyfriend (13, 31%), or fiancé (2, 5%), by a mother, stranger, or friend (1 each). Strangulation, as a method of domestic violence, is quite common in women seeking medical help or shelter in a large urban city. This study suggests that strangulation occurs late in the abusive relationship; thus, women presenting with complaints consistent with strangulation probably represent women at higher risk for major morbidity or mortality.

Frequency and relationship of reported symptomology in victims of intimate partner violence: the effect of multiple strangulation attacks

The objective of this study is to examine the correlation between the number of times a victim of intimate partner violence (IPV) has been strangled and symptom development subsequent to the attacks. One hundred and one female subjects responded to a series of questions regarding the history and characteristics of the strangulation and the development of specific medical symptoms. Multiple strangulation victims, individuals who had experienced more than one strangulation attack, on separate occasions, by the same abuser, reported neck and throat injuries, neurologic disorders, and psychological disorders with increased frequency. Despite the increased frequency of symptoms, only 39% of the multiple strangulation victims sought medical care. These observations strongly support the need for health care professionals to inquire about the incidence of strangulation, examine the victim closely for evidence of injuries caused by the attacks, and recommend immediate care in anticipation of the potentially long term medical needs.

The prevalence of female-to-male intimate partner violence in an urban emergency department

Female-to-male intimate partner violence (IPV) recently has become a recognized health care issue. We screened a heterosexual male Emergency Department population for IPV using the HITS scale, a four-question survey. Two hundred eighty-two men were enrolled in the study. Basic demographics, along with the answers to the HITS scale, were analyzed. Of the men screened, 29.3% had a positive history of IPV. Men who were positive for IPV were more likely to score higher on questions regarding the frequency of verbal aggression than actual or threatened physical violence. This study reinforces the need to screen both genders for IPV in the Emergency Department.

Family presence during invasive procedures and resuscitation.

Cardiovascular and Critical Care Programs, Boston Children’s Hospital, Boston, Massachusetts; University of Pennsylvania (Nursing, Anesthesia, and Critical Care Medicine), Philadelphia, Pennsylvania; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; and Institute for Professionalism and Ethical Practice and Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts

Injury prevention and control.

Despite recent efforts to apply a public health epidemiology to violence in America, most physicians do not incorporate violence prevention methodologies into their own individual practices. The challenge of integrating violence detection, prevention, and management into the delivery of health care begins by building on the recent successful implementation of injury prevention and control policies. Three specific issues that physicians can address in their individual practice settings are reviewed: 1) alcohol and substance abuse, 2) firearms, and 3) family violence. This article focuses on these issues and addresses the concept of the physician as an advocate for change.

Walking and talking victims of strangulation. Is there a new epidemic? A commentary

This issue of JEM presents five articles addressing the issue of manual strangulation in surviving victims of intimate partner violence (IPV). These landmark articles reveal to the medical community what the social services and advocate community has known for a long time: strangulation, or throttling, is a common means of domestic violence inflicted upon victims by their perpetrators.

Health care cost containment : an overview of policy options

While health care has become one of the leading policy concerns of the American public, cost containment has emerged as the most prominent underlying factor. Components of health care cost escalation include societal problems, consumer demand, an aging population, the technology explosion, administrative inefficiencies, the malpractice crisis, fraud and abuse, the lack of health promotion and disease prevention, the rising number of uninsured, and regulatory issues. The three major categories of health reform proposals, with characteristic cost containment features, are discussed. A comprehensive listing of available cost containment interventions is summarized in ten categories.