Joellen W. Hawkins

Health Behaviors as Mediators for the Effect of Partner Abuse on Infant Birth Weight

BackgroundIntimate partner abuse of pregnant women has been linked to the delivery of low-birth-weight infants. Also, abused pregnant women have reported a greater prevalence of substance abuse, poor nutrition, and demographic risk factors for poor birth outcomes. These factors may play a role in the reported relation between intimate partner violence and birth weight. ObjectivesTo explore the role of substance abuse (smoking, alcohol, and drug use) and weight gain of less than 15 pounds during pregnancy as potential mediators of the relation between recent partner abuse and infant birth weight, and to investigate the role of demographic risk factors as potential moderators for the impact of abuse on birth weight. MethodsData were extracted on abuse screening results, demographics, birth outcomes, and a range of medical and obstetric risks and complications from the medical records of 1,969 women who had been screened by clinicians for domestic abuse during pregnancy. Hypotheses were tested using multiple regression analysis. ResultsRecent physical or psychological abuse had a small but significant effect on birth weight in this sample. Smoking and low weight gain were weak but significant mediators of the relation between recent abuse and infant birth weight. Single marital status was the strongest demographic predictor of decreased birth weight. No moderator effects were found. ConclusionsAlthough prospective studies are warranted, nursing care to reduce smoking and promote adequate weight gain in all women along with support for women’s efforts to seek safety from abuse may help to improve birth outcomes and promote maternal well-being.

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.

Women in advertisements in medical journals

To determine the images of women in picture advertisements, a stratified random sample of 32 medical journals, representing approximately 12% of medical journals published in the United States that are directed toward physicians in clinical practice, was subjected to content analysis. The sample consists of 209 different ads. The subjects of the ads included men, women, and children representing a variety of ethnic, racial, and socioeconomic groups. Notable, however, was the preponderance of Caucasian males pictured as physicians and the absence of women and people of color in this role. Women are pictured as 68.1% of consumers and men as 31.9%, a significant difference. Statistically significant differences also occur in the images of men and women as consumers. Most of the workers are men (68.2%), another significant difference. When women depicted are workers, they are secretaries and waitresses. Portrayals of women in medical advertisements continue to be stereotyped and outdated.

Preceptor rewards: How to say thank you for mentoring the next generation of nurse practitioners

Purpose: To answer the question how do faculty nurture and reward clinical preceptors and what supports do preceptors require? Data sources: Data came from the literature and from surveying a purposive sample of 26 faculty members teaching clinical courses and arranging precepted experiences for nurse practitioner (NP) students at 26 public and private institutions across the United States. The vehicles for the survey were personal contact and e‐mail. Conclusions: Schools offer preceptor rewards varying widely in their monetary value, from tuition and continuing education vouchers, verification of hours toward recertification, access to services and events on campus, reduced price or free admission to museums, cultural and sports events, and lectures. Faculty nurture preceptors by nominating them for awards, providing letters of reference, editing manuscripts, and collaborating on research projects. Supports for preceptors from the literature reflected National Organization of Nurse Practitioner Faculties guidelines (2000), and the policies of schools and clinical agencies, such as providing copies of program objectives and student credentials. Implications for practice and education: As NP programs have proliferated, there is increased pressure on faculty to find, nurture, reward, and retain good preceptors. Faculty must continue to work with program and agency administrators to comply with policies and create preceptor rewards to recognize their gifts to us, to our schools, and to the profession.

Moving toward a Nursing Model in Advanced Practice

The nurse practitioner focus has been evolving from a medical to a nursing orientation since the inception of the role in 1965. The purpose of this study was to examine relationships between role attitudes and values, confidence about practice knowledge and skills, and orientation to a medical or nursing model to guide practice. A national random sample of482 nurse practitioners completed the Attitudes and Values Scale, the Confidence in Skills Scale, and a demographic survey. Findings indicate that nurse practitioners are very confident about their practice skills and knowledge and have a very strong nursing orientation. There is a direct positive correlation between level of confidence and degree of nursing orientation. Nurses in the sample also rated themselves as more confident about hands-on skills than indirect role components such as utilization of research, change theory, and evaluation of practice outcomes. The discussion interweaves this studys findings with role theory and offers a comparison and contrast to the existing body of knowledge.

Screening for abuse during pregnancy: implementing a multisite program.

Screening for abuse at every healthcare visit is a standard of practice promulgated by many healthcare professional organizations. The need for such screening is underscored by reports of homicide as a leading cause of maternal mortality during pregnancy and the first year of the baby’s life in Massachusetts and Maryland, and by the calculation of the costs of intimate partner violence in the United States. This article discusses how we addressed problems that arose in implementing screening for abuse in 13 different sites as a part of a clinical nursing research project. Engaging in clinical nursing research necessitates close relationships with clinical agencies and their staff members. This often means establishing and maintaining relationships with all nurses caring for patients in each clinical unit serving as a study site. For research on abuse during pregnancy, our study team members were engaged in interactions with prenatal care providers at 13 different study sites. Central to the study was implementing use of a standardized abuse screening tool, the Abuse Assessment Screen, at each study site. This article also describes the lessons we learned in attempting to implement such a large scale change in clinical practice.

What do you mean you want me to teach, do research, engage in service, and clinical practice? Views from the trenches: The novice, the expert.

The purpose of this column is to explicate two points of view-the novice and the expert nurse practitioner (NP) faculty member, highlighting the importance of mentoring new faculty NP members into the diverse faculty roles relating to both general academic requirements and those particular roles related to NP education. For example, arranging clinical placements is one of the most important and time-consuming responsibilities of NP faculty. Learning to juggle all the roles is a challenge to new faculty members. Such mentoring may help alleviate the phenomenon of young faculty members leaving academia and returning to full-time clinical practice. Mentoring is crucial to integrating new NP faculty members into academic life.

Informed Consent and the Limits of Confidentiality

Investigators encounter many legal and ethical issues when they conduct research on partner abuse. Balancing abused women’s rights to privacy with legally mandated reporting requirements involves considerable thought and planning. Failure to protect participants may result in escalation of abuse as well as loss of children to protective services. Various perspectives on maintaining participant privacy while conforming to legal mandates to report child abuse, homicidality, and suicidality are discussed. The role of confidentiality certificates in providing legal immunity for researchers and the method of obtaining the certificates are presented. In addition, the authors describe the strategies for participant protection that are implemented in a federally funded study of abuse, women’s self-care, and pregnancy outcomes. The decision to clearly and specifically inform abused women of the limits of confidentiality allows participants to make informed decisions about disclosures, but may result in diminished recruitment.

Mentorship: the heart and soul of health care leadership

The key to the development of leaders for the health care professions is mentoring. Both leaders and mentors need to develop their own self-knowledge, strategic visions for their own careers, engage in risk-taking, express creativity through all aspects of their lives, feel inspired and inspire others. Communication is central to a positive mentoring relationship and a successful role in a health care leadership position. Thus, when neophyte health care lead- ers have the opportunity to be mentored, the development of good communication skills will benefit them in their future leadership positions. An important gift health care leaders can give to their professions is to serve as mentors for those who will lead health care organizations and institutions into the next decades. In this article, the authors will discuss the mentoring role integral to assuming leadership roles and present a number of models for mentoring programs in the health care professions.

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.