Lois A. Haggerty

Nursing presence. As real as a milky way bar.

Data sets from three individual studies on nursing judgment were reviewed from a wider perspective. This yielded meanings and phenomena not readily identified in the individual studies, and it was tentatively labeled presence. A hermeneutic study using 10 transcripts from each data set asked: What are the common features of the context of nursing judgment? and, What are the features of the nurses’ connection with the patient that contribute to nursing judgment? The analysis yielded six features of nursing presence: uniqueness, connecting with the patient’s experience, sensing, going beyond the scientific data, knowing (what will work and when to act), and being with the patient. These features of nursing presence are logical distinctions and serve as ways to grasp the idea of nursing presence.

Stages of Change-Based Nursing Interventions for Victims of Interpersonal Violence

Recently, the health care system has become recognized as an important site for domestic violence programs. However, most of these programs focus on screening for violence. There is a need for conceptually based intervention strategies that provide help for victims once they are identified. The Transtheoretical Model of Change is useful in suggesting interventions that are consistent with the ways victims perceive their situations and take actions to end violence in their lives.

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.

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.

Assessment Parameters and Indicators in Expert Intrapartal Nursing Decisions

Objective: To determine what clinical parameters and indicators expert intrapartal nurses used to assess the severity of fetal stress. Design: A descriptive, qualitative study using tape-recorded interviews from verbal protocols during clinical problem solving. Setting: Labor and delivery units of two metropolitan hospitals in the northeastern United States. Participants: Eighteen nurses, designated as experts by nurse managers, with an average of 11.3 years of intrapartal experience. Results: The clinical assessment parameters identified by content analysis included duration of stress, fetal reserve status, reversibility of stress, and specific signs of stress. The clinical assessment parameters included whether the disturbing pattern was brief or prolonged, continuous or intermittent, and how rapidly the mothers labor was progressing. Indicators of fetal reserve status were maternal pregnancy health status, gestational age of the fetus, and biophysical indicators of fetal status. Reversibility of stress was assessed based on the precipitating factors involved and responsiveness of the fetus to resuscitation. Specific signs of stress included the characteristics of the fetal monitor strip changes, scalp sample results, and amniotic fluid color. Conclusions: Contextual features of clinical problems are key links in the decision-making processes of expert intrapartal nurses. Knowledge elicitation techniques can be used to identify these links.

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.

Tools for screening for interpersonal violence: state of the science

In recent decades, the prevalence of abuse against women, older persons, and persons with disabilities has become a major public health problem. Health professionals, urged by their professional associations to universally screen these groups, have employed various tools in an effort to identify individuals in need of help. Yet many of the tools used widely in clinical settings have limitations in terms of empirical soundness. This article presents tools used to screen women, older persons, and persons with disabilities as well as data on the reliability and validity of these instruments. These properties and the resources needed to reduce harm are important factors to consider before implementing screening. The article concludes with a summary of the risk–benefit issues related to the use of these tools and universal screening in general.

Clinical StudiesAssessment Parameters and Indicators in Expert Intrapartal Nursing Decisions

Objective: To determine what clinical parameters and indicators expert intrapartal nurses used to assess the severity of fetal stress. Design: A descriptive, qualitative study using tape-recorded interviews from verbal protocols during clinical problem solving. Setting: Labor and delivery units of two metropolitan hospitals in the northeastern United States. Participants: Eighteen nurses, designated as experts by nurse managers, with an average of 11.3 years of intrapartal experience. Results: The clinical assessment parameters identified by content analysis included duration of stress, fetal reserve status, reversibility of stress, and specific signs of stress. The clinical assessment parameters included whether the disturbing pattern was brief or prolonged, continuous or intermittent, and how rapidly the mothers labor was progressing. Indicators of fetal reserve status were maternal pregnancy health status, gestational age of the fetus, and biophysical indicators of fetal status. Reversibility of stress was assessed based on the precipitating factors involved and responsiveness of the fetus to resuscitation. Specific signs of stress included the characteristics of the fetal monitor strip changes, scalp sample results, and amniotic fluid color. Conclusions: Contextual features of clinical problems are key links in the decision-making processes of expert intrapartal nurses. Knowledge elicitation techniques can be used to identify these links.