Margaret H. Brackley

MEXICAN AND MEXICAN AMERICAN WOMEN IN A BATTERED WOMEN'S SHELTER: BARRIERS TO CONDOM NEGOTIATION FOR HIV/AIDS PREVENTION

Anecdotal information suggests that, for Hispanic women who are involved with abusive partners, condom use request as an HIV/AIDS sexual risk-reduction behavior may expose the women to risk of both abuse and HIV/AIDS. A qualitative study explored barriers to condom negotiation for HIV/AIDS prevention among Mexican and Mexican American women in abusive relationships. A convenience sample of 14 Mexican and Mexican American women was recruited from a battered womens shelter. A demographic form, a domestic violence assessment form, and audiotaped responses to a semistructured interview guide were used to collect data. Descriptive statistics were used to describe the sample. Audiotaped interviews were transcribed verbatim and submitted to content analysis, which revealed past and present themes of physical, psychological, and sexual abuse of Mexican and Mexican American women who requested condom use by their male sexual partners. Also identified by content analysis was the influence of mens power on womens public, private, and sexual interactions.

Community Readiness to Prevent Intimate Partner Violence in Bexar County, Texas

The purpose of this article is to describe the Community Readiness Model implemented by the San Antonio Safe Family Coalition in Bexar County, Texas, a coordinated community response to prevent intimate partner violence. The project used a participatory action process to (a) determine the citys and countys stage of readiness to prevent intimate partner violence; (b) identify differences in the city and county by dividing the area into sectors for the assessment; (c) engage the community in determining the accuracy and usefulness of the results of the assessment; (d) develop targeted strategies to move the city and county to a higher stage of readiness for prevention of intimate partner violence; and (e) evaluate the results of the project.

Being Emotionally Abused: A Phenomenological Study of Adult Women's Experiences of Emotionally Abusive Intimate Partner Relationships

The purpose of this study was to explore and describe individual perceptions, meanings, and definitions of emotional abuse through the lived experience of women who identified themselves as being emotionally abused by an intimate partner (IP). To answer the research question, “What is it like to live the life of a woman who is emotionally abused by her intimate partner?” A descriptive, phenomenological research design was undertaken. Unstructured individual interviews with 15 emotionally abused adult women resulted in the discovery of seven essential themes: captivity, defining moments, disassociation from self, fixing, mindful manipulation, relentless terror, and taking a stand. A combination of a hermeneutic approach and Diekelmanns approach to data analysis was used to explore differences in perceptions and develop essential themes that portrayed the essence of a womans lived experience of being emotionally abused by her IP. The data also demonstrated that (1) IP emotional abuse has no prerequisite for partner rage or obvious emotional manipulation, (2) the absence of caring and respectful partner behaviors was just as powerful in creating an emotionally abusive experience as openly abusive behaviors, and (3) being emotionally abused was a life journey, encompassing multiple culminations, secondary physical and mental health symptoms, and quality of life issues that extended well beyond the immediate abuse experience.

Project Hope: changing care delivery for the substance abuse patient.

Project Hope is a program designed to assist healthcare providers in the assessment, care, referral, and follow-up of the hospitalized substance abuse patient. First implemented in 1990 at what is now called University Hospital in San Antonio, Texas, the program has influenced care in a positive way through change in the attitude and knowledge of personnel, administrators, and community. In this paper, the authors provide an overview of the approaches utilized, improvement process, and outcomes obtained from this project. To formally evaluate the effectiveness of Project Hope, a quasi-experimental, Solomon-Four design study was conducted. Eighty nurses from various educational backgrounds and experience with alcohol were divided into groups by nursing unit. A normative-reeducative intervention was applied as described by Chin and Benne. Test of cognition showed significant change (p < .01) in the experimental group; no significance was found for attitudes change. Reasons for these findings and lessons learned from the process are described.

Quality and Safety Graduate Competencies in Psychiatric Mental Health Nurse Practitioner Education

Education of the psychiatric mental health nurse practitioner (PMHNP) is undergoing massive change, partially driven by practice requirements and national certification changes, the development of new nurse practitioner competencies, and the development of the graduate quality and safety in nursing (QSEN) competencies. We are in the middle of a paradigm shift of expectations, not only just from these new competencies but also from the context of care and the impact PMHNP graduates will have on policy and health care delivery in the future. In this review article, the authors will discuss the general categories of the graduate QSEN competencies and how they relate to PMHNP education, competency development, and the application to curricular development in PMHNP programs across the United States. Importantly, these changes into PMHNP education, while remaining true to the fundamental tenants of advanced practice psychiatric nursing, prepare the PMHNP to meet the challenges of health care reform and service delivery.

Tuberculosis education for nurse practitioner students: where we are and where we need to go.

Tuberculosis (TB) has reemerged as a public health concern. This study tested the reliability and validity of an instrument examining self-efficacy in providing TB care, beliefs about educational preparation, and knowledge about TB among nurse practitioner students from diverse programs. A one-time self-report instrument was distributed during a final clinical course. Rasch analysis was used to assess the instruments reliability and validity. Most of the 92 respondents were from family nurse practitioner programs and had received TB education via lecture. Students were moderately knowledgeable on TB content and had a moderate level of perceived self-efficacy. They valued TB education as it related to both their current program and their clinical practice. The instrument had excellent reliability (alpha = 0.96 to 0.98), and it appears to be an effective measure to help faculty understand student knowledge and confidence in the care of individuals with TB.

Substance Abuse Interface with Intimate Partner Violence: What Treatment Programs Need to Know

This article provides suggestions for skill development for substance abuse (SA) treatment agencies and providers for implementing Treatment Improvement Protocol number 25: Substance Abuse Treatment and Domestic Violence. Methods for detecting, screening, intervening, and referring victims and perpetrators of intimate partner violence enrolled in SA treatment are presented. Evidence-based brief intervention is presented. A 2-minute screen for domestic violence as well as danger assessment for lethality of abuse and the Conflict Tactics Scales 2 are reviewed. A survey of interventions aimed at establishing trust, brief intervention from best practice, guidelines for safety planning, compliance strategies for SA treatment, and community resource development are presented.

Men who experienced violence or trauma as children or adolescents and who used violence in their intimate relationships

Understanding the lived experience of men who have committed violent acts against their intimate partners may provide insight into nursing interventions that may prevent or cease violence against women. Nurses have opportunities to intervene with men who use violence in their intimate relationships who present with a history of maltreatment or trauma as a child or young adult or who have a history of having been exposed to cultures that promoted violence. The purpose of this study was to gain insight into the lived, everyday experiences of men who have used violence in their intimate relationships, including the mens values, purposes, and choices they had in life. To answer the research question, “What is the lived experience of men who have used violence in their intimate relationships and who have used alcohol or other drugs?” a descriptive, phenomenological research design was undertaken. Unstructured individual interviews with seven men resulted in the emergence of 16 themes, three of which are described in this paper: being part of a family culture that promoted violence; being part of a non-family culture that promoted violence; and early experiences of maltreatment or trauma. The participants described how their experiences with maltreatment or trauma as children and young adults impacted their mental health as adults and their use of violence in their adult intimate relationships. The participants’ experiences provided insight into how nurses can intervene to prevent or stop violence against women and provided implications for future research.

A Continuous Improvement Process for Health Providers of Victims of Domestic Violence

BACKGROUND Health care providers can play an important role in the prevention of domestic violence through established processes of identification, safety assessment, validation, documentation, and referral. In 1998 the Safe Family Project, funded by University Health System (UHS), affiliated with University of Texas Health Science Center at San Antonio, provided for a clinical review of existing services for victims of domestic violence. A subsequent review of the health systems policy and clinical practice supported the need for resources and training and for an improved care process for victims of domestic violence. THE CONTINUOUS IMPROVEMENT PROCESS (CIP) MODEL: UHS adapted the Shewhart cycle of activities popularly referred to as PDSA (plan change, do change, study results, act on results), a systematic, process-focused approach to achieving continuous and measurable improvement, as its CIP model, and it formed a process improvement team. This process led to translation of research findings into best practice guidelines for treatment of domestic violence and staff education. RESULTS Significant improvements were made in the overall qualitative chart reviews, although the diagnostic coding (using ICD-9 codes and e-codes) did improve. The CIP can be replicated in other settings to improve the care of victims of domestic violence. DISCUSSION The CIP effort is being extended to outpatient facilities, and managers have requested that the training manual be replicated and placed throughout UHS as a resource manual. Other activities are intended to improve prevention of domestic violence and intervention when it occurs.

Sexual Abuse and Posttraumatic Stress Disorder in Adult Women with Severe Mental Illness: A Pilot Study

Research indicates that women with serious mental illness (SMI) are vulnerable to sexual abuse, resulting in adverse health outcomes such as posttraumatic stress disorder (PTSD). The purpose of this pilot study was to examine the prevalence of undiagnosed PTSD among a cohort of 20 women with SMI and reporting past sexual abuse. Furthermore, the researcher sought to identify specific symptom manifestations of PTSD among women with SMI and sexual abuse histories. Finally, the feasibility of using specific data collection tools was examined. Results indicated that PTSD was not previously diagnosed or recognized in the study sample, in spite of the presence of a sexual trauma history. The screening tools were effective in identifying depression, guilt, emotional withdrawal, blunted affect, decreased psychomotor activity, suicidal ideations, sexual dysfunction, and substance abuse. Additionally, the data collection tools provided a framework for discussing sensitive issues related to sexual abuse. Implications of this pilot study suggest the need to evaluate all women with SMI and history of sexual abuse for PTSD.