Pamela D. Connor

Does exposure to medically underserved areas during training influence eventual choice of practice location

Introduction  There are an increasing number of communities within the United States that have limited or no access to primary healthcare. In recognition, many medical schools now provide opportunities and activities that offer exposure to these demographic areas in order to increase the presence of and community access to medical care and to promote these locations as practice site choices for graduating students. Evaluation of these enhancements has led to doubts whether this exposure timing is optimal in promoting practice in these settings. The purpose of this study is to identify whether early exposure(s) to medically underserved settings prior to medical school is associated with eventual choice of practice location.

Psychometric Properties of an Intimate Partner Violence Tool for Health Care Students

Health care professionals have acknowledged intimate partner violence (IPV) as a highly prevalent public health problem necessitating the creation of standardized education programs, survey tools, and well-defined outcome measures. Testing and evaluation of these measures, however, has been limited to specific populations of health care professionals. In 2007 and 2008, psychometric properties of the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) were adapted, tested, and evaluated on a group of medicine, nursing, social work, and dentistry students during their last semester of college. The adapted instrument demonstrated high reliability within some IPV constructs, and six of the eight scales described in the original PREMIS were identified. Three scales presented a Cronbach’s α ≥ .70, demonstrating acceptable reliability, and a new scale, IPV Screening, was also identified that showed good reliability (α = .74). The adapted instrument showed good stability of psychometric properties in the student population and generally good correlation within several measures.

Outcomes Of Cesarean Sections Performed By Family Physicians And The Training They Received: A 15-Year Retrospective Study

Background: Family physicians are the major or sole providers of Cesarean section services in many communities. Approximately 2800 family physicians provide Cesarean section services in communities of all sizes across the country. Methods: The outcomes of all Cesarean sections performed at two rural hospitals during a 10- to 15-year period were examined and compared with standard quality-outcome criteria published in the medical literature. Outcome criteria included rates of various surgical complications, use of blood transfusion, infant Apgar scores, and length of postoperative hospital stay. Other descriptive data were examined including patient demographics, operating time, anesthesia type, and choice of incision. Statistical analysis consisted of chi-squares, odds ratios, and stepwise multiple regression. Results: Five hundred sixty-three Cesarean sections were performed by 12 residency-trained family physicians, 68 by general practitioners, 70 by general surgeons, and 9 by obstetrician-gynecologists. Family physicians met or surpassed the referenced standards in all measures examined. The number of Cesarean sections each physician performed while in residency training was also examined. The average number of in-training Cesarean sections was 46, ranging from 25 to 100. Conclusions: The results of this study support the ability of family physicians to provide Cesarean section services based on a wide range of training backgrounds and variable numbers of procedures done in training.

Nursing Students and Intimate Partner Violence Education: Improving and Integrating Knowledge Into Health Care Curricula

This study measured intimate partner violence (IPV) curriculum content exposure; knowledge, attitudes, beliefs, and self-reported behaviors; and IPV prevalence within doctor of nursing practice and doctor of philosophy nursing programs at a university in the southern United States. The survey instrument was an adaptation of the Physician Readiness to Manage Intimate Partner Violence Survey modified with language that focused on students in the health care arena. Three summary scales-Perceived Preparedness, Perceived Knowledge, and Actual Knowledge-were also created. Mann-Whitney U tests and exploratory multivariable and logistic regression analyses were employed to analyze the data. Results indicated that nursing students who received IPV training prior to graduate school had significantly higher perceived preparation and perceived knowledge ratings than those reporting no IPV training prior to graduate school. Results also showed that 40% of nursing students surveyed had personally experienced some type of domestic violence including IPV. Identifying and responding to curricular shortcomings and ascertaining student IPV prevalence are critical steps in strategizing and implementing comprehensive curriculum revision, enabling students to enter the nursing profession with the capacity to directly impact the care and treatment of IPV victims.

Training in obstetric sonography in family medicine residency programs: results of a nationwide survey and suggestions for a teaching strategy.

Background: Obstetric sonography is a valuable diagnostic procedure for family physicians who provide obstetrics; however, physicians tend to use technology that was effectively modeled during residency. The purpose of this study was to learn how many family medicine residency program directors had an interest in and a need for training in obstetric sonography, as well as whether they were willing to commit faculty and finances for adding the technology to their programs. Methods: All program directors listed in the 1989 American Academy of Family Physicians (AAFP) Directory of Family Practice Residency Programs (n = 379) received a five-item questionnaire about obstetric services and use of sonograms in their programs and their desire for training in obstetric sonography. Results: More than 81 percent of respondents said their programs provided obstetrics. Sixty-eight percent of these respondents used sonograms, and 53 percent indicated a need for training in obstetric sonography. Forty-five percent of all respondents, regardless of whether their programs offered obstetrics, indicated a desire for training. Conclusions: The high level of interest in obstetric sonography can be explained, in part, by the 81 percent of respondents whose programs provided obstetrics. These figures suggest a need to establish a training curriculum in obstetric sonography for family medicine residency programs. Our training program, designed to reach faculty, residents, and practicing physicians, is described.

Overcoming Barriers in Intimate Partner Violence Education and Training of Graduate Social Work Students.

Intimate partner violence (IPV) is a highly prevalent problem detected frequently in the social work field, and also extends to the personal lives of social workers and students, with compelling evidence that professionals and students are often victims of IPV. However, students continue to lack substantive knowledge of IPV. This article addresses the need for increased IPV education and training for social work students and professionals by measuring IPV education, knowledge, and attitudes among students, while also examining the incidence of student personal experience with IPV and exploring the role this experience plays in identifying and safely intervening in IPV situations.

Vulnerable Populations: Drug Court Program Clients

Substance abuse and addiction are chronic conditions characterized by an inability to control ones urge to use mood- or mind-altering drugs. Recognition of the association between addictions and crime to support the addiction, along with the relapsing nature of addictions, presents treatment and management challenges for clinicians and frustration for patients and their families. Pressures to reduce the burgeoning jail population have resulted in collaboration between the treatment community and the court--a diversion program called drug court. This article reviews the drug court programs, the clients, and the processes of accountability that direct the progress toward sobriety in the drug court clients. It also argues that the drug court clients have unique health needs requiring interventions best suited for the recovering addict enrolled in a diversion program within the criminal justice system. Nurses have the ability to influence these systems and provide safety-net clinics to drug court clients through outreach, case finding, and culturally and linguistically appropriate care that can ultimately help this population to reach a higher level of wellness.

Lessons Learned from Expansion of a Public Health Nursing Doctorate in Nursing Practice Program

AbstractDespite nurses’ demonstrated expertise in the public health workforce, there has been a continued erosion of public health nursing (PHN) positions in health departments and academe. The need for a strong public health infrastructure and well-educated public health workforce remains vital in meeting PHN research challenges. In response to these needs, our college of nursing undertook a six-year Health Resources and Services Administration-funded expansion of the PHN Doctor of Nursing Practice (DNP) program. This article illustrates program evaluation, lessons learned, and PHN DNP graduate and workforce outcomes related to supplying culturally diverse PHN leaders, assuring quality improvement, creating sustainable partnerships, and improving poor health outcomes.

Identifying Predictors for Children Witnessing Intimate Partner Violence

Research has shown that intimate partner violence (IPV) prevalence and severity is higher and IPV duration is longer among couples that have children. Women frequently report that their children are the reason why they stay, leave, or return to an IPV relationship. Our study used results from a two-wave telephone survey to determine what IPV-associated factors were significant predictors of respondents’ children witnessing IPV, as well as estimating prevalence of children’s exposure to violence. We found that an increase in respondents’ age was significantly associated with increased odds of a child being exposed to violence. We also found that children witnessing violence were almost twice as likely to have mothers who reported leaving abusers. We hypothesize that increasing age corresponds to improved confidence in help-seeking behaviors. Our findings represent an important first step for future research on understanding how children influence IPV victims’ decision-making in seeking out service providers for help.