Polly A. Hulme

Retrospective Measurement of Childhood Sexual Abuse: A Review of Instruments

In this comprehensive review of retrospective childhood sexual abuse (CSA) instruments, instruments from studies published between 1986 and 2001 are examined according to administration method, number and specificity of questions, CSA operational definitions, psychometric properties, and the use of scales. It was found that both self-administered and interview instruments range from the vagueness of a single question to the preciseness of multiple, specific questions. Furthermore, the review demonstrated that CSA instruments generally lack standardization. Many are developed for one-time use and others modified when reused. Descriptive CSA instruments have been preferred by researchers and primarily used to measure CSA dichotomously. However, little consensus exists as to how to operationally define CSA. One positive trend is the development of scales that measure CSA as an interval-level variable, allowing for more extensive psychometric data to be collected.

Family Empowerment: A Nursing Intervention With Suggested Outcomes for Families of Children With a Chronic Health Condition

Families of children with a chronic health condition often feel powerless in satisfying the health care needs of their child and in sustaining their family life. A small body of scholarly literature suggests that family empowerment is an intervention that nurses could use to help these families. This interactive intervention is designed to aid families through the empowerment process, which consists of phases that correspond to the amount of trust and decision making a family shares with health professionals. Intervention activities are based on the assumption that all people have existing strengths and capabilities and the capacity to grow and become more competent. Suggested family outcomes of the intervention include negotiation with health professionals, minimization of the effect of the chronic condition on the child and siblings, rearrangement of family roles and responsibilities, satisfaction of the health care needs of the child, and lowered health care use and costs.

Theoretical perspectives on the health problems of adults who experienced childhood sexual abuse.

With the wide variety of health problems reported by adults who experienced childhood sexual abuse (CSA) and no universality for any of them, it is vital that treatment and research be theory-based. The purpose of this article is to review the highlights of major theories, models, and conceptual frameworks found in the literature that explain the relationship of CSA with adult health problems, along with their associated moderating or mediating variables. The theories vary in their scope (macro, middle range, or micro) and in the health problems they explain, from purely psychosocial to both physical and psychosocial problems.

Patterns of Childhood Sexual Abuse Characteristics and Their Relationships to Other Childhood Abuse and Adult Health

The purpose of this study was twofold: (a) to cluster women who experienced childhood sexual abuse (CSA) according to their shared patterns of CSA characteristics and (b) to examine differences across clusters on measures of other childhood abuse and adult health. Seven CSA characteristic variables were used for cluster analysis. The seven-cluster solution that emerged ranged from a noncontact extrafamilial CSA cluster that occurred without force only once to the most severe clusters in which penetration by an intrafamilial or extrafamilial abuser occurred multiple times with force. Significant differences among clusters were found for childhood emotional abuse and physical abuse, adult physical and psychosocial symptomatology, and depression. There were no significant differences for health care utilization. The results promote further understanding of which victims of CSA are more likely to have experienced other forms of childhood abuse and which victims are more at risk for poor health in adulthood.

School-based childhood sexual abuse prevention programs: an integrative review

One prevention strategy for childhood sexual abuse (CSA) involves educational programs delivered to children in the school environment. The purpose of this integrative literature review was to determine the state of the science on school-based CSA prevention programs. The authors extracted data from 26 articles that fit inclusion criteria to answer research questions on types of programs, methods used to evaluate programs, and program success. Analysis of the extracted data led to the identification of seven categories of teaching learning content. Delivery methods included films, plays, discussion, and role play. Most authors used an untreated or placebo control group pretest/posttest design for evaluation. According to the child outcome measures chosen, the majority of programs were successful. The review also found school nurses rarely involved in these programs. Although not a traditional aspect of their responsibilities, information from this review can help school nurses implement a school-based CSA prevention program.

Psychosocial and Developmental Characteristics of Civilly Committed Sex Offenders

A convenience sample of 38 civilly committed sex offenders completed questionnaires on selected psychosocial and developmental characteristics. More than half (61%) demonstrated an external locus of control. They had higher levels of empathy compared to normative data for the general population, and their levels of anger, aggression, and hostility were similar to male college students. Somatization was comparable to psychiatric outpatients. A high proportion reported at least one form of childhood trauma (87%), with 66% reporting childhood sexual abuse. Issues related to the use of self-report instruments with this patient population are discussed and recommendations for future studies are suggested.

Changes in Diurnal Salivary Cortisol Levels in Response to an Acute Stressor in Healthy Young Adults

Background: Knowledge of the diurnal cortisol response to acute stress in healthy individuals can help us better understand the physiological and health effects of chronic stress. Objective: To compare the diurnal patterns of cortisol secretion of 15 medical students 2 weeks before a major written examination (control phase) and 2 weeks later at the time of the examination (acute stress phase). Design: Interrupted time series within-subjects. Results: During the acute stress phase, less cortisol was secreted over the course of the day, as demonstrated by a more prolonged and steeper decline in cortisol levels. In addition, higher cortisol levels were present in the evening. Despite these changes in the usual diurnal pattern, overall exposure to cortisol remained the same for both phases. Conclusions: The results of this study suggest that specific adaptations to the diurnal pattern of cortisol are made in the face of acute stress, important information for understanding cortisol regulation in health and illness.

Educating integrated family/ psychiatric–mental health nurse practitioners: Program development and evaluation

BACKGROUND This article describes the development, implementation, and outcomes of an integrated family nurse practitioner/psychiatric-mental health nurse practitioner (FNP/PMH-NP) program. The program was designed to help alleviate health professional shortages in rural areas. METHOD Faculty from both specialties developed a 3-year integrated curriculum, with attention to course sequencing and removing redundancies. Students completed all FNP and PMH-NP specialty courses and 855 clinical hours. Specialty integration occurred during the final semester through faculty-facilitated integrated case studies and clinical preceptorships with dual-certified rural nurse practitioners. RESULTS Thirteen students completed the program between 2006 and 2014. A survey of graduates (75% response rate) demonstrated that most were dual certified, and less than half practiced in rural areas. All were very satisfied with their nurse practitioner role. CONCLUSION The program successfully prepared graduates to care for patients across the mind-body spectrum in integrated mental health-primary care positions. More work may be needed to market the integrated role and rural practice.

Pilot Study on Childhood Sexual Abuse, Diurnal Cortisol Secretion, and Weight Loss in Bariatric Surgery Patients.

Childhood sexual abuse increases risk for adult obesity. A potential contributing factor is altered cortisol secretion. In this pilot study, relationships among childhood sexual abuse, diurnal salivary cortisol secretion, and weight loss were explored in 17 bariatric surgery patients. Measurement points were before surgery (baseline) and 3 and 6 months after surgery. Childhood sexual abuse was measured by the Childhood Trauma Questionnaire. The results showed moderate but nonsignificant positive correlations between the childhood sexual abuse subscale score and baseline morning cortisol, evening cortisol, and daily mean cortisol. An unexpected positive correlation was noted between the Childhood Trauma Questionnaire total score and weight loss at six months. Diurnal cortisol secretion did not change over time after surgery nor correlate significantly with weight loss at six months.

Cancer survivorship care plans: Processes, effective strategies, and challenges in a Northern Plains rural state

OBJECTIVES Health systems face resource and time barriers to developing and implementing cancer survivorship care plans (SCPs) when active cancer treatment is completed. To address this problem, the South Dakota (SD) Department of Health partnered with two of SDs largest health systems to create the SD Survivorship Program. The purpose of this program evaluation study was to describe and compare SCP development and implementation at the two health systems. DESIGN & SAMPLE A descriptive qualitative design was used. Interview participants were instrumental in the development and implementation of SCPs within their respective health system. MEASURES Content analysis was used to analyze the interview data. RESULTS The two health systems used similar processes for (a) early designation of program personnel, (b) developing SCP templates, (c) provider/staff input, and (d) identifying/tracking eligible patients. In contrast, they developed differing processes for SCP completion and delivery. The two health systems also identified effective strategies and challenges in SCP development and implementation. CONCLUSION This evaluation suggests that partnerships between state health departments and local health systems could be key for meeting the nation-wide goal of universal SCP implementation. Particularly, other low-population rural states like SD can use the findings to help build their SCP programs.