Wanda K. Mohr

Prevalence and effects of child exposure to domestic violence

In recent years, researchers have focused attention on children who are exposed to domestic violence. Although presently there are no scientifically credible estimates of the national prevalence of children exposed to domestic violence, existing data suggest that large numbers of American children are affected. This article discusses the limitations of current databases and describes a promising model for the collection of reliable and valid prevalence data, the Spousal Assault Replication Program, which uses data collected through collaboration between police and university researchers. Research examining the effects of childhood exposure to domestic violence is also limited by a range of methodological problems. Despite this, however, sufficient evidence from the body of studies exists to conclude that such exposure has adverse effects. The specific effects may differ depending on a host of variables, such as the childrens ages, the nature and severity of the violence, the existence of other risk factors in the childrens lives (for example, poverty, parental substance abuse), and whether the children are also directly physically abused. In general, childhood exposure to domestic violence can be associated with increased display of aggressive behavior, increased emotional problems such as depression and/or anxiety, lower levels of social competence, and poorer academic functioning. A scientifically credible body of research on the prevalence and effects of childhood exposure to domestic violence is necessary to promote the development of effective interventions and to permit the proper channeling of public and private funds. This article identifies some of the steps that can be taken to build the research capacity necessary to obtain the needed data.

A restraint on restraints: the need to reconsider the use of restrictive interventions.

Children with behavior problems are put in units with milieu therapy for the support and guidance of a specialized health care team, supposedly experts in the care of children with these unique and urgent needs. The reality of such units, however, is that those with the most contact with the children are often inadequately prepared, both in terms of knowledge and skills, to manage disruptive behaviors. As a result, the milieu that is supposed to provide support and structure can actually exacerbate the trauma for the vulnerable child. Preliminary data are presented from an ongoing study that is investigating the experiences and memories of formerly hospitalized children. Three types of traumatic experiences are described: vicarious trauma, alienation from staff, and direct trauma. Many of the traumatic events endured by child patients are the result of an inappropriate use by staff of power and force. There was a marked lack of understanding by the children of why given interventions were used. Although coercive interventions are sometimes necessary, ethical, legal, and other professional considerations make it clear that more work is needed. Research to identify the patterns of lack of knowledge and skills, as well as to develop appropriate interventions are recommended.

Children Exposed to Family Violence: A Review of Empirical Research from a Developmental-Ecological Perspective

This article employs the major foci of a developmental-ecological model to evaluate the past decade of research on children exposed to family violence. The foci of this framework were operationalized into a coding system that was then applied to all empirical studies published in this area since 1987. This coding system allowed for inspection of the current state of the knowledge base from this perspective and the ability to determine the progress that has been made in this research area. A total of 21 quantitative studies and 1 qualitative study were reviewed. Despite progress having been made over the past 10 years, foundational issues related to definitions of the independent variable, substantiation of exposure, developmental sensitivity, and methodology remain. The authors critique the extant literature and present recommendations for future research studies.

Dirty Hands: The Underside of Marketplace Health Care

The ethos of the corporation and the urgency for profit maximization place pressures on health care corporations to act in a way that may be incompatible with ethical practice. Profit-driven incentives often result in corporate deviance and criminal behavior. Nurses may be pressured to go along with schemes that may be unethical or illegal and because of shaky job markets may be unable to adhere to professional ethical guidelines. Recent events in health care are drawn on to argue that ethical theory and research must begin to consider the issue of moral compromise of professionals as a result of deviant organizational environments.

Safeguarding Themselves and Their Children: Mothers Share Their Strategies

This paper describes a single aspect of an ongoing program of research that seeks to create an open dialog among low-income parents of young children, staff from a large urban Head Start program, and researchers on child and woman safety. Authors conducted a content analysis of three focus groups within a larger ethnographic study employing qualitative methods. Data emerging from this analysis illustrates the ingenuity with which women keep themselves and their children safe in unsafe contexts.

Restraints and the code of ethics: An uneasy fit

This article examines the use of physical restraints through the four broad principles of ethics common to all helping professions. It asks whether the continued use of physical restraints is consistent with ethical practice through the lens of those principles. It also examines where the necessity to use restraints in the absence of empirically supported alternatives leaves professionals in terms of conflicts between ethical principles and makes recommendations for changes in education and clinical practice. It concludes that an analysis through a bioethics lens demonstrates that the use of restraints as a tool in psychiatric settings is a complex and multifaceted problem. Principles of ethics may often be in conflict with each other in instances where patients must be physically restrained.

Domestic Violence and Children’s Presence: A Population-based Study of Law Enforcement Surveillance of Domestic Violence

The purpose of the present study was twofold: (1) to test whether law enforcement officers could reliably use a standard protocol to collect data on domestic violence events (DVEs) across a large municipality, and (2) to use these data to examine prevalence and nature of the violence and children’s presence. Reliability checks indicated that data were collected reliably on over 5,000 substantiated DVEs. Findings showed that 48% of all assaults in the municipality were DVEs. Victims were predominantly females in their early thirties, and injuries were predominantly minor and resulted from body contact. Children were present in nearly 50% of the DVEs. They were disproportionately present in domestic violence households compared to all other households in the municipality. Domestic violence households with children were more likely to have mothers and fathers involved in the violence and were disproportionately minority households headed by single females in relatively poor neighborhoods.

Unlicensed residential programs: the next challenge in protecting youth.

Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. The Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START) is a multi-disciplinary group of mental health professionals and advocates that formed in response to rising concerns about reports from youth, families and journalists describing mistreatment in a number of the unregulated programs. This article summarizes the information gathered by A START regarding unregulated facilities. It provides an overview of common program features, marketing strategies and transportation options. It describes the range of mistreatment and abuse experienced by youth and families, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions, medical and nutritional neglect, rights violations and death. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who pursue residential treatment.

Integrating esthetics into nursing: Literature as a suggested modality

In this article the author argues for the importance of reintegrating the neglected pattern of esthetics into the teaching and practice of nursing. Approaching art as both a means and end, the essay illustrates, how art can inform the specialty. By exposure to selected literary works, nurses can vicariously achieve understanding of human conditions that they could not otherwise experience. Through the art act, nurses can examine the depths of their interventions, identify them, and creatively center themselves. Integrating esthetics into nursing education and collaborating with colleagues in the field of humanities can invigorate a discipline in search of identity and justification during a time of professional turbulence.

Malfeasance and Regaining Nursing’s Moral Voice and Integrity

This article discusses some of the most recent developments in US mental health services that follow on the heels of the for-profit hospital scandal that was brought to public attention less than a decade ago. As individuals and as a profession, nurses have a responsibility to uncover, openly discuss and condemn malfeasance when it occurs, yet there has been a collective silence about these developments. The authors explore the reasons for this and make recommendations for regaining nursing’s moral voice and integrity.