Stress measurement among charge nurses: developing a cross-cultural tool.

AIM: The aim of this study was to develop a cross-cultural tool for the measurement of stress among charge nurses in general hospitals. BACKGROUND: Studies of the specific stressors unique to different nursing roles are few, particularly those related to hospital charge nurses. The Charge Nurse Stress Questionnaire is a well-validated Israeli-developed scale. However, it has not been tested cross-culturally. DESIGN: A descriptive methodological study was conducted in Israel, Ohio and Thailand. METHOD: A total of 2616 nurses from 23 hospitals (small to large size) completed the questionnaire between 2011-2013. The questionnaire was translated into English and Thai. To establish tool validity and reliability, content validity, internal consistency reliability, exploratory and confirmatory factor analysis were performed. RESULTS: Analyses resulted in a final abbreviated version of the questionnaire with 25 items and four stress subscales. Internal consistency for the subscales indicated very good internal consistency. CONCLUSIONS: We developed a self-reported, cross-cultural, valid and reliable tool for evaluating the specific stressors of the role of charge nurses. A rigorous assessment of charge nurse stress provides a good basis for planning tailored stress reduction interventions. It is recommended to further use the tool in different settings across different countries.

Evaluation of a standardized sedation assessment for opioid administration in the post anesthesia care unit.

The impact of opioid-related sedation progressing to respiratory depression in the Post Anesthesia Care Unit (PACU) can be extensive; however, there is a paucity of research on the subject of standardized assessment tools to prevent adverse events. The purposes of this study were: (1) to measure the efficacy of a standardized method of assessing sedation and administering opioids for pain management via the Pasero Opioid-Induced Sedation Scale (POSS) with interventions in the PACU; (2) to increase PACU nurses' confidence in assessing sedation associated with opioid administration for pain management and in the quality of care provided in their clinical area; and (3) to facilitate PACU and postoperative clinical unit nurses' communications during patient handoffs regarding safe opioid administration. A quasi-experimental design was used to evaluate the POSS protocol. Two PACUs and six nursing units receiving postsurgical patients in a Midwestern inner-city hospital served as the setting for this research. Medical records were surveyed for outcome data to evaluate the efficacy of the care protocol in two patient cohorts before and after implementation of the POSS protocol. Nurses completed a written survey to identify changes in satisfaction with nurse-to-nurse communication, perceptions of quality of care, and confidence with opioid administration. The final sample included 842 PACU patients and 67 nurses from the PACU and clinical units. The intervention did not significantly change PACU length of stay or amount of administered opioids and patients were noted to be more alert at time of discharge from the PACU. Nurses reported increased perceptions of quality of care and confidence in opioid administration. The findings from this study support the use of the POSS Scale with interventions in the PACU care protocols.

Facilitators and barriers to disclosing abuse among women with disabilities.

An anonymous audio computer-assisted self-interview (A-CASI) designed to increase awareness of abuse was completed by 305 women with diverse disabilities. Data were also collected about lifetime and past year abuse; perpetrator risk characteristics; facilitators and barriers to disclosing abuse; abuse disclosure to a health provider, case manager, or police officer; and whether a health provider had ever discussed abuse or personal safety. A total of 276 (90%) women reported abuse, 208 (68%) reported abuse within the past year. Women who reported the most abuse experiences in the past year and the most dangerous perpetrators endorsed fewer facilitators and more barriers, but were also more likely to have ever disclosed abuse. Only 15% reported that a health provider had ever discussed abuse and personal safety.

Development of an accessible Audio Computer-Assisted Self-Interview (A-CASI) to screen for abuse and provide safety strategies for women with disabilities.

To increase safety and minimize the risk of interpersonal violence, it is critical that women with disabilities and Deaf women have an opportunity to identify whether or not abuse is happening in their lives. Awareness and knowledge of what constitutes abusive behaviors is an essential first step in addressing interpersonal violence. This article includes a description of the development and evaluation of the Safer and Stronger Program (SSP), an audio computer-assisted self-interview program, which was created for women with disabilities and Deaf women for the purposes of increasing awareness of abuse, encouraging safety-planning behaviors, and providing information about community resources.

Development of measures of abuse among women with disabilities and the characteristics of their perpetrators.

Three hundred and five women with diverse disabilities completed an anonymous audio computer-assisted self-interview designed to increase women's awareness of abuse. Data were also collected regarding abuse experienced in the past year and the risk characteristics of their perpetrators. Overall, 68% reported some type of abuse. Preliminary evidence for the validity and reliability of questions to assess abuse and perpetrator risk characteristics was found. Latent class analysis revealed four distinct classes of abuse experiences: sexual abuse, physical abuse, multiple forms of abuse, and minimal abuse and three classes of perpetrator risk characteristics: controlling characteristics, noncontrolling characteristics, and minimal risk characteristics.

Interpersonal violence and women with disabilities: analysis of safety promoting behaviors.

Very little information exists related to the interpersonal violence safety promoting behaviors of women with disabilities. Information about women's use of safety promoting behaviors was gathered from 305 disabled and deaf women who completed an anonymous Audio Computer-Assisted Self-Interview. Exploratory factor analyses revealed factors related to seeking abuse-related safety information, building abuse-related safety promoting skills, using relationship support, planning for emergencies, taking legal action, and managing safety in personal assistance relationships. Four of these factors demonstrated significant relationships to women's experience of different forms of abuse and their perpetrator's characteristics.

Women's views of prenatal violence screening: acceptability and confidentiality issues.

OBJECTIVE: The purpose of this research was to address the need for evidenced-based practices for violence screening by identifying women's perceptions of, and experiences with, prenatal violence screening. METHODS: Audio- and video-enhanced anonymous computer interviews were completed by women in 2 Level III postpartum units. RESULTS: The sample was composed of 519 primarily African-American and white women who were educationally and economically diverse. Although 312 women (60.1%) reported being screened for violence by a health care provider at some point during their pregnancy, only 201 of 519 (38.7%) were asked by their prenatal care provider, with the remaining women reporting that they were screened during emergency room, triage visits, and labor and delivery admission. Of those who were screened by their prenatal care provider 195 of 201 (97%) women stated that they were not embarrassed, angry, or offended when assessed. Of the 66 women who were both abused and screened during their pregnancy, only 11 women disclosed abuse, with a resulting disclosure rate of 16.7%; however, 29 abused women who denied abuse to their health care provider stated that they would have changed their response if they had known that violence disclosure was not reportable in their state unless the victim was seriously injured or was wounded with a lethal weapon. CONCLUSION: This study provides evidence that the great majority of pregnant women are not offended when screened for domestic violence and may increase their disclosure if they are told about state reporting mandates that preclude mandatory reporting for adults. LEVEL OF EVIDENCE: II-3.

Perinatal violence assessment: teenagers' rationale for denying violence when asked.

OBJECTIVE: To describe teenagers' experiences with perinatal violence assessment. DESIGN: A descriptive design utilizing qualitative content analysis. SETTING: Participants were recruited from gynecologic clinics of two level III maternity units and interviewed offsite. PARTICIPANTS: Twenty nonpregnant teenagers between the ages of 18 and 20 years who had experienced physical or sexual abuse in the year before or during (or both) a pregnancy occurring within the last 3 years were recruited for this study, regardless of past pregnancy outcome. METHODS: Data were analyzed using categorical content analysis. RESULTS: Participants reported a range of violence experiences from their parents, current and past intimate partners, and gangs (groups). Four categories emerged that addressed their reasons for not disclosing violence to their health care providers: Power/Powerlessness, Fear/Hope, Trust/Mistrust, and Action/Inertia. CONCLUSIONS: Abused teenagers have unique needs and concerns that should be addressed when providing pregnancy care.

Staff perspectives of violence in the emergency department: Appeals for consequences, collaboration, and consistency.

BACKGROUND: Violence committed by patients and their families and visitors against Emergency Department staff in the United States is common and detrimental to staff well being, morale, and care practices. Hospitals losses occur due to decreased staff retention, prestige, and patient and visitor satisfaction. OBJECTIVE: The purpose of the baseline survey reported here was to identify and describe staff experiences, concerns, and perceptions related to violence and abuse perpetrated by patients, family, and non-family visitors in a Level 1 emergency department. PARTICIPANTS: The survey sample was composed of 41 registered nurses and 10 paramedics. The majority of the participants (84%, n= 41) were female and worked full time (82%, n= 41) on the 7P-7A (49%, n= 25) shift. METHODS: The cross-sectional mixed-method descriptive design used a survey to measure violence experiences and interviews with key informants. Specific analytical methods included descriptive and inferential statistics and ethnography. RESULTS: The findings are summarized by a model that portrays 1) Contributing factors to the development of violence in the ED, 2) maladaptive reactions to workplace violence of Cynicism, Concern for focus on customer service, and Conflict, and 3) three themes that, depending on their presence or absence, serve as barriers or facilitators to violence: Consistency, Consequences and Collaboration. CONCLUSIONS: Interventions developed to minimize violence in the ED must focus on modifiable risk factors and address what is in the department's control including staff education in recognizing escalating anxious or aggressive behavior, policy development and implementation, and environmental changes.

Keeping safe: teenagers' strategies for dealing with perinatal violence.

OBJECTIVE: To identify strategies adolescents use to cope with and keep safe from perinatal violence. DESIGN: Exploratory descriptive design incorporating qualitative content analysis. A semistructured interview guide was used to inquire about coping strategies. SAMPLE: 20 nonpregnant teenagers between the ages of 18 and 20 years who experienced violence before, during, or after a prior pregnancy, regardless of outcome, were recruited for this study from community advertising and two outpatient gynecologic clinics. RESULTS: The teenagers described experiences of rape, stalking, and physical and sexual violence. They identified perpetrators as family members, nonintimate social acquaintances, and male and female intimate partners. Five themes were identified that described the teenagers' experiences with "Keeping Safe," including Losing Ground: Moving Backward; Minimizing Damage: Decreasing the Impact and the Severity of Violence; Keeping Away: Drawing Inward and Moving On; Getting Help: Reaching Out to Others; and Taking Charge: Being Proactive. CONCLUSIONS: The teenagers were actively engaged in developing creative strategies to minimize stress and the severity of violence in their lives. They also incorporated maladaptive behaviors that further increased their jeopardy. Asking about the ways that teenagers deal with violence might assist health care workers to proactively minimize damage from ineffective coping mechanisms.

"Keep a blank face. I need to tell you what has been happening to me.

PURPOSE: To explore adolescents' experiences of abuse in the year before and during pregnancy. METHODS: This prospective study used structured and focused interviews and content analysis. Forty teens' stories of abuse were extracted from focused interview questions during a larger study of pregnant adolescents aged 18 to 20. Elements of the stories were coded and categorized according to content and meaning. Seven themes were identified using a generalized qualitative approach that blended content and thematic analysis. RESULTS: Teens reported abuse from a variety of individuals, including intimate partners, former partners, and family members. Thirteen of the 40 teens reported being pregnant in the year before the index pregnancy, with 11 of the pregnancies ending in miscarriage, elective abortion, or fetal demise. Four of the pregnancy losses were directly attributed to abuse. Seven themes were identified that reflected the teens' stories of violence: seeking safety (self-protection with risks and benefits); losing faith (negative experiences with police and social justice institutions); experiencing loss (compromised reproductive health); living on the edge (substance abuse concerns); taking the next step (developmental concerns); crying out for help (suicide attempts); and changing and temporary relationships (loss of family bonds and serial monogamy). CLINICAL IMPLICATIONS: Routine screening for violence prior to and during pregnancy should include questions about past pregnancies, sexual abuse, and multiple perpetrators, as well as perpetrators other than intimate partners. Adolescent developmental concerns should be incorporated in safety planning and advocacy interventions.

Effects of an educational bereavement program on health care professionals' perceptions of perinatal loss.

BACKGROUND: The purpose of this study was to examine the differences in health care professionals' perceptions of perinatal loss situations before and after an educational program on perinatal bereavement. METHOD: A quasi-experimental design was used in a pretest and posttest format. RESULTS: Scores were significantly higher (p = .000) on each of the posttest vignettes. Overall scores were lowest for the miscarriage pretest, whereas scores for the pretest vignettes for the stillbirth and neonatal loss were similar. A similar pattern occurred in the posttest vignette scores. CONCLUSION: Health care professionals' perceptions of the emotional care needs of families experiencing perinatal loss were significantly increased after an educational program. The miscarriage vignette had the largest change score and the lowest mean scores on the pretest and posttest, which indicates professionals do not view miscarriage as significant a loss as stillbirth and neonatal loss.

Efficacy of a computerized abuse and safety assessment intervention for women with disabilities: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of a computerized disability-specific abuse assessment intervention on abuse awareness, safety self-efficacy, and safety promoting behaviors of women with diverse disabilities. RESEARCH DESIGN: A randomized control group design was used, with the intervention group completing the assessment intervention both at Time 1 (T1) and 3 months later at Time 2 (T2) and control participants completing it for the first time at T2. Analyses compared intervention and control groups at T2 and evaluated change over time in intervention group participants. The relationship between outcome variables (abuse awareness, safety self-efficacy, safety behaviors) was also explored. RESULTS: The intervention group had greater abuse awareness than the control group at T2, and abuse awareness increased from T1 to T2 among women in the intervention group, particularly among women who had experienced little or no abuse in the past year. Both abuse awareness and safety self-efficacy were significantly related to safety behaviors. CONCLUSIONS: The computerized program offers promise as a nonthreatening method of conducting abuse assessments among women with disabilities while also serving as an intervention to enhance abuse awareness.

Breaking the barriers: the promise of computer-assisted screening for intimate partner violence.

Although intimate partner violence (IPV) affects hundreds of thousands of women, the majority of women seen in health care settings are not screened for IPV. Many women are hesitant to disclose their abusive situations to their health care providers and, sadly, there is evidence that when women do disclose violence, their health care providers do not give them needed support and information. This article discusses the importance of IPV screening and barriers that may contribute to the current lack of screening by providers and the low disclosure rate by IPV survivors, describes how computer-assisted screening for IPV can address those barriers, and reports the findings of an integrative review of studies about computer-assisted self-interview (CASI) IPV screening. Computer screening strategies consistently identified a higher prevalence of IPV and were the approach preferred by the study participants. The findings of these initial studies provide support for the development and testing of computer screening and intervention strategies for IPV.

Revision of the Abuse Assessment Screen to address nonlethal strangulation.

The Abuse Assessment Screen has been used since 1987 to identify and assess for intimate partner violence in a wide variety of clinical and research settings. It has been translated and successfully used in at least 7 languages in addition to English. Meanwhile, a growing body of research indicates that nonlethal strangulation (commonly called "choking") is a significant form of intimate partner violence and that choking has substantial consequences for the health of the woman. This paper describes the modification of the Abuse Assessment Screen to include "choking."

Postpartum women's evaluations of an audio/video computer-assisted perinatal violence screen.

For universal screening to become a reality, research must first validate the effectiveness and acceptability of violence screening. This study describes postpartum women's perceptions of an anonymous computer-assisted self-interview for perinatal violence screening. A sample of 519 postpartum women completed interviews that included audio and video enhancements. Post-response evaluations were positive with most women, indicating that they preferred computer interviews to face-to-face or written abuse screening. In addition, participants indicated that the computer format and associated anonymity positively influenced their willingness to answer the violence questions truthfully. Computer interviews offer an alternative approach to violence screening that may help women who are hesitant to disclose abuse directly to their healthcare providers.