Postoperative pain: acupuncture versus percutaneous electrical nerve stimulation.

The purpose of this study was to examine the effect of traditional acupuncture compared with acupuncture with percutaneous electrical nerve stimulation (PENS) on postoperative surgical pain relief in gynecologic oncology patients. Twenty postoperative gynecologic oncology patients were randomly assigned into the two groups, and the intervention was initiated within 24 hours after surgery. The patients in each group received four treatments in the subsequent 48 hours, with 12 hours between each treatment. Either traditional acupuncture needles or acupuncture needles with a pulsed electric current were applied to stimulate the area of points Sp6 and Sp8 near the saphenous nerve. Pain measurement instruments included a visual analog scale and the McGill Pain Questionnaire. Although the PENS treatment group demonstrated a consistent decrease in pain with each treatment application compared with the traditional acupuncture group, after 48 hours both groups experienced equivalent pain relief.

Tools for screening for interpersonal violence: state of the science.

In recent decades, the prevalence of abuse against women, older persons, and persons with disabilities has become a major public health problem. Health professionals, urged by their professional associations to universally screen these groups, have employed various tools in an effort to identify individuals in need of help. Yet many of the tools used widely in clinical settings have limitations in terms of empirical soundness. This article presents tools used to screen women, older persons, and persons with disabilities as well as data on the reliability and validity of these instruments. These properties and the resources needed to reduce harm are important factors to consider before implementing screening. The article concludes with a summary of the risk-benefit issues related to the use of these tools and universal screening in general.

School nursing on the iron range in a public health nursing model.

Frontier nursing in the public health model might invoke images of school nurses on horseback in rural Kentucky or the wilds of the western prairies. Northern Minnesota was a frontier in the last decade of the 19th century, due to the discovery of one of the richest seams of iron ore on the North American continent. Immigrants from Europe responded to the opportunities this discovery created. Among the many Finns arriving on the Iron Range of Minnesota, as it came to be named, were the parents of Lillian Augusta Wilhelmena Beck, John and Hulda Beck. Over her more than nine decades of life, their daughter became one of the most well known school nurses on the Iron Range. Her story evokes memories of the creation of school nursing in the public health model by nurses at the Henry Street Settlement in New York City.

Redefining boundaries: a grounded theory study of recidivism in women.

Incarceration rates for women in the United States are at least three times greater than those of any other nation (National Council on Crime and Delinquency, 2006). Recidivism, reoffense following prior conviction for a crime, compounds this problem, with nearly seven out of 10 convicted persons in the United States rearrested within 3 years of release (Hughes & Wilson, 2003). Our purpose in this article is to present a grounded theory of recidivism from the perspective of incarcerated women and to discuss the public health and other societal implications. While the participants in this research were U.S. women, we hope to provide a new perspective on the decision making of some women that results in recidivism, in order to initiate dialogue that could lead to more effective interventions worldwide.

Children who witness violence: what services do they need to heal?

Children are witnesses to violence far too often in their daily lives. To elicit information on the needs of children and adolescents living in the United States who have witnessed violence in their homes, neighborhoods, or communities, we held focus groups with mothers who have survived interpersonal violence and whose family included child witnesses to violence (CWV), professionals who work with families affected by violence, and with adolescents who have witnessed violence. Based on four separate focus group discussions held in Massachusetts, involving a total of 45 participants, recommendations for screening, programming, and the development of healing interventions are offered to mental health professionals.

Using technology to expedite screening and intervention for domestic abuse and neglect.

OBJECTIVE: In response to escalation of community violence, the U.S. Department of Commerce funded Home Health VNA (HHVNA), serving the Merrimack River valley communities in Massachusetts and New Hampshire, for a project demonstrating innovative use of technology in screening for abuse and neglect. DESIGN: All health care providers in the HHVNA were trained in screening through tools loaded on their personal digital assistants. SAMPLE: The sample was comprised of patients served by HHVNA during the study period. INTERVENTION: When a patient screened positive, the health care provider mobilized resources, including social workers, the office of elder services, or the local department of social services office for same-day follow-up. OUTCOMES: Screening for abuse and neglect was mainstreamed into routine care. Health care providers noted significant reduction in redundant domestic abuse data collection. The close communication networks created enabled health care providers to mobilize resources, initiating same-day in-depth social work assessment and referrals to appropriate community agencies. Health care providers now transmit selected encrypted health information and mandated reports to official agencies. CONCLUSIONS: Wedding technology with health care professionals' skills and knowledge can move prevention of and early intervention for domestic abuse and neglect to a new level of efficacy.

Adapting and testing the Appraisal of Violent Situation scales.

The purpose of this study was to test the psychometric properties of a vertical version of horizontally oriented three Appraisal of Violent Situation scales that elicit women's subjective appraisals of severity, dangerousness, and controllability of violence. Construct validity of the vertical scale eliciting 64 abused women's perceptions of severity of violence experienced was supported by a low to modest correlation between that scale and the Severity of Violence Against Women Scale. Concurrent validity between the horizontal and vertical versions of the scales was demonstrated with a subsample of 26 abused women completing both. Results provide preliminary support for the revised scales.

Creating a community coalition to address violence.

Building a community-wide coalition to address violence evolved out of a five-year federally funded project on abuse during pregnancy. The setting for this coalition building is Haverhill, Massachusetts, a city of about 60,000, located northeast of Boston in the Merrimack River Valley. For nearly eight years, representatives of more than 30 agencies and institutions have been meeting monthly and creating programs and strategies to address violence in homes, schools, and neighborhoods, and designing interventions for children witnessing this violence. The purpose of this article is to describe the process of coalition building and provide an analysis of this work.

Preceptor rewards: How to say thank you for mentoring the next generation of nurse practitioners.

PURPOSE: To answer the question how do faculty nurture and reward clinical preceptors and what supports do preceptors require? DATA SOURCES: Data came from the literature and from surveying a purposive sample of 26 faculty members teaching clinical courses and arranging precepted experiences for nurse practitioner (NP) students at 26 public and private institutions across the United States. The vehicles for the survey were personal contact and e-mail. CONCLUSIONS: Schools offer preceptor rewards varying widely in their monetary value, from tuition and continuing education vouchers, verification of hours toward recertification, access to services and events on campus, reduced price or free admission to museums, cultural and sports events, and lectures. Faculty nurture preceptors by nominating them for awards, providing letters of reference, editing manuscripts, and collaborating on research projects. Supports for preceptors from the literature reflected National Organization of Nurse Practitioner Faculties guidelines (2000), and the policies of schools and clinical agencies, such as providing copies of program objectives and student credentials. IMPLICATIONS FOR PRACTICE AND EDUCATION: As NP programs have proliferated, there is increased pressure on faculty to find, nurture, reward, and retain good preceptors. Faculty must continue to work with program and agency administrators to comply with policies and create preceptor rewards to recognize their gifts to us, to our schools, and to the profession.

Integrating practice issues in managed care into the curriculum: a Delphi survey.

PURPOSE: This project evolved from a partnership between an advanced practice nurse (APN) graduate program and a care management insurer. The purpose of this Delphi survey was to identify (a) role components germane to the practice of APNs in managed care and (b) topics reflecting these components in the curriculum. DATA SOURCES: Data were gathered from two expert panels, clinician preceptors and faculty members. Each panel had 11 members: 11.3% and 100%, respectively, of the target populations of clinicians and faculty in the partnering agencies. CONCLUSIONS: There was considerable congruence between the panels on the survey. IMPLICATIONS FOR PRACTICE: Case vignettes could be used as a vehicle for discussion of the broader issues of population approaches to specific problems. Faculty could partner with clinicians to develop cases for discussion of evidence-based practice. Faculty and clinicians could create preceptorships focused on business management, postgraduate fellowships within managed care systems, and regular opportunities to dialogue about curriculum and essential attributes of APN graduates.

The Effect of Evidence-Based Scripted Midwifery Counseling on Women's Choices About Mode of Birth After a Previous Cesarean.

INTRODUCTION: The purpose of this study was to evaluate how a scripted counseling intervention affected the experience of decision making and actual choice for trial of labor after cesarean (TOLAC) or elective repeat cesarean birth (ERCB) in a cohort of women receiving care from nurse-midwives. METHODS: A pilot study of scripted counseling for women who had a previous cesarean about TOLAC versus ERCB was conducted at Boston Medical Center. Candidates for a TOLAC, receiving prenatal care from nurse-midwives in 2012 and 2013, were enrolled before 28 weeks' gestation. The women received 4 scripted counseling sessions during the routine prenatal visit, evidence-based information pamphlets, and an opportunity to review the hospital TOLAC consent form. Pre and post questionnaires were completed regarding birth preference, information sources, and decision factors. A midpoint assessment of the participants' knowledge of risks and benefits of TOLAC versus ERCB was conducted, and satisfaction with the intervention and outcome were assessed after the birth. RESULTS: Twenty-two women participated in the study, and 20 completed all study questionnaires. More of the participants believed they had enough information after the intervention (95% after intervention vs 70% before the intervention). Reasons for choosing ERCB included being afraid of vaginal birth complications, having prior positive experience with cesarean, and convenience of knowing when the neonate will be born. Reasons for choosing a TOLAC included the personal importance of having a vaginal birth and that recovery is faster and easier. Few women cited concerns for their own safety and that of their newborns when choosing TOLAC. DISCUSSION: Women were satisfied with the scripted counseling and found it useful in helping them make a birth mode decision. While the scripted counseling did not appear to influence preferred mode of birth, it appeared to help women follow through with the mode of birth they chose prenatally.

Screening for abuse during pregnancy: implementing a multisite program.

Screening for abuse at every healthcare visit is a standard of practice promulgated by many healthcare professional organizations. The need for such screening is underscored by reports of homicide as a leading cause of maternal mortality during pregnancy and the first year of the baby's life in Massachusetts and Maryland, and by the calculation of the costs of intimate partner violence in the United States. This article discusses how we addressed problems that arose in implementing screening for abuse in 13 different sites as a part of a clinical nursing research project. Engaging in clinical nursing research necessitates close relationships with clinical agencies and their staff members. This often means establishing and maintaining relationships with all nurses caring for patients in each clinical unit serving as a study site. For research on abuse during pregnancy, our study team members were engaged in interactions with prenatal care providers at 13 different study sites. Central to the study was implementing use of a standardized abuse screening tool, the Abuse Assessment Screen, at each study site. This article also describes the lessons we learned in attempting to implement such a large scale change in clinical practice.

Role of nurse practitioners in encouraging use of personal health records.

With increased mobility, it is important that individuals keep their own personal health records (PHRs). Nurse practitioners are encouraged to assume greater responsibility for PHR adoption and recognize the key role they play in recommending PHR use. This article also briefly discusses college students' perceptions of their exposure to online PHRs.

Cognitive dissonance experienced by nurse practitioner faculty.

PURPOSE: The purpose of this study was to explicate the concept of cognitive dissonance as experienced and reported by nurse practitioner (NP) faculty members. DATA SOURCES: Responses from NP faculty members to an online survey about their experiences with cognitive dissonance. CONCLUSIONS: The respondents detailed their experiences with cognitive dissonance, citing differences between expectations for which they are rewarded and those for which they are paid. IMPLICATIONS FOR PRACTICE: Expecting all faculty members to excel in practice, research, teaching, and service may create unrealistic workloads for NP faculty members. Examining expectations and considering creation of a clinical track for faculty who practice may be options administrators of NP programs might explore.

The evolution of specialists in women's health care across the lifespan: women's health nurse practitioners.

PURPOSE: In this article, we will trace the beginnings of this nurse practitioner specialist, illustrating with the stories of women's health nurse practitioners who were some of the pioneers in developing the role and models of care to meet the unique needs of women across their lifespan. DATA SOURCES: Oral history interviews with pioneers in the role who graduated from both certificate and master's programs preparing nurse practitioners informed and shaped the story. Additional data came from the literature on the evolution of advanced practice nurse roles and education and documents from early educational programs and the legal and regulatory literature affecting the roles and practices of advanced practice nurses. CONCLUSIONS: Women's health nurse practitioners have evolved to fill an important role in healthcare delivery, caring for women across generations often within the same families. IMPLICATIONS FOR PRACTICE: Women's health nurse practitioners, as do all nurse practitioners, offer a unique approach to care. To paraphrase the words of one participant, I think we address a major healthcare need because if women are educated about themselves and what they need to do to take care of themselves, the result is a better community.

What do you mean you want me to teach, do research, engage in service, and clinical practice? Views from the trenches: The novice, the expert.

The purpose of this column is to explicate two points of view-the novice and the expert nurse practitioner (NP) faculty member, highlighting the importance of mentoring new faculty NP members into the diverse faculty roles relating to both general academic requirements and those particular roles related to NP education. For example, arranging clinical placements is one of the most important and time-consuming responsibilities of NP faculty. Learning to juggle all the roles is a challenge to new faculty members. Such mentoring may help alleviate the phenomenon of young faculty members leaving academia and returning to full-time clinical practice. Mentoring is crucial to integrating new NP faculty members into academic life.

Public health nursing pioneer: Jane Elizabeth Hitchcock 1863-1939.

Jane Elizabeth Hitchcock was one of many distinguished nursing leaders of the 19th and early 20th centuries who attended a women's college before enrolling in a nurse training school. Like many of her contemporaries with equally impeccable family credentials, Hitchcock was something of an enigma to her family for choosing nursing over teaching, the most common acceptable career for women of her social class. Hitchcock's endowment of character, according to contemporary Lavinia Dock, exemplified the best of her Puritan roots. Her contributions to the evolution of public health nursing and the integration of public health nursing content into curriculums of training schools rivalled the achievements in higher education of her famous father, grandfather, and brother but garnered no comparable recognition. Her life presents an interesting case for analysis of an independent woman, a characteristic shared by many pioneers in the early years of public health nursing: 1893 to 1920.

Health behaviors as mediators for the effect of partner abuse on infant birth weight.

BACKGROUND: Intimate partner abuse of pregnant women has been linked to the delivery of low-birth-weight infants. Also, abused pregnant women have reported a greater prevalence of substance abuse, poor nutrition, and demographic risk factors for poor birth outcomes. These factors may play a role in the reported relation between intimate partner violence and birth weight. OBJECTIVES: To explore the role of substance abuse (smoking, alcohol, and drug use) and weight gain of less than 15 pounds during pregnancy as potential mediators of the relation between recent partner abuse and infant birth weight, and to investigate the role of demographic risk factors as potential moderators for the impact of abuse on birth weight. METHODS: Data were extracted on abuse screening results, demographics, birth outcomes, and a range of medical and obstetric risks and complications from the medical records of 1969 women who had been screened by clinicians for domestic abuse during pregnancy. Hypotheses were tested using multiple regression analysis. RESULTS: Recent physical or psychological abuse had a small but significant effect on birth weight in this sample. Smoking and low weight gain were weak but significant mediators of the relation between recent abuse and infant birth weight. Single marital status was the strongest demographic predictor of decreased birth weight. No moderator effects were found. CONCLUSIONS: Although prospective studies are warranted, nursing care to reduce smoking and promote adequate weight gain in all women along with support for women's efforts to seek safety from abuse may help to improve birth outcomes and promote maternal well-being.