Preexisting Mental Health Illness Among Victims of Sexual Assault: Case Studies to Inform Sexual Assault Nurse Examiner Practice.

BACKGROUND: Sexual assault is a pervasive problem associated with negative long- and short-term consequences related to mental health consequences, educational function, physical health, and sexual and relationship functioning. People with mental illness, particularly those with psychotic disorders, have a significantly higher risk of becoming victims of violence compared with the general population. METHODS: Three case studies of women with preexisting mental health problems who were sexually assaulted and requested a sexual assault examination are presented. These cases illustrate common mental health problems, how mental health problems can be associated with an increased risk for sexual assault, and things the sexual assault nurse examiner (SANE) should consider in the care and treatment of these patients. RESULTS: These cases illustrate important ideas regarding the care of people who have been sexually assaulted: prioritizing safety, ethical issues related to consent, the importance of empathetic communication, and the need for SANEs to expand their knowledge to improve care of patients with mental health disorders. DISCUSSION: Being sexually assaulted can contribute to destabilization, prolongation, and exacerbation of existing mental illness, placing patients at an increased risk for sexual assault, beginning a vicious cycle of mental illness and violence. Working effectively with the interdisciplinary team, the SANE can help break this devastating cycle of violence.

Creating a culture of support for nursing surveillance.

BACKGROUND: An estimated 98,000 deaths annually result from medical errors. Preventing these deaths must be a US healthcare goal. Surveillance decreases adverse events. Surveillance is essential for patient safety. Creating a unit culture that supports surveillance requires attention to its antecedents (nurse education, nurse expertise, nurse staffing, as well as organizational culture). METHOD: The current literature on topics salient to creating a culture of nursing surveillance including its antecedents and its attributes were reviewed. The findings are summarized and presented. DISCUSSION: Suggestions and tools enhancing a culture of safety allow the transition from one set of behaviors to another. An organizational culture that strives for excellence promotes surveillance which results in improved patient outcomes and better qualified nurses. CONCLUSION: Unit change resulting in support for surveillance can minimize failure to rescue and promote interruption of adverse events. The patient outcomes include decreased morbidity and mortality.

Nursing surveillance: A concept analysis.

AIM: To provide a framework to assess and evaluate nursing surveillance of patients. BACKGROUND: The Nursing Interventions Classifications define surveillance as the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making and is essential for improving patient safety. DATA SOURCE: The existing literature was searched using CINAHL, OVID, EmCare, and 11 ScienceDirect databases. METHODS: The Walker and Avant method was used to analyze the concept of surveillance. RESULTS: Technology that facilitates surveillance in the community is ubiquitous in acute care settings. Nurses caring for patients use a tremendous volume of patient data to inform their clinical decision-making. Five attributes are associated with nursing surveillance: systematic process, pattern recognition, coordinated communication, the anticipation of problems of instability, and decision making. Surveillance is dynamic and extends over time. Antecedents to nursing surveillance include sufficient nurse education, nurse expertise, nurse staffing, as well as an organizational culture that supports nursing surveillance. When nursing surveillance is present, patient safety is enhanced and adverse events that harm patients are reduced. The concept of nursing surveillance is complex and defies empirical measurement, though it is possible to measure the attributes and outcomes. CONCLUSIONS: Nursing surveillance is essential to the safe management of complex patient cases. Surveillance is more than monitoring or simple patient observation. Monitoring is an essential part of surveillance but incorporating the critical attributes of surveillance lead to improved patient outcomes.

Intimate Partner Violence: The Lived Experience of Single Women.

Research in intimate partner violence has focused on married, cohabiting, adolescents, or college aged women. The experience of intimate partner violence by single women has not been studied separately from other groups of women. An interpretive phenomenological approach was used with feminist inquiry to gain insight into the experience of intimate partner violence by single women. The overarching theme was control and manipulation by the abuser. Subthemes included not feeling safe, poor communication skills, and caretaking. Nurses need to be aware of the occurrence of intimate partner violence in male and female partnered relationships to provide comprehensive and nonjudgmental care.

Human Trafficking, Sexual Assault, or Something Else? A Complicated Case With an Unexpected Outcome.

This case report presents a patient who presented multiple times with vaginal injuries and bleeding, reporting sexual assault with a foreign object. Findings from her history and physical examination were consistent with sexual assault and human trafficking. The outcome of this case was not what we initially expected when the patient first presented for care. However, the patient ultimately received the care she needed. This case illuminates the need for excellent continuing education, interdisciplinary communication, and continuity of care.

Sexual assault: where are mid-life women in the research?

PURPOSE: There is extensive literature related to the experience of sexual assault of women with a majority focused on younger women, college-aged women, or older women. There is little research about the experience of sexual assault of mid-life women. DESIGN AND METHODS: This paper synthesizes the current literature associated with sexual assault by describing the increased number of single women in the population, defining terms associated with sexual assault, examining rape myths, characteristics of the victim, describing the relationship of victim to assailant, extent of victimization experienced by women, common physical injuries, age-related physiological changes, psychological considerations, and post-traumatic stress disorder specific to mid-life women. FINDINGS: The population of single women has increased across the life span. Current studies utilize varying definitions of sexual assault, examine results across variable age groups, and include the responses of single women with married women. Characteristics of victims demonstrate similarities by age group, relationship type, living conditions, and physical or mental capabilities that affect the occurrence of sexual assault. PRACTICE IMPLICATIONS: There are few studies that examine the sexual assault experiences of single mid-life women. Further research into the experiences of single mid-life women is warranted to provide direction for nursing education programs and clinical practice.

The Lived Experience of Female Veterans Deployed to the Gulf War II.

PURPOSE: The purpose of this inquiry is to discover the experiences of female veterans in order to understand the impacts of combat on their physical and mental health, and to shed light on directions for future research. The research question for this inquiry is: What is the lived experience of female combat veterans who deployed to Iraq and Afghanistan from 2001 through 2013? METHODS: The methodology used in this qualitative inquiry is a descriptive phenomenological approach using Husserl's philosophical framework. Colaizzi's method was used for data analysis. FINDINGS: Analysis revealed seven themes: living in constant fear while deployed, combat has different meanings, bringing the war home, fear of being forever changed, disrespect from fellow military members, physical health-for better or worse, and combat has rewarding experiences. CONCLUSION: Early detection and assessment is crucial to providing interventions to military veterans to reduce the invisible wound of war, posttraumatic stress disorder, and ultimately increase the quality of life.

Biologic correlates to the development of post-traumatic stress disorder in female victims of intimate partner violence: implications for practice.

PURPOSE: The purpose of this article is to discuss the current literature about the risk of post-traumatic stress disorder (PTSD) in victims of intimate partner violence (IPV). CONCLUSIONS: PTSD is a complex and serious syndrome with emotional symptoms, psychiatric symptoms, and physical consequences. PTSD is associated with impaired immune function, obesity, increased risk of diabetes, increased severity of premenstrual syndrome symptoms, depression, suicide, and increased likelihood of re-abuse. Female victims of IPV develop PTSD and related consequences at a rate of 74-92%, compared to 6-13% in non-abused women. PRACTICE IMPLICATIONS: Advanced practice nurses (APNs) are likely to see one or both of these problems in their practices. The vague, nonspecific symptoms can present challenges to APNs. Biologic correlates are identified to help the APNs identify those most at risk of developing PTSD. Treatment options are discussed.

Competency in nursing: a concept analysis.

Competency is a topic of great interest to educators and administrators in practice disciplines, particularly health care disciplines such as nursing. This article focuses on the role of competency in nursing. Through a concept analysis process, various elements of competency were assessed. The defining attributes of competency are the application of skills in all domains for the practice role, instruction that focuses on specific outcomes or competencies, allowance for increasing levels of competency, accountability of the learner, practice-based learning, self-assessment, and individualized learning experiences. The learning environment for competency assurance involves the learner in assessment and accountability, provides practice-based learning opportunities, and individualizes learning experiences.

Geriatric Training Academy: innovative education for certified nurse aides and charge nurses.

Quality care for the rapidly growing number of older Americans is a major challenge facing the health care industry today. With the baby-boom generation "coming of age"--older age-the need for quality long-term care workers is on the rise. It is estimated that the number of persons needing assisted or alternative living arrangements will increase from 15 million in 2000 to 27 million in 2050 (U.S. Department of Health and Human Services [HHS], 2003). In response to the rising demand for quality long-term care workers, the Geriatric Education and Training Academy (the Academy) was created at Texas Tech University Health Sciences Center (TTUHSC) to provide advanced geriatric education and training for certified nurse aides (CNA), licensed vocational nurses (LVN) and registered nurses (RN) who work in long-term care facilities. This article describes how the Academy is addressing the need for the recruitment, education, and retention of long-term care workers for the expanding geriatric population in West Texas.

Integrating long-term care concepts into baccalaureate nursing education: the road to quality geriatric health care.

Increased numbers of aging Americans requires that today's health care professionals be grounded in education that focuses on patient-centered care of older adults. The growing demand for competent geriatric nurses in West Texas, led the School of Nursing (SON) at Texas Tech University Health Sciences Center (TTUHSC) to conduct an in-depth analysis of its baccalaureate curriculum to determine how, when, and where care of older adults was being addressed. A task force appointed by the SON subsequently chose, as a blueprint for curricular redesign, Older Adults: Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care (American Association of Colleges of Nursing & the John A. Hartford Foundation Institute for Geriatric Nursing, 2000). This article describes how the SON task force planned and implemented a new and strengthened geriatric core in its curricula.