Testing a Talkstory Intervention to create Supportive and Safe Violence-Free Communities for Women.

The purpose of this paper is to report on a community-designed and led talkstory intervention to increase awareness of intimate partner violence (IPV), decrease acceptability of IPV, and increase community leadership to address IPV. In collaboration with women engaged in prior IPV outreach and education in Hawai'i, a talkstory intervention for IPV was developed, and a single-group, pre-post-test design was used to test it. The intervention included five talkstory sessions over seven months with community groups interested in violence prevention. Pre- and post-testing were conducted to determine changes in group means on three measures. Ninety-two individuals participated in the intervention, 77 (84%) of these completed the 1-month follow-up measure, and 59 (64%) of these also completed the 6-month follow-up measure. The findings included: (1) participants in the talkstory intervention groups decreased their acceptability of violence and increased their awareness, knowledge, and confidence to address IPV; (2) the community leaders in the intervention groups gained skills in facilitation; and (3) intervention groups continued to sponsor other IPV awareness-raising activities in their communities following completion of the study. Working with community leaders to design and facilitate the intervention not only provided IPV education within the context of the community, but also led to sustainable efforts to enhance the safety and wellbeing of women experiencing violence.

Engaging Native Hawaiians and Pilipinos in creating supportive and safe violence-free communities for women through a piloted "talkstory" intervention: Implications for program development.

In Hawaii, 20% of women have been victims of intimate partner violence (IPV). Although disaggregated data specific to Native Hawaiians or Pilipinos (The official Filipino language recognizes both Filipino (Filipina) and Pilipino (Pilipina) as terms for the citizens of the country. Participants in this study chose to use the terms Pilipino (Pilipina). Retrieved from: www.pilipino-express.com/history-a-culture/in-other-words) are limited, greater than 70% of women murdered in Hawaii as a result of IPV are Pilipino or native Hawaiian. A consortium was formed to assist Native Hawaiian and Pilipino women addressing abuse and strengthening support from the community. A quasi-experimental community-based participatory research study was designed to assess a community "talkstory" intervention for IPV. "Talkstory" refers to informal gatherings considered to be a laid-back conversation involving a "reciprocal exchange of thoughts, ideas, feelings about self, and other issues" (Affonso et al., 1996. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 25, 738). This article describes the development of an intervention to address IPV in Hawaii and presents the findings obtained from the pilot studies. Results from the pilot study were used to modify the proposed "talkstory" intervention, revise the data collection tools, and provide the program developers with insights into how the community viewed IPV. The most significant change was an increased perception of their awareness, knowledge, and confidence to address IPV following the intervention.

A statewide consortium's adoption of a unified nursing curriculum: evaluation of the first two years.

AIM: This article provides an evaluation of the first two years of implementation of a statewide nursing consortium (SNC) curriculum on nursing faculty work life, teaching productivity, and quality of education. BACKGROUND: In response to the call for nursing education reform, the SNC incorporated new approaches to competency-based, student-centered learning and clinical education. METHOD: Faculty and two cohorts of students were measured at three points over the first two years of the curriculum implementation. RESULTS: The expected positive impact of the SNC was documented at the start of the first year, but not sustained. Students reported having more confidence in their clinical skills at the start of the first year, yet demonstrated significantly less confidence in their ability after two years. CONCLUSION: Faculty indicated that the SNC allowed greater opportunity for collaboration, but that the experience did not alter their classroom performance or satisfaction beyond the first year.

Developing a statewide nursing consortium, island style.

This article describes the transformational changes in the scope and pedagogy of nursing education within a state university system through the development of the Hawaii Statewide Nursing Consortium (HSNC) curriculum. Modeled after the Oregon Consortium for Nursing Education, the HSNC used a community-based participatory approach to develop the curriculum to support all students within the state who are eligible to earn a baccalaureate degree. The curriculum was designed as a long-term solution to the anticipated shortage of nurses to care for Hawaii's diverse population. It is also an effort to increase capacity in schools of nursing by making the best use of resources in the delivery of a baccalaureate curriculum that offers exit opportunities after the completion of an associate degree. Finally, it provides new ways of educating students who will be better prepared to meet Hawaii's health needs.

Creating innovative models of clinical nursing education.

Although nursing care has changed significantly over the past 30 years, methods to clinically train nursing students have not. The traditional model of clinical nursing education, where a faculty member oversees a group of six to eight students on an acute care unit for a 4- to 8-hour shift, provides a haphazard approach to learning. A need exists to find innovative ways to effectively train more nursing students to better prepare them for today's health care environment. Using a change framework, seven approaches to clinical nursing education were created through academic-practice partnerships. These approaches may increase the effectiveness and efficiency of the clinical nursing education system.

Responding to the needs of culturally diverse women who experience intimate partner violence.

This paper presents the findings from a community based participatory research (CBPR) study that investigated the interface between culture and intimate partner violence (IPV) for women in selected cultural groups in Hawaii: Native Hawaiian, Filipino, Samoan, and Chuukese. The research question was, "What are the cultural perceptions, responses, and needs regarding IPV of selected individuals and groups served through a variety of programs that are affiliated with the three participating Community Health Centers (CHCs)?" This cross sectional, descriptive study collected both qualitative and quantitative data. Individual interviews were conducted with women who had experienced IPV. Focus groups were also conducted with other women from the same culture. Five common themes were identified across the four cultural groups: Living within a Collective; Cultural Protective Factors; Cultural Barriers to Helpseeking; Gender Specific Roles; and Belonging to a Place. The outcome from this study is increased knowledge that will be used to develop culturally appropriate interventions. Specific findings from each cultural group have been published. The purpose of this paper is to present common perceptions and responses to IPV from the four groups and suggest interventions based on the findings. Implications for practice are presented.

The Voices of Native Hawaiian Women: Perceptions, Responses and Needs Regarding Intimate Partner Violence.

Using a community based participatory approach, individual interviews and focus groups were conducted with Native Hawaiian women to understand their cultural perceptions, responses, and needs regarding intimate partner violence (IPV). Semi-structured interview guides were used for both interviews. The overriding theme derived from content analysis is that IPV "starts in the home," it is learned in the family and in the community. Visible injuries requiring emergency care is commonly perceived as IPV. The response to IPV included a primary theme of "defend the collective." Intimate partner violence is understood to be a "family matter," dealt within the family or by oneself. Native Hawaiian women who participated in this study sought to re-connect or establish relationships with self, others, spirit, natural elements, cultural practices, and community. Responding to IPV requires an understanding of cultural perceptions, responses, and needs of Native Hawaiians, with implications for families and communities. The needs expressed by Native Hawaiian participants reflect what they need to access "health." Implications for health care providers require understanding how best to facilitate an individual's access to "health" vs. access to "health care."

Listening to Filipina women: perceptions, responses and needs regarding intimate partner violence.

Interpersonal violence (IPV) is a complex issue effecting women worldwide. Reported rates of IPV vary widely from one cultural group to another (Magnussen et al., 2004 ; Tjaden & Thoennes, 2000 ). This paper presents a community based participatory research (CBPR) study of the perceptions, responses, and needs of Filipina women regarding IPV. Data was collected by using interviews and focus groups. The women believed that it was their responsibility to keep the family intact regardless of IPV and did not realize that IPV has a significant negative impact on the mental health and well-being of both women and their children. Immigrant Filipino women may be particularly at risk of IPV.

Expatriate Japanese women's growth and transformation through childbirth in Hawaii, USA.

The purpose of this study was to describe the meaning of the childbirth experience for Japanese mothers who gave birth soon after they moved to Hawaii, USA. The research design was descriptive, using Colaizzi's phenomenological approach. The sample consisted of 10 Japanese expatriate women. The major findings of this study consisted of four theme categories: the challenges of living overseas, the challenges of motherhood, reaching the goal of motherhood, and relationships with others. In describing the meaning of their childbirth experience, the new mothers recognized their own parents' efforts in raising them and their love. The new mothers also identified themselves as "irreplaceable" mothers for their new family. They believed that their childbirth experience in Hawaii helped them to become more mature as individuals. The implication arising from this study for caregivers is that it is necessary to understand culturally sensitive care that meets the individual needs of women in each transition.

Informational needs and the experiences of women with abnormal Papanicolaou smears.

PURPOSE: To describe the experience of women with abnormal Papanicolaou (Pap) smears with a particular focus on their informational needs. DATA SOURCE: The small purposive sample consisted of 10 demographically diverse women with a history of at least one abnormal Pap smear, who attended one Women's Health outpatient clinic that typically serves a multiethnic, low-income population. Individual 30- to 60-min tape-recorded interviews were conducted, transcribed verbatim, and analyzed according to Colaizzi's eidetic method of phenomenological analysis. A manual categorizing strategy and a computer software (Qualrus, version 2.0) strategy were used for data management and coding. CONCLUSIONS: Six major themes emerged from the data: initial response to the diagnosis; dealing with stigma; seeking information and support; enduring diagnostic and treatment procedures; formulating a concept of disease; and normalizing. The essential structure of the experience of having an abnormal Pap smear in terms of informational needs involved initial anxiety at disclosure, followed by an urgent need for information. Stigma associated with a sexually transmitted disease (STD) and a dearth of information available for male partners were problematic and influenced decisions about disclosure of human papillomavirus (HPV) infection to current or future partners. Misinformation or misunderstanding of available information was common. Information obtained from the Internet was experienced as private and allowed adequate time, but Web sites that grouped HPV with general STD information were confusing and further stigmatizing. Information obtained from healthcare providers was experienced as supportive if facts were accompanied by reassurance and familiar analogies were used. Information from providers was experienced as nonsupportive if too much medical jargon was used, if not enough time was spent to explain the information, if facts were not accompanied by interpersonal concern, or if a patient-provider relationship was not established. IMPLICATIONS FOR PRACTICE: Patient education regarding abnormal Pap smears and HPV should address the concerns of those affected and should use message framing that informs but decreases stigmatization. Women should be offered the option of individualized informative and supportive counseling resources after initial disclosure of an abnormal Pap smear to adequately address concerns such as information for partners, the nature of HPV, an appropriate concept of cancer risk, and reassurance regarding potential effects on sexuality and fertility. Public information forums should address issues specific to high-risk HPV rather than generalization as an STD.

Intimate partner violence: perceptions of Samoan women.

UNLABELLED: The purpose of this study was to examine cultural perceptions, awareness, responses, and actions recommended about IPV by Samoan women served by a Community Health Center (CHC). THEORETICAL FOUNDATION: This investigation is a part of a series of exploratory community based participatory research (CBPR) studies based on critical social theory. RESEARCH DESIGN AND METHODS: This qualitative study was conducted using focus groups with Samoan women served by a health center. Analysis of qualitative data was accomplished using content analysis. Demographic data were analyzed using descriptive methods. PARTICIPANTS: Eight Samoan women, 18 years and older participated in the focus groups. PROCEDURE: The instruments were translated from English to Samoan and back translated into English. The facilitators conducted an initial focus group and a validation group with the same participants. Sessions were taped and transcribed in Samoan and back translated into English. RESULTS: The women clearly identified IPV and were aware that it occurs in their cultural group. They identified multiple responses of individual women, families, and communities to IPV. In Samoa there was a formalized process for addressing this problem that has been changed in Hawai'i. The CHCs are viewed as an important resource for the families and can be a source of interventions. IMPLICATIONS: Health care providers should be aware of differences between Western notions of independence and the ideals of interdependence held by specific cultural groups. The CHC personnel have raised questions about the appropriateness of using tools that were developed for use with Western women with immigrant women.

Through the eyes of women: cultural insights into living as a battered woman in Hawaii.

This phenomenological study examined the impact of culture on the lived experience of women who were victims of intimate partner violence (IPV). The analysis of the data, using the method of Colaizzi, yielded three theme clusters: "living in misery", "enduring terror and sadness", and "no happy ending". They revealed the essential structure of living in a violent situation. The women, from diverse cultural backgrounds, had similar individual responses to violence. Although on a societal level, responses to violence are unique, the results revealed that women's responses were very personal and common across cultures, demonstrating their fundamental humanness. This finding underscores the importance of providing caring, individual support when working with victims of IPV, even though various cultures might perceive IPV differently. An ecological model for understanding the responses to IPV includes both individual and group perspectives related to IPV and the factors that influence the behavior of both women and men.

Applying the Principles of Significant Learning in the e-learning environment.

E-learning technologies in education use adult learning theories that view the educator as a facilitator of learning and an assessor of outcomes. The change to this technology requires a shift in the focus of a course from the educator to the subject. The experience of one faculty member involved in an implementation of an online program is used to demonstrate the application of Fink's principles of significant learning in the virtual environment. Fink urged faculty to create learning-centered courses, as opposed to content-centered courses. The taxonomy of six course components he proposed as necessary to significant learning are foundational knowledge, application, integration, human dimension, caring, and learning how to learn. Fink's taxonomy of significant learning can be used as a framework to focus course planning and assessment of student outcomes as courses are adapted to a Web-based environment.

Intimate partner violence: perceptions of Chuukese women.

PURPOSE: This qualitative study examined Chuukese women's views about Intimate Partner Violence (IPV). METHODS: Focus groups were conducted in Chuukese. Themes emerged from content analysis. RESULTS: Migration may disrupt protective cultural practices. Cultural norms place the responsibility for family peace on the women who perceive that IPV is closely linked with marital infidelity. IMPLICATIONS: Understanding cultural practices is important in addressing IPV.

Intimate partner violence: systematic review of literature focused on the cultures of Hawai'i.

Although research on intimate partner violence (IPV) categorizes populations broadly; there is great diversity within the broad categories of Asian and Pacific Islanders. This paper reviewed the literature published between 1996 and 2005 focused on the intersection of IPV and culture within specific cultures in the State of Hawai'i. The current research literature related to IPV against women and these specific populations is summarized.

Facilitating program and NCLEX-RN success in a generic BSN program.

This article focuses on a study of predictors of program and NCLEX-RN success and withdrawal in a generic BSN program at the University of Hawaii at Manoa School of Nursing. Data were collected over a 5-year period after a new curriculum was implemented. High program (95.09%) and NCLEX-RN (97.25%) success were achieved. Of the 11 who did not meet the definition of program success, 100% completed the program by another two to three semesters and 90.91% passed the NCLEX-RN as first-time takers. The program withdrawal rate was 20%. It is very important to use measures to promote program completion and NCLEX passing for both the normally progressing and at-risk student to meet the demands of the nursing shortage.

Finding solutions to challenges faced in community-based participatory research between academic and community organizations.

Partnerships between communities and academic institutions have been vital in addressing complex health and psychosocial issues faced by culturally diverse and hard-to-reach populations. Community-based participatory research (CBPR) has been suggested as a strategy to develop trust and build on the strengths of partners from various settings to address significant health issues, particularly those persistent health issues that reveal disparities among minority populations. There have been many challenges to developing these partnerships in the United States. The purpose of this paper is to discuss approaches and solutions used by this research team in response to the challenges they have faced in using CBPR. The team uses CBPR to understand and support the process of disclosure of intimate partner violence (IPV) within the context of the community health centers that provide services for multicultural and multi-lingual populations. While CBPR provides a route to develop trust and build on the strengths of partners from various settings, there are multiple challenges that arise when partnering organizations present with different infrastructures, missions, resources and populations served. Examples of common challenges and solutions from the literature and from the team's experience will be discussed. Implications for partners, partnerships, practice and research will be explored.

Legislative advocacy skills for baccalaureate nursing students.

One of the most effective ways for nurses to demonstrate professionalism is to be involved in public policy, advocating for issues of public interest that contribute to healthcare improvements. Faculty designed a program to provide nursing students an opportunity to develop legislative advocacy skills by serving as legislative interns. The authors describe the process by which the project was implemented.

Intimate-partner violence: a retrospective review of records in primary care settings.

PURPOSE: The goals of this study were (a) to gather data regarding the documentation of disclosure of battering in primary care settings and (b) to collect demographic data, including ethnicity, of women who disclose intimate partner violence (IPV) in primary care settings in Hawaii. DATA SOURCES: We conducted a retrospective chart review focusing on documentation of IPV in four community health centers on Oahu. The review included 337 charts. The data were analyzed using descriptive statistics. CONCLUSIONS: Of the 337 records reviewed, IPV was reported in 31 (9.1%). Documentation of reported IPV differed among members of the various ethnic groups seen in the clinics. IMPLICATIONS FOR PRACTICE: Practitioners should develop a common area for documenting reports of IPV. The level and depth of resources available within the setting and the community may affect providers' willingness to screen for IPV.