The implications of domestic violence for home care providers.

The effects of domestic violence are revealed in shelters for battered women, but with more emphasis on prevention, cues to violence may first be detected in home settings. The most common injury sites involve the upper body. Based on a 2-year record (N = 153) review at a shelter for battered women, prevalence of injuries, health conditions and substance use were examined. Most women (82%) reported injuries, and most had past injuries severe enough to require surgery or hospitalization. This article educates home care providers about the types of abuse they are likely to find in women from violent homes and their health implications.

An analysis of nurses' communications in a shelter setting.

The purpose of this study was to analyze written communications among nurses providing care to battered women and their children in a community shelter setting over a 1-year period of time. Interviews were conducted with the nurses to study the perceived effectiveness of the manual used to update daily shelter health operations, clients of concern, follow-up recommendations, or other ongoing issues. The unit of analysis was each entry recorded in the manual. The Communications Process Model guided the study (Budd, Thorp, & Donohew, 1967). Communications were transcribed and analyzed for categories of meaning from the data utilizing the Ethnograph software (Seidel & Clark, 1983). When content analysis was applied, 10 distinct categories emerged: (a) injury assessment, (b) acute condition assessment, (c) chronic condition assessment, (d) pregnancy assessment, (e) emergency assessment, (f) nursing care and procedures, (g) teaching and counseling, (h) community referrals and resources, (i) housekeeping, and (j) health program issues. From the categories, 3 primary themes were identified: nursing assessments, nursing interventions, and health program operations. The nurses were positive about using the manual for various communications. Nurses who consider working in shelter settings may find descriptions of the realities of practice and application of a working tool for communications useful. Shelter administrators and board members need to recognize the importance of having nurses on staff to address inevitable injuries and health concerns of battered women and their children. Researchers are encouraged to develop models that relate to care of clients and caregivers in this challenging practice setting.

Clients' evaluation of health care services in a battered women's shelter.

There is a dearth of evaluation research regarding shelter health care. Health needs outweigh health services which are rarities within shelter settings (Gross & Rosenberg, 1987). The purposes of this article are to review the need for shelter health care, describe how shelter-based advanced practice nurses (APNs) addressed health care needs and program goals in one shelter setting, and report findings from an impact evaluation study where APN services were rated by shelter clients (n = 69) for themselves and their children (n = 95). APNs have the ability to manage health care in shelter settings, but need to seek creative funding by documenting their worth. A 21-item evaluation survey was designed to measure components of health assessment and education provided to clients by APNs. Content and construct validity were addressed by a statistician and nursing experts, and the internal consistency reliability coefficient (Cronbach's alpha) was measured at .91. Results showed that clients (96.1%) identified strongly positive responses to health services provided with some weak areas detected. Implications include the need to continue programs that serve vulnerable populations in times of cutbacks. Measuring program effects via impact evaluation is recommended for services in process to monitor quality and to give impetus to funding opportunities.

Detecting abuse against women in the home.

Assault is the single major cause of injury to women. Between 1.8 and 4.0 million American women are abused in their homes each year. The perpetrator of domestic violence is usually male (95%), the victim usually female. Most domestic violence is a result of the learning and reinforcement of a power imbalance between partners. Home care providers are in a prime position to detect actual or potential abuse against women, but the dynamics of abuse often produce an artificial home atmosphere, with the occupants ill at ease with the home care provider. This makes detection more difficult. Although a direct inquiry about abuse is usually the best approach, both distinct and subtle signs of abuse can be detected by informed providers. Once physical abuse is detected, it is of paramount importance to select the most appropriate referrals, resources, and strategies to assist the woman in freeing herself of abuse. Emergency departments are recommended for immediate physical treatment, shelters for therapeutic and rehabilitative services.

Integrative review of effects on children of witnessing domestic violence.

The purpose of this study was to conduct an integrative review of research studies concerning the effects on children of witnessing domestic violence. Databases were selected from MEDLINE, CINAHL, Health, and PsychInfo. Inclusion criteria required primary research in refereed journals during the last two decades that focused on children who had witnessed domestic violence (n = 14 studies). A total of 912 children and their parents comprised the subjects of this review. General agreement existed in this literature that children from families with domestic violence tended to have more difficulties than children from nonviolent families. Multidisciplinary findings revealed that the effects of witnessing violence were serious, varied, and generally framed in emotional and behavioral manifestations. Implications of these effects for clinical nursing research are considerable and merit further study.

Partner abuse against female nursing students.

Although nurses may have the necessary skills to plan care of clients in a variety of settings, experience and research demonstrate that nursing interventions with women victims of violence have been consistently inadequate. Of the 243 nursing students included in this study, 8% reported experiencing physical abuse, and 18.9% reported experiencing nonphysical abuse. Difficulties with depression for 26.1% of the students and some level of clinical stress were reported in over half of the group. Specific needs to combat violence and abuse against nurses and nursing students include providing better information on such behavior by incorporating family-violence education into nursing-school curricula, and using this proactively in confronting domestic violence in home and work settings.

Risk identification of abused women participating in a women, infants, and children program.

Demographic characteristics, social and health risk factors, and responses to open-ended questions regarding health and abuse experiences were analyzed in a study of women participants in a Women, Infants, and Children supplemental food program at a mid-western county health department. Of the 400 respondents, 124 had experienced physical abuse according to the Partner Abuse Scale: Physical (PASPH) for determining physical abuse (Hudson, 1990). Quantitative and qualitative procedures were applied to the data. A trimmed model indicated that the best predictors of PASPH score were self-perceived abuse and number of medical/health conditions. Implications for service and program development include strategies for ongoing assessment, intervention, and evaluation to detect and to address physical and nonphysical assault. Epidemiological investigation and follow-up are recommended for health conditions discovered as prevalent in this population.

Health needs of school-age children in two midwestern counties.

Administrators, school nurses, and informed parents (N = 113) were queried by means of the Delphi Technique to determine priority health needs and barriers in two midwestern counties. Needs of health education and school nurses and barriers of restricted resources received top ranking by all participant groups. Descriptive measures were computed by using Kendall's tau.