Implementation of a STI risk behavior reduction program for university students.

Objective To implement a STI risk behavior reduction program to reduce sexual risk behaviors in university-aged students. Participants Fifty-nine freshman from the university participated in the STI Risk Behavior Reduction program. Methods Pre- and post-test design using descriptive statistics evaluated the STI Risk Behavior Reduction Program. Results The majority of participants were 19 years of age, female, and freshman. Condom use as a pregnancy prevention increased from 18 (before intervention) to 23 participants (after intervention). Retrospective data noted 72 referrals the year before implementation whereas, 148 referrals were made after implementation. Conclusions An increase in referrals to community centers and condom usage was noted after the STI Risk Behavior Reduction Program. This may have been due to the increase in knowledge of risky sexual behaviors and when seeking treatment early by recognizing the signs of sexual transmitted infections.

Strategies to Successfully Implement an Eat, Sleep, Console Protocol.

ABSTRACT: Neonatal opioid withdrawal syndrome is pervasive, reflected in a case rate increase among most demographics in the United States from 4.0 newborns per 1,000 hospitalized births in 2010 to 7.3 newborns per 1,000 hospitalized births in 2017. Historically, assessments have been based on present symptomatology, excluding the mother's input, and increasing the likelihood of pharmacotherapy. The Eat, Sleep, Console approach provides an opportunity for the mother to act as the treatment for her newborn as she performs nonpharmacologic interventions that reduce withdrawal severity. Maternal confidence to help her newborn grows with this level of involvement and mother/infant dyad care improves, as do nurse and mother interactions. Assessments are less subjective and less time-consuming for nurses to conduct than those of the often-used Finnegan tool, and are conducted in collaboration with the mother. Facilities implementing this approach have seen a reduction in newborn hospital length of stay, pharmacotherapy, associated medical costs, and improved breastfeeding rates. Implementing an Eat, Sleep, Console protocol involves a stepwise approach to ensure all stakeholders are effectively prepared for the transition. We present strategies to implement an Eat, Sleep, and Console clinical protocol. A stepwise approach to implementation along with a clinical nursing maternal education protocol exemplar is included. Methods to overcome barriers to implementation and recommendations for further development are discussed.

Evidence-Based Practice Model to Increase Human Papillomavirus Vaccine Uptake: A Stepwise Approach.

OBJECTIVE: To increase uptake of human papillomavirus (HPV) vaccination by implementing a stepwise evidence-based practice model to offer HPV education along with a strong provider recommendation to parents of youth and adolescents. DESIGN: Evidence-based practice change model. SETTING: A nurse practitioner-run, primary care walk-in clinic in a rural area of the southeastern United States. PARTICIPANTS: Parents of youth and adolescents ages 11 to 17 years. INTERVENTIONS/MEASUREMENTS: Education targeting parental hesitancy and strong recommendations for immunization was administered by health care providers to parents of youth and adolescents eligible for vaccination. The Parent Attitudes About Childhood Vaccine instrument was used to identify the presence and degree of parental hesitancy. Vaccination uptake was measured and compared to the same time period from the previous year. RESULTS: Data collected from the clinic vaccination log during the same 6-week time period in 2018 identified that four youth/adolescents were vaccinated with the HPV vaccine in 2018. During the same 6-week period in 2019 when the practice change was implemented, 38 parents were approached; 24 met eligibility criteria, and all 24 of their youth/adolescents received HPV vaccination. CONCLUSION: Implementation of an evidence-based practice model that includes standing vaccine orders and reminders and recalls may provide an effective way to ensure completion of the HPV vaccine series. Every missed clinical opportunity to vaccinate youth and adolescents against HPV can contribute to lower vaccination rates and increased risk for genital warts and cancers associated with HPV infection.

Obstetrician-gynecologist and patient factors associated with intimate partner violence screening in a clinical setting.

Screening for intimate partner violence is recommended by the medical community. This study investigated obstetrician-gynecologists' intimate partner violence screening patterns and physician and patient factors associated with screening. Four hundred obstetricians-gynecologists completed the Physician Readiness to Manage Intimate Partner Violence Survey between December 2014 and July 2015. Their patients completed the Patient Safety and Satisfaction Survey. Hierarchical generalized linear modeling analyzed physician and patient variables related to the likelihood of being screened. Forty-four physicians responded. The viable patient response rate was 81.3 percent (n = 894) of patients from included physicians. Less than half (43.2 percent) of physicians reported screening during annual exams. There was a statistically significant difference for patient race/ethnicity (p < .03) and the number of previous doctor visits (p < .03) with not being screened. These patient-level variables accounted for approximately 68.3 percent of the variance screening odds. There was no significant difference (p < .10) between physicians' perceived preparation, knowledge, and attitudes for not being screened. The hierarchical generalized linear modeling analysis showed a trend for physicians with a high-perceived preparation for screening was related to initial visits. This study identified that obstetrician-gynecologists do not routinely screen for IPV and race/ethnicity and number of visits are factors in screening for intimate partner violence.

Implementation of an intimate partner violence screening program in a university health care clinic.

Objectives: To examine whether an intimate partner violence (IPV) screening program is related to a positive change in health care providers' knowledge, attitudes, and self-efficacy of IPV screening. Participants: Eleven health care providers at a university health care clinic participated in the IPV screening program. Methods: A one-group pretest-posttest design was used to examine whether an IPV screening program was related to a change in health care providers' knowledge, attitudes, and self-efficacy of IPV screening. Results: Findings indicated that there was a significant difference (p < 000) between the posttest scores and the pretest scores on the Domestic Violence Healthcare Provider Survey Scale. Domain analysis of the scale revealed a significant difference in perceived self-efficacy (p = .001), system support (p = <.002), victim provider safety (p = .015), and beliefs of blaming victims (p = <.004). No statistical difference was found in professional role resistance/fear of offending (p = .158). Conclusions: A university health care clinic IPV screening program was related to a positive change in health care providers' knowledge, attitudes, and self-efficacy of IPV screening.

Incivility in nursing: Implementing a quality improvement program utilizing cognitive rehearsal training.

BACKGROUND: Workplace incivility can be a factor in unhealthy work environments. Addressing unit culture improves job satisfaction and organizational commitment. AIM: The purpose of this quality improvement program was to educate nurses to identify and respond to hospital incivility. SETTING: A community hospital in the Northeastern United States. Participants-A convenience sample of nurses. METHODS: A quality improvement program was conducted, which included an incivility education module and cognitive rehearsal training. The nursing incivility scale (NIS) was used to evaluate the effectiveness of the educational module. Participants completed the NIS before, immediately after, and 1 month after the program. Cognitive rehearsal training included role playing using scripted responses to uncivil behavior. RESULTS: A one-way repeated measures analysis of variance was conducted to compare total score and eight subscale scores on the NIS before, after, and 1 month after implementation of the intervention. There was a statistically significant difference for effect of total time as well as for five of the eight subscales. CONCLUSIONS: Incivility programs can provide nurses with the needed tools to identify uncivil behaviors and react in a proactive, professional manner; this promotes a safe working environment for nurses and their patients.

Association Development and Professional Transformation model for nurse leaders.

AIMS: This pilot study evaluated an Association Development and Professional Transformation (ADAPT) model for nursing leadership development and assessed satisfaction with the ADAPT workshop. BACKGROUND: Nurses often lack self-confidence and self-efficacy in leadership roles. There is a need for nurses to take leadership opportunities that serve to advance the nursing profession. METHODS: A quasi-experimental pre-test post-test design was used. The sampling method selected professional nursing association (PNA) members. Novice participants completed a pre-assessment and post-assessment Leadership Practice Inventory-Self (LPI-S) survey and attended the ADAPT workshop. Experienced nurse leaders participated as mentors. Both groups completed a satisfaction survey after the workshop. RESULTS: Awareness of nursing leadership behaviours increased. Total mean scores for each subscale on the LPI-S increased but this was not statistically significant. All participants reported satisfaction with the ADAPT workshop. CONCLUSIONS: This study offers evidence that the ADAPT model influences leadership behaviours. The ADAPT workshop provided a method to gain a leadership perspective and to encourage nurses to fulfil a leadership role within professional nursing associations. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations and professional nursing associations that support the leadership potential of nurses must invest in providing leadership development opportunities.

The PRO leader model.

A transformative approach to influence change.

Continued Intimate Partner Violence During Pregnancy and After Birth and Its Effect on Child Functioning.

OBJECTIVE: To investigate the effect of intimate partner violence (IPV) during pregnancy with continued IPV up to 6 months after birth and its effect on child functioning. DESIGN: Nonexperimental descriptive design. SETTING: Safe shelters and the District Attorney's office in a large urban community in the United States. PARTICIPANTS: Abused women (N = 284) who reported IPV and reached out for services. METHODS: Abused women who reported IPV answered a questionnaire on the effects of abuse during pregnancy and continued abuse after birth and child behaviors. Women who continued to experience abuse during pregnancy were compared with women who did not report abuse during pregnancy and after birth. The Achenback Child Behavior Checklist was used to evaluate child behavior. Research questions were analyzed through the use of nonparametric analyses. RESULTS: Between the two groups, the relationship between IPV during pregnancy and IPV during the first 6 months after birth was significant (p < .001). The relation between women who reported abuse during pregnancy and conception rape was significant (p < .001). Most abused women (76%) were not screened for IPV during pregnancy (p = .025). Significant findings related to child behaviors and IPV during pregnancy were found for internalizing behaviors (p < .009), externalizing behaviors (p < .001), and total behavioral problems (p < .001). CONCLUSION: Intimate partner violence during pregnancy increases the risk of IPV 6 months after birth. These findings also indicated a negative intergenerational effect of IPV during pregnancy on child behavior. Screening for IPV during pregnancy is vital to interrupt ongoing IPV and possible negative outcomes for mother and child.

Interrupting Intimate Partner Violence During Pregnancy With an Effective Screening and Assessment Program.

Intimate partner violence is a public health problem that affects many women during pregnancy and can compromise the health and safety of mothers and infants. Identification and routine assessment of intimate partner violence during pregnancy is essential, and health care providers must be afforded training and resources that support an effective screening and assessment program. The essential components of an intimate partner violence assessment program for women who are abused during pregnancy are explored.

Women's functioning following an intervention for partner violence: new knowledge for clinical practice from a 7-year study.

Intimate partner violence affects one in three women worldwide, with women who experience violence almost twice as likely to experience poor mental health, especially depression, compared with women who are not abused. To learn the impact of interventions of safe shelter and justice services on improved mental health and behavior functioning, 300 abused women are interviewed every 4 months in a 7-year prospective study. For this paper, abuse, mental health and resiliency status of these women, 1 year after accessing services for the first time, are reported. Measures of mental health (depression, anxiety, post-traumatic stress disorder (PTSD), somatization), and adult behavioral functioning are reported. At 4 months following a shelter stay or justice services, a large effect size was measured for improvement in all mental health measures; however, improvement was the lowest for PTSD. All mental health measures plateaued at 4 months with minimum further improvement at 12 months. Both internal behavioral dysfunctions (withdrawal and somatic complaints) were worse with increased depressive symptoms, as were external behavioral dysfunctions (aggressive and rule-breaking behaviors). A concerning 39.2% of the women had clinical PTSD scores at 12 months following receipt of safe shelter or justice services, compared with a much lower percentage of women with clinical depression (14.2%), clinical somatization (9.4%), and clinical anxiety (13.5%). Depression was a significant positive predictor of internal and external behavioral dysfunctions, indicating that women who had higher levels of depression tended to report more internal dysfunctions (withdrawal, anxiety, somatization) and more external behaviors (aggression and rule-breaking).

Effect of abuse during pregnancy on maternal and child safety and functioning for 24 months after delivery.

OBJECTIVE: To evaluate the long-term safety and functioning outcomes for abused women reporting abuse during pregnancy and their children's behavior compared with abused women who do not report abuse during pregnancy. METHODS: Forty-six abused women seeking assistance for partner abuse and reporting being pregnant during the preceding 4 months were evaluated every 4 months for 24 months to compare levels of abuse, danger for murder, anxiety, depression, somatization, and posttraumatic stress disorder (PTSD) for abused women who report abuse during pregnancy (n=24) compared with abused women reporting abuse only outside of pregnancy (n=22). Internalizing and externalizing behavior scores were evaluated for the children. RESULTS: At entry into the study, abused women reporting abuse during pregnancy reported significantly greater (P<.05) threats of abuse, sexual abuse, physical abuse, danger for murder, and PTSD compared with abused women not reporting abuse during pregnancy. Effect sizes were large. When evaluated over the course of 24 months after delivery, risk for murder remained higher for women reporting abuse during pregnancy for 8 months after delivery, depression was higher at 4, 8, 16, and 20 months after delivery, and PTSD was appreciably higher for 24 months. Children living with mothers abused during pregnancy displayed more behavioral problems for the entire 24-month period, especially problems of depression and anxiety. CONCLUSION: The study documents the negative safety and function effects of abuse in pregnant women that remain for at least 24 months after delivery. This warrants incorporating abuse screening during the antenatal and postdelivery periods and a protocol of care during the antenatal period and beyond.

Functioning outcomes for abused immigrant women and their children 4 months after initiating intervention.

OBJECTIVE: To measure the impact of shelter intervention and protection orders on the mental health functioning, resiliency, and further abuse of documented and undocumented immigrant women and their children in Houston, Texas, United States. METHODS: A prospective cohort study initiated in 2011 examined a subsample of 106 immigrant mothers, primarily from Mexico and Central America, and evaluated their functioning with a battery of 13 well-established instruments as they accessed either shelter or justice services; followed-up was conducted 4 months later to measure improvement. Data were analyzed with a series of repeated measures 2 x 2 x 2 factorial analysis of variance tests. RESULTS: Large effect size improvements were observed in abused immigrant women's mental health, resiliency, and safety, regardless of whether the intervention accessed was safe shelter or justice services, and regardless of duration of shelter stay and whether or not a protection order was issued. Similarly, large effect size improvements were observed in child functioning, independent of which type of intervention, the duration of shelter stay, or the issuance of a protection order. CONCLUSIONS: Accessing protective services has the potential to improve the health of immigrant women and their children, regardless of documentation status. Global policy for improved access and acceptability of shelter and justice services is essential to promote immigrant women's safety and to maximize functioning of women and children.

Rapid assessment to identify and quantify the risk of intimate partner violence during pregnancy.

BACKGROUND: Abuse during pregnancy is common and affects upwards of one in six pregnant women worldwide. The objective of this study is to describe the demographics, frequency, and severity of abuse, and the risk of murder for women who report abuse during pregnancy compared with women who do not report abuse. METHODS: A total of 300 women seeking assistance for partner abuse were recruited to participate in a 7-year prospective study. Of the 300 women, 50 reported they had been pregnant within the last 4 months; 25 of the women (50%) reported they were "beaten" during the pregnancy; and 25 women (50%) reported they had not been "beaten." Analysis was completed on differential severity for abuse and risk for murder between the two groups. RESULTS: Women reporting abuse during pregnancy had statistically significant (p < 0.001) higher scores for Threat of abuse, F(1, 49) = 14.37, p < 0.001; Physical abuse, F(1, 49) = 21.21, p < 0.001; and Danger for murder weighted F(1, 49) = 22.99, p < 0.001. All effects sizes were large. CONCLUSION: Women abused during pregnancy are at greater risk for further abuse and in severe danger for murder. To ensure the safety of pregnant women, screening policies are essential.

Functioning outcomes for abused immigrant women and their children 4 months after initiating intervention / Resultados en cuanto al desempeño de mujeres inmigrantes maltratadas y sus hijos, 4 meses después de iniciada una intervención

OBJECTIVE: To measure the impact of shelter intervention and protection orders on the mental health functioning, resiliency, and further abuse of documented and undocumented immigrant women and their children in Houston, Texas, United States. METHODS: A prospective cohort study initiated in 2011 examined a subsample of 106 immigrant mothers, primarily from Mexico and Central America, and evaluated their functioning with a battery of 13 well-established instruments as they accessed either shelter or justice services; followed-up was conducted 4 months later to measure improvement. Data were analyzed with a series of repeated measures 2 x 2 x 2 factorial analysis of variance tests. RESULTS: Large effect size improvements were observed in abused immigrant women’s mental health, resiliency, and safety, regardless of whether the intervention accessed was safe shelter or justice services, and regardless of duration of shelter stay and whether or not a protection order was issued. Similarly, large effect size improvements were observed in child functioning, independent of which type of intervention, the duration of shelter stay, or the issuance of a protection order. CONCLUSIONS: Accessing protective services has the potential to improve the health of immigrant women and their children, regardless of documentation status. Global policy for improved access and acceptability of shelter and justice services is essential to promote immigrant women’s safety and to maximize functioning of women and children.

OBJETIVO: Determinar la repercusión de la intervención de albergue y las órdenes de protección sobre el desempeño en cuanto a la salud mental, la resiliencia y el maltrato adicional de mujeres inmigrantes, documentadas e indocumentadas, y sus hijos, en Houston, Texas, Estados Unidos. MÉTODOS: En un estudio prospectivo de cohortes iniciado en el 2011, se examinó una submuestra de 106 madres inmigrantes, procedentes principalmente de México y Centroamérica, y se evaluó su desempeño mediante una serie de 13 instrumentos bien establecidos cuando accedían a los servicios de albergue o de justicia; cuatro meses después, se llevó a cabo su seguimiento con objeto de medir el grado de mejora. Los datos fueron analizados mediante pruebas de análisis de la varianza, con una serie de mediciones repetidas, según un diseño factorial 2 x 2 x 2. RESULTADOS: Se observaron mejoras de gran magnitud de efecto sobre la salud mental, la resiliencia y la seguridad de las mujeres inmigrantes maltratadas, independientemente de si la intervención correspondía a un albergue seguro o a servicios de justicia, e independientemente del tiempo de permanencia en el albergue y de la expedición de una orden de protección. De manera análoga, se observaron mejoras de gran magnitud de efecto sobre el desempeño de los niños, independiente del tipo de intervención, el tiempo de permanencia en el albergue o la expedición de una orden de protección. CONCLUSIONES: El acceso a los servicios de protección puede mejorar la salud de las mujeres inmigrantes y sus hijos, independientemente de su situación en cuanto a documentación. Resulta esencial el establecimiento de una política mundial dirigida a mejorar el acceso y la aceptabilidad de los servicios de albergue y de justicia para promover la seguridad de las mujeres inmigrantes y potenciar al máximo su desempeño y el de sus hijos.

A practical approach to labor support.

In the United States, intrapartum nurses are present at 99% of births. These nurses have a unique opportunity to positively affect a laboring woman's comfort and labor progress through the use of labor support behaviors. These nonpharmacologic nursing strategies fall into four categories: physical, emotional, instructional/informational, and advocacy. Implementation of these strategies requires special knowledge and a commitment to the enhanced physical and emotional comfort of laboring women.