A continuous improvement process for health providers of victims of domestic violence.

BACKGROUND: Health care providers can play an important role in the prevention of domestic violence through established processes of identification, safety assessment, validation, documentation, and referral. In 1998 the Safe Family Project, funded by University Health System (UHS), affiliated with University of Texas Health Science Center at San Antonio, provided for a clinical review of existing services for victims of domestic violence. A subsequent review of the health system's policy and clinical practice supported the need for resources and training and for an improved care process for victims of domestic violence. THE CONTINUOUS IMPROVEMENT PROCESS (CIP) MODEL: UHS adapted the Shewhart cycle of activities popularly referred to as PDSA (plan change, do change, study results, act on results), a systematic, process-focused approach to achieving continuous and measurable improvement, as its CIP model, and it formed a process improvement team. This process led to translation of research findings into best practice guidelines for treatment of domestic violence and staff education. RESULTS: Significant improvements were made in the overall qualitative chart reviews, although the diagnostic coding (using ICD-9 codes and e-codes) did improve. The CIP can be replicated in other settings to improve the care of victims of domestic violence. DISCUSSION: The CIP effort is being extended to outpatient facilities, and managers have requested that the training manual be replicated and placed throughout UHS as a resource manual. Other activities are intended to improve prevention of domestic violence and intervention when it occurs.

Mexican and Mexican American women in a battered women's shelter: barriers to condom negotiation for HIV/AIDS prevention.

Anecdotal information suggests that, for Hispanic women who are involved with abusive partners, condom use request as an HIV/AIDS sexual risk-reduction behavior may expose the women to risk of both abuse and HIV/AIDS. A qualitative study explored barriers to condom negotiation for HIV/AIDS prevention among Mexican and Mexican American women in abusive relationships. A convenience sample of 14 Mexican and Mexican American women was recruited from a battered women's shelter. A demographic form, a domestic violence assessment form, and audiotaped responses to a semistructured interview guide were used to collect data. Descriptive statistics were used to describe the sample. Audiotaped interviews were transcribed verbatim and submitted to content analysis, which revealed past and present themes of physical, psychological, and sexual abuse of Mexican and Mexican American women who requested condom use by their male sexual partners. Also identified by content analysis was the influence of men's power on women's public, private, and sexual interactions.

Mental health assessment/mental status examination.

More than one-half of primary care patients have mental health symptoms or disorders. As health insurers are forced to cover mental disorders on parity with physical illness, the number of patients with mental health complaints will increase. Nurse practitioners must increase their skills in assessing, diagnosing, and treating mental disorders. This article provides a framework for mental health assessment, especially mental status examination. A method for improving mental health assessment skill is suggested.

The plight of American family caregivers: implications for nursing.

The author conducted a phenomenological study to learn about the caregiving experience. In sharing their stories, the caregivers (N = 10) reported common themes. The author discusses how psychiatric mental health nurses might become sensitive to the needs of caregivers and their families, how public policy is failing the American caregiver, and how nurses can become the caregiver's advocate.

A role supplementation group pilot study: a nursing therapy for potential parental caregivers.

This pilot study addressed the question: Will transition support for mid-life women during role transition into the caregiver or care manager role for their parents lead to role adaptation? A systematic sample of 30 women between the ages of 30 and 60 was drawn from a pool of employees of a large health science center in the Southwest; their mothers were also asked to volunteer as research subjects. A before-after group with random assignment design was used to determine the effects of a CNS-led support group on role adaptation of mid-life women during role transition. Role adaptation was measured by correlating the scores of mother and daughter pairs on the Brackley Concerns of Aging Scale. The level of depression as an indicator of role insufficiency was determined by score on Zung's Self-Rating Depression Scale. The independent variables were social support and the CNS-led group. A two-way analysis of covariance was calculated to test each hypothesis. Hypothesis 1, which predicted a decrease in role insufficiency following transitional nursing support, was rejected. Support was found for Hypothesis 2, which specified an increase in role adaptation following transitional nursing support. Alpha was set at p less than or equal to 0.05.

The health experience of single women who have children through artificial donor insemination.

Little is known about the health care needs of single women who decide to have children through artificial insemination. An exploratory qualitative research study was conducted to investigate this health experience. A case study design was used, consisting of two single women who had children through artificial donor insemination. Results suggested that the decision to have donor insemination was made after a lengthy process of considering multiple factors. The subjects' relationships and roles were affected, as were future goals and aspirations. Personal perspectives of self-enhancement were evident and feelings of aloneness and vulnerability. Health care needs that can be met by the clinical specialist were identified with emphasis on the decision counseling, direct care, educative, and leadership aspects of this nursing role. Directions for future research were proposed.

Nursing support of family caregivers.

The relationship between caregiver and elder is a unique one. It cannot be compared to a mother-infant dyad; there is no role reversal. Family caregiving is undertaken out of a sense of filial obligation on the family's part coupled with the needs of the elderly person. The relationship that emerges is based on the dependency of one adult on another and is functional for the family and for society at large. We need families to continue to care for their elderly members at home and families need us to insure their survival. We must constantly be aware that care needs increase over the years, whereas family resources do not. Nursing by its very nature is tied to insuring that families are given the guidance and assistance with which to meet these needs.