A feasibility test of an online intervention to prevention dating violence in emerging adults.

Dating violence in emerging adults is a significant problem and few prevention programs based on the developmental needs of this age group have been developed. Our research team developed an online dating violence prevention program called WISER (Writing to Improve Self-in-Relationships) for emerging adults. The program is based on narrative therapy principles and uses structured writing techniques. A single group pre-post feasibility test of WISER was conducted with 14 college women. WISER was demonstrated to be feasible and acceptable and to show promise as an effective program to decrease dating violence in this population.

How older adults with multimorbidity manage their own care within a formal care coordination program?

As the number of older adults with multimorbidity increases, care coordination programs are being designed to streamline the complex care older adults receive from multiple providers by improving health and reducing unnecessary costs. Well-coordinated care requires actions by both patients and providers. Yet little attention is paid to the what older adults do to manage their own care alongside a formal Care Coordination Program (CCP). This paper presents a qualitative descriptive study that explored what actions older adults took on their own to manage their care. Findings from this study identified that there were two actions older adults took to manage their care; they lived within their limits and they lived with grit. This study suggests that by recognizing what older adults do to self-manage their care within the context of a CCP, nurses can build on older adults' actions and provide person-centered strategies for care coordination.

Use of a Systematic Consultation Process to Facilitate Nursing Research Projects: An Exemplar.

PURPOSE/OBJECTIVES: The purpose of this article is to describe the use of a well-established, 5-stage consultation process, to advise a research team on planning strategies to engage domestic violence shelters (DVSs) as community partners in their study. The research team is testing a health promotion intervention for teens living in shelters with their parent and needed to enlist shelters as sites to recruit teens and conduct the intervention. Consultation aims were to (a) identify highly promising strategies described in peer-reviewed literature for identifying, recruiting, and collaborating with community organizations in research and (b) identify DVSs that would potentially serve as effective community partners for the study. METHODS: A clinical nurse specialist and a public health master's degree student led the consultation. The consultation process included (a) a systematic review of 29 peer-reviewed articles about research or program evaluation studies that engaged community partners and (b) a comprehensive online search of information about DVSs. OUTCOMES: Consultants identified 104 strategies used in studies to engage community partners and 10 specific DVSs most likely to effectively engage in the study. CONCLUSION: Clinical nurse specialists are well situated to provide consultation to research teams and should follow well-established consultation processes and systematic data collection procedures.

Designing an Internet Intervention for Emerging Adults Who Experience Troubled Relationships.

This article describes how the Internet Intervention Model (IIM) was used as an organizing framework to design a theoretically based Internet intervention for emerging adults who experience troubled intimate partner relationships. In the design process, the team addressed six fundamental questions related to the several components of the IIM. Decisions made regarding the design of the intervention based on the six questions are described. We focus in particular on how the intervention is based on the Theory of Emerging Adulthood and the Theory of Narrative Identity.

Assessing Fidelity of a Community-Based Opioid Overdose Prevention Program: Modification of the Fidelity Checklist.

BACKGROUND: The evaluation and maintenance of treatment fidelity is an important methodological consideration in intervention research. Treatment fidelity is the degree to which interventions are delivered as outlined by the program developers. A lack of fidelity to the intervention model has the potential to be a large source of error, including type I and type II error. Monitoring and assuring fidelity is critical to assuring the validity of the interventions. The Fidelity Checklist is a reliable and valid tool designed to measure fidelity in a group-based parenting program. The Fidelity Checklist assesses group leaders' maintenance of the intervention protocol (adherence) and their group facilitation and process skills (competence). OBJECTIVES: The purpose of this article is to describe the systematic process of modifying the Fidelity Checklist for use in a community-based opioid overdose prevention group educational intervention. METHODS: A biphasic approach was used to modify the Fidelity Checklist. Phase 1 included engaging key stakeholders during a full-day meeting to determine adherence subscale components. Phase 2 included: (a) the modification of the competence subscale of the Fidelity Checklist, (b) adaptation of the coding manual defining the components of the Fidelity Checklist, and (c) creating a fidelity checklist to guide interventionists. RESULTS: The biphasic systematic modification approach resulted in a revised Fidelity Checklist that was successfully used to measure treatment fidelity in a community-based opioid overdose prevention program. CLINICAL RELEVANCE: The findings of this study provide information for nurse researchers and nurse educators for modifying a fidelity checklist that can be used to enhance community-based educational interventions.

Employment Maintenance and Intimate Partner Violence.

Intimate partner violence (IPV) is a major public health problem in the United States. Negative outcomes of IPV affect women's attainment and maintenance of employment. The purpose of this study was to develop a theoretical framework that described and explained the process by which women who have experienced IPV attain and maintain employment. Grounded theory methodology was used to analyze interviews of 34 women who had experienced IPV. Analysis suggested that women who had experienced IPV could attain employment; however, they had difficulty maintaining employment. Entanglement of work and IPV was experienced by all 34 participants because of the perpetrator controlling their appearance, sabotaging their work, interfering with their work, or controlling their finances. Some women described ways in which they disentangled work from IPV through a dynamic unraveling process, with periods of re-entanglement, resulting in job security and satisfaction.

Stimulating Research Interest and Ambitions in Undergraduate Nursing Students: The Research-Doctorate Pipeline Initiative.

BACKGROUND: Innovative strategies may support the Institute of Medicine's recommendation to increase the number of doctorally prepared nurses by 50% by 2020. Moreover, strategies implemented may increase the number and diversity of Doctor of Philosophy (PhD)-prepared nurses in particular. METHOD: The purpose of this article is to describe the approaches used by one college of nursing to enact a research-doctorate pipeline initiative to inspire a diverse pool of undergraduate students to consider pursuing a PhD degree. Principles that served as the foundation for this pipeline initiative are identified. RESULTS: Sixteen undergraduate students, with varying degrees of research interest, participated in this initiative. Students contributed an average of 35 hours as full members of research teams, and 94% completed the experience. Students with initial low interest in research reported enhanced interest after participation. Overall student experiences were positive and influenced future career plans. CONCLUSION: Lessons learned and future steps for the pipeline initiative are presented.

Unique Outcomes in the Narratives of Young Adults Who Experienced Dating Violence as Adolescents.

BACKGROUND: Narrative therapy, an approach based on the reauthoring of life narratives, may be a useful psychotherapeutic strategy for youth who have experienced dating violence. OBJECTIVE: A cornerstone of narrative therapy is the concept of unique outcomes, which are moments that stand in contrast to a client's otherwise problem-saturated narratives. The purpose of this study was to identify and categorize unique outcomes embedded in narratives about adolescent dating violence. DESIGN: Text units representing unique outcomes were extracted from transcripts of interviews with 88 young adults who had experienced dating violence and were categorized using standard content analytic techniques. RESULTS: Six categories of unique outcome stories were identified: facing-facts stories, standing-up-for-myself stories, cutting-it-off stories, cutting-'em-loose stories, getting-back-on-track stories, and changing-it-up stories. CONCLUSION: This typology of unique outcomes can inform clinicians who work with clients who have a history of adolescent dating violence.

Development of a regional nursing research partnership for academic and practice collaborations.

Background. Collaborative nursing research across academic and practice settings is imperative to generate knowledge to improve patient care. Models of academic/practice partnerships for nursing research are lacking. This paper reports data collected before and during a one-day retreat for nurse researchers and administrators from local universities and health care organizations designed to establish a regional nursing research partnership. Methods. Quantitative and qualitative methods were used to address the study aims: (1) to assess research involvement and institutional research resources; (2) to assess interest in and concerns regarding cross-institutional collaborations; and (3) to describe perceptions of the purpose of a partnership and resources needed to ensure success. Results. Participants (n = 49) had differing perceptions of accessibility to resources; participants in practice settings reported less accessibility to resources, notably grant development, informatics, and research assistant support. Participants were interested in collaboration although concerns about conflict of interest were expressed. Four themes related to partnering were identified: harnessing our nursing voice and identity; developing as researchers; staying connected; and positioning for a collaborative project. Conclusion. Academic-practice research collaborations will become increasingly important with health care system changes. Strategies to develop and sustain productive partnerships should be supported.

Breaking up is hard to do: how teens end violent dating relationships.

BACKGROUND: Dating violence affects nearly 30% of teens and is associated with numerous negative health outcomes. Teens do not tend to use adult or peer assistance to end violent dating relationships, and little is known about how they manage to end them. OBJECTIVE: The purpose of this study was to determine the common ways in which teens end violent dating relationships. DESIGN: Grounded theory methods were used to analyze transcribed interviews conducted with a community sample of 83 young adults who had experienced dating violence as teens. RESULTS: Participants described six ways of ending violent dating relationships: deciding enough is enough; becoming interested in someone else; being on again, off again; fading away; deciding it's best for us both; and moving away. CONCLUSIONS: Professionals working with teens can present the six ways of breaking up as a tool to initiate discussion about the issues involved in ending violent dating relationships.

Patterns of dating violence across adolescence.

Adolescent dating violence (ADV) is a prevalent social and health problem associated with a number of adolescent risk behaviors and negative outcomes. The purpose of this study was to identify patterns of dating violence across adolescence. We used cross-case analysis to analyze interviews with 88 young adults (men and women aged 18 to 21) who were involved in violent dating relationships as teens. We identified four patterns of dating violence throughout adolescence. We also identified two patterns for adolescents who had only one violent relationship based on the length of the relationship-contained ADV and prolonged ADV-and two patterns for those who had multiple violent relationships based on the level of violence severity-repetitive ADV and escalating ADV. Knowledge of these four patterns can be used to guide therapeutic interactions with teens and to develop pattern-specific prevention and intervention strategies.

Altruism in survivors of sexual violence: the typology of helping others.

BACKGROUND: Sexual violence is a significant and prevalent problem that affects many people in the United States. Helping others is one way people cope with, or heal from, sexual violence. OBJECTIVE: To develop of Typology of Helping Others describing how survivors of sexual violence engage in altruism. STUDY DESIGN: Qualitative descriptive methods were used to describe how survivors of sexual violence engaged in altruism in response to their experiences with violence. RESULTS: Helping others was a salient concern for most participants who experienced sexual violence. Participants indicated multiple and varied ways of helping others. Results also indicated that participants experienced some healing from their experiences before they were able to actively engage in, or be effective in, helping others. CONCLUSIONS: Clinicians working with survivors of sexual violence should be attuned to the different ways survivors engage in altruism and the potential influences of race and gender on helping others.

Adolescent dating violence and Peplau's dimensions of the self.

BACKGROUND: Adolescent dating violence (ADV) is a significant public health problem. Despite an association between ADV and lowered self-esteem, little research has examined identity issues in persons who have experienced ADV. OBJECTIVES: To use Peplau's model of the dimensions of the self to describe identity concerns in those who experienced ADV. DESIGN: Verbatim comments that met Peplau's definitions of self-statements were extracted from the narratives of 50 young adults who had taken part in an ongoing qualitative study on ADV. The statements were coded into Peplau's dimensions using content analysis. RESULTS: 175 verbatim sentences were extracted from the narratives. The statements addressed 16 different personal characteristics, including strength, sociability, and aggressiveness. CONCLUSIONS: Individuals who have experienced ADV have a number of concerns related to self-concept. Recommendations are made regarding how these concerns may be addressed with investigative counseling, as described by Peplau.

Listening to the voices of important others: how adolescents make sense of troubled dating relationships.

Nearly one third of adolescents experience dating relationship maltreatment. Grounded theory methods were used to explicate a typology of ways by which adolescents incorporate views of others in making sense of their troubled dating relationships. Interviews with 90 young adults (ages 18-21 years) who had troubled adolescent dating relationships were analyzed using constant comparative techniques. A typology of ways in which adolescents "listen to the voices of important others" emerged. The six ways were "preventing challenging voices of important others," "deflecting irksome voices of important others," "succumbing to demanding voices of important others," "soliciting confirming voices of important others," "considering cautionary voices of important others," and "heeding knowing voices of important others." Professionals can use this model when deciding how to offer input about troubled adolescent dating relationships.

Proximal antecedents to violent events in adolescent dating relationships.

Dating violence affects 25-60% of adolescents. This study developed a typology of proximal antecedents to violent events in adolescent dating relationships. Descriptions of 307 dating violence events were extracted from transcribed interviews with 87 young adults who experienced dating violence as adolescents. Verbatim text preceding the description of each violent event was identified as a proximal antecedent. Cross-case analysis was used to develop a typology of five antecedent categories: "pulling away,"  "demanding obedience," "discovering involvement with a rival," "defining the relationship," "demonstrating disrespect." Practitioners can use this typology to engage teens in discussions of factors that precede dating violence events.

Healing from childhood sexual abuse: a theoretical model.

Childhood sexual abuse is a prevalent social and health care problem. The processes by which individuals heal from childhood sexual abuse are not clearly understood. The purpose of this study was to develop a theoretical model to describe how adults heal from childhood sexual abuse. Community recruitment for an ongoing broader project on sexual violence throughout the lifespan, referred to as the Sexual Violence Study, yielded a subsample of 48 women and 47 men who had experienced childhood sexual abuse. During semistructured, open-ended interviews, they were asked to describe their experiences with healing from childhood sexual abuse and other victimization throughout their lives. Constructivist grounded theory methods were used with these data to develop constructs and hypotheses about healing. For the Sexual Violence Study, frameworks were developed to describe the participants' life patterns, parenting experiences, disclosures about sexual violence, spirituality, and altruism. Several analytic techniques were used to synthesize the findings of these frameworks to develop an overarching theoretical model that describes healing from childhood sexual abuse. The model includes four stages of healing, five domains of functioning, and six enabling factors that facilitate movement from one stage to the next. The findings indicate that healing is a complex and dynamic trajectory. The model can be used to alert clinicians to a variety of processes and enabling factors that facilitate healing in several domains and to guide discussions on important issues related to healing from childhood sexual abuse.

The role of electronic communication technology in adolescent dating violence.

PROBLEM: Adolescent dating violence and electronic aggression are significant public health problems. The purpose of this study was to (a) identify ways in which technology is used in dating violence and (b) present examples of dating violence in which electronic aggression played a salient role. METHODS: The data set included the transcribed narratives of 56 young adults who had described their adolescent dating violence experiences for an on going study. FINDINGS: Eight ways in which technology is used in dating violence were identified using qualitative descriptive methods. CONCLUSIONS: The findings indicate that electronic communication technology influences dating violence by redefining boundaries between dating partners.

A Meta-Summary of Qualitative Findings about Professional Services for Survivors of Sexual Violence.

Sexual violence occurs at alarming rates in children and adults. Survivors experience myriad negative health outcomes and legal problems, which place them in need of professional services. A meta-summary was conducted of 31 published qualitative studies on adults' responses to sexual violence, with a focus on survivors' use of professional services. Combined samples included 46 men, 984 women, and six couples who had experienced sexual violence at any point in their lives. Findings indicated that qualities of professional service providers and outcomes of professional services were perceived either positively or negatively (rather than neutrally) by survivors, regardless of the provider's professional discipline. Professionals who work with sexual violence survivors can use these findings to improve their practices.

Attributes of Spirituality Described by Survivors of Sexual Violence.

This study focuses on what aspects of attributes of spirituality as defined by Martsolf and Mickley (1998) are most salient for female and male survivors of sexual violence. Content analysis of secondary narrative data, provided by 50 participants in a study of women's and men's responses to sexual violence, was coded to the five attributes of spirituality as defined by Martsolf and Mickley. The attribute aspects of connecting with others in spiritual ways and with God/higher power were particularly significant. The attribute of transcendence was found less important, and the attributes of value, becoming, and meaning were not found important. The Martsolf and Mickley framework helped organize narrative data for a content analysis of spirituality in survivors of sexual violence.