Tools for screening for interpersonal violence: state of the science.

In recent decades, the prevalence of abuse against women, older persons, and persons with disabilities has become a major public health problem. Health professionals, urged by their professional associations to universally screen these groups, have employed various tools in an effort to identify individuals in need of help. Yet many of the tools used widely in clinical settings have limitations in terms of empirical soundness. This article presents tools used to screen women, older persons, and persons with disabilities as well as data on the reliability and validity of these instruments. These properties and the resources needed to reduce harm are important factors to consider before implementing screening. The article concludes with a summary of the risk-benefit issues related to the use of these tools and universal screening in general.

Doctorate in nursing practice: a survey of massachusetts nurses.

Recently, the American Association of Colleges of Nursing (AACN) resolved that a new practice degree, the doctorate in nursing practice (DNP), is to become the terminal practice degree and minimum education standard for advanced practice nurses by the year 2015(American Association of Colleges of Nursing. (2004). AACN position statement on the practice doctorate in nursing. Retrieved July 1, 2007, from http://www.aacn.nche.edu.html). The DNP will have a clinical-intensive focus. Advanced practice nurses potentially impacted by this resolution will include nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists. A task force at the William F. Connell School of Nursing at Boston College conducted an electronic survey in 2006 in an attempt to understand nurses' thoughts about doctoral preparation and the interest of nurses in Massachusetts in pursuing doctoral study. A self-selected group of 376 nurses participated in the study. Nurses identified both positive and negative perceptions related to the degree's viability and practicality, with a majority (55%) preferring the DNP as an educational option.

Adapting and testing the Appraisal of Violent Situation scales.

The purpose of this study was to test the psychometric properties of a vertical version of horizontally oriented three Appraisal of Violent Situation scales that elicit women's subjective appraisals of severity, dangerousness, and controllability of violence. Construct validity of the vertical scale eliciting 64 abused women's perceptions of severity of violence experienced was supported by a low to modest correlation between that scale and the Severity of Violence Against Women Scale. Concurrent validity between the horizontal and vertical versions of the scales was demonstrated with a subsample of 26 abused women completing both. Results provide preliminary support for the revised scales.

Clinical wisdom: the essential foundation of "good" nursing care.

Clinical wisdom, an essential foundation of nursing care that provides for the "good" of individual patients while taking into account the common good, is a concept that is difficult to define and comprehend. However, understanding what constitutes clinical wisdom is essential for the education of the types of nurses who are most likely to provide leadership that is consistent with the goals of nursing as outlined in the 2005 Code of Ethics for Nurses of the International Council of Nurses and the 2001 Code of Ethics for Nurses With Interpretive Statements of the American Nurses Association. The three key elements of wisdom, derived from the psychology and philosophy literature, are (1) balancing and providing for the good of another and the common good, (2) the use of intellect and affect in problem solving, and (3) the demonstration of experience-based tacit knowing in problematic situations. We conceptualized clinical wisdom as a more specific variant of general wisdom by examining how the core elements described can be linked to wisdom for nursing practice. In doing so, the nature of clinical wisdom is clarified and strategies are suggested to assist nurse educators in developing wise nurses.

Stages of change-based nursing interventions for victims of interpersonal violence.

Recently, the health care system has become recognized as an important site for domestic violence programs. However, most of these programs focus on screening for violence. There is a need for conceptually based intervention strategies that provide help for victims once they are identified. The Transtheoretical Model of Change is useful in suggesting interventions that are consistent with the ways victims perceive their situations and take actions to end violence in their lives.

Birth outcomes and maternal morbidity in abused pregnant women with public versus private health insurance.

PURPOSE: To compare the effects of recent intimate partner abuse on maternal and infant health in publicly versus privately insured pregnant women. DESIGN: Exploratory descriptive analysis in 13 Massachusetts prenatal care sites from records of 2,052 women who had been screened during pregnancy for domestic violence. METHODS: Clinicians screened pregnant women for domestic violence using the Abuse Assessment Screen. After delivery, prenatal and birth outcome data and abuse screening results were extracted from medical records by project staff. Odds ratios were used to compare maternal and infant health indicators in abused and nonabused women. Data from women with public and private health insurance then were examined separately, using logistic regression to control for low education and single marital status while examining the odds of adverse maternal and infant outcomes in abused and nonabused women. FINDINGS: In the sample as a whole, recently abused women were more likely to be publicly insured and unmarried, to have less than 12 years of formal education, and to have medical and obstetrical complications. Parity, ethnic background, and infant birth outcomes did not differ in relation to abuse. In separate analyses for women with public and private health insurance, after controlling for marital status and education, abuse increased the odds of low infant Apgar scores, poor nutrition, hyperemesis, hypertension, and substance abuse in publicly insured women, and abuse increased the odds of poor nutrition and bleeding during pregnancy for privately insured women. CONCLUSIONS: The different correlates of abuse in publicly and privately insured women might be important for clinicians caring for these different populations. Screening for abuse and providing abuse-related services are indicated for pregnant women.