A model for trauma-informed primary care.

Childhood trauma has been associated with negative health behaviors and conditions in adulthood. However, few primary care providers screen for trauma or alter their care to accommodate the multiple effects of trauma on patient health. The purposes of this article were to discuss the health consequences of childhood trauma and to offer a model for trauma-informed primary care (TIPC). The TIPC model provides a guide for primary care providers to screen for adverse childhood experiences and personalize the care of patients with a history of childhood trauma. The model, based on the trauma-informed care model used in mental health, has five components: (a) screening and trauma recognition, (b) understanding the health effects of trauma, (c) patient-centered communication and care, (d) emphasis on emotional safety and avoiding triggers, and (e) knowledge of helpful treatment for trauma patients. The TIPC model offers a theoretical underpinning for improving the care, health care experiences, and health outcomes for patients with a history of childhood trauma.

Health Care of Sexual Minority Women.

Sexual minority women may be invisible in health care settings unless practitioners ask every patient about sexual attractions/behaviors and identity. Sexual minority women need to feel comfortable and able to share information about their sexual identity, partners, and lives. No medical diagnoses are found more commonly in sexual minority women, but problems such as overweight/obesity, increased tobacco and alcohol use, increased mental health problems, and a past history of childhood sexual abuse are common. These factors intertwine when treating sexual minority women.

Nurse practitioner screening for childhood adversity among adult primary care patients: A mixed-method study.

BACKGROUND AND PURPOSE: Researchers have demonstrated an association between experiencing childhood abuse and multiple chronic health conditions in adulthood, yet this evidence has not been routinely translated to practice. The purpose of this research study was to examine nurse practitioner (NP) practices, skills, attitudes, and perceived barriers associated with screening adult patients for childhood abuse to determine the extent to which evidence of the association between childhood abuse and negative health outcomes has been translated to NP practice. METHODS: A mixed-method approach with web-based questionnaires and online focus groups was used to examine NP screening for histories of childhood abuse. CONCLUSIONS: A total of 188 complete NP surveys were analyzed along with data from focus groups with 12 NPs. One third of the NPs regularly screened for childhood abuse and believed screening was their responsibility. Six barriers, including insufficient time and lack of confidence when inquiring about abuse, were significantly associated with NP screening practices. The focus group participants discussed how and when one should ask about childhood abuse, and the need for education about screening. IMPLICATIONS FOR PRACTICE: Time constraints and NPs' lack of confidence in their ability to screen for histories of childhood abuse must be addressed to encourage routine screening in primary care practice.

Resilience Intervention for Young Adults With Adverse Childhood Experiences.

BACKGROUND: Adverse childhood experiences (ACEs) are correlated with risk behaviors of smoking, disordered eating, and alcohol and substance abuse. Such behaviors can lead to significant public health problems of chronic obstructive pulmonary disease, obesity, liver disease, and hypertension, yet some individuals do not appear to suffer negative consequences but rather bounce back. OBJECTIVE: To pilot the feasibility and potential efficacy of the Empower Resilience Intervention to build capacity by increasing resilience and health behaviors and decreasing symptoms and negative health behaviors with young adults in an educational setting who have had ACEs. DESIGN: A two-group pre-post repeated measures design to compare symptoms, health behaviors, and resilience and written participant responses. RESULTS: There was a statistically significant cohort by time interaction for physical activity in the intervention group. There was no significant change in risk behaviors or resilience score by cohort. Young adults in the intervention group reported building strengths, reframing resilience, and creating support connections. CONCLUSIONS: An increase in health behavior is theoretically consistent with this strengths-based intervention. Evaluating this intervention with a larger sample is important. Interrupting the ACE to illness trajectory is complex. This short-term empower resilience intervention, however, holds promise as an opportunity to reconsider the negative effects of the trauma of the past and build on strengths to develop a preferred future.

Lateral violence in nursing: a review of the past three decades.

The author of this article reviews the literature on lateral violence in nursing. This concept was first discussed over three decades ago. Bullying and incivility are concepts similar to lateral violence that have become increasingly utilized in nursing research and scholarly writing. The research on these concepts suggests that the behavior still exists in the nursing workplace, and that few interventions have been developed to change the behaviors or the power dynamics that cause them. Suggestions are included to change practice and scholarship in this area.

Faculty roles: dilemmas for the future of nursing education.

METHODS: Literature review and analysis. FINDINGS: Recent reports emphasized the need for the development of nursing classroom education that is more rigorous and coordinated with clinical experiences. Faculty roles in research universities in nursing have increased the number of clinical and part-time faculties, and have increased the requirements for funded research for tenure-track faculty over the last decade. These changes have led to various groups of faculty with different roles and responsibilities, some of whom teach a great deal and others who teach very little. CONCLUSIONS: This article reviews the development of these faculty roles and reviews the dilemmas that they present for the future of nursing education.

The development of the Nurse Workplace Scale: self-advocating behaviors and beliefs in the professional workplace.

AIM: This project developed and tested the Nurse Workplace Scale (NWS) using data from a random sample of registered nurses in Massachusetts (n = 904). The NWS was adapted from an earlier checklist that measured group behaviors and beliefs in the workplace of a variety of nurses. BACKGROUND: Nurses have been thought to display non-self-advocating behaviors and beliefs that have contributed to disempowering their contribution in health care systems, but no tool has been available to assist nurse managers or clinical nurse leaders to test outcomes that measure progress toward changing these behaviors. METHOD: A cross-validation procedure was used to establish the reliability and validity of the NWS to measure behaviors in nurses that are counterproductive in the workplace. RESULTS: Two components, "internalized sexism" and "minimization of self" behaviors, were established. Scores on the scales were shown to vary with the age and practice settings of the nurses. CONCLUSIONS: The NWS can be used in professional development settings and nurse workplace intervention studies to measure outcomes congruent with nurse empowerment.

Health care recommendations for lesbian women.

OBJECTIVE: To review research literature to provide clinicians with data-based recommendations for care of lesbians. DATA SOURCES: Medline searches and references from selected articles with the search term "lesbian health." STUDY SELECTION: Literature was selected whether lesbian or women who have sex with women was utilized as a category in the study and results were available on this population. DATA EXTRACTION: Data were organized according to specific health problems noted frequently in the research articles. DATA SYNTHESIS: Lesbians have previously been invisible in health services and research, but in several areas, data now exists on which to base care. CONCLUSIONS: Lesbians are now more comfortable "coming out" to providers but continue to have lower screening rates than other women. Risk is especially high in this population for cancer, heart disease, depression, and alcohol abuse. Adolescent lesbians are especially at risk for smoking and suicide/depression.

The use of a writing group to enhance voice and connection among staff nurses.

The aim of this study was to pilot test a group-writing intervention to decrease negative workplace behaviors. The pilot test demonstrated that cohesive and supportive relationships developed and allowed nurses to talk about important topics. The participants suggested that a writing group would be a forum that could be used by staff development educators to encourage nurses to support each other and develop their voices.

Empowering older women: strategies to enhance their health and health care.

Older persons, especially older women, report that often their needs are not met in health care encounters. Lack of active participation by the patient is a major reason for this dissatisfaction. This article reviews research on older women's socialization that discourages them from challenging the status quo in interactions with others. It suggests ways that health care providers can empower female patients: They can encourage active participation during health care encounters, and they can help patients prepare for encounters so they can have their needs met.

Health related behaviors and cancer screening of lesbians: results of the Boston Lesbian Health Project II.

This paper reports data on health related behaviors and cancer screening from the Boston Lesbian Health Project II (BLHP II), a replication of a national survey of lesbians on a variety of health-related variables completed in 1987. The findings suggest that lesbians have increased their use of primary care, including routine physical examinations, pap smear screening for cervical cancer, and mammography for breast cancer, but that rates continue to be lower than would be expected for women in general. Younger lesbians in this sample smoked at high rates. Smoking rates continue to be of concern in other age groups, although they are lower than national data from women in general. BLHP II data confirm other findings that lesbians are more likely to drink alcohol and to drink more heavily than other women. Implications for health care of lesbians and future research with this population are discussed.

Lesbian use and abuse of alcohol: results of The Boston Lesbian Health Project II.

The Boston Lesbian Health Project II, a national survey of 1139 self-identified lesbian women, found higher rates of drinking alcohol, heavy alcohol intake and self reported alcoholism than in national studies of women in general. Several known risk factors for alcoholism were higher in lesbians who self defined as alcoholic in this sample: family history of alcoholism and drug abuse, rape and childhood sexual abuse and report of having made a suicide attempt. These findings are consistent with other studies that found a high rate of drinking alcohol, alcohol abuse and problem drinking among lesbians. The reasons for these findings are not clear and further research is needed to continue to explore the reasons.