Transforming research to a global application for assessment of women and children exposed to violence

Among women in the United States (U.S.) and worldwide, an estimated 30% have experienced intimate partner violence (WHO 2013). Consequences of violence include acute trauma, poor physical health, and compromised functioning (Ellsberg, Jansen, Heise, Watts Garcia-Moreno, 2008) and is most commonly associated with mental health problems of depression and posttraumatic stress disorder (PTSD) (Symes, McFarlane, Nava, Gilroy, Maddoux, 2013). Recent research indicates the pass through of poor mental health of the mother to behavioral problems of the children (McFarlane, Symes, Binder, Maddoux, Paulson, 2014). To better understand the risk predictors of sustained poor mental health, specifically PTSD, for women reporting intimate partner violence, a multi-year study is underway in Houston, Texas, USA. Methods of the study include recruitment of 300 mothers reporting intimate partner violence to justice or shelter services for the first time. The women are followed for 7-years to determine the temporal sequencing of how violence impacts women s mental health and the impact on poor maternal mental health, specifically PTSD, on her children s functioning. To learn the determinants that mitigate or intensify the impact of violence on mental health, specifically PTSD, measures of mental health are completed every 4-months using validated tools. (One child of each mother is being followed and the child s behavioral functioning and school performance is measured every four months also). At year 5 of the study, 94% of the mothers and children are retained. A portfolio of 40 peer-reviewed articles are published, including predictor tools to determine mothers at highest risk to sustained mental health problems, especially PTSD. To transform the research to a smart device, such as a phone and tablet, predictor models were derived and validated for sustained maternal PTSD and sustained child dysfunction and the information programmed to a predictor application. The predictor applications are available in English and Spanish, designed for use on a hand-held device, and disseminated through the World Wide Web at no charge. The predictor tools enable first responders and front line providers to quickly assess and triage women and children exposed to domestic violence to needed services. The predictor applications, termed FAST (First Assessment Screening Tools) Apps, translate 5-years of research into strategies for practitioners worldwide to optimize health of women and children experiencing domestic violence, by taking into account determinants of health measured through nursing research. The presentation will discuss the continued validation of the First Assessment Screening Tools and uptake internationally of the application. Connection of the FAST application to addressing Sustainable Development Goals 2013 (Transforming Our World, 2016) will be discussed. Additionally, the audience will have the opportunity to download the FAST application and comment on usefulness for best practices during the presentation

The socio-cultural contexts of male Iraq and Afghanistan war veterans help-seeking behavior and healthcare utilization: An interpretive phenomenological study

Session presented on Monday, November 9, 2015: Background: Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans have combat-related healthcare needs that include post-traumatic stress disorder (PTSD), major depression, generalized anxiety disorders, and traumatic brain injury (TBI) (Stecker, et al., 2010; Morissette et al., 2011; Kim, et al., 2010; Reiber et al., 2010). A low number of OIF/OEF veterans seek help for their healthcare needs or use available healthcare resources (Kim, et al., 2010; Seal et al., 2010; Vogt, 2011; Brown et al., 2011; Randall, 2012). The disparity between increased healthcare needs and underuse of healthcare services indicates the need to understand what seeking help means to the veterans and what informs their decision to seek help or not. The study explored the research question: What is the meaning of seeking healthcare for the United States male veterans who served in the Iraq and Afghanistan wars? The aim is to provide an enhanced understanding of what seeking help for healthcare needs means to the veterans and the context of their help-seeking behaviors and health resource use. Method: Heidegger\u27s interpretive phenomenology served as the philosophical underpinning for this study. Purposive sampling with snowball strategy was used to recruit participants from a large veteran organization and around the Houston metropolis after institutional review board approval was granted. The inclusion criteria were that participants be United States male veterans who served in either, or both the Afghanistan and Iraq wars, and who were community dwelling veterans. All participants were properly consented. Data was collected in a face-to-face interview that lasted between 30-45 minutes using a semi-structured interview guide that elicited information on three core areas: health maintenance, seeking healthcare, and reflections on healthcare decisions. All interviews were digitally audio-recorded and transcribed verbatim for analysis. Analysis: Data collection and analysis were conducted concurrently. The final sample size (N =20 ) was determined by saturation of analytic data. Data was analyzed using Ricoeur\u27s interpretation method adapted by Lindseth and Norberg\u27s (2004) with hermeneutic circle technique. This is an iterative process of in-depth reading of each transcript several times to identify words, phrases, and concepts, which were coded. The codes were then categorized and further merged into five themes. The researcher used the technique of hermeneutic circle that involves moving forth and back between explanation and understanding in the analysis process, employing the researcher\u27s pre-knowledge, and experiences of help-seeking phenomenon among men and the OEF/OIF veterans to achieve interpretation and thus a richer understanding of the phenomenon of seeking help. Qualitative rigor is established by methodic consistency, resulting in the potential for replication and for establishing the readers\u27 trust in the research findings (Thomas and Magilvy, 2011). Rigor was maintained through congruency between the study design, research question, the philosophical underpinning, and methodology, such as the interview technique for data collection and analysis through textual interpretation. Data collection continued until data saturation. Divergent views were identified and reported for balance and credibility. Descriptive data and rich texts are provided to support themes and conclusions that depicted the participants\u27 demographics and help-seeking experiences. Result: Most informants (N=20) were single white males between 25-40 years of age, 90% were of enlisted military rank, and 75% served in the Army. All the participants were deployed veterans; 90% had experienced combat; and most were deployed more than once. Five themes emerged from analysis that highlighted the psychosocial and cultural basis of the meaning of participants\u27 help-seeking behaviors and healthcare decisions- Health perception: I just felt like I was a soldier ; I didn\u27t need to go to the doctor ; Conforming to traditional masculinity values: you\u27re not a man if you can\u27t fix your own problems ; Military culture values: suck it up and keep going ; Stigma of seeking help: you just feel weak. Like I\u27m being a pansy or a wuss, a cry baby ; and Paradox of multiple masculinities: I\u27ve done everything beyond my means to fix myself ; they\u27re the people that can fix me. Discussion, practice implications, and future research: Help-seeking behavior is situated in contexts and was mostly constructed through the lens of traditional masculinity values of self-reliance, resilience, strength, and stoicism that interplayed with military culture and multiple masculinity values. It is a dynamic and complex behavior that is impacted by interrelated personal, social, and cultural factors. What it means to seek help is illuminated and understood within the contexts of time, participants\u27 socio-cultural milieu, and healthcare needs. Having a better understanding of OEF/OIF veterans\u27 perception of health, health beliefs, attitudes, values, and what influence them to seek or use healthcare resources or not, will help in formulating policies, interventions, and programs that not only focus on access issues but on psychosocial and cultural issues that may lead to increase in seeking healthcare and better use of healthcare services. Strategies and interventions that may enhance OEF/OIF veterans\u27 healthcare experiences to facilitate help-seeking, implications for nursing practice, and suggestions for future studies are discussed

Problem-Solving and Mental Health Outcomes of Women and Children in the Wake of Intimate Partner Violence

The environmental stress of intimate partner violence is common and often results in mental health problems of depression, anxiety, and PTSD for women and behavioral dysfunctions for their children. Problem-solving skills can serve to mitigate or accentuate the environmental stress of violence and associated impact on mental health. To better understand the relationship between problem-solving skills and mental health of abused women with children, a cross-sectional predictive analysis of 285 abused women who used justice or shelter services was completed. The women were asked about social problem-solving, and mental health symptoms of depression, anxiety, and PTSD as well as behavioral functioning of their children. Higher negative problem-solving scores were associated with significantlyP&lt;0.001greater odds of having clinically significant levels of PTSD, anxiety, depression, and somatization for the woman and significantlyP&lt;0.001greater odds of her child having borderline or clinically significant levels of both internalizing and externalizing behaviors. A predominately negative problem-solving approach was strongly associated with poorer outcomes for both mothers and children in the aftermath of the environmental stress of abuse. Interventions addressing problem-solving ability may be beneficial in increasing abused women’s abilities to navigate the daily stressors of life following abuse.</jats:p

Exploring the comfort experience of adolescents with metastatic cancer

Session presented on: Friday, July 26, 2013: Purpose: Adolescents with cancer are challenged not only by the biophysical and emotional changes of a normally developing person; also pain and distress from their treatment affecting their quality of life. Most of our knowledge about adolescent comfort experience is derived from parent and staff perspectives. Parents cannot speak everything about their children. There is more to know about them being the least investigated age group. This study explored the meaning and significance of comfort experienced by adolescents with metastatic or progressive cancer. Methods: Descriptive phenomenology was used to uncover the comfort experience of adolescents with metastatic or progressive cancer. This qualitative study utilized purposive sampling to recruit patients who were 15-21 years old, undergoing treatment for their disease in a children\u27s cancer hospital of a large tertiary cancer institution. Kolcaba\u27s comfort theory was used as the framework of the study. A questionnaire identified the demographics of the participants. Semi-structured interview questionnaire designed by the research team guided the interviews and explored the depth and breadth of the participants\u27 lived experience. Results: Van Manen\u27s method was used to analyze data from thirteen ethnically diverse middle and late adolescents who mostly had progressive disease. Eight broad themes emerged from their statements. They reported distorted body image, shock from the diagnosis, uncertain future, isolation from friends, help from Higher Being, existential well -being, social support from family, friends, health providers, and the uniquely adolescent environment. Their experiences fit the definition of comfort in Kolcaba\u27s theory. Comfort improved their wellbeing and helped them cope with the debilitating effects of cancer. Conclusion: Comfort is significant to these adolescents because it gave them hope, motivation, and the will power to live. Healthcare staff should be sensitive for the presence of distressing symptoms and develop a standard of care to address the comfort needs of adolescents

Arriving at readiness: How women deal with sexual assault

Few sexual assault survivors seek the resources developed to help them with recovery from emotional consequences of sexual assault. A lack of knowledge of helpseeking endeavors hampers nurses' efforts to develop strategies for delivering care to survivors. The purpose of this study was to discover the evolving behaviors and processes as women survivors seek help. Using the methods of grounded theory, the process model Arriving at Readiness was developed from data collected during semistructured interviews with eleven women survivors of sexual assault and three other expert informants. Arriving at Readiness illustrates a differing, often lengthy, and potentially beneficial process women survivors of sexual assault follow to heal. Many survivors keep silent to avoid the risk of further hurt unless a Triggering Experience occurs. Responses to calls for help are harming or helping. Hanning responses may begin a cycle of increasingly more dangerous behaviors. Nurses should develop and test protocols that support survivors through the process of arriving at readiness. Education programs are needed to disseminate information about behaviors that may indicate sexual assault and about sources of help for survivors