Evaluating the communities care program: best practice for rigorous research to evaluate gender based violence prevention and response programs in humanitarian settings

Background

Gender-based violence (GBV) is a significant issue for women and girls in humanitarian settings. Innovative primary prevention programs are being developed and implemented with existing response programs to change harmful social norms that sustain GBV in humanitarian settings. Social norms are expectations of how women, men, girls and boys should behave, who should have power and control over behavior, and how families and communities value women and girls and support their rights and opportunities.

Methods

The United Nations Children’s Fund (UNICEF) led Communities Care program is a primary prevention and response program designed from the understanding that within the context of conflict and displacement, there is an opportunity for positive change in social norms that support gender equity, and decrease GBV. The goal is to support communities in humanitarian settings to create healthy, safe and peaceful environments with quality response services for women and girls by transforming harmful social norms that uphold violence into norms that promote dignity, equity, and non-violence.

Conclusion

This manuscript will highlight the use of best practices in GBV research to rigorously evaluate the Communities Care program in two diverse in humanitarian settings, Somalia and South Sudan.

Comprehensive development and testing of the ASIST-GBV, a screening tool for responding to gender-based violence among women in humanitarian settings

Background

Conflict affected refugees and internally displaced persons (IDPs) are at increased vulnerability to gender-based violence (GBV). Health, psychosocial, and protection services have been implemented in humanitarian settings, but GBV remains under-reported and available services under-utilized. To improve access to existing GBV services and facilitate reporting, the ASIST-GBV screening tool was developed and tested for use in humanitarian settings. This process was completed in four phases: 1) systematic literature review, 2) qualitative research that included individual interviews and focus groups with GBV survivors and service providers, respectively, 3) pilot testing of the developed screening tool, and 4) 3-month implementation testing of the screening tool. Research was conducted among female refugees, aged ≥15 years in Ethiopia, and female IDPs, aged ≥18 years in Colombia.

Results

The systematic review and meta-analysis identified a range of GBV experiences and estimated a 21.4 % prevalence of sexual violence (95 % CI:14.9-28.7) among conflict-affected populations. No existing screening tools for GBV in humanitarian settings were identified. Qualitative research with GBV survivors in Ethiopia and Colombia found multiple forms of GBV experienced by refugees and IDPs that occurred during conflict, in transit, and in displaced settings. Identified forms of violence were combined into seven key items on the screening tool: threats of violence, physical violence, forced sex, sexual exploitation, forced pregnancy, forced abortion, and early or forced marriage. Cognitive testing further refined the tool. Pilot testing in both sites demonstrated preliminary feasibility where 64.8 % of participants in Ethiopia and 44.9 % of participants in Colombia were identified with recent (last 12 months) cases of GBV. Implementation testing of the screening tool, conducted as a routine service in camp/district hospitals, allowed for identification of GBV cases and referrals to services. In this phase, 50.6 % of participants in Ethiopia and 63.4 % in Colombia screened positive for recent experiences of GBV. Psychometric testing demonstrated appropriate internal consistency of the tool (Cronbach’s α = 0.77) and item response theory demonstrated appropriate discrimination and difficulty of the tool.

Conclusion

The ASIST-GBV screening tool has demonstrated utility and validity for use in confidential identification and referral of refugees and IDPs who experience GBV.

Stoichiometric control of live cell mixing to enable fluidically-encoded co-culture models in perfused microbioreactor arrays

A cell mixer microbioreactor array platform that permits the rapid establishment of perfused cell co-culture models in a high-throughput, programmable fashion.

Examining sex differences in knee pain: the multicenter osteoarthritis study

OBJECTIVE

To determine whether women experience greater knee pain severity than men at equivalent levels of radiographic knee osteoarthritis (OA).

DESIGN AND METHODS

A cross-sectional analysis of 2712 individuals (60% women) without knee replacement or a recent steroid injection. Sex differences in pain severity at each Kellgren-Lawrence (KL) grade were assessed by knee using visual analog scale (VAS) scale and Western Ontario and McMaster Universities Arthritis Index (WOMAC) with and without adjustment for age, analgesic use, Body mass index (BMI), clinic site, comorbid conditions, depression score, education, race, and widespread pain (WSP) using generalized estimating equations. Effect sizes (Cohen's d) were also calculated. Analyses were repeated in those with and without patellofemoral OA (PFOA).

RESULTS

Women reported higher VAS pain at all KL grades in unadjusted analyses (d = 0.21-0.31, P < 0.0001-0.0038) and in analyses adjusted for all covariates except WSP (d = 0.16-0.22, P < 0.0001-0.0472). Pain severity differences further decreased with adjustment for WSP (d = 0.10-0.18) and were significant for KL grade ≤2 (P = 0.0015) and 2 (P = 0.0200). Presence compared with absence of WSP was associated with significantly greater knee pain at all KL grades (d = 0.32-0.52, P < 0.0001-0.0008). In knees with PFOA, VAS pain severity sex differences were greater at each KL grade (d = 0.45-0.62, P = 0.0006-0.0030) and remained significant for all KL grades in adjusted analyses (d = 0.31-0.57, P = 0.0013-0.0361). Results using WOMAC were similar.

CONCLUSIONS

Women reported greater knee pain than men regardless of KL grade, though effect sizes were generally small. These differences increased in the presence of PFOA. The strong contribution of WSP to sex differences in knee pain suggests that central sensitivity plays a role in these differences.

The dis-ease of nursing academia: putting the vulnerability 'out there' (Part 2)

In this article, the second in a two-part series on research investigating the lived experiences of women nurse academics in australia, the results of the study are revealed. The major findings indicated that the Australian university system remains competitive and non-supportive of women nurse academics. The women who participated in this study had a strong desire to share their stories and reveal their vulnerability associated with their everyday life experiences in universities. Cultural descriptions revealed the complexity of women nurse academics' vulnerability as well as the dimensions of emotional resilience and optimism for their associated emotional healing.

Epistemology at work: the ontological relationship between feminist methods, intersubjectivity and nursing research--a research exemplar

This article explores the importance of strong epistemological and ontological links in nursing research by examining the design and process of a recent research project. The research topic concerns the relationship between self-concept and nursing practice. In this article, the authors demonstrate that commitment to a methodologically consistent process and the necessary associated epistemological and ontological positions provides a depth and structure to nursing research. It is the authors' belief that such consistency within research acts to strengthen the research process, and consequently strengthens nursing's research base and knowledge.

The dis-ease of nursing academia: putting the vulnerability 'out there' (Part 1)

This article is the first in a two-part series on a recent research study investigating the lived experiences of women nurse academics in Australia. This article begins with a discussion on the growing necessity of nurses to care for one another while working in stressful environments. The author then discusses the need to research nurse academics. The majority of the article focuses on the methodological considerations associated with planning and researching the above topic. A comprehensive discussion of research methodology, methods and ethical concerns ensues.

Intimate partner violence screening and intervention: data from eleven Pennsylvania and California community hospital emergency departments

OBJECTIVE

To provide clinical practice recommendations for screening and interventions for intimate partner violence (IPV) in ED settings.

SETTING

Eleven mid-sized community-level hospital emergency departments (20,000 to 40,000 admissions annually) in Pennsylvania and California.

PARTICIPANTS

All women (4641) aged 18 years or older who came to the emergency department during 309 selected shifts.

METHODS

An anonymous survey inquiring about physical, sexual, and emotional IPV was conducted from 1995 through 1997. In addition, medical records were abstracted for every woman (18 years and older) seen in the 11 participating emergency departments during the study period.

RESULTS

The vast majority of both abused and nonabused women supported routine screening for IPV; however, fewer than 25% of women said they were asked about IPV by ED staff. ED screening rates for IPV were higher among women who came to the emergency department because of acute trauma from abuse (39%) than for women who reported that they had been abused within the past year (13%). The prevalence of past year and lifetime IPV was significantly higher when the questionnaire was self-administered than when it was administered by a nurse. More than a third of women who had recently been abused and 76% of women who acknowledged experiencing physical or sexual IPV within the past year reported that they did not come to the emergency department for treatment of an injury. Although the majority of women (76% to 90%) agreed with the concept of health care providers reporting IPV to the police, women abused recently were significantly less likely to support this practice.

CONCLUSION

The study provides evidence supporting standard protocols for routine screening for IPV among women who come to emergency departments and chart prompts for both screening and interventions. These actions are acceptable to the majority of both abused and nonabused women seen in the emergency department and should be considered in systematic repeated training of health care professionals in emergency departments. This information is important for health care providers who are seeking to improve their identification of and care for abused women.

Views of nurses, patients and patients' families regarding palliative nursing care

This article presents the findings of a 3-phase project, that used the qualitative approach of storytelling to examine the degree of congruency between the perceptions of nurses, patients and patients' families respectively, in relation to the nature and effects of palliative nursing care. The major difference in the stories was the slight emphasis on the personal qualities palliative nurses bring to their work and the activities in which they engage. Nurses emphasized their work activities, whereas patients and relatives gave equal emphasis to the positive and negative aspects of nurses' qualities and activities.

An evaluation of a system-change training model to improve emergency department response to battered women

OBJECTIVES

To evaluate a system-change model of training from the Family Violence Prevention Fund and the Pennsylvania Coalition Against Domestic Violence for improving the effectiveness of emergency department (ED) response to intimate partner violence (IPV).

METHODS

An experimental design with outcomes measured at baseline, 9-12, and 18-24 months post-intervention. Twelve hospitals in Pennsylvania and California with 20,000-40,000 annual ED visits were randomly selected and randomly assigned to experimental and control conditions. Emergency department teams (physician, nurse, social worker) from each experimental hospital and a local domestic violence advocate participated in a two-day didactic information and team planning intervention.

RESULTS

The experimental hospitals were significantly higher than the control hospitals on a staff knowledge and attitude measure (F = 5.57, p = 0.019), on all components of the "culture of the ED" system-change indicator (F = 5.72, p = 0.04), and in patient satisfaction (F = 15.43, p < 0.001) after the intervention. There was no significant difference in the identification rates of battered women (F = 0.411, p = 0.52) (although the linear comparison was in the expected direction) in the medical records of the experimental and control hospitals.

CONCLUSIONS

A system-change model of IPV ED training was effective in improving staff attitudes and knowledge about battered women and in protocols and staff training, as well as patient information and satisfaction. However, change in actual clinical practice was more difficult to achieve and may be influenced by institutional policy.

An Experience of Peer Mentoring with Student Nurses: Enhancement of Personal and Professional Growth

This article discusses the importance of peer mentoring in nursing education. The current literature is reviewed and areas for further research are identified. Most specifically, the article explores the results of a recent research study conducted at Southern Cross University in Australia. The research investigated the relationship between personal and professional growth and peer mentoring with a group of women nurses. Seven nurses participated in this qualitative research project. Six of the participants were student nurses enrolled in an undergraduate nursing degree and the seventh participant was the degree program coordinator. The research was conducted over a 12-week period and was located in critical paradigm. The research methods used were reflective journaling and interviewing. The results indicated that the process of peer mentoring in nursing education demonstrated a strong relationship to personal and professional growth for all of the participants. Characteristics of the peer mentoring process such as shared learning, shared caring, reciprocity, commitment to each other's personal and professional growth, and friendship, are discussed.

Making a difference with dying people: positive nurse-patient interactions

This paper presents some of the qualitative findings from a recent research study, which explored the nature and effects of palliative nursing care for patients. By using story telling as the research methodology, the participants related their positive experiences about palliative care nursing. The results of the research indicated that there was a strong link between positive experiences and effective nurse-patient interactions. The characteristics and the results of these interactions are presented in this article. The article concludes with a discussion of the potential ethical problems of assessing palliative care patients suitability for research.

Nurse healers: exploring their lived experience as nurses

This article explores the lived experience of nurse healers in nursing, reporting on three themes identified in a recent hermeneutic phenomenological research study. These themes, mapped out in the words of the participants, are termed responding, evolving, and weaving.

Women battering in primary care practice

BACKGROUND

The organization of health care system to emphasize managed care has placed the primary care provider in an ideal position to assess the impact of intimate partner violence (IPV) on the health of women. Primary care practice provides a setting in which women can develop an ongoing relationship with their health care provider in which they feel safe to discuss IPV and possible options to improve their lives. Women's health and safety could be dramatically improved if primary care providers were prepared to assess, intervene and appropriately refer women who are in violent relationships.

OBJECTIVES

The purpose of this article is to describe the prevalence of intimate partner violence in primary care populations and review the known physical, mental health and pregnancy consequences of abuse as well as discuss the implications of intimate partner violence on primary care practice.

Contemporary theories and contemporary nursing--advancing nursing care for those who are marginalized

This paper critiques the topic of postmodernism and how it is represented in nursing and social science literature. This critique classified the debates into three identifiable constructs, those being: dissatisfaction; fragmentation and integration. The authors propose a solution from the integration debate by putting forward the notion of an 'integrated postmodern turn'. The 'solution' is situated within feminism and draws on modernist and postmodernist theory. The integrated model is grounded in nursing clinical examples which demonstrate the usefulness and workability of this approach when caring for those who are marginalized by nurses because of their ethnicity, gender, cultural and/or spiritual beliefs.

Discovery of self: exploring, interconnecting and integrating self (concept) and nursing

Self concept of individual nurses is still largely unexplored in nursing. While the role of self-knowledge and self-actualisation are recognised as integral to nursing practice, little has been done to examine their relationships to self concept and nursing practice. The aim of this research study was to explore the role and significance that self concept plays in women nurses' experience of their beginning practice. The exploration examined factors which contribute to and impact on self concept within a nursing practice environment. Self concept relates to how an individual experiences oneself and is integrally linked to one's interactions and relationships with others. This two phase research was situated in critical and feminist theory using reflective journalling (phase one) and story telling/narrative (phase two) as the research methods. This paper discusses the three major themes which arose in phase one of the research. Those were: exploring experiences; interconnecting personal and professional worlds; and, integrating self 'into' nursing. The paper also explores inter-subjectivity in terms of the contribution this concept makes to our understanding of research findings.

"Super" presencing nurse healers' stories of healing

This article describes the experience for nurse healers of being a channel for healing. In particular this was explored by revealing "super" presencing--an essential theme of the lived experience of nurse healers, described in a recent research study. "Super" presencing not only enhances our knowledge but gives inspiration in an otherwise undernourished area of the healing profession of nursing.

An emancipatory impulse: a feminist postmodern integrated turning point in nursing research

This article critiques the current debates regarding feminism, postmodernism, and feminist/postmodernism within nursing research. The critique classified the debates into three identifiable constructs: dissatisfaction, fragmentation, and integration. The authors propose a solution from the integration debate as an emancipatory "workable" turning point for nursing research. The solution is situated within feminism and draws on the epistemological constructs of both modernism and postmodernism. Nursing research is framed within the proposed ontological links that characterize the integrated solution.

Prevalence of intimate partner abuse in women treated at community hospital emergency departments

CONTEXT

The majority of prior studies examining intimate partner abuse in the emergency department (ED) setting have been conducted in large, urban tertiary care settings and may not reflect the experiences of women seen at community hospital EDs, which treat the majority of ED patients in the United States.

OBJECTIVE

To determine the prevalence of intimate partner abuse among female patients presenting for treatment in community hospital EDs and describe their characteristics.

DESIGN

An anonymous survey conducted from 1995 through 1997 inquiring about physical, sexual, and emotional abuse.

SETTING

Eleven community EDs in Pennsylvania and California.

PARTICIPANTS

All women aged 18 years or older who came to the ED during selected shifts.

MAIN OUTCOME MEASURES

Reported acute trauma from abuse, past-year physical or sexual abuse, and lifetime physical or emotional abuse.

RESULTS

Surveys were completed by 3455 (74%) of 4641 women seen. The prevalence of reported abuse by an intimate partner was 2.2% (95% confidence interval [CI], 1.7%-2.7%) for acute trauma from abuse, 14.4% (95% CI, 13.2%-15.6%) for past-year physical or sexual abuse, and 36.9% (95% CI, 35.3%-38.6%) for lifetime emotional or physical abuse. California had significantly higher reported rates of past-year physical or sexual abuse (17% vs 12%, P<.001) and lifetime abuse (44% vs 31%, P<.001) than Pennsylvania. Logistic regression modeling identified 4 risk factors for reported physical, sexual, or acute trauma from abuse within the past year: age, 18 to 39 years (odds ratio [OR], 2.2; 95% CI, 1.7-3.0); monthly income less than $1000 (OR, 1.7; 95% CI, 1.3-2.1); children younger than 18 years living in the home (OR, 2.0; 95% CI, 1.5-2.6); and ending a relationship within the past year (OR, 7.0; 95% CI, 5.5-8.9).

CONCLUSION

If the prevalence of abuse in community hospitals throughout the United States is similar to the range of prevalence estimates found in this study, then heightened awareness of intimate partner abuse is warranted for patients presenting to the ED.

Exploring women's experiences: the critical relationship between nursing education, peer mentoring and female friendship

A research study was conducted in 1995 with seven women nurses from Southern Cross University, Australia. The aim of this research was to investigate the possible relationship between female friendship, mentoring and nursing education. The researchers comprised six second-year nursing degree students and the programme co-ordinator for the Bachelor of Nursing programme. This research was framed in an emancipatory paradigm of critical social science and feminist theory. Reflective journalising and interviewing were used as the research methods. The results indicated that there is an inextricable link between female friendship and peer mentoring. These two 'features' created a productive climate for shared learning, shared caring, reciprocity and commitment to one another's personal and professional growth.

The contested work place: reactions to hospital based RNs doing degrees

This article focuses on the findings from a research project investigating hospital based RNs' attitudes and reactions to nursing degrees. Specifically, the results describe the tension and hostility which was predominating in clinical settings when the research was conducted. The reactions of both degree and non-degree nurses to the changes in nursing education are put forward. It is suggested by the author that while work environments have been characterised by destructive behaviours, nurses' verbalising their reactions to this situation, have provided a platform to deal more constructively with personal and professional change.

Desmoplastic fibroma of the mandible in a child: report of a case

A 6-year-old girl was seen with a history of progressive trismus and expansion of the right mandible over a 9-month period. Desmoplastic fibroma was diagnosed on biopsy. This report reviews the diagnostic criteria and surgical management of this uncommon primary bone tumor of the maxillofacial region.

Separation of conjoined twins

Preparing for surgical separation of conjoined twins involves coordination, communication, and multidisciplinary planning by several specialties. This article discusses the embryology, etiology, and incidence of conjoined twins and provides a historical perspective of the different types of conjoined twins. A case study describes the perioperative management of conjoined twins at Texas Children's Hospital's, Houston. Team members' roles are discussed, and the perioperative care of conjoined twins detailed.

Severe perinatal Marfan syndrome

The cardiovascular manifestations of the Marfan syndrome in older children and adults have been well described. Clinical, radiographic, and echocardiographic data regarding three patients with severe perinatal Marfan syndrome are described. Two of these patients had the syndrome at birth and died in infancy. The syndrome was diagnosed in the third patient at 6 months of age and the child is still alive at 3 years of age. The possible relationship among the Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta is considered. Patients with Marfan syndrome and severe cardiorespiratory problems early in life tend to have a limited life expectancy.

Fatal hepatic necrosis caused by disseminated type 5 adenovirus infection in a renal transplant recipient

This is an unusual case of fatal hepatic necrosis caused by disseminated type 5 adenovirus in a renal transplant recipient. This adult patient may have been colonized at the time of transplantation with a kidney from a pediatric donor. The adenovirus became invasive when the host's cellular immune system was suppressed by high doses of corticosteroids given to reverse acute allograft rejection.

Long-term clean intermittent self-catheterization in renal transplant recipients

Eight renal transplant recipients with neurogenic bladders or lower urinary tract dysfunction were managed with clean intermittent self-catheterization after transplantation instead of urinary diversion. A total of 85 treatment months was reviewed. Of the patients 5 continue to do well after 10 to 17 months of intermittent catheterization and 3 suffered immunological graft failures. In selected renal transplant recipients with lower urinary tract dysfunction clean intermittent catheterization is a reasonable alternative to urinary diversion.

Treatment of end-stage diabetic nephropathy: over a decade of experience at one institution

Results of treatment of end-stage renal disease in 139 patients with diabetes mellitus revealed survival of 76% at 1 year and 48% at 5 years. These results compare favorably with other reports from Europe and the United States, probably because of the greater number of patients receiving renal transplants, and possibly because of the use of continuous ambulatory peritoneal dialysis as a recent treatment modality. Patients not receiving transplants were much older (mean age, 47.8 years) than those receiving transplants. Of those not given transplants, survival was best on CAPD. Comparison of those surviving at least 3 years was made with those expiring in the first year. Long-term survivors were younger, had diabetes for a shorter period, but had higher mean blood pressures and serum creatinine values than short-term survivors. Short-term survivors also had over a 50% incidence of prior myocardial infarction or cardiorespiratory arrest, while no long-term survivors had such a history. Long-term survivors were also more likely to have received a transplant, and short-term survivors were more likely to have received intermittent peritoneal dialysis or hemodialysis. A transplant from a living related donor is the treatment of choice for diabetics under age 40 and perhaps for older patients as well. The choice among CAPD, hemodialysis and cadaver transplant requires consideration of many factors.