Improving Intimate Partner Violence Screening Practices Among Postpartum Nurses

Abstract Background and Review of the Literature: Intimate partner violence (IPV) during pregnancy is a global public health issue that has negative outcomes on both an individual and a societal level. Health care providers play a pivotal role in providing services to women experiencing violence during pregnancy. Regardless of the setting, barriers to IPV screening exist among healthcare providers. Review of the literature examined the existing IPV screening practices and screening barriers among healthcare providers to better understand the relationship between barriers and frequency of screening for IPV. Purpose: The purpose of this DNP project was to enhance knowledge of IPV for postpartum nurses. Methods: Sixty-eight postpartum nurses employed at an inner city academic medical center were invited to complete the Barriers to Abuse Assessment Tool adapted for Postpartum Nurses (BAAT-PPN) followed by a DNP student created eLearning module. Fifteen nurses completed the BAAT-PPN aimed at identifying site specific barriers to IPV screening. Sixty-seven nurses completed the educational intervention focused on IPV in pregnancy and site resources. A pre/post intervention test was used to assess the nurses knowledge. Results: Systemic (50.00%) and knowledge (25.00%) barriers were identified as most important in IPV assessment. Outcome measures indicated an increase in nursing knowledge specifically in the areas of defining IPV (28.01%), frequency of IPV (26.52%), factors associated with IPV in pregnancy (14.71%), and resources available at the site (32.31%). Conclusion: Nurses consider IPV screening within their scope of practice but identified lack of training as a barrier. Raising awareness through education is an important facilitator in improving recognition of and response to IPV among nurses. Keywords: domestic violence, intimate partner violence, pregnancy, postpartum, screening, nursing, and barriers

Justice and non-human beings. Part 1

It is widely held that moral obligations to non-human beings do not involve considerations of justice. For such a view, nonhuman interests are always prone to be trumped by human interests. Rawlsian contractarianism comprises an example of such a view. Through analysis of such theories, this essay highlights the problem of reconciling the claim that humans have obligations to non-humans with the claim that our treatment of the latter is not a matter of justice. We argue that if it is granted that the basic interests of non-human beings sometimes count for more than the peripheral interests of humans, then our understandings of obligation and of justice must be aligned, so that what we say about obligation is not countered by assumptions about the invariable priority of humans in matters of justice. We further consider whether such a conclusion can be endorsed by those who adopt certain alternative theories to contractarianism. We conclude that adherents of a range of theories including sentientism and biocentrism must accept that human interests can sometimes be superseded by animal interests, and that this applies not least in matters of justice

Understanding predictors of mental health and substance use treatment utilization among US adults: a repeated cross-sectional study

Background: Understanding discrepancies in mental health and substance use treatment utilization can help identify inequities in access to health services. We investigate mental health and substance use treatment utilization as function of demographic and social determinants, as well as pre-existing mental health and substance use disorders. Methods: In this repeated cross-sectional study, we used the 2017–2019 National Survey on Drug Use and Health data on US adults above age 18. Two logistic regression models were conducted, using predictors of age, gender, race/Hispanicity, sexual identity, education, insurance, family income, and past year mental health and substance use disorders, with outcomes of mental health or substance use treatment utilization. Weighted estimates of substance use disorders and insurance types and Pearson's correlation tests of vulnerability among age, gender, and treatment type were reported. Findings: Racial minorities, uninsured populations, sexual minorities, and females had lower odds of receiving mental health treatment, while older populations, lower income groups, and dual eligible enrollees had higher odds. Individuals with substance use disorders but no mental illness had higher odds of receiving mental health treatment. Those utilizing mental health treatment were mostly of high income, privately insured, and using cannabis, cocaine, and opioids. Older populations, men, and Medicaid only enrollees had higher odds of receiving substance use disorder treatment, whereas racial minorities had lower odds. Distribution of income, insurance type, and substance use were more widespread than mental health treatment. Interpretation: Mental health treatment can be used as an avenue for substance use treatment, particularly opioid use disorders. It is important to target vulnerable populations, like racial minorities and uninsured populations to improve access to mental health and substance use treatment

Origin of chemical and dynamical properties of the Galactic thick disk

We adopt a scenario in which the Galactic thick disk was formed by minor merging between the first generation of the Galactic thin disk (FGTD) and a dwarf galaxy about 9 Gyr ago and thereby investigate chemical and dynamical properties of the Galactic thick disk. In this scenario, the dynamical properties of the thick disk have long been influenced both by the mass growth of the second generation of the Galactic thin disk (i.e., the present thin disk) and by its non-axisymmetric structures. On the other hand, the early star formation history and chemical evolution of the thin disk was influenced by the remaining gas of the thick disk. Based on N-body simulations and chemical evolution models, we investigate the radial metallicity gradient, structural and kinematical properties, and detailed chemical abundance patterns of the thick disk. Our numerical simulations show that the ancient minor merger event can significantly flatten the original radial metallicity gradient of the FGTD, in particular, in the outer part, and also can be responsible for migration of inner metal-rich stars into the outer part (R>10kpc). The simulations show that the central region of the thick disk can develop a bar due to dynamical effects of a separate bar in the thin disk. The simulated orbital eccentricity distributions in the thick disk for models with higher mass-ratios (~0.2) and lower orbital eccentricities (~ 0.5) of minor mergers are in good agreement with the corresponding observations. The simulated V_{phi}-|z| relation of the thick disk in models with low orbital inclination angles of mergers are also in good agreement with the latest observational results. Our Galactic chemical evolution models can explain both the observed metallicity distribution functions (MDFs) and correlations between [Mg/Fe] and [Fe/H] for the two disks in a self-consistent manner.Comment: 19 pages, 22 figures, accepted in Ap

Hierarchical processing in Balint’s syndrome : a failure of flexible top-down attention

Patients with Balint’ s syndrome are typically impaired at perceiving multiple objects simultaneously, and at evaluating the relationship between multiple objects in a scene (simultanagnosia). These deficits may not only be observed in complex scenes, but also when local elements of individual objects must be integrated into a perceptual global whole. Thus, unlike normal observers, patients with simultanagnosia typically show a bias towards the local forms, even to the extent that they cannot identify the global stimuli. However, we have previously shown that global processing is still attainable in Balint patients in certain scenarios (e.g., when local elements are unfamiliar). This suggests that in addition to a possible perceptual deficit that favors the local elements in these patients, impaired attentional control may be at the core of their unique performance. To test this hypothesis we manipulated the perceptual saliency of the local and global elements in a compound letter task so that it included global-more-salient or local-more-salient displays. We show that a Balint patient was able to accurately identify both global and local targets as long as they were the salient aspect of the compound letter. However, substantial impairment was evident when either the global or local elements were the less salient aspect of the compound letter. We conclude that in Balint’ s syndrome there is a failure of flexible top-down attention both in biasing attention away from salient irrelevant aspects of the display (salience-based-selection) and in impaired disengagement from irrelevant but salient items once they have been selected

Towards a fully consistent Milky Way disc model: Part 1 The local model based on kinematic and photometric data

We present a fully consistent evolutionary disc model of the solar cylinder. The model is based on a sequence of stellar sub-populations described by the star formation history (SFR) and the dynamical heating law (given by the age-velocity dispersion relation AVR). The combination of kinematic data from Hipparcos and the finite lifetimes of main sequence (MS) stars enables us to determine the detailed vertical disc structure independent of individual stellar ages and only weakly dependent on the IMF. The disc parameters are determined by applying a sophisticated best fit algorithm to the MS star velocity distribution functions in magnitude bins. We find that the AVR is well constrained by the local kinematics, whereas for the SFR the allowed range is larger. A simple chemical enrichment model is included in order to fit the local metallicity distribution of G dwarfs. In our favoured model A the power law index of the AVR is 0.375 with a minimum and maximum velocity dispersion of 5.1 km/s and 25.0 km/s, respectively. The SFR shows a maximum 10 Gyr ago and declines by a factor of four to the present day value of 1.5 M_sun/pc^2/Gyr. A best fit of the IMF leads to power-law indices of -1.46 below and -4.16 above 1.72 M_sun avoiding a kink at 1 M_sun. An isothermal thick disc component with local density of ~6% of the stellar density is included. A thick disc containing more than 10% of local stellar mass is inconsistent with the local kinematics of K and M dwarfs.Comment: 20 pages, 18 figs., accepted by MNRA

Self-Management of Unpleasant Auditory Hallucinations: A Tested Practice Model

Individuals who experience auditory hallucinations (AH) frequently report hearing unpleasant voices saying disturbing things to them, making derogatory remarks about them, or commanding them to do something, including harming themselves or someone else. The Self-Management of Unpleasant Auditory Hallucinations Practice Model was developed to help psychiatric-mental health nurses in both inpatient and outpatient settings implement evidence-based nursing care for voice hearers who are distressed by unpleasant voices. The model\u27s utility extends to nursing education, administration, and research. The model is comprised of three parts: (a) Assessment of Voice Hearer\u27s Experience, (b) Nursing Interventions, and (c) Voice Hearer\u27s Expected Positive Outcomes. These three parts of the model describe nursing assessments conducted with an interview guide and two self-report tools, nursing interventions that teach strategies to manage unpleasant AH in a 10-session course or individually, and evaluation of voice hearer outcomes with two self-report tools