Injury as a Global Phenomenon of Concern in Nursing Science

Professionals' Awareness of Sexual Abuse in Late Life: An Exploratory Survey

BACKGROUND

The sexual abuse phenomenon is considered taboo. It has been discussed, to date, mainly in relation to children and young women, with insufficient attention to sexual abuse in a late-life context.

OBJECTIVES

The aim of this survey was to explore professionals' awareness of elder sexual abuse (ESA).

DESIGN

The survey was conducted among 161 Jewish and Arab professionals from health care and social services, who worked with older adults in Israel.

RESULTS

Of the entire sample, 70 professionals (only 43%) reported encountering at least one to three cases of ESA. A total of 98% of the victims were women, and the primary offender was the spouse (75%). In most cases (70%), the victim reported the abuse, which was mainly sexual assault (64%). All participants (100%) noted taking action.

CONCLUSION

This exploratory survey indicates that professionals are partially aware of the existence of and the need to address the ESA phenomenon.

Reasons for and reservations about research participation in acutely injured adults

PURPOSE

The purpose of this study was to explore the reasons adult patients seeking emergency department care for minor injuries agree to participate in clinical research and to identify their reservations about participating in a research study.

DESIGN AND METHODS

This is a secondary analysis of data from a longitudinal cohort study of 275 adults who sought emergency department care for physical injury and were followed over 12 months. At the final interview, participants were asked open-ended short-answer questions about their perception of participating in the study. Free text responses were analyzed using conventional content analysis.

FINDINGS

The final sample of 214 participants was composed equally of males and females, predominantly Black (54%) and White (42%), with a mean age of 41 years. Six themes about reasons for participation emerged from free text responses: being asked, altruism, potential for personal benefit, financial gain, curiosity, and valuing or knowledge of research. Most did not report reservations. Those reservations identified included time constraints, confidentiality, and whether patients felt well suited to fulfill the study requirements.

CONCLUSIONS

Although injured patients are identified by the research community as vulnerable, they are willing to participate in research studies for diverse reasons, and their participation is commonly associated with positive experiences.

CLINICAL RELEVANCE

Understanding perceptions of participants' experiences of being in a research study after acute injury can guide researchers to improve future study protocols and recruitment strategies in order to optimize participants' experiences. Recruitment and retention into clinical research studies is essential to build nursing science to enhance the recovery of injured individuals.

Emergency Department-Based Brief Intervention to Reduce Risky Driving: A Life Course Perspective

Screening, Brief Intervention, and Referral to Treatment (SBIRT) has promise as a clinical intervention for health-compromising behaviors. We used a randomized controlled design in an Emergency Department (ED) setting to determine the efficacy of a nurse-delivered SBIRT to address risky driving in people 18 to 44 years of age. Risky drivers (n = 476) were randomized to brief intervention (BIG), contact-control (CCG), or no-contact-control (NCG) groups and were followed at 3, 6, 9, and 12 months. Outcomes included safety belt use, speeding, and driving through traffic lights. Safety belt use, times speeding between 10 and 19 mph over speed limit, and times driving through a yellow light declined significantly in the BIG as compared with the CCG at 3, 6, and 9 months. SBIRT reduced risky driving in our sample, but its effects did not persist after 9 months. We suggest that SBIRT has the potential to reduce vehicular-related injury in the 9 months after a brief intervention.

Demographic profile and epidemiology of injury in Mthatha, South Africa

OBJECTIVE

To determine the magnitude, socio-demographic and epidemiological characteristics of injury at a Provincial referral hospital.

METHODS

This review was conducted on all trauma patients admitted at the Mthatha Hospital Complex and Nelson Mandela Academic Hospital from the 1(st) January 1997 to the 31(st) December 2000.

RESULTS

The incident rate of injuries was 3.2% (n=2460/75,833 total admissions). Injured patients were mostly black (80%) and males (ratio: 5 men: 1 woman). Only 8.1% of injured patients were transported to hospital by ambulances. The leading causes of injuries were inter-personal violence accounting for 60% of cases, and motor vehicle accidents accounting for 19%; of them 38% were due to poor visibility, over speeding, and fatigue. The overall mortality was 33% (n=821) independently predicted by poverty (OR=8.2 95%CI 6-11.1; P<0.0001) and age>40 years(OR=7.8 95%CI 7.7-12.1;P<0.0001).

CONCLUSION

The burden of injury is a mass issue that warrants regional attention with quality of care and training.

Collecting injury surveillance data in low- and middle-income countries: the Cape Town Trauma Registry pilot

Injury is a major public health issue, responsible for 5 million deaths each year, equivalent to the total mortality caused by HIV, malaria and tuberculosis combined. The World Health Organisation estimates that of the total worldwide deaths due to injury, more than 90% occur in low- and middle-income countries (LMIC). Despite the burden of injury sustained by LMIC, there are few continuing injury surveillance systems for collection and analysis of injury data. We describe a hospital-based trauma surveillance instrument for collection of a minimum data-set for calculating common injury scoring metrics including the Abbreviated Injury Scale and the Injury Severity Score. The Cape Town Trauma Registry (CTTR) is designed for injury surveillance in low-resource settings. A pilot at Groote Schuur Hospital in Cape Town was conducted for one month to demonstrate the feasibility of systematic data collection and analysis, and to explore challenges of implementing a trauma registry in a LMIC. Key characteristics of the CTTR include: ability to calculate injury severity, key minimal data elements, expansion to include quality indicators and minimal drain on human resources based on few fields. The CTTR provides a strategy to describe the distribution and consequences of injury in a high trauma volume, low-resource environment.

Intentions of older homebound women to reduce the risk of falling again

PURPOSE

Researchers have tested interventions to prevent recurrent falls for older people without exploring their intentions to prevent another fall. Lack of knowledge about such intentions is an impediment to intervention effectiveness. The purpose was to describe intentions to prevent another fall as discerned during a study with older homebound women.

METHODS

Data were obtained during a series of four in-home interviews over 18 months with monthly telephone contacts between interviews; fall history was updated at each contact. A descriptive phenomenological method was used to analyze data.

FINDINGS

Of the 40 women, 36 (aged 85 to 98 years) had fallen at home at least once before enrolling in the study, or had a subsequent or initial fall during the study. The overall intention was reducing my risk of falling again at home, with its components figuring out the reason that I fell and changing my ways to reduce my risk of falling again at home. Most women explained reasons for a fall and voiced intentions to prevent a similar fall. Women who viewed falls as unexpected events were uncertain that they could prevent a fall or felt unable to do so and voiced few preventive intentions. A few women voiced generalized preventive intentions to change health-related behaviors or habits.

CONCLUSIONS

Most intentions were tied directly to the situation in which a fall had occurred. Such specificity could limit effectiveness of personal efforts to prevent falls in other situations.

CLINICAL RELEVANCE

Practitioners should converse with older women who have fallen about their intentions to prevent another fall and weigh the need to help them generalize both the risk of falling again and their risk reduction intentions.

Injury surveillance in low-resource settings using Geospatial and Social Web technologies

Background

Extensive public health gains have benefited high-income countries in recent decades, however, citizens of low and middle-income countries (LMIC) have largely not enjoyed the same advancements. This is in part due to the fact that public health data - the foundation for public health advances - are rarely collected in many LMIC. Injury data are particularly scarce in many low-resource settings, despite the huge associated burden of morbidity and mortality. Advances in freely-accessible and easy-to-use information and communication (ICT) technology may provide the impetus for increased public health data collection in settings with limited financial and personnel resources.

Methods and Results

A pilot study was conducted at a hospital in Cape Town, South Africa to assess the utility and feasibility of using free (non-licensed), and easy-to-use Social Web and GeoWeb tools for injury surveillance in low-resource settings. Data entry, geocoding, data exploration, and data visualization were successfully conducted using these technologies, including Google Spreadsheet, Mapalist, BatchGeocode, and Google Earth.

Conclusion

This study examined the potential for Social Web and GeoWeb technologies to contribute to public health data collection and analysis in low-resource settings through an injury surveillance pilot study conducted in Cape Town, South Africa. The success of this study illustrates the great potential for these technologies to be leveraged for public health surveillance in resource-constrained environments, given their ease-of-use and low-cost, and the sharing and collaboration capabilities they afford. The possibilities and potential limitations of these technologies are discussed in relation to the study, and to the field of public health in general.

Changes in childhood risk taking and safety behavior after a peer group media intervention

BACKGROUND

Risk taking is a significant health-compromising behavior among children that often is portrayed unrealistically in the media as consequence-free. Physical risk taking can lead to injury, and injury is a leading cause of hospitalization and death during childhood.

OBJECTIVE

The aim of this study was to examine the effectiveness of a 4-week program for school-age children in reducing risk-taking behaviors and increasing safety behaviors.

METHODS

A two-group, experimental, repeated-measures design was used to compare 122 White and Latino children randomly assigned to an intervention group or a wait-list group at baseline and at 1, 3, and 6 months after intervention. Children received a behaviorally based intervention delivered in four 2-hour segments conducted over consecutive weeks. The thematic concept of each week (choices, media, personal risk taking, and peer group risk taking) moved from the general to the specific, focusing on knowledge and awareness, the acquisition of new skills and behaviors, and the supportive practice and application of skills.

RESULTS

Participants increased their safety behaviors (p = .006), but risk-taking behaviors remained unchanged. Families in the intervention group increased their consistent use of media rules (p = .022), but decreases in media alternatives suggest difficulty in taking up other habits and activities. Coping effectiveness was predictive of safety behaviors (p = .005) at 6 months, and coping effectiveness plus television watching was predictive of risk taking (p = .03).

CONCLUSIONS

Findings from this study suggest that interventions that influence children's media experiences help enhance safety behaviors and that strategies to aid parents in finding media alternatives are relevant to explore.

Managing the common problem of missing data in trauma studies

PURPOSE

To provide guidance for managing the problem of missing data in clinical studies of trauma in order to decrease bias and increase the validity of findings for subsequent use.

ORGANIZING CONSTRUCT

A thoughtful approach to missing data is an essential component of analysis to promote the clear interpretation of study findings.

METHODS

Integrative review of relevant biostatistics, medical and nursing literature, and case exemplars of missing data analyses using multiple linear regression based upon data from the National Study on the Costs and Outcomes of Trauma (NSCOT) was used as an example.

FINDINGS AND CONCLUSIONS

In studies of traumatically injured people, multiple imputed values are often superior to complete case analyses that might have significant bias. Multiple imputation can improve accuracy of the assessment and might also improve precision of estimates. Sensitivity analyses which implements repeated analyses using various scenarios may also be useful in providing information supportive of further inquiry. This stepwise approach of missing data could also be valid in studies with similar types or patterns of missing data.

CLINICAL RELEVANCE

In interpreting and applying findings of studies with missing data, clinicians need to ensure that researchers have used appropriate methods for handling this issue. If suitable methods were not employed, nurse clinicians need to be aware that the findings may be biased.

Effects of injection--drug injury on ankle mobility and chronic venous disorders

PURPOSE

To identify potential confounders and test a causal model of injection-site risk, chronic venous disorders (CVD), and ankle mobility. The reliability and validity of goniometry measurements of ankle mobility were also of interest because they are seldom performed in people with a history of injection-drug use.

DESIGN

The study was a test-retest design, consisting of 104 participants from a methadone maintenance treatment center.

METHODS

Each participant provided demographic information, health and drug histories, and underwent bilateral ankle goniometric measures of dorsiflexion, plantar flexion, inversion, and eversion. The clinical portion of the Clinical-Etiology-Anatomy-Pathophysiology (CEAP)was used to classify CVD severity.

FINDINGS

Reliability of goniometry measurements ranged from .70 to .90. Causal modeling supported hypotheses of increased risk from leg injection and reciprocal effects involving ankle mobility and disease progression. Ankle inversion mobility was the strongest indicator of ankle mobility.

CONCLUSIONS

Injury to the lower extremities from IDU affected CVD and mobility. Further research should include assessment of comorbidity and other potential confounders. Ankle inversion should remain part of the goniometry assessment.