Background Intimate partner violence (IPV) is any form of abuse by - - PDF document

APNA 29th Annual Conference Session 3013.2: October 30, 2015 McCall 1

Intimate Partner Violence & the APN: Does Vicarious Trauma Matter?

Marla McCall, PhD, PMHNP-BC Alice Pasvogel, RN, PhD Psychiatric Nurse Practitioner Assistant Research Scientist mmccallnp@gmail.com University of Arizona

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Acknowledgements

I want to thank my dissertation committee at University of Arizona College of Nursing for their help in conducting this study:

• Pamela Reed, PhD, RN, chair
• Elaine G. Jones, PhD, RN, FAANP
• Judith Berg, PhD, RN, WHNP-BC, FAAN, FAANP

Alice Pasvogel, PhD, RN for invaluable help with primary and secondary data analysis The speaker has no disclosures to make

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Background

• Intimate partner violence (IPV) is any form
• f abuse by a current or former partner
• 1 in 3 adults have a lifetime experience of

IPV

• Worldwide rate is as high as 60-70%
• Nurses are at risk of secondary traumatic

stress symptoms (STS) due to exposure to traumatized patients

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APNA 29th Annual Conference Session 3013.2: October 30, 2015 McCall 2

Objectives

• Describe factors that assist APNs in the

appropriate management of intimate partner violence in the clinical setting

• Identify factors that may negatively impact

APNs ability to effectively manage IPV

• Identify warning signs of Secondary Traumatic

Stress in themselves

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Why IPV?

• IPV affects roughly one in three people
• Many advanced practice nurses (APN) are

the first health care provider victims will encounter when they might need help

• Nurses may experience secondary

traumatic stress (STS) or vicarious trauma(VT) as a result of work with victims

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Study Design

• National quantitative survey of APNs conducted

in summer of 2014, n = 494

• Survey tools used
• Modification of PREMIS
• Secondary Traumatic Stress Scale
• New General Self Efficacy Scale
• Brief Resilience Scale

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APNA 29th Annual Conference Session 3013.2: October 30, 2015 McCall 3

Results

• Instruments had psychometric reliability
• APNs averaged 5-10 hours of IPV

education; up from 1-4 hours in only other national study in 1999

• APNs knowledge on IPV topics high-86%

knowledge questions correct compared with 66% correct answers by physicians

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Performance of APNs on IPV

• 20% do not screen for IPV
• 37% screen all new patients; unchanged
• 90% of APNs did safety assessments
• 94% helped develop safety plans
• IPV disclosures reported in past 6 months-

mean = 2.86

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What Most Influenced Self- Efficacy to Treat IPV?

• Estimated hours of IPV education
• Years in full-time practice
• APN role belief
• Difficulties encountered by APNs include

lack of privacy to screen, unclear work protocols, no place to chart, lack of resources; only half felt they had good

• verall support to treat IPV

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APNA 29th Annual Conference Session 3013.2: October 30, 2015 McCall 4

Characteristics of Participants

• Overall sample had above average

resilience and self-efficacy

• Close to 13% of APNs surveyed met

clinical definition for STS or vicarious trauma (VT)

• Mean years in practice 10, compared with 13

years without STS or VT (p = .047)

• Age 27 - 71 years (Mean 49, SD 11 years)

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Differences Between Groups with and without VT

• Those with VT had lower scores (t-test)
• Brief Resilience Test, p = .001
• New General Self-Efficacy test, p < .001
• Fewer years in FT practice, p = .047
• No differences between the groups on

practice community type, location, past personal trauma, IPV education, educational degree, or age

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Results

Top variables in final model in order of weight

• 1. Current practices (resources included in this scale)

2. IPV education 3. Age in Years 4. Role Belief 5. Resilience 6. Vicarious Trauma-negative correlation with self- efficacy to treat 7. General Self-Efficacy 8. Workplace screening tools & protocols 9. IPV knowledge

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APNA 29th Annual Conference Session 3013.2: October 30, 2015 McCall 5

Conclusions & Future Directions

• Those with VT had
• Less resilience and general self-efficacy
• Less work experience as an APN (3 years)
• Must work on interventions to support APNs to

reduce the incidence of VT

• Increase interventions to boost resilience

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References

• Beck, C. T. (2011). Secondary traumatic stress in nurses: a systematic review.

Archives of Psychiatric Nursing, 25(1), 1-10. doi: 10.1016/j.apnu.2010.05.005

• Bride, B.E., Robinson, M.R., Yegidis, B., & Figley, C.R. (2004). Development and

validation of the Secondary Traumatic Stress Scale. Research on Social Work Practice, 14, 27-35.

• Chen, G., Gully, S.M., & Eden, D. (2001). Validation of a new general self-efficacy
• scale. Organizational Research Methods, 4(1), 62-83.
• Hinderliter, D., Doughty, A. S., & Delaney, K. (2003). The effect of intimate partner

violence education on nurse practitioners' feelings of competence and ability to screen patients. Journal of Nursing Education, 42(10), 449-454.

• Laschinger, H. K.S., Grau, A. L., Finegan, J., & Wilk, P. (2012). Predictors of new

graduate nurses' workplace well-being: testing the job demands-resources model. Health Care Management Review, 37(2), 175-186. doi: 10.1097/HMR.0b013e31822aa456

• McCall, M. (2014). Advanced practice Nurses’ Self-efficacy to Treat Intimate Partner

Violence as Related to Professional, Workplace and Personal Factors (Doctoral Dissertation). http://arizona.openrepository.com/arizona/handle/10150/344226 Available after Dec. 8, 2015

• Short, L. M., Surprenant, Z. J., & Harris, J. M., Jr. (2006). A community-based trial of

an online intimate partner violence CME program. American Journal of Preventive Medicine, 30(2), 181-185. doi: 10.1016/j.amepre.2005.10.012

• Smith, B.W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008).

The brief resilience scale: Assessing the ability to bounce back. International Journal

• f Behavioral Medicine, 15(3), 194-200. doi: 10.1080/10705500802222972

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