Hey guys!

Sorry I couldn't come to class last week to hear about everyone's brilliant projects and ideas! Hope all is well! Right now I am working on my questionnaire. It turns out to be much harder than I thought it was going to be. It is really making me think about what exactly I want to ask because I need to know what data I can really use. I also need to be conscious of my wording because each of the subjects in my study will be coming from different educational backgrounds with different reading levels. I am so used to trying to write very eloquently with wide vocabulary. I am finding it hard to sort of "dumb" down my words or break it down to layman's terms, so that the women will actually understand what I am asking them. I am planning on asking 3 or 4 basic demographic questions, 6 questions using a likert scale, and four opened questions. For those of you who are like "what is a likert scale?". You've probably seen them many times before but it's the type of question where you would answer with one of the following: strongly agree, agree, neutral, disagree, or strongly disagree. I hope to have an outline of this questionnaire finished so I can meet with my adviser within the next week or so. When she approves it, I'll put it online so that you guys can read it!

Proposal accepted!

 Here's what I presented at the meeting on Wednesday!! Now that its accepted... the real work begins!

BRIDGING THE GAP IN DOMESTIC VIOLENCE VICITIMS' ACCESS TO HEALTHCARE

An Undergraduate Honors Project Presented

By

Ericka Samoorian

To

The School of Nursing

Rhode Island College

2013

                My intent for my nursing Honors Project would be to create a project around domestic violence (DV) and nursing. I have experience working with domestic violence prevention and awareness groups. I am currently a volunteer at the Women’s Center of Rhode Island (WCRI). The Women’s Center of Rhode Island provides both residential and community services to women and their children who are facing domestic violence.

            During my time volunteering in the shelter, I have become aware that the residents and their children have many healthcare needs. Whether it is because the women and their children have preexisting health conditions, both physical and psychiatric, that require regular healthcare maintenance, or are on medication, or they may need access to health care related to the health consequences of the domestic violence. The WCRI does not provide any health services  within the shelter. The purpose of this study is to research what barriers the women of DV face when accessing healthcare and to see if a telehealth nursing service would be beneficial for them. The study would look at their access to health care which can be defined by how the women take care of their health, such as their health promotion activities, going to primary care visits, preventative visits, what types of healthcare providers do they see and how often, and what is their level of comfort with their healthcare providers.

             I would like to research the residents’ access to healthcare services to find out if they could benefit from an intervention of population specific telehealth nursing services. Telehealth services provide patient care through electronic technology. Telenursing can take place through a nursing call center where nurses can provide telephone triage, health information, and referral services available twenty-four hours a day, seven days a week. The nurses can use a wide array of technologies such as the telephone, computer, telemonitoring equipment to assess, plan, and provide nursing care (Hutcherson, 2001).

Objectives:

·         To assess WCRI's residents’ access to healthcare by looking at

o   Health care practices before the shelter and during their time within the shelter

o   Participation in primary care and other services such as

§  Ob/Gyn Services

§  Mental Health Services

§  Dental Services

§  Ophthalmology Services

o   Participation in preventative healthcare screenings such as

§  Mammograms

§  Colonoscopies

§  Pap smears

o   Comfort levels with their providers

§  How comfortable are they with making an appointment, going to an appointment, and following up with referred care

o   Other barriers to care such as

§  Health insurance

§  Being from out of state

§  Language barriers

§  Being scared to get help

o   Perception of nursing care

§  Awareness of telenursing services

Methodologies:

·         An exploratory study utilizing a self-created questionnaire containing both quantitative and qualitative questions (between 10-15 questions) to research the objectives.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

·         Descriptive analysis will be used to synthesize the data from the likert scale questions. Themes from the open-ended questions will be coded and analyzed.                                                                                         

Dates:

o   Choose advisor                                                                                               January 2013                                                                                                                            (Completed)

o   Obtain permission to conduct research within WCRI                                       March 2013                                                                                                                             (Completed)

o   Gather literature to support research                                                                  Spring 2013

o   Create questionnaire                                                                                            April 2013

o   Submit to RIC IRB                                                                                          May 1, 2013

o   Gather data via survey @ WCRI                                                                   Summer 2013

o   Compile/analyze data & complete research paper                                  Fall 2013-4/1/2014

o   Present Honors Project                                                                                      Spring 2014

Advisor: Dr. Karen Hetzel

                                                            Reference

Hutcherson, C.M. (2001). Legal Considerations for nurses practicing in a telehealth setting.

The Online Journal of Issues in Nursing. 6(3). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No3Sept01/LegalConsiderations.html

Flip Flopping Ideas!

Okay, so after meeting with my adviser today I am not going to look at the medication patterns. She said it's already been done and not really a route I should go in.

So staying with the issue of domestic violence. I am going to look at the resident's access to health care to find out if they could benefit from a nursing intervention such as, a telenursing service. The access to healthcare questions would include some of the health consequences of DV, what types of doctors do they go to or if they go to any at all. Do they have insurance. I want to ask about their level of comfort with these healthcare practitioners. Do they do preventative care such as mammograms  colonoscopies, or pap smears? What were their healthcare practices before they were in the shelter vs. now. 

So I was talking to Dr. Cook about telenursing the week before last. That's the route I am going to go in. So for those of you who don't know what telenursing is "Telenursing is the use of “technology to deliver nursing care and conduct nursing practice”⁵ (p.558). Although the use of technology changes the delivery medium of nursing care and may necessitate competencies related to its use to deliver nursing care, the nursing process and scope of practice does not differ with telenursing. Nurses engaged in telenursing practice continue to assess, plan, intervene, and evaluate the outcomes of nursing care, but they do so using technologies such as the Internet, computers, telephones, digital assessment tools, and telemonitoring equipment" 
(source:http://www.ncbi.nlm.nih.gov/books/NBK2687/)

I will still survey the residents (With shelter approval). I am emailing the director today to see if it is something I can do. If not Dr. Hetzel may have a contact in a shelter in MA for me to possibly work with. 

I need to get my survey completed before May 1st to send it into the review board for the college for their last meeting of the year on May 10th. 

thoughts?

New Ideas!

So, last week I was kind of freaking out about my topic and ideas about this project. With the deadline for my proposal coming up I am super overwhelmed. As I am sitting in the shelter right now thinking about what I want to do. I think I should focus more on the psychological sequelae of intimate partner violence and patterns of medication use with women who face IPV. Then to think about how I can tie this into nursing and nursing interventions, and the shelter; I'm not completely sure. Still thinking I would like to provide a medication education class for the staff here at WCRI. I don't think I'll be able to do anything about their medication protocols or anything of that nature. It just seems so tight and not much room to budge. I still need to meet with the director of the shelter. I am feeling a tad overwhelmed.

I am studying medication use by women in IPV relationships because I want to see if there is a pattern between usage of certain medication related to IPV/DV, in order for my reader to understand the psychological effects on abused women's mental/physical health.

...thoughts?

Mind mapping: Take two!

Okay, I am a tad late at posting! However, better late than never!!

So after mind mapping in class I think that I am going to be directed in the route of medical protocols within Domestic Violence shelters in RI. I think if I was able to create a policy for something as simple as medication administration or the use of identification when administering meds. 

I wrote a paper for my pediatrics class last semester about medication delegation in schools and school nurses. I am going to take a few blurbs from my paper so you folks can all see where I think I am headed.

"Delegation is defined as by the American Nurses Association as "the transfer of responsibility for the performance of an activity to another, with the former retaining accountability for the outcome." (American Nurses Association, 2005). Delegation is a complex process, which is left up to the school nurse to decide which tasks to delegate to UAP. School nurses also need to follow the five rights to delegation. These five rights consist of the right task, right circumstance, right person, right direction and communication, and right supervision and evaluation"
- I think that the last line is really important.

"491 school nurses who report using UAP, 363 (76.9%) report that the UAP receive inservice education on medication administration"Many of these programs last less than two hours and occur annually. (p. 375). It is alarming to think that the school nurse who is in school for at least four years for their bachelor's degree, plus they have extra schooling that is needed for their education degree or teaching certificate, would pass off a task to someone with only two hours of medical education per year.

With receiving such little education about medication and its administration, it is not uncommon for there to be medication errors. "UAP also are more than three times as likely as a school nurse is to make a medication error" (McCarthy, et al., 2000 p. 376). , "491 school nurses who report using UAP, 363 (76.9%) report that the UAP receive inservice education on medication.

So, I know I am not going to be in schools. As a part of my research I'd be interested to see if there were any sort of rules or guidelines that should be in place in the shelters. 

Another problem I am facing is that I do not want to lose sight of the topic of domestic violence. I know we said last time that my topic wasn't really surrounding domestic violence, but I'd like to tie that in some how. Maybe I could use it to make a catchy opening to my presentation, paper, or something.

Ideas are more than welcome!

February 1st, 2013

Domestic Violence awareness is something that I have always been very passionate about. I volunteer at a women's shelter every Friday. I'd like to start my blog about domestic violence by this video. It is a very powerful video about why women stay in abusive relationships from the perspective of an abused woman.

The various blogs I have found are stories from survivors of domestic violence, why women stay, and other interesting articles and blogs.
Blogs about domestic violence: 

• http://domesticviolenceblognetwork.tumblr.com/
• http://blogs.courant.com/overcoming_battered_lives/
• http://www.thehotline.org/category/share-your-voice/
• http://domesticviolencedefenseblog.blogspot.com/
• http://pregoandtheloon.wordpress.com/tag/domestic-violence-blog/
• http://thecaucus.blogs.nytimes.com/2013/01/23/house-democrats-seek-to-pass-expansive-domestic-violence-law/
• http://keperawatanjiwa-resutha.blogspot.com/
• http://feminismfordinner.wordpress.com/2013/01/29/domestic-violence-in-the-us/