Psychological risk factors in pregnant inmates. A challenge for nursing

PURPOSE: To explore pregnant prisoners' experiences with childhood violence and substance abuse, their parenting attitudes, and their psychological health. DESIGN: This study used a prospective design to describe incarcerated pregnant women's experiences with childhood violence, substance abuse, parenting attitudes, and psychological health and the relationships among these factors. METHODS: Sixty-three pregnant prisoners in their third trimester were interviewed. Owing to the low literacy of this population, all questions were read to participants to maximize comprehension and reliability. RESULTS: Over 60% of respondents reported experiencing family violence during childhood or adolescence. Almost one-half of the women reported using drugs and alcohol during the past year and in their current pregnancy. Substance-abusing respondents were twice as likely to have been victims of physical abuse. All of the women who had been sexually abused during childhood were substance abusers; women who did not use drugs had no such history. Many women in the study had parenting and child rearing attitudes indicative of risk for poor parenting and abuse. More than 70% of the women reported depressive symptoms above the level considered indicative of clinical depression. Women reported low levels of social support; further, 50% of the women had lost an important relationship within the last year and 80% were not in a relationship with a partner at the time of their interview. CLINICAL IMPLICATIONS: The essential components of caring for pregnant prisoners should include extensive screening for substance abuse as well as history of past and current violence. Pregnant prisoners, with their many risk factors, are a group that could benefit from programs that address substance abuse and violence to decrease mental distress.     

Struggling to survive: the experiences of women sexually assaulted while intoxicated

Approximately half of all sexual assault cases involve substance abuse or misuse, yet no studies have focused specifically on women who were under the influence of a substance when assaulted. The aim of this study was to explore the experiences of women who were sexually assault while under the influence of a substance. A phenomenological approach was used to gather data using individual, in-depth interviews with women following a sexual assault while intoxicated. Interviews were conducted using open-ended and probing questions to explore participants' life experiences from childhood to the present. The study uncovered a continuous struggle to survive among the participants. Five themes including previous victimization, substance misuse, struggling with feelings, finding support, and struggling to break the cycle were found. This research revealed lives complicated by substance misuse and histories of victimization. Intoxication raises vulnerability and risk for sexual assault. Effective nursing interventions designed to address the women's history of victimization and substance misuse may benefit women sexually assaulted while intoxicated.     

Comparison of psychosocial and behavioral profiles of victimized and nonvictimized homeless women and their intimate partners.

The purpose of this study was to examine the psychosocial, behavioral, and environmental profiles of homeless women, both those with and without a history of victimization, and their intimate partners. Five hundred seven homeless women and their intimate partners participated in the study. Thirty-nine percent of the women reported being physically and/or sexually assaulted as adults. Controlling for potential confounders, victimized women were more likely than others to have a history of childhood sexual and physical abuse, lifetime substance use, greater mental health symptomatology, and current risky sexual activity. Thus, homeless women with mental health and substance abuse problems ought to be screened for violent experiences and encouraged to obtain treatment appropriate to their problems to reduce their ongoing risk of victimization.     

Families of origin of homeless and never-homeless women

Naturalistic inquiry was used to compare the characteristics of families of origin of homeless women with never-homeless women. The women's experiences in their families of origin were explored during in-depth interviews using Lofland and Lofland's conceptions of meanings, practices, episodes, roles, and relationships to guide the analysis. The two groups were similar with respect to family abuse history, transience, and loss. The never-homeless women had support from an extended family member who provided unconditional love, protection, a sense of connection, and age-appropriate expectations, as contrasted with homeless women who described themselves as being without, disconnected, and having to be little adults in their families of origin. The experience of family love and connection seemed to protect never-homeless women from the effects of traumatic life events in childhood. These findings provide support for the influence of a woman's family of origin as a precursor to homelessness.     

Behavioral misuse among clients in substance abuse treatment: an interview study

Background: The co-occurrence of substance misuse and behavioral misuse such as excessive food intake, sexual activities, gambling and exercise has been increasingly acknowledged in both research and treatment practice during the last decades. It has also been showed that behavioral misuse complicates substance abuse treatment, and that clients with such co-occurring difficulties have considerable treatment needs.

Methodology: This study is based on interviews with six clients in substance abuse treatment, who also had a history of behavioral misuse. The interviews concerned the participants’ perception of their behavioral misuse and of themselves, and were analyzed using interpretative phenomenological analysis.

Findings and clinical implications: The participants perceived behavioral misuse as an escape from self-criticism and experiences of non-coherence. They also perceived relations and affects as overwhelming. Through behavioral misuse, relational and affective needs, as well as distressing self-experiences, were mitigated. The participants also described the efforts they had made to comprehend themselves. Their experiences were interpreted with respect to dissociation and concretization. It is suggested that during treatment, practitioners need to support client’s comprehension and their capacity to approach affects and relational needs, and in this process, dissociation and concretization need to be handled.     

Management of childhood constipation: parents' experiences

BACKGROUND: Constipation in childhood is common and places a burden on child health services. Whilst constipation can have a variety of causes, for most children it is usually non-organic and requires limited intervention. It has been suggested that health professionals can resent consultations for such a common problem, believing them to be inappropriate. However, they can underestimate the impact of this condition, leading to adverse clinical effects, as well as parental dissatisfaction. Little research has explored parents' experiences of consulting health professionals about the management of childhood constipation. AIM: To explore parents' experiences of consulting health professionals about management of childhood constipation and to use the findings to inform more effective therapeutic encounters when responding to parental concerns. METHODS: A phenomenological approach was adopted, using in-depth interviews with parents of 14 children receiving health interventions for constipation. FINDINGS: Six themes emerged from analysis including: 'enduring and extreme constipation', which reflected the substantial and sustained impact of the child's constipation; 'dismissed and fobbed off', which captured parents' feelings that their concerns were frequently dismissed by health professionals; 'asserting the need for action', a perception that they had reached a point at which they had to demand some intervention; and 'validation and acknowledgement', which reflected acknowledgment that, finally, their concerns for their child had been taken seriously and acted on. DISCUSSION: The findings indicate a failure by some health professionals to appreciate fully the significance of childhood constipation, thereby appearing to be unconcerned and insensitive to the needs of child and family. The impact of this is a potential loss of trust in health professionals by parents, which can then have implications for how they perceive and access health services for management of this common childhood problem. The findings offer an insight into parental experiences and indicate the need for a more sensitive approach during health consultations.     

Planning and emotional health of abused adult children caregivers.

The purpose of this study was to explore markers associated with the advance-planning patterns and emotional health of adult child caregivers pre-selected for their history of childhood abuse within the family. An informational decision grid and two classification procedures were used to organize and link 246 written plans of 50 adults providing nearly 6 hours of care per day to a cognitively impaired parent. Results revealed 3 constellations of plans describing hands-on person-centred, instrumental, and grief-based approaches to caregiver planning. The 31 participants taking an instrumental approach to planning were significantly more likely than the 17 taking a grief-driven approach to report experiences of abandonment, betrayal, suicidal ideation, and use of alcohol. The 2 participants taking a person-centred approach reported significantly less emotional arousal and risk for loss of health and did not recount experiences of distress or emotion-focused coping. Nurses can use the findings to highlight and strengthen the decision-making and parental-care capacities of caregivers traumatized in childhood.     

Patterns and correlates of illicit drug selling among youth in the USA

PURPOSE: Despite the high rates of drug selling among youth in juvenile justice and youth residing in disadvantage neighborhoods, relatively little is known about the patterns of illicit drug selling among youth in the general population. METHODS: Using the public-use data file from the adolescent sample (N = 17 842) in the 2008 National Survey on Drug Use and Health (NSDUH), this study employed multiple logistic regression to compare the behavioral, parental involvement, and prevention experiences of youth who sold and did not sell illicit drugs in the past year. RESULTS: Findings from a series of logistic regression models indicated youth who sold drugs were far more likely to use a wide variety of drugs and engage in delinquent acts. Drug-selling youth were significantly less likely to report having a parent involved in their life and have someone to talk to about serious problems but were more likely to report exposure to drug prevention programming. CONCLUSION: Selling of drugs by youth appears to be a byproduct of substance abuse and deviance proneness, and the prevention programs these youth experience are likely a result of mandated exposure derived from contact with the criminal justice system. Assuming no major drug supply side reductions, policies, and practices associated with increasing drug abuse treatment, parental involvement and supervision, and school engagement are suggested.     

Responding to child-to-parent violence: the experiences of family support group providers

Support groups for families negatively affected by a relative’s substance use provide a vital community service for people who otherwise have little formal or informal support. While global mutual-aid networks exist, including organizations such as Al-Anon and SMART recovery, many smaller independent support groups in the UK are marginalized and minimally funded. Consequently, they do not have the access to resources of the larger networks to advance their knowledge and skills. This small UK study set out to explore the experiences of people who ran such groups. In particular, it focused on how they identified and responded to domestic abuse and what their training and resource needs were. Twelve semi-structured telephone interviews were conducted with family support group providers around the UK. Despite a focus on domestic abuse, what emerged from the interviews was a high level of abuse of parents from intoxicated children of all ages. The findings suggest the need for greater support for family support group providers who require information on child-to-parent violence, its relationship to substance use, and how to overcome barriers to disclosure.     

A phenomenological study of siblings bereaved by suicide: A shared experience

This interpretative phenomenological analysis explored the key issues in the grief experiences of seven young adults bereaved by the youth suicide of a sibling. We conducted semi-structured phone interviews from which we derived four themes describing the participants’ experiences of: (a) the process of grief, (b) grief interactions (within families and outside), (c) continuing bonds, and (d) meaning-making and growth through grief. The stories highlight the impact of family relationships on the grieving process in siblings and the need for support to help family members better communicate, understand, and respect each other’s needs as they process their grief.     

How stroke survivors and primary support persons experience nurses in rehabilitation.

The role of nursing in rehabilitation has been studied from various perspectives. This study explored experiences with nursing care in rehabilitation from the perspective of stroke survivors and their primary support persons (PSP). The sample consisted of six stroke survivors and seven primary support persons. Through in-depth phenomenological interviews, participants related the experiences with nursing care that stood out for them. The experience was conceptualized as a two-dimensional continuum from helpful to adversarial, with none of the participants articulating a therapeutic presence from nurses. Implications for nursing are explored.     

Childhood sexual abuse and substance abuse in relation to depression and coping

Objectives: To examine relationships between childhood sexual abuse (CSA), substance abuse, substance abuse relapse, depression and coping styles in an Australian sample. Methods: Participants were 79 adults actively seeking treatment for substance abuse or CSA. CSA and substance use history were assessed using a purpose built questionnaire. Depression was assessed using the Beck Depression Inventory Second Edition (BDI‐II), and coping styles were evaluated using the Coping Scale for Adults.

Results: Among substance abusers, self‐reported CSA history was associated with (1) severe depression; (2) less optimistic coping; (3) longer duration of substance abuse; and (4) the use of drugs to alleviate negative moods. A non‐substance‐abusing CSA group was remarkably similar to the CSA substance‐abusing group on all measures. Penetrative abuse, younger age at CSA onset, and lack of confidence in dealing with CSA were associated with more severe depression in CSA victims.

Conclusions: Despite several limitations of the present study, these findings have implications for treatment of substance abusing CSA victims and suggest directions for future research on the CSA‐substance disorder relationship.     

Street children and their relationship with the police

Background: This paper explores and analyses the experiences of school‐age street children. It specifically addresses the relationship of the street children who live on the streets of São Paulo (a large Brazilian metropolis), in relation to their experiences, with the policemen. Methods: The paper is a secondary analysis of date previously collected in 1999. The data were collected through individual semi‐structured interviews, with 14 school‐age children frequenting two city public refuges, with their legal guardians' consent. The text from transcribed interviews was organized according to the validity norms of ‘thematic analysis’, a technique of contents analysis method. The decomposing and reconstructing process of that analysis gave rise to thematic categories (among which ‘the police category’) that represented the reconstruction of the difficulties faced by the children in their development. Results and discussion: The children portrayed the police as an enemy, a fearful figure and one of the most agonizing street experiences. Rarely did the police have a positive image to them. According to the children, police violence occurs in three forms: through systematic police persecution in an effort to remove the children from the streets against their will; actions that had the deliberate intent to humiliate them with verbal or physical aggression; and through alleged sexual abuse, revealed by the children in a veiled manner. The authority that is supposedly intended to protect them is portrayed as one of the most feared social agents. Conclusion: The reported hostile behaviour of the policemen shows the state of vulnerability of those children living on the street. This situation must be focused like a health problem because it causes injury to development of children. Nurses can help them through organizing assistance to children in situation of personal and social risk in the school nursing and health institution.     

The Association of Family and Peer Factors with Tobacco, Alcohol, and Marijuana Use Among Chilean adolescents in Neighborhood Context

Research on adolescent use of substances has long sought to understand the family factors that may be associated with use of different substances such as alcohol, tobacco and marijuana. However, scant attention has been focused on these questions in Latin American contexts, despite growing concerns about substance use among Latin American youth. Using data from a sample of 866 Chilean youth, we examined the relationship of family and neighborhood factors with youth substance abuse. We found that in a Latin American context access to substances is an important predictor of use, but that neighborhood effects differ for marijuana use as opposed to cigarettes or alcohol. Age of youth, family and peer relationships, and gender all play significant roles of substance use.The study findings provide additional evidence that the use of substances is complex whereby individual, family, and community influences must be considered jointly to prevent or reduce substance use among adolescents.