The International Lactation Consultant Association (ILCA), International Board of Lactation Consultant Examiners, and Lactation Education Accreditation Approval Review Committee jointly hosted the 2014 Lactation Summit, “Addressing Inequities Within the Lactation Consultant Profession” following the 2014 ILCA Conference. The Summit was the first conversation as part of a genuine process to address inequities within the profession that prevent access. A summary of the proceedings will be published in the December 2014 issue.

Previous studies have demonstrated a connection between intimate partner violence (IPV) and a child’s alienation from the abused parent, but little is known about the relationships between the type of IPV, aspects, and severity of a child’s alienation, and the target parent’s gender. This study assessed the presence of an IPV history (verbal and physical aspects) among parents who identify as targets of their children’s unreasonable rejection. Also investigated were associations between the form of IPV and manifestations of a child’s alienated behavior, parent’s gender and type of IPV, and parents’ gender and degree of the child’s alienation. Self-identified alienated parents (n = 842) completed an online survey that included an IPV screening measurement (Hurts, Insults, Screams, Threatens screening tool) and a measure of the parent’s perception of their child’s alienated behaviors (Rowlands Parental Alienation Scale). The majority identified as IPV victims and reported a higher level of verbal than physical abuse. More mothers than fathers identified themselves as IPV victims. As a group, IPV victims rated their child as more severely alienated than did non-IPV alienated parents. Mothers were more likely than fathers to report physical aggression by the other parent and more likely than fathers to assess their child’s alienated behaviors as more severe. Victims of physical violence reported their children were less likely to withhold positive affection from them. This knowledge may assist in earlier identification of the alienation process and greater recognition, legitimacy, funding, and opportunities for enhanced collaboration among stakeholders. This, in turn, may lead to improvements in prevention, intervention, and accountability, thus helping to interrupt alienation processes.

This study adds to the available literature on female-perpetrated intimate abuse by examining Dutton’s (2007) theory of the abusive personality (AP) in a sample of 914 women who had been involved in dating relationships. Consistent with the AP, recalled parental rejection, borderline personality organization (BPO), anger, and trauma symptoms all demonstrated moderate-to-strong relationships with women’s self-reported intimate psychological abuse perpetration. Fearful attachment style demonstrated a weak-to-moderate relationship with psychological abuse perpetration. A potential model for explaining the interrelationships between the elements of the AP was tested using structural equation modeling (SEM). Consistent with the proposed model, recalled parental rejection demonstrated relationships with BPO, trauma symptoms, and fearful attachment. Similarly consistent with the model, trauma symptoms demonstrated a relationship with anger; and BPO demonstrated strong relationships with trauma symptoms, fearful attachment, and anger. Additionally, anger itself had a strong relationship with women’s self-reported perpetration of intimate psychological and physical abuse. Contrary to the proposed model, fearful attachment had a nonsignificant relationship with anger when this relationship was examined using SEM.

The study of men’s violence against their intimate partners is segregated from the study of other forms of violence. Comparing intimate partner violence (IPV) to other violence, however, allows one to examine whether the motivation and the legal response are similar. I examine whether men’s assaults on partners are particularly likely to have a control motive, whether women’s assaults on partners are particularly likely to be motivated by self-defense, and whether intimate partner violence is less likely to be reported to the police and legally sanctioned. The evidence casts doubt on the feminist approach, which has dominated the study of IPV. I suggest that a theory of instrumental violence provides a better understanding of IPV. Such an approach recognizes a variety of motives and emphasizes the role of conflict in intimate relationships, sex differences in strength and violence, and the importance of chivalry. Finally, I suggest that social scientists who study IPV should be more careful in their descriptive terminology.

Partner aggression is a major public health concern. Batterers’ intervention programs (BIPs) are commonly used as an alternative to incarceration for offenders who have been arrested for domestic assault. Historically, BIPs have shown little effectiveness in reducing partner aggression. This article presents a new BIP based on acceptance and commitment therapy (ACT; Hayes, Strosahl, & Wilson, 1999). ACT is a third-wave therapy that builds on the cognitive-behavioral tradition, focusing on increasing psychological flexibility by promoting acceptance and mindfulness processes. Several lines of evidence support the use of ACT in the treatment of partner aggression. Achieving Change Through Values-Based Behavior (ACTV; Lawrence, Langer Zarling, & Orengo-Aguayo, 2014) was developed based on ACT principles with a specific focus on feasibility and transferability to the community correctional setting and court-adjudicated treatment. ACTV incorporates experiential skills training and uses innovative methods to engage participants and teach the ACT processes. This article details the components of ACTV, including a case study to illustrate one participant’s journey through the program. We also present preliminary pilot data, which look promising with respect to reductions in domestic assault and violent recidivism.

The goal of this project was to determine if a nurse practitioner (NP) designed and managed primary care based asthma quality improvement (QI) program titled Asthma Control and Elimination of Symptoms (ACES) could improve asthma outcomes in a high-morbidity pediatric population. A convenience sample of 31 children age 2 to 17 years with persistent asthma were recruited from a private practice in a rural community to participate in this prospective study with 3 months of follow-up. The primary outcome measures were symptom improvement and use of symptom prevention medication. The secondary outcome measures were reduced ED visits and hospitalizations. Participants in the ACES program had significant improvement in daytime asthma symptoms, nighttime asthma symptoms, use of rescue medication, activity tolerance, missed school days, attacks lasting longer than 24 hr, and use of symptom prevention medication. There was a decrease in ED visits and no change in rate of hospitalizations. One hundred percent of participants completed the program and the QI project improved health outcomes of all children in the program.

Background: Congenital heart disease (CHD) is the leading cause of death within the first year of life because of birth defects. Complications related to respiratory infection caused by respiratory syncytial virus (RSV) increase risks in the CHD population. Prevention is key to minimizing risk, and administration of RSV prophylaxis, palivizumab, is recommended for infants with hemodynamically significant heart disease. Objective: Use the electronic medical record (EMR) to identify and ensure appropriate referral of CHD patients eligible for RSV prophylaxis. Design: Comparative, cross-sectional study design. Setting: Cardiac specialty clinic of a regional children’s hospital. Population: CHD patients younger than 24 months of age eligible for RSV prophylaxis. Intervention: Use the EMR to develop a method for identifying CHD patients eligible for RSV prophylaxis and implement a referral process. Results: Similar number of patients in the 2 RSV seasons studied. Rates of eligibility for RSV prophylaxis over the 2 seasons were the same. Improvements in documentation of eligibility by the provider from the first season to the second. Limitations: Inability to determine referral rates. Initial EMR search did not identify patients eligible for RSV prophylaxis. Inconsistent EMR data entry. Conclusions: Ongoing education on eligibility for RSV prophylaxis. Need for automated EMR referral. Ongoing evaluation of EMR systems identifying patients eligible for RSV prophylaxis.

As hospitals face increasing practice management challenges, as in decreased staffing, decreased reimbursement, increased malpractice, rising costs, and increased quality and safety demands, many hospitals today have turned toward increased use of nurse practitioners (NPs). Utilization of NPs within hospitals has been safe, effective, and profitable and is increasingly accepted. Hospitals are now developing defined clinical leadership roles to oversee the daily practice management of advanced practice providers. A doctor of nursing practice (DNP) is the ideal clinical leader to develop and implement such innovative practice solutions for hospital-based NP programs. This article will address the basic principles of building a practice billing model for acute care NPs at a major medical center in Houston, Texas. Creating new models requires comprehensive analysis and continued evaluation as the complexities in providing health care continuously shift. The direct benefit of NP utilization will become evident through direct reimbursement or practice improvement.

There is a controversy about the origin, definition, and types of acute mastitis, breast pain, and their clinical management. This article reviews current definitions, bacteriological findings, their possible meanings, and their use in clinical settings as well as the latest evidence-based clinical management guidelines.

Interventions for men who perpetrate intimate partner violence (IPV) have historically been relatively ineffective at reducing or stopping subsequent IPV. However, there are several strong theoretical reasons that suggest Acceptance and Commitment Therapy (ACT), an intervention that emphasizes the use of mindfulness and aims to foster psychological flexibility, may be particularly well-suited to interrupting the factors that maintain IPV. The goal of the present article is to review the evidence for the application of ACT to target IPV. In addition, empirical studies that have, to date, shown promising initial support for a targeted intervention (Achieving Change Through Values-Based Behavior; ACTV) are reviewed. The implications for using ACT-based skills with perpetrators of IPV are discussed, along with potential future directions and further applications of ACT to hard-to-treat populations.

The increase in breastfeeding rates in the African American community is largely due to the efforts of several grassroots organizations. This article briefly describes some of these organizations, highlighting their objectives, mission, founders, and beginnings.

The state of New Jersey certifies nurse practitioners and clinical nurse specialists from all specialties as advanced practice nurses (APNs). There are more than 4,000 certified APNs in the state in 17 specialty areas. APNs in the state have the privilege of practicing in various settings such as ambulatory, inpatient, and long-term care. The state does not limit the setting where an APN chooses to practice. A trend is emerging in the state to address the concern of primary care–educated APNs to prepare them for the delivery of care in the acute care setting. Some institutions within the state of New Jersey are requiring their primary care–educated and primary care–certified adult primary care APNs working in an inpatient setting obtain an acute care certification. Recognizing the needs of these adult primary care APNs, Dr. Helen Miley developed a postmaster’s certificate program which has been approved by Rutgers School of Nursing faculty. Although the first cohort has not yet been admitted to the program, it will be implemented in the near future. Because it is important to address the educational needs of adult primary care APNs, this article describes the needs assessment and development plan used for this program.

This article describes the steps of a pilot dissemination study toward adopting a pain assessment tool for older homebound adults with dementia. The chosen practice site had not previously used adequate pain assessment tools for older adults with dementia. After the selection process by a pain assessment tool committee, providers (N = 20) were asked to choose between three tools: pain assessment in advanced dementia (PAINAD), the Abbey Pain Scale, and DOLOPLUS-2/ DOLOSHORT. Providers voted to use the PAINAD (54%) for the following 2 weeks. A preintervention audit showed that without the use of a pain assessment tool, 97.7% of the charts did not have any documentation of a pain diagnosis nor an intervention. Postintervention using PAINAD, 91.3% of the charts had both (χ²[1] = 18.645, p < .001). The feedback obtained from providers (n = 10) after 2 weeks of testing the tool was unanimously positive. Many providers reported increased confidence in identifying pain and some changed their practice by placing pain assessment in the forefront of their encounter with their older clients with dementia. PAINAD was adopted as the pain assessment tool for this practice.

An interprofessional team developed a yearlong post-doctorate of nursing practice (DNP) residency program funded by the Veteran Affairs (VA) Office of Academic Affiliations. As the VA’s first post-DNP residency, this multidisciplinary team sought to develop a mentoring environment that would provide DNP residents with increased clinical training, interprofessional networking, role transition, and dedicated mentoring. The authors discuss critical design elements for a successful residency design along with lessons learned. Initial findings support continuation and solidification of post-DNP residencies for new DNPs.

Trauma-related biased perception of threat, typically defined in terms of physical danger or harm, is associated with intimate partner aggression perpetration. Yet, it is unclear if such threat (a) functionally motivates aggression and (b) includes diverse forms of threat. Theory and limited research suggest that threats of rejection/abandonment and social dominance may be two distinct functional precipitants of aggression among trauma-exposed individuals. Sixty-four heterosexual couples (N = 128 individuals) selected for elevated symptoms of posttraumatic stress disorder in either partner were observed during conflict discussions. Small correlations between men's and women's engagement in threats of rejection/abandonment and social dominance suggest that they reflect distinct types of threat. Partners' rejection/abandonment threats and social dominance threats were more strongly associated with engagement in aggression among men with a relatively high frequency of trauma exposure, compared to men with a low frequency of trauma exposure and all women. Women with a high, relative to low, frequency of trauma exposure behaved more aggressively in the context of their partners' social dominance threats; women's aggression was not associated with the severity of their partners' rejection/abandonment threats. Results align with research suggesting that highly traumatized men's misperceptions of threat may motivate their aggression, and indicate that aggression may also be used in the context of accurately detected threat. Integration of methods to alter contextual and individual factors influencing aggression perpetration may improve intervention outcomes. Compared to individually-based interventions, conjoint couple interventions may be better poised to address maladaptive contextual processes that contribute to relationship aggression perpetration.

Background: Gentrification is impacting urban communities across the globe. Some urban communities have undergone major displacement of longtime residents thus placing older persons at particular risk of social isolation and the loss of social networks. Objective: The objective of the article is to bring attention to the impact of gentrification on communities and specifically addresses the impact on older persons, especially as it relates to displacement, social isolation, and social networks. Additionally the article aims to address implications for social work practice. Method: A review of the literature was used to gather information on this important topic. Additionally, newspaper articles were reviewed that discussed gentrification in urban neighborhoods. Content analysis was used to gather themes that would inform practice recommendations. Additionally the author used community mapping through personal observation. Findings: Gentrification is perceived as both positive and negative, depending on the stakeholder. It also has been associated with negative health effects as well as social isolation and the loss of social networks. Older persons of color are particularly at risk of displacement. Emotional and financial hardships. Conclusions: Practice implications include an examination of quality of life factors, introduction of financial counseling and advocacy for policies that respect the quality of life of older persons faced with gentrification.

Women who experience domestic violence are more likely to use or become dependent on substances. Their health and safety are at greater risk when Violence Against Women (VAW) shelters have policies prohibiting admission if noticeably impaired. Harm reduction strategies can help reduce harms caused by substance use. Minimal research was found about impacts of integrating harm reduction in VAW shelters. We examined women's experiences with a harm reduction service delivery model at a Canadian rural VAW shelter. Interviews were conducted with 25 former residents to explore their experiences. Most women preferred to have harm reduction implemented, although most women also wanted changes made to harm reduction practices. These recommended changes would enhance positive experiences and feelings of safety for all women, thereby achieving the goal of all women welcome. Overall, our findings support the integration of harm reduction in VAW shelters that balances harm reduction philosophy and practices with the individualized needs of traumatized women and safety of children.

Mothers with persistent, reoccurring issues with plugged milk ducts in their breasts are usually in great amounts of pain and, therefore, at great risk for premature weaning. Why some mothers struggling with this issue seems unclear, but there is a treatment option that can offer immediate relief and perhaps a permanent resolution of these trouble areas in the breast. Using ultrasound treatment of the affected area of the breast is a highly effective, last resort treatment, but most IBCLCs do not have access to healthcare providers to refer to for this procedure. In this article, plugged duct treatments will be discussed with a focus on the specifics of using ultrasound for resolving this issue.

Over the years, much of the folklore of breastfeeding has been lost because women did not write history, they told stories. This article shares breastfeeding lore from stories told to the authors by American Indian women from the Eastern Shoshone and Northern Arapaho tribes on the Wind River Reservation near Lander, Wyoming. These women related stories describing treatment for milk fever (mastitis), the white man’s influence on mother/baby separation and its outcome, elderly women inducing lactation, breastfeeding and birth control, and how women dressed for ease of breastfeeding in former times. It is with appreciation for other cultures that we add this information from American Indians to the archives of breastfeeding history.

The Joint Commission on Accreditation of Hospital Organization (JCAHO) has handoff requirements to create the safe and effective transfer of patient information between providers. Multiple studies have investigated standardized nurse-to-nurse handoffs and nurse-to-physician handoffs. However, very few studies have examined handoff communication between anesthesia providers. A near-miss scenario during a sitting craniotomy procedure is reviewed, and a root cause analysis conducted to demonstrate the importance of communication and how a standardized anesthesia handoff tool can facilitate patient safety.

Results of outcome evaluations of the domestic violence (DV) programs are not encouraging. Overall, the most optimistic conclusion is that these programs have only a modest impact on reducing repeat partner violence. Recently, there are calls for DV programs to “grow up,” adapt a paradigm shift, shed ideology, and determine how the maximum impact can be realized from work to reduce intimate partner violence (IPV). The following review examines why program results are so unconvincing and proposes a comprehensive framework to advance the field. Specifically, it recommends that applying the risk-need-responsivity (RNR) principles of effective corrections could substantially improve treatment results. Using this framework, the article identifies selected risk assessment tools to screen offenders into appropriate levels of service (the risk principle) and provides an extensive review of the literature on appropriate targets for change (the need principle). Problems with substance use (particularly alcohol abuse), emotion management, self-regulation, and attitudes supportive of partner abuse have substantial empirical support as factors related to IPV. There is weaker but promising support for targeting the impact of association with peers who are supportive of abuse of women, poor communication skills, and motivation to change abusive behavior patterns. Responsivity could be enhanced through incorporation of motivational interviewing techniques, the processes of change identified in the Transtheoretical Model, solution-focused and strength-based approaches, and attention to identity change and cultural issues. In addition, the review describes strategies to insure ongoing program integrity, a key factor in implementing effective interventions.

Research demonstrates that child-to-parent violence (CPV), an under researched form of family violence, is associated with intimate partner violence (IPV). The aim of this article is to critically explore the influence of the Duluth model of IPV on the overarching conceptual frameworks used to explain CPV. Although gender socialization could indeed be a factor implicated in CPV, the prefixed assumptions of the Duluth model about gender as the ultimate etiological factor, have shaped and dominated the discourses of CPV resulting in devaluation of a range of other factors pertinent for understanding this type of violence. It has been established that violence, and more specifically family violence, is a highly complex phenomenon that has history and continuity; as such contextual, multi-modal explanations are favored (Asen & Fonagy, 2017). This article discusses the tenets of the theory and consequently, its influence on discourses around etiology and maintenance of this narrative. Future recommendations include ecological, lifespan approaches based upon tailored, evidence-based interventions.

Nursing education is undergoing a major transition with a shift in advanced practice registered nurse (APRN) educational preparation from a master’s degree to the clinical doctorate that is targeted to be fully implemented by 2015. This paradigm shift in nursing education is expanding the role and scope of APRNs. Some doctor of nursing practice (DNP) programs for APRNs focus on the provision of comprehensive care to a panel of patients. These APRNs with DNP (DNP/APRN) programs in comprehensive care expand master’s preparation to prepare expert clinicians who are knowledgeable about individuals’ health care needs across the life span; to practice in all clinical settings; to analyze and interpret evidence as the basis for health care choices; and to engage patients in a collaborative relationship to provide continuous, coordinated services that include health promotion, disease prevention, and definitive disease management in all clinical settings (Smolowitz, Honig, & Reinisch, 2010).

Nursing has a unique opportunity to track this new DNP/APRN subgroup from its inception using systematic and structured data collection. With this paradigm shift in nursing education, the role and scope of APRNs will continue to evolve. We developed a survey that could be distributed nationally to DNP/APRNs to (a) track roles and competencies of doctorally prepared nurse clinicians in relation to comprehensive care and (b) identify performance measures and quality indicators for delivery of comprehensive care. The purpose of this pilot study was to test the survey on a sample of master’s prepared APRN (M/APRN) and DNP/APRNs engaged in faculty practice at the Columbia University School of Nursing.

Sore nipples are the bane of breastfeeding mothers. Nipple pain and/or damage ranks in the first 2 or 3 reasons for the early abandonment of breastfeeding. There exists a plethora of suggested remedies, many of which have little or no high quality evidence to recommend their use. This article reviews approaches to managing sore nipples and suggests that more research be conducted to better remedy this ongoing problem.

Beginning with grass root movements in the early 1970s, batterer intervention programs (BIP) have evolved into the most prominent and visible form of intervention for individuals who commit acts of violence against their intimate partner. Evidence indicates, however, that these programs do not demonstrate high levels of effectiveness at stopping abuse/violence. To this end, this conceptual article presents an analytic discussion that first outlines traditional BIP approaches highlighting the literature finding ineffectiveness. Next, six ideas with the potential to change the field are presented followed by a brief description of how integrating strengths into work with batterers can improve intervention.

Intimate partner violence (IPV) is a major public health issue; worldwide, almost 1 in 3 women is affected. Police involvement in IPV cases has substantially increased because of “proarrest” and “procharging” policies and the enforcement of laws protecting victims of domestic violence. In the course of these changes, several front-line instruments have been developed to structure police risk assessment and decision-making strategies in such cases. One of those is the Ontario Domestic Assault Risk Assessment (ODARA). To investigate its validity in a Swiss police setting, a total cohort of male IPV offenders was retrospectively assessed for a fixed time at risk of 5 years. The recidivism base rate was 32% when recidivism was defined as subsequent police-registered IPV. Although ODARA scores were significantly correlated with IPV recidivism, they showed poor discrimination and calibration. Despite comparable base rates of recidivism, the Zurich sample scored significantly higher on the ODARA than the development sample. This mismatch of the expected and observed recidivism rates resulted in an overestimating of risk, especially in the two highest risk bins. Several reasons for those deviations, such as level of intervention, victim’s reporting behavior, and the dynamic nature of IPV, are discussed.

The primary purpose of this study was to assess the educational efficacy of the pamphlet Treatment Options for Avascular Necrosis of the Hip for patients with avascular necrosis (AVN). This pamphlet was designed to provide patients with information on 3 domains: (a) basic knowledge of AVN, (b) understanding of the risk factors associated with AVN, and (c) awareness of current AVN treatment options. The sample was composed of 20 AVN patients reflecting the racial diversity of the Eastern urban academic medical center. Fourteen (70%) of the patients were aware of their AVN diagnosis, and 13 (65%) reported of having conducted research on AVN. Prior to the presentation of the pamphlet, the AVN Assessment Inventory, a 13-item true/false test assessing the three domains, was answered by the patients (see Appendix A). The principal investigator presented to the sample the educational pamphlet for their review and the AVN Assessment Inventory for their answers once again. Results of the 2 (Time: pre/post) × 3 (Domain: knowledge, risks, treatment) × 2 (Diagnosed: yes/no) × 2 (Prior research: yes/no) mixed analysis of variance (ANOVA) supported the educational efficacy of the patient pamphlet Treatment Options for Avascular Necrosis of the Hip. Implications of this study are discussed.

Tongue-tie can cause many serious breastfeeding problems and even lead to breastfeeding cessation. As the mothers’ stories listed in “When Tongue-Ties Were Missed: Mothers’ Stories” attest, healthcare providers often do not correctly identify when a baby has a tongue-tie. Assessing tongue-tie is essential. What should clinicians look for? Which professionals should be the ones identifying and identifying tongue-tie? Assessing tongue-tie is the focus of this article.