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OBJECTIVE: To determine whether pregnant women's perceptions of abuse severity and danger, and their ability to control the abuse, are significantly correlated with the acts of abuse they experience, and to find out whether relationships exist among women's appraisals of abuse severity, danger, and their perceived ability to stop the abuse. DESIGN: A correlational design was used to compare the abusive acts experienced by the women and their perceptions of that abuse. SETTING: Nine prenatal clinics in urban areas of the northeastern United States. PARTICIPANTS: Sixty-one ethnically diverse, pregnant abused women were interviewed. MAIN OUTCOME MEASURE: Pearson's product-moment correlations were used to examine relationships between abusive experiences and women's perceptions of abuse. RESULTS: Women's perceptions of abuse severity were modestly correlated with threatened (r = .25) and actual violence (r = .36). Perceptions of abuse severity and danger were correlated (r = .41). CONCLUSIONS: Women's beliefs about abuse severity, danger, and their ability to control abuse cannot be fully comprehended by exploring the discrete acts they experience. Further research is needed to identify additional factors that influence those beliefs.

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Domestic abuse is the leading cause of injuries and death among women of childbearing age in the United States. The broad purpose of this research is to discover how pregnant women's psychological and behavioral responses to abuse affect birth outcomes. To select a diverse sample of women, we identified 8 prenatal care sites and completed the human subjects approval process with each. Rates of screening for abuse range from all but 12 women over a 2-1/2-year period at one site to no screening for abuse at another site. In this article, we will review pertinent literature and discuss the supports and barriers we observed when implementing an abuse screening program using the Abuse Assessment Screen, a well-tested and valid clinical instrument. Suggestions will be made for improving the screening rates at those sites where screening is absent or inconsistent.

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OBJECTIVE: To determine which clinical factors experienced obstetric nurses consider most important in determining fetal risk during the intrapartum period. DESIGN: Ten dichotomized variables relevant to participants' clinical decision-making were manipulated in fractional factorial vignettes. Participants were asked to rate the severity of fetal risk on a Likert scale after reading the vignettes. SETTING: About 87% of the participants worked in institutions with 4,000 or fewer deliveries per year. More than 25% worked in tertiary level facilities, and the remainder were employed in primary or secondary level facilities. PARTICIPANTS: Participants (N = 573), randomly selected from a list of nurses certified in "inpatient obstetric nursing" by the National Certification Corporation, were mailed the vignettes. The average number of years of intrapartum nursing experience was 13. MAIN OUTCOME MEASURE: Multiple regression analysis was used to determine the weights given to the 10 clinical factors by participants. RESULTS: Fetal scalp pH, maternal parity, amniotic fluid color, and long-term variability of the fetal heart rate were the most important predictors of nurses' fetal risk assessments. CONCLUSIONS: Long-term variability was the most important cardiotocographic factor in nurses' fetal risk assessments and the only cardiotocographic factor of the best 4 predictors of fetal risk. This indicated that participants were realistic about the limitations of electronic fetal monitoring (EFM).

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Investigators encounter many legal and ethical issues when they conduct research on partner abuse. Balancing abused women's rights to privacy with legally mandated reporting requirements involves considerable thought and planning. Failure to protect participants may result in escalation of abuse as well as loss of children to protective services. Various perspectives on maintaining participant privacy while conforming to legal mandates to report child abuse, homicidality, and suicidality are discussed. The role of confidentiality certificates in providing legal immunity for researchers and the method of obtaining the certificates are presented. In addition, the authors describe the strategies for participant protection that are implemented in a federally funded study of abuse, women's self-care, and pregnancy outcomes. The decision to clearly and specifically inform abused women of the limits of confidentiality allows participants to make informed decisions about disclosures, but may result in diminished recruitment.

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The reliability, validity, and efficacy of electronic fetal monitoring (EFM) remain matters of controversy. In fact, several professional organizations, including the American College of Obstetricians and Gynecologists, have endorsed the use of intermittent auscultation for low-risk pregnant women. Nevertheless, in 1996, 83% of laboring women in the United States are monitored electronically. Nurses should encourage healthy, low-risk pregnant women to weigh carefully decisions about the use of EFM.

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Data sets from three individual studies on nursing judgment were reviewed from a wider perspective. This yielded meanings and phenomena not readily identified in the individual studies, and it was tentatively labeled presence. A hermeneutic study using 10 transcripts from each data set asked: What are the common features of the context of nursing judgment? and, What are the features of the nurses' connection with the patient that contribute to nursing judgment? The analysis yielded six features of nursing presence: uniqueness, connecting with the patient's experience, sensing, going beyond the scientific data, knowing (what will work and when to act), and being with the patient. These features of nursing presence are logical distinctions and serve as ways to grasp the idea of nursing presence.

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Nursing presence emerged in the nursing literature in the 1960s as a coherent and consistent philosophical term based in the existentialism of Gabriel Marcel and Martin Heidegger, and the religious philosophy of Martin Buber. Since the mid-1980s, however, the precision in definition has deteriorated and presence has accrued multiple meanings, resulting in a weakened sense of the concept. After delineating the etymological and philosophical foundations of nursing presence, the concept is defined. The existential nature of nursing presence is explored and arguments for the indispensability of nursing presence are offered to counter the claims of bottom-line thinking. A definition is offered of nursing presence as an intersubjective encounter between a nurse and a patient in which the nurse encounters the patient as a unique human being in a unique situation and chooses to "spend" herself on his behalf.

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OBJECTIVE: To determine what clinical parameters and indicators expert intrapartal nurses used to assess the severity of fetal stress. DESIGN: A descriptive, qualitative study using tape-recorded interviews from verbal protocols during clinical problem solving. SETTING: Labor and delivery units of two metropolitan hospitals in the northeastern United States. PARTICIPANTS: Eighteen nurses, designated as experts by nurse managers, with an average of 11.3 years of intrapartal experience. RESULTS: The clinical assessment parameters identified by content analysis included duration of stress, fetal reserve status, reversibility of stress, and specific signs of stress. The clinical assessment parameters included whether the disturbing pattern was brief or prolonged, continuous or intermittent, and how rapidly the mother's labor was progressing. Indicators of fetal reserve status were maternal pregnancy health status, gestational age of fetus, and biophysical indicators of fetal status. Reversibility of stress was assessed based on the precipitating factors involved and responsiveness of the fetus to resuscitation. Specific signs of stress included the characteristics of the fetal monitor strip changes, scalp sample results, and amniotic fluid color. CONCLUSIONS: Contextual features of clinical problems are key links in the decision-making processes of expert intrapartal nurses. Knowledge elicitation techniques can be used to identify these links.

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The purpose of this study was to determine whether the effectiveness of senior nursing students' immediate responses to patients is influenced by type of distress presented by patients or by type of student degree programme. Forty-four ADN and 31 BSN seniors from four schools agreed to participate. Subjects viewed two videotaped simulations of 'patients' complaining of pain and two of 'patients' manifesting emotional distress. Content validity of simulations was established through nurse experts. After each tape, subjects answered four research questions based on Orlando's nursing process concept. The fourth question asked what subjects would say initially to 'the patient'. The data revealed eight response categories which were scored according to their congruence with Orlando's concepts. Independent categorization of responses yielded a 0.92 inter-related reliability; t-tests indicated that type of distress was related to response effectiveness (P less than 0.01) but type of degree was not (P greater than 0.01). The presumed emphasis on communication and psychosocial foundations in BSN curricula may not translate into more effective exploratory skills in these students. These skills are a key component of the complex assessment skills which enable nurses to 'diagnose human responses' to health problems. Orlando's model is recommended for teaching BSN students to conceptualize the interactional process and its goals.

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