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AIMS: To examine and describe women’s emergency department visits and care-seeking experiences, including recognition, evaluation, and communication of symptoms, injuries, and health risks after non-fatal intimate partner strangulation. DESIGN: Using a diagnostic process framework, this mixed-methods study explores concordance and discordance of interview and medical records data to highlight opportunities for clinical diagnostic improvement. METHODS: In-depth, semi-structured interviews with women after an emergency department visit for non-fatal intimate partner strangulation, concurrent with medical records reviews were conducted between March 2018 and January 2019. A constant comparative approach was used to analyze interview and medical record data using an a priori codebook designed based on the National Academies of Science, Engineering and Medicine’s conceptual model of the diagnostic process and prior intimate partner violence research. RESULTS: Interviews reflected participants did not have a sense of long-term health risks from their strangulation beyond addressing emotional trauma. Women noted that forensic and emergency nursing support was treatment in and of itself that allowed them to be heard and validated. Medical record clinical impressions and final diagnoses included domestic violence, domestic abuse or sexual assault, but not specifically strangulation. CONCLUSION: This study contributes to the growing literature regarding strangulation diagnosis and care. Our findings provide new details of women’s emergency department care-seeking experiences which, while overall aligned with medical records documentation, were not reflected in final diagnostic impressions nor in patient recollection of long-term health risks. IMPACT: Nurses are strongly positioned as clinical practice leaders and policy advocates to improve collective responses to this dangerous violence mechanism. Actions such as improving patient education, referral, and follow up options to better communication and address long-term strangulation risk are one example. Further research on non-fatal intimate partner strangulation and care-seeking is warranted to expand on this knowledge, particularly in longitudinal cohorts and varied geographical areas.

People who inject drugs often have a higher prevalence of risk factors associated with coronavirus disease 2019 (COVID-19) infection and associated morbidity and mortality, compounded by challenges in health care access. This increased vulnerability underscores the critical need to prioritize people who inject drug in ongoing COVID-19 vaccination efforts. Co-location of syringe services, COVID-19 vaccination services, and other communicable disease testing has proved an effective model to provide necessary interventions without creating additional barriers. Here, we describe a partnership between the Baltimore City Health Department, Johns Hopkins Mobile Vaccine Unit, and the Center for Infectious Disease and Nursing Innovation at the Johns Hopkins School of Nursing to provide COVID-19 vaccination, HIV and sexually transmitted infection testing, wound care, and linkage to care services co-located with a long-running syringe services program. We describe the services offered by each partner and lessons learned from this community-based co-location of services initiative.

Introduction Nonfatal intimate partner strangulation poses significant acute and long-term morbidity risks and also heightens women’s risk for future femicide. The lifetime prevalence of nonfatal intimate partner strangulation has been estimated to be approximately 10%, or 11 million women, in the general United States population. Given the potential for significant health risks and serious consequences of strangulation, this study adds to the limited literature by estimating prevalence and describing the associated characteristics of strangulation-related visits among United States ED visits by adult women after intimate partner violence. Methods Prevalence estimation as well as simple and multivariable logistic regression analyses were completed using data from the Nationwide Emergency Department Sample spanning the years 2006 to 2014. Results The prevalence of strangulation codes was estimated at 1.2% of all intimate partner violence visits. Adjusting for visits, hospital characteristics, and visit year, higher odds of strangulation were noted in younger women, metropolitan hospitals, level I/II trauma centers, and non-Northeast regions. Increases in strangulation events among intimate partner violence–related visits in recent years were also observed. Discussion A relatively low prevalence may reflect an underestimate of true nonfatal intimate partner strangulation visits owing to coding or a very low rate of ED visits for this issue. Higher odds of strangulation among intimate partner violence visits by women in more recent years may be due to increased recognition and documentation by frontline clinicians and coding teams. Continued research is needed to further inform clinical, postcare, and social policy efforts.

OBJECTIVE: To describe characteristics of strangulation, and associated medical care, documentation, and injuries of women after non-fatal intimate partner strangulation (NF-IPS) who present for care to a community-based ED with an associated IPV advocacy program between 2008 and 2016. SETTING, DESIGN, AND PARTICIPANTS: A retrospective review of 345 female ED patients’ medical records who sought care at a community hospital ED following a physical assault including strangulation by an intimate partner was conducted. Demographics, characteristics related to reported signs and symptoms, injuries, and subsequent imaging, diagnoses and discharge information were abstracted. RESULTS: Commonly reported symptoms were neck pain (67.2%) and headache (45.8%), with fewer patients reporting more severe symptoms such as loss of consciousness (22.6%), dysphagia (25.0%), or dysphonia (26.7%). Rates of patients disclosing strangulation to the entire multidisciplinary team and dedicated neck imaging appeared to improve between 2008 and 2014. Among the 45 patients with noted head and neck findings, two patients were found to have an internal carotid artery dissection, two patients were found to have strokes, and one patient was found to have an intracranial hemorrhage. CONCLUSIONS: Survivors of NF-IPS may present to community-based hospitals, and existing imaging guidelines can support clinicians in identifying serious internal injury like carotid artery dissection and stroke. Further research is needed to better discern symptoms previously attributed to psychological trauma from post-strangulation brain injury. This study contributes to the growing literature on NF-IPS with data specific to community-based ED visits.

The impact of the SARS-CoV-2 virus on delivery of hospital care during the ongoing COVID-19 pandemic has required effective nursing leadership of large teams of Advanced Practice Registered Nurses (APRNs). At a large academic medical center in the mid-Atlantic United States, nurse leaders combined knowledge of the psychological phases of disaster and principles of the Serving Leadership framework to mobilize and lead APRN teams to deliver high-quality care to all patients and provide a safe working environment for healthcare teams. In this article, we discuss exemplars that demonstrate the flexibility and strengths of APRNs in all roles who addressed rapidly evolving needs such as resource allocation and education. The conclusion highlights the value and relevance of APRN skillsets to clinical practice and the opportunity to further capitalize on these strengths during the continuing journey through this COVID-19 pandemic and beyond.

Severe intimate partner violence (IPV) including loss of consciousness from head injuries and/or strangulation can result in traumatic brain injury (TBI), a brain pathology characterized by altered brain function, cognitive impairment, and mental health disorders, including depression and posttraumatic stress disorder (PTSD). This study examines the prevalence of probable TBI (defined as loss of consciousness from a blow to the head and/or strangulation) and its association with comorbid PTSD and depression among Black women, who experience both higher rates of IPV and greater mental health burden than White and Latina women. Data come from a retrospective cohort study of 95 Black women with abuse history including IPV, forced sex, and childhood maltreatment. About one-third of women (n=32) had probable TBI. Among them, 38% (n=12) were hit on the head, 38% (n=12) were strangled to unconsciousness, and 25% (n=8) were strangled and hit on the head. Women with IPV history and probable TBI had significantly greater odds of various physical injuries including those that required medical care compared to other abused women. Probable TBI significantly increased comorbid PTSD and depression by 8.93 points (SE=3.40), after controlling for past violence (F((4, 90))=3.67, p

Introduction Nonfatal strangulation by a current or former intimate partner is a distinct mechanism of violence with the potential for severe injury or death. As nonfatal strangulation has gained recognition for its significant medical and legal implications, there have been multiple calls for nursing and other health care providers to improve practices related to strangulation screening, assessment, and treatment. Given that US estimates suggest higher prevalence of strangulation of women than of men, this integrative evidence review examines existing literature related to women's injuries and their subsequent experiences in seeking health care after surviving intimate partner strangulation. Methods Following PRISMA guidelines, 5 electronic databases were searched, ultimately resulting in 13 articles for inclusion. Results Overall, nonfatal intimate partner strangulation was associated with multiple negative physical and psychological outcomes for women, although only 5% to 69% of strangled women sought health care in studies reporting this finding. Discussion Nonprobability sampling, participant self-reports, and relatively small sample sizes were frequently encountered limitations across studies. Heterogeneity of women's ages and race/ethnicities also limited comparisons. However, existing research provides a beginning framework to support practice and future inquiry.Image 1Contribution to Emergency Nursing Practice •Prevalence estimates suggest nonfatal intimate partner strangulation (NF-IPS) is higher in women than in men. •Injuries after NF-IPS may be subtle, covert, or minimized yet can result in serious health outcomes. •Screening, assessment, and objective documentation of findings by emergency nurses can improve recognition of NF-IPS, support appropriate care plans and referrals, and help future legal recourse. •Additional research is needed to test screening, imaging and treatment protocols, use of emerging technology to enhance assessments, and long-term health outcomes associated with NF-IPS.

Because identification of intimate partner violence (IPV) in health care settings is low and strangulation increases lethality risk among women experiencing IPV, we examined the prevalence and correlates of nonfatal strangulation among 1,008 women survivors of IPV.Trained researchers conducted semistructured interviews with women survivors of IPV referred by police. Multinomial logistic regression examined differential correlates of attempted, completed, and multiple strangulation.Interviews were conducted with 71.14% of eligible women contacted by researchers. A high proportion (79.66%) of the women interviewed experienced attempted (11.70%), completed (30.16%), or multiple (37.80%) strangulation. Each form of strangulation was independently significantly associated with sexual violence when compared with no strangulation. African American women were at increased risk of attempted (adjusted relative risk ratio [ARR], 2.02; p .05), completed (ARR, 1.79; p .05), and multiple strangulation (ARR, 2.62; p .001). Compared with no strangulation, multiple strangulation was associated with more IPV injury and risk factors for homicide, including loss of consciousness (ARR, 2.95; p .05) and miscarriage (ARR, 5.08; p .05). Women who had lost consciousness owing to strangulation were more likely to seek medical care than those who had been strangled but had not lost consciousness (p .01).Strangulation is a prevalent form of IPV that presents significant health risks to women. Women's health practitioners are optimally positioned to identify subtle signs and symptoms of strangulation, help women to understand the delayed sequelae and potential future fatality associated with strangulation, and connect them with appropriate resources to reduce the risk of morbidity and mortality.

Objectives The Patient Safety and Quality Improvement Act (PSQIA) of 2005, inspired by the Institute of Medicine's (IOM) 1999 report To Err Is Human, affords federal protections in exchange for error disclosures. However, the PSQIA is unlikely to be effective unless frontline providers are aware of its existence. In this study, we assessed the quantity of publications regarding this protection within the medical literature. Methods Four reviewers independently evaluated 2060 safety-related articles, identified through a PubMed database search, to determine whether they discussed actual (or proposed) national legal protections for voluntary reporting of medical errors. Using a reviewer method based on a standard Delphi consensus model, agreement was achieved if at least 3 of 4 reviewers agreed with the decision. Results Articles were separated into pre-IOM report (1990-1999) and post-IOM report (2000-2008) literature. No articles were determined to be "on topic" in the pre-IOM period (n = 624). Twenty-seven articles were considered "on topic" in the post-IOM period (n = 1436), constituting 1.8% of the period total (95% confidence interval, 1.2%-2.6%). Of the 27 on topic articles, 7 appeared in practice-related journals, whereas the remaining 20 were in journals with a health policy or health care administration focus. Conclusions Few published studies were found in clinical journals describing the PSQIA. This raises serious concerns and indicates that physicians may not be aware of the new legal protections afforded for error disclosure. If the health care system is to realize the benefits of error reporting systems, greater education of physicians regarding their legal protections may be needed.

Research on human subjects entails unique challenges, particularly when risks to patient safety are under scrutiny. Therefore, many factors must be considered in study design. This chapter serves to provide a broad overview of commonly used frameworks and methods for injury research related to patient safety. We review methods used to reveal hazards in health care, analyze and prioritize the risks associated with these hazards, and evaluate interventions to reduce these hazards.