THROUGH THEIR WHOLE-PATIENT focus and

Transcription

1 NURSING STUDENTS AND INTIMATE PARTNER VIOLENCE EDUCATION: IMPROVING AND INTEGRATING KNOWLEDGE INTO HEALTH CARE CURRICULA PAMELA D. CONNOR, PHD, SIMONNE S. NOUER, MD, PHD, PATRICIA M. SPECK, DNSC, APN, FNP-BC, SANE-A, SANE-P, DF-IAFN, FAAFS, FAAN, SEÉTRAIL N. MACKEY, MPA, MCJ, AND NATHAN G. TIPTON, MA This study measured intimate partner violence (IPV) curriculum content exposure; knowledge, attitudes, beliefs, and self-reported behaviors; and IPV prevalence within doctor of nursing practice and doctor of philosophy nursing programs at a university in the southern United States. The survey instrument was an adaptation of the Physician Readiness to Manage Intimate Partner Violence Survey modified with language that focused on students in the health care arena. Three summary scales Perceived Preparedness, Perceived Knowledge, and Actual Knowledge were also created. Mann Whitney U tests and exploratory multivariable and logistic regression analyses were employed to analyze the data. Results indicated that nursing students who received IPV training prior to graduate school had significantly higher perceived preparation and perceived knowledge ratings than those reporting no IPV training prior to graduate school. Results also showed that 40% of nursing students surveyed had personally experienced some type of domestic violence including IPV. Identifying and responding to curricular shortcomings and ascertaining student IPV prevalence are critical steps in strategizing and implementing comprehensive curriculum revision, enabling students to enter the nursing profession with the capacity to directly impact the care and treatment of IPV victims. (Index words; Intimate partner violence; Curriculum revision; Student knowledge and training; Intimate partner violence prevalence) J Prof Nurs 29: , Elsevier Inc. All rights reserved. THROUGH THEIR WHOLE-PATIENT focus and their recognition of intimate partner violence (IPV) as a high priority, nursing professionals are the Professor, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN. Assistant Professor, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN. Associate Professor, College of Nursing, The University of Tennessee Health Science Center, Memphis, TN. Senior Research Specialist, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN. Coordinator, Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN. Address correspondence to Dr. Connor: Department of Preventive Medicine, The University of Tennessee Health Science Center, 66 North Pauline Street, Suite 101, Memphis, TN dconnor@uthsc.edu /12/$ - see front matter third most common resource cited by women who present for IPV (Johnston, 2006; Pakieser, Lenaghan, & Muelleman, 1998). Nursing professionals generate enormous impact in this area by bringing high levels of clinical competence and knowledge at the point of care while also contributing to the growth of nursing science through scholarly research. Nursing professionals also protect IPV victims in clinical settings through interventions including routine screening, guiding, and advocating on behalf of patients (Davila, 2005; Johnston, 2006). It is therefore crucial that nursing professionals be adequately versed in recognizing and responding to the myriad issues surrounding IPV. This recognition and response can occur through clinical practice, provision of clinical practice-oriented leadership, initiating institutional change in response to Journal of Professional Nursing, Vol 29, No. 4 (July/August), 2013: pp Elsevier Inc. All rights reserved.

2 234 CONNOR ET AL IPV, or by formulating and implementing substantive public policy. Research, however, continues to show nursing professionals receiving minimal IPV education and training as a part of their undergraduate or graduate nursing curricula (Davila, 2005; Woodtli & Breslin, 2002). Education and training reinforce best practice guidelines in IPV (Boursnell & Prosser, 2010) and provide the most efficient and effective method for understanding and addressing IPV. Yet, the lack of education and concomitant shortage of comprehensive IPV curricular content often leaves nurses at all professional levels with feelings of inadequacy and perceived lack of competence (Tufts, Clements, & Karlowicz, 2009). This study explores IPV content exposure in doctor of nursing practice (DNP) and doctor of philosophy (PhD) nursing curricula and documents the incidence of students' personal IPV experience. Student responses allowed us to examine the impact of personal experience on IPV knowledge and practice opinions and to identify and respond to current IPV curricula shortcomings by strategizing and implementing additional training and counseling. These findings constitute the first phase of a comprehensive curriculum revision effort for all colleges within our university. Part of this effort includes using our data to ascertain student's current curricular needs so that we can revise and deploy an existing IPV prevention and intervention curriculum in accordance with these identified needs. This curriculum will then be incorporated (either wholly or in part) into future course catalogs as an established part of student's required coursework. Subsequent to this curriculum incorporation, student IPV knowledge gain can be longitudinally tracked, allowing us to explore how this knowledge gain translates into future practice and/or advancements in theoretical research. We hope that, ultimately, nursing students at all educational levels who receive this IPV training and education will enter the profession with the capacity to emphasize, apply, and promulgate procedures via their academic or clinical workplace settings. Moreover, this increased capacity will provide for enhanced recognition and prevention strategies, practices, policies, and methodologies that will directly impact the care and treatment of IPV victims. Review of the Literature The National Center for Injury Prevention and Control (NCIPC; 2009)defines IPV as violence occurring between two people in a close relationship (including current and former spouses and dating partners), existing along a continuum from a single episode of violence to ongoing battering, and including four types of behaviors: physical violence, sexual violence, threats of physical or sexual violence, and emotional abuse. Nursing literature has consistently affirmed IPV as a health issue, and IPV education and training have historically helped nursing professionals understand the dynamics of abusive relationships and to teach them how to provide victims with the support and referral to community resources necessary to enable them to eventually leave such relationships (Schoening, Greenwood, McNichols, Heermann, & Agrawal, 2004, p. 573). Nursing curricular texts also provide extensive coverage of recent understandings about IPV. These education and training also influence attitudes and behavioral intentions of nursing professionals and nursing students by helping combat future negative feelings often encountered when dealing with or performing research related to situations involving IPV. Inoue and Armitage (2006) have suggested that a combined approach of ongoing education and structured policies and procedures may help provide clear expected actions and responses from all nursing team members, thus enabling nursing professionals to respond appropriately (in spite of preexisting perceptions, beliefs, or experiences) to persons affected by IPV. Yet, substantial improvements or increases of IPV content in nursing curriculum have remained slow in coming (Woodtli & Breslin, 2002, p. 340). In fact, general nursing curricula for both undergraduate and graduate programs not only lacks significant information about all types of violence but is also deficient in responsive evidence-based content and practices, particularly such content and practices related to IPV. Presently, specialty tracks such as forensic nursing, which teaches nurses how to respond to victims and perpetrators of violence and collaborate with medical, social, and justice professionals, remain the principal source for information, content, and best practices about IPV (Lambe & Gage-Lindner, 2007; Stichler, Fields, Kim, & Brown, 2011). Although nurses receive a broad spectrum of training in different disciplines, they nevertheless report that instruction on recognizing and treating IPV is minimal in most schools. For instance, Hinderliter, Doughty, Delaney, Pitula, and Campbell (2003) noted that in their study of 557 nurse practitioners (NPs), 70% of these professionals surveyed had received 1 to 4 hours of IPV training during their basic education or during their advanced practice education. Still, most of these NPs felt that they were not adequately prepared to conduct a universal IPV screening. Survey respondents also stated that classes tended to focus on the cycle of violence, whereas little time was devoted to legal issues and safety planning for victims (Hinderliter et al., 2003). In addition, other studies have found that many times IPV education was presented in stand-alone lectures. As a result, not enough time was given or not enough importance was attached to imparting knowledge, changing attitudes, and facilitating the development of clinical skills necessary to perform competent IPV screening, intervention, and prevention (Tufts et al., 2009). Coincident with these curricular shortcomings are empirical findings documenting large numbers of nursing students who either have experienced abuse or are currently in abusive relationships (Anderson, 2002; Bracken, Messing, Campbell, La Flair, & Kub, 2010; Christofides & Silo, 2005; Gerber & Tan, 2009). For example, Bracken et al. surveyed nearly 2,000 female nurses and nursing personnel to determine prevalence of

3 NURSING STUDENTS AND INTIMATE PARTNER VIOLENCE EDUCATION 235 and risk factors associated with IPV and intimate partner abuse (IPA), which the authors differentiate from IPV by emphasizing the psychological and/or emotionally abusivecomponent of this violence perpetrated against this population. They found that nearly 25% of survey participants reported experiencing lifetime IPV, and 23% experienced IPA. However, these authors caution that even though nursing is a female-dominated field and women are the predominant population entering the profession, it is difficult to determine if these high IPV/ IPA rates are representative of the larger population or are specific to nursing. Method For this study, we used the IPV survey for health care students project to measure student knowledge of and attitudes about IPV, along with extent, content, and sufficiency of IPV training received by students prior to and during their graduate school studies. The survey also included an IPV experience variable so that we could determine prevalence while also gathering baseline information regarding to what extent this experience affected students' practice or research approaches to IPV. This information will be deployed as part of a larger forthcoming qualitative study. Between 2007 and 2008, 318 students in four academic concentrations (nursing, medicine, social work, and dentistry graduate programs) at our institution voluntarily agreed to participate. Of the original 318 students in our study, 52 participants were from the graduate (DNP and PhD) nursing programs at our institution. Because research has continued to show nursing professionals receiving minimal IPV education and training as a part of their undergraduate or graduate nursing curricula, we wanted to measure the quantity and quality of IPV education nursing students received at our institution. All nursing students who were recruited for this study (100.0%, n = 52) completed the survey. Ethical Considerations Ethical principles were followed. Institutional review board approval was sought and granted for this survey. All human subject protections and informed consent procedures mandated by our institution were followed. Students also received assurances that their personal data would be kept confidential, stripped of any identifying information at completion of the data collection phase of the study, and the resulting information would be used for research purposes only. Approval from deans and faculty from the college of nursing was obtained prior to surveying students. It was emphasized that the purpose of our study was not to evaluate the college's curriculum or to highlight curricular deficiencies but rather to identify ways of improving the standardized curriculum for nursing students. Data were collected in 2007 and 2008, and analyses were conducted in In addition, given the sensitive nature of the survey topic (IPV), surveyors were trained and instructed to provide counseling or brief interventions in case any respondent became upset or began disclosing. However, none of the survey respondents seemed at all bothered by the personal IPV experience question. Furthermore, students were spoken with both prior to and after the survey in order to reinforce that this was a strictly voluntary survey and that they would not be compelled to divulge any personal information. Survey Measure Our study utilized the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS; Short, Alpert, Harris, & Surprenant, 2006). We adapted this survey for student populations, with language that focused on students in the health care arena rather than on practicing physicians for which the original survey was designed (Connor, Nouer, Mackey, Tipton, & Lloyd, 2011). Our adaptation measured knowledge, attitudes, beliefs, and self-reported behaviors through a four-part (background, IPV knowledge, opinions, and practice issues), 67-item survey. The PREMIS respondent profile was also adapted to reflect the representative disciplines in our student population. Two questions related to personal and family IPV experience were added: (a) history of personal experience with some kind of physical violence, sexual abuse, intimidation, or threats of violence in an intimate partner relationship and (b) history of being a witness of physical violence, sexual abuse, or psychological abuse directed toward a family member. These questions were used to document student's personal IPV experience rather than being used as part of a long-range assessment and were designed to be dichotomous yes/no for purposes of gathering evidence on personal experience. Responses to these questions were then examined within the context of students' actual IPV knowledge, as were opinions and attitudes that could directly or indirectly influence clients. Our survey demonstrated high reliability within some IPV constructs, and six of the eight scales described in the original PREMIS were identified. Three scales from the original PREMIS (legal requirements, preparation, and selfefficacy) presented a Cronbach's alpha greater than or equal to.70, demonstrating acceptable reliability, and a new scale (IPV screening) was also identified that showed good reliability (α =.74). The construct validity of the instrument in the student population was measured by estimating the correlation between the instrument's scales. Detailed information on the reliability and validity of the modified PREMIS can be found in Connor et al. (2011). Statistical Analysis Data on IPV training for nursing students prior to and during their graduate programs were individually tabulated for each category, and the results were presented individually in order to facilitate comparison with regard to total hours of training received. Data on personal experience with some kind of physical violence, sexual abuse, intimidation, or threats of violence in an intimate partner relationship and data on witnessed physical violence, sexual abuse, or psychological abuse directed toward a family member were combined to create a lifetime IPV experience variable. Three summary scales

4 236 CONNOR ET AL Perceived Preparedness (12 items), Perceived Knowledge (16 items), and Actual Knowledge were also created. For preparedness and perceived knowledge, the average was estimated by respondent, and then, the overall average was calculated for the sample. For actual knowledge, the sum of correct scores for each respondent was calculated, and then, the sum of correct responses for the sample was averaged. Mann Whitney U tests were conducted comparing the summary scales of students with IPV training prior to graduate school to those without training; students with IPV training as part of their graduate program were compared with those without training, and students reporting personal experience with IPV were compared with those who did not have personal IPV experience. Significance was reached with an alpha (α) less than.05. Pairwise deletion was used to exclude students with missing data. Listwise deletion would have provided the same information and sample size as the used pairwise deletion. Missing cases were minimal, with only two students (3.8%) having missing information related to any IPV experience. Despite our small sample size, we conducted an exploratory multivariable analysis in an attempt to better characterize nursing students with a history of exposure to IPV. Perceived preparation and perceived knowledge were highly colinear, so only perceived preparation was included in the full model. IPV training during graduate school was also excluded because the number of nursing students reporting no training in this phase was very small. The full model consisted of the following independent variables: IPV training prior to graduate school, perceived preparation to deal with IPV, actual knowledge of IPV, and age. Any personal experience with IPV was the dependent variable. Results Demographics and Training Of the nursing students who participated in our study, 84.6% (n = 44) were female and ranged from 21 to 52 years old. No IPV training received prior to graduate school was reported by 51.0% (n = 26) of these students, whereas 31.0% (n = 16) of those students who did receive IPV training prior to graduate school only received between 1 and 5 training hours. Our nursing students reported receiving IPV training in their general graduate coursework and through their specialized focus areas of public health nursing, psychiatry, and forensic nursing. While students received different doses of IPV training depending on their chosen academic concentration, our study grouped them together as a single graduate group in order to measure the extent of their core IPV knowledge. Over the course of their graduate programs, 76% (n = 40) of nursing students received between 1 and 5 hours of training, whereas 12.0% (n = 6) had between 6 15 hours of training, and 4.0% (n = 2) received more than 15 hours of IPV training. Only 8.0% (n = 4) of nursing students Table 1. Nursing School Students Demographics and Background Characteristics Characteristics n (%) Course Nursing 52 (18.2) Age (M/SD) 29.0 (7.60) Range Sex Male 44 (84.6) Female 8 (15.4) Hours of training in nursing school None 27 (51.0) (31.0) (10.0) More than 15 4 (8.0) Hours of training prior to medical school None 4 (8.0) (76.0) (12.0) More than 15 2 (4.0) Personal IPV experience * Self 10 (20.0) Family 17 (34.0) Any personal experience 20 (40.0) Note. All values are total and percentages unless otherwise stated. * Missing information: N = 2. reported receiving no IPV training during graduate school. Two fifths (40.0%, n = 20) acknowledged any personal experience with IPV (Table 1). Knowledge, Attitudes, and Perceptions Nursing students generally demonstrated positive personal attitudes and knowledge about IPV. For instance, 57.4% (n = 27) of these students indicated that they were aware of state reporting requirements regarding IPV, and 53.2% (n = 25) said that they could make appropriate community resource referrals for persons suspected of experiencing or presenting with IPV. Lack of knowledge about IPV, however, appeared to be problematic because 32.6% (n = 15) thought that they lacked knowledge to address IPV. Perceived effectiveness of previous IPV training was measured through the Perceived Perception scale, which included 12 items asking respondents how well prepared they were to work with IPV victims. Participants' scores and responses ranged from 1 (not prepared) to7(quite well prepared). Nursing students reported a score of 4.7 (SD = 1.5). Students were also surveyed through a Perceived Knowledge scale containing 16 items asking how much respondents felt they knew about IPV. Scores and responses for this scale ranged from 1 (nothing) to7 (very much). Nursing students again reported an average perceived knowledge score of 4.7 (SD = 1.4). A third measure (actual knowledge) was also created using seven multiple-choice questions and 11 true/false questions with a total possible score of 38. Nursing graduate students reported a mean actual knowledge score of 24.2 (SD = 7.0).

5 NURSING STUDENTS AND INTIMATE PARTNER VIOLENCE EDUCATION 237 Table 2. Training Prior to and During Nursing School M SD Mann Whitney U test P Prior training Perceived preparation Some None Perceived knowledge Some None Actual knowledge Some None School training Perceived preparation Some None Perceived knowledge Some None Actual knowledge Some None Effect of Training for Nursing Students Prior to Graduate School Nursing students who received IPV training prior to graduate school had significantly higher perceived preparation ratings than those reporting no IPV training prior to graduate school (Mann Whitney U test P =.001). Nursing students with IPV training prior to graduate school also had significantly higher perceived knowledge ratings than those reporting no IPV training prior to graduate school (Mann Whitney U test P =.005). In short, those nursing students who had some IPV training prior to graduate school thought that they were better prepared to screen for and intervene with IPV patients than those students who had no training. Actual IPV knowledge rating differences were nonsignificant between these two populations (Table 2). Effect of Training for Nursing Students During Graduate School Nursing students who received IPV training during graduate school had higher perceived preparation ratings than those with no IPV training during graduate school, although this difference was not statistically significant (Mann Whitney U test P =.149; Table 2). Actual knowledge or perceived knowledge score differences were not significant between these populations. Put more simply, those nursing students who had some IPV training during graduate school thought that they were better prepared to screen for and intervene with IPV patients than those students who had no IPV training during graduate school. Actual knowledge or perceived knowledge score differences were not significant between these populations. Effect of Nursing Graduate Students' Personal Experience With IPV Sizeable percentages of nursing students in the graduate program (n = 50; missing data, n = 2) reported personally experiencing IPV. Personally experiencing some kind of physical violence, sexual abuse, intimidation, or threats of violence in an intimate partner relationship was reported by 20.0% (n = 10) of our nursing students. When nursing students were asked whether they had witnessed physical, sexual, or psychological abuse directed toward a family member, these students had even higher percentages (34.0%, n = 17) of exposure. When personal or family violence was considered as a whole, 40.0% (n = 20) of the nursing students surveyed had personally experienced some type of domestic violence including IPV. It is difficult to generalize this high prevalence to the larger nursing school population at our institution, but the high prevalence of both IPV exposure and IPV experience among our nursing student sample has notable implications and interesting avenues for future studies, particularly with regard to longitudinally charting trends in student IPV experience. Furthermore, the 40% of nursing graduate students who reported personal IPV experience aptly illustrates the need not only for additional training but also for available and increased IPV counseling. Slight but nonsignificant differences in perceived preparation, perceived knowledge, and actual knowledge were found between our student populations. We were somewhat surprised that in terms of actual knowledge, nursing students who had personally experienced IPV reported slightly lower ratings than students with no personal IPV experience. Yet, in spite of their nonsignificance (indicating that differences occurred because of chance), the differences in actual and perceived knowledge between these populations are intriguing and indicate the need for future research. In particular, this research should be qualitatively evaluated by asking about how IPV is defined in a larger nursing population sample. Moreover, in a preliminary unpublished logistic regression analysis performed as part of this study's overarching data analysis, nursing students with a history of any IPV exposure had 1.6 higher odds of sensing themselves as being well prepared to deal with IPV when compared with students with no history of IPV exposure, after controlling for previous treatment, actual knowledge, and age. This association finding was not, however, statistically significant. In addition, actual knowledge of IPV was not significantly associated with previous IPV exposure, after controlling for previous training, sense of preparedness,

6 238 CONNOR ET AL and age (OR = 0.97). As expected, age was significantly associated with IPV exposure. Each year of increase in age was associated with a 1.10 odds of nursing students having a history of IPV exposure, after adjusting for previous education, actual IPV knowledge, and sense of preparedness to deal with IPV. Discussion Our study results accord with recent nursing IPV research. Bracken et al. (2010), for instance, report a high prevalence of lifetime IPV among the nursing participants in their study while also reinforcing the centrality of IPV education. We would amend their assessment by noting that having or instituting policies and procedures with structured algorithms will assist nursing professionals who may resist addressing the needs of IPV patients. These policies will also benefit those professionals who may lack adequate IPV education and training by helping them to follow and be accountable to accepted organizational, institutional, and workplace nursing standards. We were also concerned at the surprisingly high prevalence rates of IPV reported by nursing students in our study and in prior studies. There has been limited research exploring the role or influence personal IPV experience has on nursing professionals. Empirical data from Gerber and Tan (2009) and Yoshihama and Mills (2003) have shown that nursing students who have been IPV victims may experience a range of responses to IPV curricular content. These responses included anxiety, triggered resurgence of traumatic reactions associated with IPV, and feelings of helplessness, stress, irritability, fatigue, and apathy. Because nursing students transition to workplace settings such as primary care or hospital environments, they frequently carry these negative feelings with them. These feelings may subsequently manifest through an inability to concentrate and to perform to their best ability or miss more hours of work due to absenteeism (Bracken et al., 2010; Swanberg, Logan, & Macke, 2005). However, as Anderson (2002) noted in her study of practicing nurses who had experienced IPV, abuse survivors can also share with IPV victims and, in so doing, deploy various defenses and strategies used to cope with this trauma as part of their ethic of empathic caring. Yet, in spite of the many perceived consequences associated with personal IPV experience, these studies overwhelmingly favor IPV training and endorse the need for IPV education and advocacy as well as support services for victims (whether they are nurses or patients) who experience flashbacks or triggering events. We are encouraged by these positive endorsements and will, as part of a large-scale future longitudinal study, collect qualitative responses from nursing students that we hope will address attitudes about personal IPV experience. Limitations Lack of significance on our multivariable model is a prominent limitation for our study. However, this limitation can be explained by the small sample size available for the analysis. Nevertheless, our results showed a trend of association that warrants further investigation. Other study limitations include lack of generalizability to larger populations and a failure to collect qualitative responses that would allow us to produce a more well-rounded and precise evaluation of the characteristics of this population. Future Directions Although a large sample study from Gutmanis, Beynon, Tutty, Wathen, and MacMillan (2007) noted that practicing nurses and physicians (n = 925) with personal IPV experience are better prepared to inquire about violence and provide appropriate care, we recommend that future researches continue quantifying and detailing IPV prevalence among this and other student health care profession populations. As Karlowicz and King (2009) have observed, student victims of IPV often encounter emotional distress, poor psychological and physiological health, and debilitating stress and anxiety that need to be addressed through careful self-appraisal that includes seeking and receiving external validation of their experiences, feelings, and issues with confidence and self-esteem. These strategies not only allow for identification and documentation of IPV in these student populations but can also help facilitate perspectival and empathic pathways between students, the patients they encounter in their clinical experiences, and other colleagues who might also have been exposed to or directly experienced IPV. Tower (2007) has suggested that students may be more receptive to changing their practices than are established practitioners, and the provision of formal education will in turn afford health professionals both the knowledge base and the skills necessary to adequately screen, intervene, or respond appropriately to persons affected by IPV (p. 442). According to Bracken et al. (2010), regardless of whether nurses and nursing personnel have themselves experienced IPV, obtaining a sufficient educational foundation in IPV and continuing this education throughout their professional career will allow for a more caring attitude and skillful approach with colleagues as well as with patients (p. 145). Future studies should also explore the ramifications IPV has on educational and training efficacy of those professional nurses who engage in advanced research, public policy formation, and health care delivery systems leadership. We are presently charting several future directions for our findings. We are currently producing larger studies that will not only include qualitative personal IPV experience data but will also ascertain generalizability of findings to larger student populations. We also plan to begin evaluating health care systems where students will be working to determine what infrastructure changes are needed to support institutional policy, protocols, public advocacy, and foundational research. We hypothesize that these infrastructure changes will lead to improved

7 NURSING STUDENTS AND INTIMATE PARTNER VIOLENCE EDUCATION 239 IPV screening, identification, management, and quality of care for this vulnerable population. At the university level, we plan to incorporate student survey responses as part of a revision of the family violence curriculum entitled Healing Homes. Healing Homes, which was previously pilot tested in a faith-based population, utilizes a 5R (recognizing, responding, referral to resources, and being cognizant of mandated reporting requirements) approach in order to assess for and respond to presentations of family violence across populations. Educating nursing students, particularly registered nurses and students in nursing graduate programs such as the DNP or PhD, on these 5Rs is crucial to increasing knowledge of IPV. This type of education will allow students to offer empathetic and proactive responses across academic, advocacy, and clinical settings to persons affected by IPV. Furthermore, we envision Healing Homes as a required course that will be fully integrated in to the university graduate curriculum, rather than as a supplement to the already existing (albeit limited) IPV content nursing students currently receive in specific programs at our institution. As data from our study have indicated, this type of comprehensive content is not only critical to overcoming systemic knowledge gaps about IPV, but our curriculum will also successfully address the persistent calls by prior researchers and academic administrators to provide more and better IPV education for graduate nursing students on the cusp of becoming leaders in the nursing profession. References Anderson, C. (2002). Past victim, future victim? Nursing Management, 33, Boursnell, M., & Prosser, S. (2010). Increasing identification of domestic violence in emergency departments: A collaborative contribution to increasing the quality of practice of emergency nurses. Contemporary Nurse, 35, Bracken, M. I., Messing, J. T., Campbell, J. C., La Flair, L. N., & Kub, J. (2010). Intimate partner violence and abuse among female nurses and nursing personnel: Prevalence and risk factors. Issues in Mental Health Nursing, 31, Christofides, N. J., & Silo, Z. (2005). How nurses' experiences of domestic violence influence service provision: Study conducted in north-west province, South Africa. Nursing and Health Sciences, 7, Connor, P. D., Nouer, S. S., Mackey, S. N., Tipton, N. G., & Lloyd, A. K. (2011). Psychometric properties of an intimate partner violence tool for health care students. Journal of Interpersonal Violence, 26, Davila, Y. R. (2005). Teaching nursing students to assess and intervene for domestic violence. International Journal of Nursing Education Scholarship, 2, 1 13 [Article 4]. Gerber, M. R., & Tan, A. K. W. (2009). Lifetime intimate partner violence exposure, attitudes and comfort among Canadian health professions students. BMC Research Notes, 2, 191. Gutmanis, I., Beynon, C., Tutty, L., Wathen, C. N., & MacMillan, H. L. (2007). Factors influencing identification of and response to intimate partner violence: A survey of physicians and nurses. BMC Public Health, 7, 12. Hinderliter, D., Doughty, A. S., Delaney, K., Pitula, C. R., & Campbell, J. (2003). The effect of intimate partner violence education on nurse practitioners' feelings of competence and ability to screen patients. Journal of Nursing Education, 42, Inoue, K., & Armitage, S. (2006). Nurses' understanding of domestic violence. Contemporary Nurse, 21, 311. Johnston, B. J. (2006). Intimate partner violence screening and treatment: The importance of nursing caring behaviors. Journal of Forensic Nursing, 2, Karlowicz, K. A., & King, L. S. (2009). The healing power of reflective writing for a student victim of sexual assault. Journal of Forensic Nursing, 5, Lambe, A., & Gage-Lindner, N. (2007). Pushing the limit: Forensic nursing in Germany. Journal of Forensic Nursing, 3, National Center for Injury Prevention, Control (NCIPC). (2009). Understanding intimate partner violence: Fact shee. Atlanta, GA: Centers for Disease Control and Prevention. Retrieved June 15, 2011, from violenceprevention/pdf/ipv_factsheet-a.pdf. Pakieser, R. A., Lenaghan, P. A., & Muelleman, R. L. (1998). Battered women: Where they go for help. Journal of Emergency Nursing, 24, Schoening, A. M., Greenwood, J. L., McNichols, J. A., Heermann, J. A., & Agrawal, S. (2004). Effect of an intimate partner violence educational program on the attitude of nurses. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 33, Short, L. M., Alpert, E., Harris Jr., J. M., & Surprenant, Z. J. (2006). PREMIS: A comprehensive and reliable tool for measuring physician readiness to manage IPV. American Journal of Preventive Medicine, 30, Stichler, J. F., Fields, W., Kim, S. C., & Brown, C. E. (2011). Faculty knowledge, attitudes, and perceived barriers to teaching evidence-based nursing. Journal of Professional Nursing, 27, Swanberg, J. E., Logan, T. K., & Macke, C. (2005). Intimate partner violence, employment, and the workplace: Consequences and future directions. Trauma, Violence & Abuse, 6, Tower, M. (2007). Intimate partner violence and the health care response: A postmodern critique. Health Care for Women International, 28, Tufts, K. A., Clements, P. T., & Karlowicz, K. A. (2009). Integrating intimate partner violence content across curricula: Developing a new generation of nurse educators. Nurse Education Today, 29, Woodtli, M. A., & Breslin, E. T. (2002). Violence-related content in the nursing curriculum: A follow-up national survey. Journal of Nursing Education, 41, Yoshihama, M., & Mills, L. G. (2003). When is the personal professional in public child welfare practice? The influence of intimate partner and child abuse histories on workers in domestic violence cases. Child Abuse & Neglect, 27,