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Publications (English) by Patrick Palmieri

The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry, Jan 28, 2021

Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and c... more Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain). Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis. Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.

Patient safety culture in European hospitals: A comparative mixed methods study, Jan 14, 2022

Background: Poorly organized health systems with inadequate leadership limit the development of t... more Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy.

Women caring for husbands living with Parkinson’s disease: A phenomenological study protocol, Apr 20, 2022

Parkinson’s disease (PD) is an emerging pandemic caused by aging, longevity, and industrializatio... more Parkinson’s disease (PD) is an emerging pandemic caused by aging, longevity, and industrialization. Most people diagnosed with PD initially experience mild symptoms, but over time the symptoms become debilitating. Given their intensive care requirement, most married people living with PD receive care from their spouses; most are female caregivers. Because caregiving is hard work with long hours, caregivers experience stress, fatigue, and depression, often leading to exhaustion and burnout. The purpose of this descriptive phenomenological study is to understand the lived experience of women caregivers of husbands living with PD. As part of this study protocol, women caring at home for their husbands diagnosed with PD will be purposely recruited from the Colorado Parkinson Foundation. Semi-structured interviews will be conducted by Zoom© until data saturation is achieved. Colaizzi’s seven-step process will be used to analyze the data in Atlas.ti. Strategies have been incorporated into the study protocol to maximize trustworthiness and to insure methodological rigor. The study will be reported using recommendations from the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research. Findings from this study may guide intervention development to improve the caregiving experience and to inform clinical practice guidelines for health care professionals.

Reproductive decision-making of Black women living with HIV: A systematic review, Apr 11, 2022

Background: Black women living with HIV account for a higher proportion of new HIV diagnoses than... more Background: Black women living with HIV account for a higher proportion of new HIV diagnoses than other groups. These women experience restricted access to reproductive services and inadequate support from healthcare providers because their position in society is based on their sexual health and social identity in the context of this stigmatizing chronic disease. By recognizing the analytical relevance of intersectionality, the reproductive decision-making of Black women can be explored as a social phenomenon of society with varied positionality. Objective: The purpose of this review was to synthesize the evidence about the reproductive decision-making of Black women living with HIV in high-income countries from the beginning of the HIV epidemic to the present. Methods: This systematic review was guided by the JBI evidence synthesis recommendations. Searches were completed in seven databases from 1985 to 2021, and the review protocol was registered with PROSPERO (CRD420180919). Results: Of 3503 records, 22 studies were chosen for synthesis, including 19 observational and three qualitative designs. Nearly, all studies originated from the United States; the earliest was reported in 1995. Few studies provided detailed sociodemographic data or subgroup analysis focused on race or ethnicity. Influencing factors for reproductive decisionmaking were organized into the following seven categories: ethnicity, race, and pregnancy; religion and spirituality; attitudes and beliefs about antiretroviral therapy; supportive people; motherhood and fulfillment; reproductive planning; and health and wellness. Conclusion: No major differences were identified in the reproductive decision-making of Black women living with HIV. Even though Black women were the largest group of women living with HIV, no studies reported a subgroup analysis, and few studies detailed sociodemographic information specific to Black women. In the future, institutional review boards should require a subgroup analysis for Black women when they are included as participants in larger studies of women living with HIV.

Improving the physical health of psychiatric hospital residents: An evaluation of an obesity education program for mental health professionals, Sep 23, 2022

Background: People living with mental health disorders are at increased risk for developing obesi... more Background: People living with mental health disorders are at increased risk for developing obesity due to poor diet, physical inactivity, and antipsychotic medications. In the United States, the obesity rate is 36% in the general population and more than 50% for people living with mental health disorders. Although mental health clinicians concentrate on managing psychiatric disorders, they seldom recognize the gradual increase in body mass index of their patients. The result is a disconnection between the clinical management of psychiatric disorders and the medical management of obesity. Purpose: This study assessed the effectiveness of an evidence-based education program for improving the obesity management practices of mental health clinicians caring for residents at a state psychiatric hospital. Methods: This was a quasi-experimental study design with a pretest and posttest evaluation. Convenience sampling was used to recruit mental health professionals, or clinicians, at a large psychiatric hospital in the Southern region of the United States. Data was collected with the Advising and Treating Overweight and Obese Patient questionnaire (17 items). Data analysis included descriptive and inferential statistics. The findings were reported in accordance with the TREND and GREET guidelines. Results: The education program was completed by 50 MHCs. The pretest indicated that 76% of MHCs were not involved in helping obese residents manage their weight, but the posttest indicated 90% were involved. There was a significant increase in MHC knowledge about obesity management and reported actions 90-days after the program. MHCs were unable to arrange follow-up visits for residents, a task not directly within their control. Conclusions: Mental health clinicians reported increased knowledge and improved clinical practice after an education program. Because the outcomes were reported at 90-days after the program, further research needs to evaluate the longitudinal impact of this type of program, where the reported behaviors are correlated to process and clinical outcome measures for obesity.

'Staying alive' with antiretroviral therapy: A grounded theory study of people living with HIV in Peru, Oct 28, 2021

Background To achieve an optimal quality of life through chronic disease management, people livin... more Background To achieve an optimal quality of life through chronic disease management, people living with HIV (PLHIV) must adhere to antiretroviral therapy (ART). ART has been available throughout Peru since 2004 without cost in all regions; yet only 60% (43 200) of PLHIV receive ART and 32% are virally suppressed. Despite the low adherence, little is known about the experience of PLHIV with ART adherence in the context of Latin America. Methods A constructivist grounded theory design was used to understand the ART adherence experiences of PLHIV in Northern Peru. Unstructured interviews were conducted with 18 participants resulting in theoretical saturation. All interviews were recorded, immediately transcribed and analysed concurrently with data collection using constant comparative analysis with Atlas. ti (V.8) software. Rigour was maintained through openness, reflexivity, audit trail, memo writing, debriefings, member checks and positionality. Results The core category 'staying alive' emerged through the interaction of four categories, including: (1) overcoming barriers; (2) working with the healthcare team; (3) tailoring self-care strategies; and (4) appreciating antiretrovirals. Adherence is not a spontaneous outcome, instead, the surprise of HIV diagnosis transitions to living with HIV as a chronic disease. The healthcare team helps PLHIV realise ART is their life source by enhancing, supporting and facilitating self-care and overcoming barriers. Conclusion Adherence emerges from experiential learning as PLHIV recognised ART as their life source in balance with their desire to continue living a normal life. Social support and healthcare team interventions help PLHIV implement tailored self-care strategies to overcome personal, social, and structural barriers to adherence. Healthcare professionals need to recognise the challenges confronted by PLHIV as they learn how to continue living while trying to stay alive.

BMC Pregnancy and Childbirth, 2021

Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi’s seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.

Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.

Conclusion: Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.

BMC Nursing, 2020

Background: The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple... more Background: The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. Methods: This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. Results: The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate).

Journal of Nursing Education, 2019

Background: People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative at... more Background: People living with HIV/AIDS (PLHIV) experience stigma and discrimination. Negative attitudes of nursing faculty about caring for PLHIV can adversely affect student perceptions and their nursing care. The study purpose was to describe nursing faculty attitudes and beliefs about caring for PLHIV.

Method: The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru.

Results: The HPASS was completed by 98 nursing faculty. The overall mean score was 2.41 (SD = 0.69), with subscale scores: stereotypes, 2.55 (SD = 0.84); discrimination, 2.28 (SD = 0.74); and prejudices, 2.41 (SD = 0.63). Peruvian faculty had the highest scores, statistically correlated with the importance of religion, whereas Colombia had the lowest.

Conclusion: Nursing faculty attitudes toward PLHIV were slightly positive in Colombia to slightly negative in Peru; however, both countries had negative stereotypes. Knowledge deficiencies about HIV persist and attitudes appear to be influenced by culture and religion.

AIDS Research and Therapy, 2019

Background: There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adher... more Background: There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiret-roviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). Methods: This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. Results: The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efa-virenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. Conclusions: Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis , pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organiz... more The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational–technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern.

Recognizing the technology–organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

KEYWORDS: Healthcare, health information technology, planning, error, iatrogenesis, risk management, failure mode effect analysis, root cause analysis, diffusion of innovation theory, rogers, complexity theory, complex adaptive systems, organizational development, patient safety, change management, human factors, ivan illich, medical nemesis.

Iatrogenesis is a term typically reserved to express the state of ill health or the adverse outco... more Iatrogenesis is a term typically reserved to express the state of ill health or the adverse outcome resulting from a medical intervention, or lack thereof. Three types of iatrogenesis are described in the literature: clinical, social and cultural. This paper introduces a fourth type, technological iatrogenesis, or emerging errors stimulated by the infusion of technological innovations into complex healthcare systems. While health information technologies (HIT) have helped to make healthcare safer, this has also produced contemporary varieties of iatrogenic errors and events. The potential pitfalls of technological innovations and risk management solutions to address these concerns are discussed. Specifically, failure mode effect analysis and root cause analysis are discussed as opportunities for risk managers to prevent problems and avert errors from becoming sentinel events.

KEYWORDS: Healthcare; health information technology; computerized physician order entry; decision support system; bar coding; patient safety; complexity theory; complex adaptive systems; medical error; adverse event; sentinel event; innovation; technology; risk management; failure mode effect analysis; root cause analysis; Medical Nemesis; Ivan Illich; Rogers; diffusion of innovation.

Nephrology Nursing Journal, 2002

Palmieri, P. A. (2002). Obstructive nephrology: Pathophysiology, diagnosis, and collaborative man... more Palmieri, P. A. (2002). Obstructive nephrology: Pathophysiology, diagnosis, and collaborative management. Nephrology Nursing Journal, 29(1), 15-23. PMID: 11887486. Awarded Best Manuscript of the Year.

Publications (Spanish) by Patrick Palmieri

La ciencia de enfermería enfrenta ahora el reto de avanzar a la siguiente fase de desarrollo, a l... more La ciencia de enfermería enfrenta ahora el reto de avanzar a la siguiente fase de desarrollo, a lo que llamamos ´Ser relevantes a nivel mundial´. Este movimiento implica una variedad de actividades y cambios en la forma que hacemos ciencia, una responsabilidad que debe ser compartida por los científicos en todo el mundo. En el paradigma de la ciencia del cuidado, el método "es siempre subordinado a la esencia del cuidado, y el ethos es el valor basado en la ciencia del cuidado” (Lindberg, von Post, y Eriksson, 2013, p. 100). Esto significa que los estudios de investigación de alta calidad son un resultado importante de la alineación correcta de la ontología, epistemología, metodología y métodos en respuesta a una pregunta de investigación bien definida. La disciplina de la enfermería está "Basada en la ciencia del cuidado; esto a su vez, informa a la profesión. La ciencia del cuidado sirve como punto de partida-moral-filosófico-teórico fundamental para la formación de enfermería, atención al paciente, investigación, e incluso prácticas administrativas" (Watson, 2008, p. 16). En esta tradición, la ciencia de enfermería puede ampliarse para incorporar nuevos métodos de investigación (Phillips, 1990).

Seguridad del paciente y calidad en servicio de salud, Aug 2012

Conference Proceedings (Indexed and Peer-Reviewed) by Patrick Palmieri

… of the Annual Meeting of the …, Jan 1, 2008

Nurses spend more time with patients than other health care providers, and patient outcomes are i... more Nurses spend more time with patients than other health care providers, and patient outcomes are impacted by nursing care quality. Thus, enhancements in nursing performance can lead to improvements in patient safety. Results of our comprehensive literature review (DeLucia, Ott, & Palmieri, in press) indicated that numerous factors affect the performance of nurses. These include cognitive factors (interruptions, cognitive processes), physical factors (musculoskeletal disorders, environment), and organizational factors (work hours, staffing). Here, we focus on cognitive factors. Nurses' work is cognitively demanding. Nursing involves multi-tasking, relies on procedural and prospective memory, and occurs under frequent interruptions. We discuss interruptions and cognitive processes in nursing and provide a conceptual analysis and recommendations. We conclude that the nurses' work system does not accommodate limitations and capabilities of the nurse, particularly limits in cognitive processes. The field of human factors and ergonomics is uniquely suited to redesign the nurses' work system to enhance nursing performance and improve patient safety. Of particular importance for future research is the study of interruptions and cognitive processes in nursing.

Book Chapters (Indexed & Peer-Reviewed) by Patrick Palmieri

Case Study Contributor: Patrick A. Palmieri Book Editor: Jonathan Leviss Book Description In H.I... more Case Study Contributor: Patrick A. Palmieri
Book Editor: Jonathan Leviss

Book Description
In H.I.T. or Miss: Lessons Learned from Health Information Technology Implementations, the editors—all of whom have led successful electronic health record (EHR) and Health Information Technology (HIT) projects—have collected case studies of HIT implementations that didn't go as planned, offering expert insight into key obstacles that must be overcome to leverage IT and modernize and transform healthcare.

Through their study of HIT implementations that failed, the editors document, catalogue, and share key lessons that all project managers of HIT, health system leaders in informatics and technology, hospital executives, policy makers, and service and technology providers must learn in order to succeed with HIT.

H.I.T. or Miss presents a model to discuss HIT failures in a safe and protected manner, providing an opportunity to focus on the lessons offered by a failed initiative as opposed to worrying about potential retribution for exposing a project as having failed.

Key Features:
Presents 17 de-identified, author-anonymous case studies that highlight specific failtures in health information techonology projects. Editor's analysis and editor's commentary on each case. Lessons learned presented for each case. Appendixes include an easily searchable listing of cases by project type and lessons learned, an extensive bibliography of resources, and full text of appliciable AHIMA and government resources.

The editor and associate editors all served on the 2007 leadership board of the Clinical Information Systems Working Group of the American Medical informatics Association (AMIA).

KEYWORDS: Healthcare, health information technology, information systems, computerized physician order entry, bar coding, electronic medical record, electronic health record, decision support system, complexity theory, complex adaptive systems, error, adverse event, root cause analysis, technology, iatrogenesis, human factors.

The Institute of Medicine’s seminal report, To err is human: Building a safer health system, esta... more The Institute of Medicine’s seminal report, To err is human: Building a safer health system, established the national patient safety framework and initiated interest in changing the traditionally punitive healthcare culture. This paper reviews a multidisciplinary literature and offers an attribution framework to explicate the organizational processes that contribute to an industry-wide culture where clinicians are routinely blamed for adverse patient events. Attribution theory is concerned with the manner in which people explain the behaviors of others or themselves by assigning causality for events. To date, attribution theory, though well established in the management literature, has yet to be translated to healthcare. In this paper, we first describe the historical evolution of attribution theory in relation to human behavior in clinical practice and healthcare management and then discuss the work environments in contemporary healthcare organizations. Next, we demonstrate the applicability of attribution theory to healthcare by providing two adverse event exemplar cases. Then, the Healthcare Attribution Error Model is offered to demonstrate how concepts from attribution theory serve as antecedents to the employee cynicism, learned helplessness, organizational inertia, and the emerging Just Culture perspective. We conclude by suggesting attribution theory offers an important theoretical framework that warrants further conceptual development and empirical research. In the quest to produce exceptional healthcare environments where safety and quality are fundamental employee concerns, healthcare managers and clinical professionals need theoretically supported knowledge and evidence-based insights.

KEYWORDS: Attribution theory; patient safety; just culture; punitive culture; safety culture; cynacism; learned helplessness; blame; organizational inertia; complexity theory; complex adaptive system; leadership; organizational behavior; organizational development; human resource management; sentinel event; adverse event; error; medical error; mistake; Institute of Medicine; To err is human; James Reason.

Nurses spend more time with patients than do any other health care providers, and patient outcome... more Nurses spend more time with patients than do any other health care providers, and patient outcomes are affected by nursing care quality. Thus, improvements in patient safety can be achieved by improving nurse performance. We review the literature on nursing performance, including cognitive, physical, and organizational factors that affect such performance, focusing on research studies that reported original data from nurse participants. Our review indicates that the nurse’s work system often does not accommodate human limits and capabilities and that nurses work under cognitive, perceptual, and physical overloads. Specifically, nurses engage in multiple tasks under cognitive load and frequent interruptions, and they encounter insufficient lighting, illegible handwriting, and poorly designed labels. They spend a substantial amount of their time walking, work long shifts, and experience a high rate of musculoskeletal disorders. Research is overdue in the areas of cognitive processes in nursing, effects of interruptions on nursing performance, communications during patient handoffs, and situation awareness in nursing. Human factors and ergonomics (HF/E) professionals must play a key role in the redesign of the nurses’ work system to determine how overloads can be reduced and how the limits and capabilities of performance can be accommodated. Collaboration between nurses and HF/E specialists is essential to improve nursing performance and patient safety.

KEYWORDS: Healthcare, human factors, ergonomics, nursing, work, tasks, cognition, cognitive load, interruptions, occupational health, performance, complexity theory, complex adaptive system, situational awareness, nursing shortage, patient safety, organizational behavior, organizational development, sentinel event, adverse event, error, mistake; slip, lapse, human resource management.

The meaning of postpartum sexual health for women living in Spain: A phenomenological inquiry, Jan 28, 2021

Patient safety culture in European hospitals: A comparative mixed methods study, Jan 14, 2022

Women caring for husbands living with Parkinson’s disease: A phenomenological study protocol, Apr 20, 2022

Reproductive decision-making of Black women living with HIV: A systematic review, Apr 11, 2022

Improving the physical health of psychiatric hospital residents: An evaluation of an obesity education program for mental health professionals, Sep 23, 2022

'Staying alive' with antiretroviral therapy: A grounded theory study of people living with HIV in Peru, Oct 28, 2021

BMC Pregnancy and Childbirth, 2021

BMC Nursing, 2020

Journal of Nursing Education, 2019

Method: The HPASS (Healthcare Provider HIV/AIDS Stigma Scale), Spanish version, was delivered to nursing faculty in Colombia and Peru.

AIDS Research and Therapy, 2019

Nephrology Nursing Journal, 2002

Seguridad del paciente y calidad en servicio de salud, Aug 2012

… of the Annual Meeting of the …, Jan 1, 2008

Case Study Contributor: Patrick A. Palmieri Book Editor: Jonathan Leviss Book Description In H.I... more Case Study Contributor: Patrick A. Palmieri
Book Editor: Jonathan Leviss

The editor and associate editors all served on the 2007 leadership board of the Clinical Information Systems Working Group of the American Medical informatics Association (AMIA).

Health information technology: Anticipating, recognizing, and preventing disruptions in complex adaptive health systems, Apr 1, 2014

Healthcare organizations are increasingly willing to develop more efficient and higher quality pr... more Healthcare organizations are increasingly willing to develop more efficient and higher quality processes to combat the competition and enhance financial viability by adopting contemporary solutions such as Health Information Technology (HIT). However, technological failures occur and represent a contemporary organizational development priority resulting from incongruent organization-technology interfaces. Technologically induced system failure has been defined as technological iatrogenesis. The chapter offers the Healthcare Iatrogenesis Model as an organizational development strategy to guide the responsible implementation of HIT projects. By recognizing the etiology of incongruent organizational interfaces and anticipating patient safety concerns, leaders can proactively respond to system limitations and identify hidden process instabilities prior to costly and consequential catastrophic events.

Through a number of comprehensive reviews, the Institute of Medicine (IOM) has recommended that h... more Through a number of comprehensive reviews, the Institute of Medicine (IOM) has recommended that healthcare organizations develop safety cultures in order to align delivery system processes with the workforce requirements to improve patient outcomes. Until health systems can provide safer care environments, patients remain at risk for suboptimal care and adverse outcomes. Health science researchers have begun to explore how safety cultures might act as an essential system feature to improve organizational outcomes. Since safety cultures are established via modification in employee safety perspective and work behavior, human resource professionals need to contribute to this developing organizational domain. The IOM indicates individual employee behaviors cumulatively provide the primary antecedent for organizational safety and quality outcomes. Yet, many safety culture scholars indicate the concept is neither theoretically defined nor consistently applied and researched as the terms safety culture, safety climate, and safety attitude are interchangeably used to represent the same concept. As such, this paper examines the intersection of organizational culture and healthcare safety by analyzing the theoretical underpinnings of safety culture, exploring the constructs for measurement, and assessing the current state of safety culture research. Safety culture draws from the theoretical perspectives of sociology (represented by Normal Accident Theory), organizational psychology (represented by High Reliability Theory), and human factors (represented by the aviation framework). By understanding not only the origins, but also the empirical safety culture research and the associated intervention initiatives, healthcare professionals can design appropriate human resource strategies to address the system characteristics that adversely affect patient outcomes. Increased emphasis on human resource management research is particularly important to the development of safety cultures. This paper contributes to the existing healthcare literature by providing the first comprehensive critical analysis of the theory, research, and practice that comprise contemporary safety culture science.

KEYWORDS: Safety culture, safety climate, safety attitude, safety industry, patient safety, high reliability theory, normal accident theory, complexity theory, complex adaptive system, human factors, organizational psychology, organizational sociology, human resource management, strategic human resource management, organizational behavior, organizational development, leadership, sentinel event, adverse event, errors, mistakes, Institute of Medicine, Charles Perrow, James Reason.

Recent reports by the Institute of Medicine (IOM) signal a substantial yet unrealized deficit in ... more Recent reports by the Institute of Medicine (IOM) signal a substantial yet unrealized deficit in patient safety innovation and improvement. With the aim of reducing this dilemma, we provide an introductory account of clinical error resulting from poorly designed systems by reviewing the relevant health care, management, psychology, and organizational accident sciences literature. First, we discuss the concept of health care error and describe two approaches to analyze error proliferation and causation. Next, by applying transdisciplinary evidence and knowledge to health care, we detail the attributes fundamental to constructing safer health care systems as embedded components within the complex adaptive environment. Then, the Health Care Error Proliferation Model explains the sequence of events typically leading to adverse outcomes, emphasizing the role that organizational and external cultures contribute to error identification, prevention, mitigation, and defense construction. Subsequently, we discuss the critical contribution health care leaders can make to address error as they strive to position their institution as a high reliability organization (HRO). Finally, we conclude that the future of patient safety depends on health care leaders adopting a system philosophy of error management, investigation, mitigation, and prevention. This change is accomplished when leaders apply the basic organizational accident and health care safety principles within their respective organizations.

KEYWORDS: Healthcare, patient safety; safety culture; safety climate; safety attitude; high reliability organization; high reliability theory; complex adaptive system; complexity theory; organizational development; organizational behavior; safety science; errors; medical error; human error; adverse event; sentinel event; root cause analysis; blame; law; leadership; Swiss cheese model; Institute of Medicine; To err is human; James Reason; Charles Vincent; Peter Pronovost.

Background: In developing countries, nurses are best positioned to lead large, yet feasible and a... more Background: In developing countries, nurses are best positioned to lead large, yet feasible and affordable, organizational-wide quality improvement (QI) projects. Although nursing leaders at a Peruvian hospital recognized the need for QI to better serve their patients, they lacked the knowledge, skills, and resources to effect change. A quality improvement framework with nurse leader mentoring was developed to implement a nursing-led international health facility accreditation program. Accreditation standards are an important QI tool for nurses as the majority of the standards, about 65%, are focused on nursing practices, 10% on physician work, 10% on pharmacy performance, 5% on other therapies, 5% on management and leadership, and 5% others. However, the process of international accreditation begins with organization leaders recognizing the need for system-wide changes and the willingness to work toward realizing improved outcomes. The nurse leaders at a small private hospital in the provinces of Peru recognized the need for quality improvement, accepted mentoring and education, and earned hospital leader empowerment to implement a program to achieve accreditation. The overall project lead to improve quality, safety, and financial outcomes.

Methods: he Nursing Mentorship Resource Guide, published by the Canadian Association of Public Health Nursing Management, supported the development of nurse leader mentoring relationship. The resourse guide is based on the Mertz's Conceptual Model of Mentoring that distinguishes mentoring from other kinds of supportive relationships. The quality improvement work was guided by Roger's diffusion of innovation Theory (changing culture through innovation), King's Systems Interaction Model (interaction of nursing within organizations), and Donabedian's Quality Improvement Triad (structures + processes = outcomes). With this framework, the nurse leaders were mentored to developed a project committee and specific chapter teams, where each team identified projects and sub-projects ranked from lowest to highest resistance to change for each deficiency, SMART goals were established, an iterative PDSA quality improvement process was implemented, and the results for each subproject and project were evaluated.

Key points for discussion: The nurse-leaders successfully implemented a system-wide QI project. The first self-evaluation demonstrated 27% compliance with all accreditation standards. Nurse leaders were guided in formulating strategies to impact the uncompliant areas. In addition, nurse leaders recieve mentoring to manage and overcome obstacles in implementing QI strategies. The subprojects and projects then resulted in an 86% compliance. Importantly, the standards deemed as “critical standards” were assessed at 100%. Furthermore, the operational balanced scorecard demonstrated improvements in financial outcomes and a decreased number of adverse events with harm. The official accreditation evaluation resulted in no chapter deficiencies and a full three-year accreditation was granted.

Conclusion and recommendations: Hospitals in developing countries can substantially increase the quality and decrease the cost for health services by fully engaging nurses. Specifically, international nurse leaders, educators, and clinicians can empower developing country nurse leaders to effect positive change. In addition, empowered nurses can convience hospital leaders to authorize nurse-led quality improvement projects based on accreditation standards. This quality improvement effort resulted in the diffusion of quality innovation organization-wide. In Peru, the importance of nursing practice in hospitals is under appreciated and not recognized as a quality improvement strategy. This nursing-led project clearly demonstrates that simple, structured, and affordable projects can improve hospital quality in developing countries.

This study explores the disease epidemiology attributable to human papilloma virus (HPV), the suc... more This study explores the disease epidemiology attributable to human papilloma virus (HPV), the success of school-based HPV vaccination programs, the benefits of high HPV vaccination rates, and the applicability to low- and middle-income countries (LMIC) in Latin America. New HPV vaccination programs that satisfy the World Health Organization (WHO) vaccination program requirements and optimal use of existing HPV vaccination provision mechanisms in LMIC are also presented. Globally, 610,000 (4.8%) of the estimated 12.7 million cancers annually are attributed to HPV, of which almost 85% in LMIC. Cervical cancer prevention can reduce female years of life lost by 7.8 million. School-based HPV vaccination programs have higher three-dose vaccination rates such as in Australia (79%), than non-school based vaccination rates, as in Belgium (29%) and the United States (32%). School-based vaccination programs are cost effective, deserving expansion. Due to health infrastructure deficiencies in LMIC, school-based vaccination programs are essential to vaccinate children, and ultimately improve women’s health. Three-dose HPV vaccination in LMIC schools results in year of life saved (YLS) or incremental cost-effectiveness ratio (ICER) per quality-adjusted-life-year (QALY) for less than the nation’s gross domestic product (GDP), satisfying the WHO vaccination program requirements. Sustainable HPV vaccination campaigns require media campaigns including Internet components for health care providers, parents, and students. Campaigns cosponsored by Ministries of Health and Education will increase national HPV vaccination awareness; expand resources availability for programmatic development; and increase program acceptance and utilization in school-based programs.

Palmieri, P. A., Peterson, L. T., Saettone, D. M. & Flit, M. A. (2010, August). Organizational d... more Palmieri, P. A., Peterson, L. T., Saettone, D. M. & Flit, M. A. (2010, August). Organizational disruptions caused by technological failures in healthcare delivery systems. Presented at the Annual Meeting of the Academy of Management: Montreal, Canada.

Palmieri, P. A., Saettone, D. M., Peterson, L. T., & Flit, M. A. (2010). Conceptualizing a high r... more Palmieri, P. A., Saettone, D. M., Peterson, L. T., & Flit, M. A. (2010). Conceptualizing a high reliability model for healthcare. Presented at the Annual Meeting of the Academy of Management (August): Montreal, Canada. Nominated for Best Theory to Practice Paper Award.

Palmieri, P. A. (2010). A heuristic model to study nursing workload, safety culture, and quality... more Palmieri, P. A. (2010). A heuristic model to study nursing workload, safety culture, and quality outcomes in acute care hospital systems. 50th Annual Meeting of the Western Academy of Management (March 24-28) in Kailua-Kona, Hawaii, USA.

Palmieri, P. A., & Peterson, L. T. (2010). Integrating health information technology in health s... more Palmieri, P. A., & Peterson, L. T. (2010). Integrating health information technology in health systems with inadequate organizational planning. Western Academy of Management (March 24-28) in Kailua-Kona, Hawaii, USA.

DeLucia, P. R., Ott, T. E., & Palmieri, P. A. (2009). Cognitive processes and interruptions in n... more DeLucia, P. R., Ott, T. E., & Palmieri, P. A. (2009). Cognitive processes and interruptions in nursing: Review and analysis. 53rd Annual Meeting of the Human Factors and Ergonomics Society (October 19-23): San Antonio, Texas, (USA).

Palmieri, P. A., & Peterson, L. T. (2009). Safety culture as a healthcare construct. Presented a... more Palmieri, P. A., & Peterson, L. T. (2009). Safety culture as a healthcare construct. Presented at the Annual Meeting of the Academy of Management (August 9): Chicago, Illinois, USA. Nominated for Best Paper Award, Healthcare Management Division.

Palmieri, P. A. & Peterson, L. T. (2009). Technological iatrogenesis: Expansion of the medical ne... more Palmieri, P. A. & Peterson, L. T. (2009). Technological iatrogenesis: Expansion of the medical nemesis framework to accommodate technologically induced errors as an emergent healthcare system property. Presented at the Annual Summer Meeting of the International Academy of Business and Economics (June 8): Thessaloniki, Greece.

Palmieri, P. A., & Peterson, L. T. (2009). Attribution theory: The invisible hand of punitive hea... more Palmieri, P. A., & Peterson, L. T. (2009). Attribution theory: The invisible hand of punitive healthcare cultures. Presented at the 49th Annual Meeting of the Western Academy of Management (March 20): Midway, Utah, USA.

Palmieri, P. A., & Peterson, L. T. (2008, August 11). Attribution theory: A contemporary applicat... more Palmieri, P. A., & Peterson, L. T. (2008, August 11). Attribution theory: A contemporary application to nursing practice. Presented at the Annual Meeting of the Academy of Management: Anaheim, California, USA.

Palmieri, P. A., & Peterson, L. T. (2008). Technological iatrogenesis: An expansion of the medica... more Palmieri, P. A., & Peterson, L. T. (2008). Technological iatrogenesis: An expansion of the medical nemesis framework to improve modern healthcare organization performance. Presented at the 48th Annual Meeting of the Western Academy of Management (March 27): Oakland, California, USA.

Palmieri, P. A., & Gallegos, B. (2007). Incorporating patient safety and Team STEPPS into the nu... more Palmieri, P. A., & Gallegos, B. (2007). Incorporating patient safety and Team STEPPS into the nursing curriculum. Presented at the American Association of Colleges of Nursing Hot Issues Conference (April 23): Denver, Colorado, USA.

Palmieri, P. A. (2006). Altering the nursing education paradigm: Curriculum integration and facul... more Palmieri, P. A. (2006). Altering the nursing education paradigm: Curriculum integration and faculty acceptance of the national patient safety agenda. Presented at the: Virginia Commonwealth University Patient Safety Project Session (September 15): Richmond, Virginia, USA.

Reproductive Health

Background Women living with HIV (WLH) lack evidence-based information about reproductive options... more Background Women living with HIV (WLH) lack evidence-based information about reproductive options while managing pressures from family, clinicians, and communities to give up the idea of having children. As the reproduction intentions of WLH are not well understood, stigmatizing behaviors force them to hide their disease to avoid rejection by their family, partner, and social networks. Compliance with social norms, fear of stigma, and discrimination influence their experience. Current research is individual qualitative studies lacking the synthesis perspective necessary to guide intervention development. The purpose of this study was to synthesize the evidence to explain the reproductive decision-making process for WLH in developed countries. Methods A systematic review with qualitative research synthesis was conducted through searches in 10 electronic databases (CINAHL, EMBASE, MEDLINE, Scopus, Social Science Citation Index, Web of Science, Google Scholar, Cuidatge, Cuiden Enfispo,...

Journal of Anxiety Disorders, Sep 3, 2011

Journal of alternative and complementary medicine (New York, N.Y.), Jan 23, 2016

To determine the effect of guided imagery (GI) on functional outcomes of total knee replacement (... more To determine the effect of guided imagery (GI) on functional outcomes of total knee replacement (TKR), explore psychological and neuroimmune mediators, and assess feasibility of study implementation. Investigator-blinded, randomized, placebo-controlled pilot study. Hospital, surgeon's office, participant's home. 82 persons undergoing TKR. Audiorecordings of TKR-specific GI scripts or placebo-control audiorecordings of audiobook segments. Gait velocity and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Function scale. Outcomes for 58 participants (29 receiving GI and 29 controls) were analyzed at 6 months after surgery. The most frequent reason for noncompletion was protocol-driven exclusion at 6 months for having the contralateral knee replaced before the study endpoint (n = 15). With imaging ability as a moderator, gait velocity, but not WOMAC Function score, was significantly improved at 6 months in the GI group. Participants in the GI group, but not the...

Journal of interpersonal violence, Jan 18, 2016

The Critical Incident History Questionnaire (CIHQ) measures, through multiple measurement methods... more The Critical Incident History Questionnaire (CIHQ) measures, through multiple measurement methods, the severity and frequency of traumatic events experienced by law enforcement officers. We, however, found no studies utilizing the CIHQ to examine posttraumatic growth (PTG) as measured by the Posttraumatic Growth Inventory. The purpose of this brief report was to assess the strength and direction of the relationships between PTG with trauma frequency, trauma severity, and health variables, including subjective traumatic stress, relationship stress, nontraumatic work stress, posttraumatic stress disorder (PTSD) symptoms, depression, and alcohol use among law enforcement officers (N = 193) from small and midsize agencies. In addition, we sought to explore differences between cognitive and behavioral PTG. Based on results from bivariate and multivariate analyses, we found that an idiosyncratic view of trauma severity shaped by personal experience demonstrated the strongest relationship ...

Assessment, Jan 13, 2016

The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe levels of deperso... more The Dissociative Symptoms Scale (DSS) was developed to assess moderately severe levels of depersonalization, derealization, gaps in awareness or memory, and dissociative reexperiencing that would be relevant to a wide range of clinical populations. Structural analyses of data from four clinical and five nonclinical samples (N = 1,600) yielded four factors that reflected the domains of interest and showed good fit with the data. Sample scores were consistent with expectations and showed very good internal consistency and temporal stability. Analyses showed consistent evidence of convergent and divergent validity, and posttrauma elevations in scores and in patients with posttraumatic stress disorder provided additional evidence of construct validity. Item response theory analyses indicated that the items assessed moderately severe dissociative experiences. Overall, the results provide support for the reliability and validity of DSS total and subscale scores in the populations studied....

Journal of Consulting and Clinical Psychology, Feb 1, 2009

Journal of Anxiety Disorders, Apr 30, 2011

Journal of Clinical Sleep Medicine Jcsm Official Publication of the American Academy of Sleep Medicine, Dec 1, 2010

Study Objectives:To estimate the prevalence of, and to identify correlates of clinically signific... more Study Objectives:To estimate the prevalence of, and to identify correlates of clinically significant sleep problems in adult Israeli citizens exposed to chronic terrorism and war trauma or threat thereof.Methods:A population-based, cross-sectional study of 1001 adult Israeli citizens interviewed by phone between July 15 and August 26, 2008. The phone survey was conducted in Hebrew and assessed demographics, trauma/stressor exposure, probable posttraumatic stress disorder (PTSD), probable depression, and sleep problems. Probable PTSD and depression were assessed with the PTSD Symptom Scale (PSS) and Patient Health Questionnaire (PHQ-9), respectively, following DSM-IV diagnostic criteria. Sleep problems in the past month were assessed with the Pittsburgh Sleep Quality Index (PSQI), on which a global composite score ≥ 6 indicates a clinical-level sleep problem.Results:Prevalence of probable PTSD and depression was 5.5% and 5.8%, respectively. Prevalence of clinically significant sleep problems was 37.4% overall, but was significantly higher for probable PTSD (81.8%) and probable depression (79.3%) subgroups. Independent correlates of poor sleep included being female, older, less educated, experiencing major life stressors, and experiencing psychosocial resource loss. Psychosocial resource loss due to terrorist attacks emerged as the strongest potentially modifiable risk factor for sleep problems.Conclusions:Sleep problems are common among Israeli adults living under chronic traumatic threat and trauma exposure. Given the continuing threat of war, interventions that bolster psychosocial resources may play an important role in preventing or alleviating sleep problems in this population.Citation:Palmieri PA; Chipman KJ; Canetti D; Johnson RJ; Hobfoll SE. Prevalence and correlates of sleep problems in adult Israeli Jews exposed to actual or threatened terrorist or rocket attacks. J Clin Sleep Med 2010;6(6):557-564.

Journal of Personality Assessment, 2010

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Psychological Assessment, Jun 1, 2007

The authors examined the structural validity of the parent informant version of the Strengths and... more The authors examined the structural validity of the parent informant version of the Strengths and Difficulties Questionnaire (SDQ) with a sample of 733 custodial grandparents. Three models of the SDQ&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s factor structure were evaluated with confirmatory factor analysis based on the item covariance matrix. Although indices of fit were good across all 3 models, a model that included a newly hypothesized positive construal method factor in addition to the 4 symptom factors (Emotional Symptoms, Conduct Problems, Hyperactivity-Inattention, Peer Problems) and the single Prosocial Behavior factor originally intended for the SDQ provided the best representation of this instrument&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s latent structure. Structural validity was further evidenced by measurement invariance across grandparent race and grandchild gender and age, a conceptually meaningful pattern of cross-scale correlations, and the acceptable internal reliability estimates found for each subscale. Measurement and clinical implications of the results are discussed.

Journal of traumatic stress, Jan 21, 2015

Frequency and severity of trauma exposure are thought to influence posttraumatic reactions. Weiss... more Frequency and severity of trauma exposure are thought to influence posttraumatic reactions. Weiss et al.'s Critical Incident History Questionnaire (CIHQ; 2010) measures these variables among law enforcement officers; they reported findings using a sample of officers from large urban departments. We noted the need for replication studies utilizing samples from smaller and rural police agencies. The purpose of this study was to replicate the CIHQ findings from Weiss et al. using a sample (N = 193) of officers from small and midsize police departments and officers whose duties include policing rural and isolated jurisdictions. Frequency and severity findings were similar to those reported by Weiss et al. (). Regarding frequency, the present study found the critical incident exposure mean score was 188.5, compared to 168.5 from Weiss et al. (). Making a mistake that kills or injures a colleague had the highest mean nomothetic severity rating in both studies. Among the various variab...

Psychological trauma : theory, research, practice and policy, 2012

We examined a dual pathway, longitudinal mediational model in which child sexual abuse (CSA) infl... more We examined a dual pathway, longitudinal mediational model in which child sexual abuse (CSA) influences adulthood interpersonal functioning and sexual risk through its impact on resiliency resources and psychological distress. Women were recruited from two obstetrics and gynecological clinics serving primarily low-income, inner-city women (N = 693) and interviewed at pretest (Time 1) and 6-month follow-up (Time 2). The proposed mediators were resiliency resources (i.e., self-esteem and self-efficacy) and psychological distress (i.e., depressive and posttraumatic stress symptoms). The interpersonal outcomes were general interpersonal problems (measured via recent loss of interpersonal resources, lack of perceived current social support, and recent social conflict) and HIV/sexual risk (measured via lack of confidence asserting safe sex practices, intimate partner risk, and perceived barriers to safe sex). A respecified partial structural equation model implying full mediation supporte...

Psychological Trauma: Theory, Research, Practice, and Policy, 2011

Psychological Trauma: Theory, Research, Practice, and Policy, 2009