Disclosure

This report represents a concept analysis on disclosure. The objective is to gain an in-dept understanding on the concept of disclosure and to define what it represents as well as what it does not represent. The focus and motivation is to define a foundation for future exploring, measuring, and testing the idea in regard to a full dissertation on abused pregnant women. The report outline can be attributed to Avant and Walker’s Strategies for Theory Construction in Nursing and therefore provides a brief discussion of the overall concept and insights into why this topic was selected and how it relates to nursing as well as abused pregnant women. The format then discusses the inherent literature search process and attempts to identify possible uses of the concept including non-nursing literature. Next is an attempt to determine the defining attributes of the concept and then to try to construct cases for the concept such as: Model, Borderline, Related, Contrary, Invented, and Illegitimate. The report then attempts to identify some antecedents and/or consequences of the concept as well as to try to identify empirical referents related to the concept. For the reports conclusion, it briefly discusses how the theoretical framework used relates to the original concept.

Similar to the idea behind concepts, theories should be classified by how abstract they are as compared to a continuum of grand theories to practice theories. Thus, theories that are considered grand are overly broad and too abstract and therefore can not always lend themselves to scientific application and/or testing. However, narrow range theories would be overly precise and therefore restrictive in their overall focus. Because medicine in general can be considered an atheoretical science, so concepts, statements and theories must be developed through analysis, synthesis and derivation. This report is attempting to meet the problem halfway. “Mid-range theories go some way to solving this problem. They are moderately abstract and inclusive but are composed of concepts and propositions that are measurable. Therefore, mid-range theories, at their best, balance the need for precision with the need to be sufficiently abstract.” (McKenna, 1997)

Concept Discussion

The Health Insurance Portability and Accountability Act (HIPAA) and its companion regulations require the medical community to prevent the disclosure of confidential patient information. These regulations require organizations and their employees to do detailed risk analysis so as not to unwittingly pass on or unknowingly discuss anything that could open up any unauthorized confidential information. The problem the medical community face is that some information could greatly enhance the patient care aspects of the profession but that information is now unusable.

There are many concepts that are very meaningful to society. Consider the many theories available for study, “… include: a theory of menstrual care, a theory of family care-giving, a theory of relapse among ex-smokers, a theory of uncertainty in illness, a theory of the perimenopausal process, a theory of self-transcendence, a theory of personal risking and a theory of illness trajectory.” (McKenna, 1997) Throughout world history, theories have also focused on gender related inequality and inequity which are prominent. “Immigrants’ rights activists, the domestic violence movement, women’s rights organizations, and service providers are increasing their efforts to build networks and coalitions in their own communities, as well as across the country.” (Volpp, Leti, “Working With Battered Women — A Handbook to Make Services Accessible, Part 6” 1995)

Domestic violence in the United States and the world is on the rise. “As many as 46,000 German women are estimated to spend some time at women’s refuges every year because of domestic violence.” (World: Europe, Germany Gets Tough On Domestic Violence) In the United States, domestic violence is the primary reason women and children are homeless. “Domestic violence and sexual assault occur frequently in the United States. 1,500,000 women are raped or physically assaulted by an intimate partner annually in the United States, and 1 in 4 women in the United States will experience domestic violence or sexual assault in her lifetime.” (Domestic Violence in the United States)

But honing in on actual victims of domestic violence brings a surprising detail to the surface and in our technologically advanced globally driven world. One such societal oversight revolves around the abuses being regularly suffered by the world’s pregnant women. The overall media hype touts that things have been getting better for women but the recent murder of a young pregnant woman named Lacy Peterson has brought a new focus on a situation that is in reality near epidemic proportions. From a nursing perspective, a strategy needs to be developed that will help examine the attributes and characteristics of abuses being suffered by pregnant women. How best can the medical community and nursing in general help similar victims in a timely fashion while adhering to the concepts associated with disclosure?

Discuss Literature Search Process

To address the problem of pregnant women’s abuses, a detailed literature search process would be in order. The approach would need to be comprehensive and systematic and the idea of creating a detailed protocol would help guide the literature search process. The search would begin by attempting to identify relevant journals, organizations, and experts. From there the process would revolve around searching with a detailed strategy and collecting studies by:

Hand Searches: hand search core journals relevant to the topic

Electronic Databases: identify keywords and search a variety of electronic databases for relevant studies

Submissions: incorporate studies and student journal

Website Searches: search websites for core and topic-relevant organizations and relevant studies

Extensive Outreach: contact topic experts and relevant organizations to request studies and statistics as well as to request recommendations of potential interview subjects

Determine the Defining Attributes

It is critical to clearly define the attributes associated with the aspects of this idea. The first is the concept of disclosure itself which will be driven by the legal community. The second attribute structure would revolve around the pregnant women abused in a scientifically significant way. “Walker and Avant maintained that mid-range theories balance this specificity with the conceptual economy normally seen in grand theories. As a result mid-range theories provide nurses with the ‘best of both worlds ‘ – easy applicability in practice and abstract enough to be scientifically interesting. Thus, the attributes associated with pregnant women’s abuses would be of a relatively broad scope of phenomena and would not cover the full range of phenomena that could be of concern in this discipline.

Thus the attributes would focus on only the medical aspects such as caring for the victim and the fetus after a physical abuse as opposed to a full blown research on stopping or controlling all aspects associated with pregnant women’s abuses. This mid-range theory for nursing on medical care after a pregnant woman is abused is broader than a theory of abdominal blows but narrower than the goal of stopping all abuse. By establishing attributes in the Mid-range theory will help the report focus on concepts of interest to nurses that are more readily applicable in direct care situations. Domestic Abuse involving pregnancy is a large sample. “Battering often occurs during pregnancy. One study found that 37% of pregnant women, across all class, race, and educational lines, were physically abused during pregnancy. 60% of all battered women are beaten while they are pregnant.” (Women’s Rural Advocacy Programs, 2005)

Abuse has a specific definition according to the Women’s Rural Advocacy Programs. The attributes of abuse include:

Physical: slapping, pushing, hitting, kicking, biting, etc.

Emotional: name-calling, putting down, insults, etc.

Sexual: being forced into sexual contact

Threats: “If you…I’ll kill you!”

Intimidation: gestures, looks, smashing things

Isolation: being kept from seeing or talking to others, not allowed to go out.

Economic: being given an allowance, not allowed to have a job, etc.

The attributes for this theory would therefore hone in on only physical abuses of pregnant women which entails slapping, pushing, hitting, kicking, biting, etc. And in some instances only the attributes would also include sexual abuse such as physical rape.

In the same light, the information gathering aspects surrounding domestic abuse with highlight to pregnancy would need a methodology for identifying cases of unauthorized disclosure and thus eliminating speculation about possible but not yet realized threats or vulnerabilities. It would be important to establish attributes that detail the probability of information hazards and to show relationships of unauthorized disclosures pertaining to pregnant domestic situations from the vast database of incidences of unauthorized disclosures.

Model, Borderline, Related, Contrary, Invented, and Illegitimate

The model or the concept to best present an understanding about disclosure as it pertains to domestic abuse on pregnant women can be filtered. Like the risks associated with disclosure abuses, domestic violence seems to be a repetitious cycle that is difficult if not impossible in some situations to break. As demonstrated by the high number of refuge cases throughout the United States and the recent Peterson scenario, most abused individuals have found out that the only way to break the vicious cycle of abuse is leaving the abusive relationship or death. Typically, after each occurrence of an abusive episode, it is likely that the cycle of domestic violence has then been shortened. Risk analysis in disclosure cases also demonstrates that disclosure hazards are events that organizations repeat in cyclic patterns. Thus, to prevent violations and to accurately estimate the probability of an unauthorized disclosure, there are many opportunities to measure the abuses just as there are many opportunities to discover abuse on pregnant women.

Breaking the pattern of violence on pregnant women without help is very difficult and leaving home is not always a feasible or safe alternative. The high number of domestic murders for pregnant women demonstrates that leaving an abuser can be fatal. The abused is usually the only one in the world who truly knows if and when to go but that may be a time that is too late. But addressing the needs of the abused in regard to the HIPAA rules is possible.

Identify Antecedents And Consequences

Although pregnant and recently pregnant women are far more likely to be victims of a homicide than to die of any other cause and as many as 324,000 women each year experience intimate partner violence during their pregnancy, it is unfortunate that this particualr study would be limitied in the sense that it cannot help every scnario from a nursing perpstive. The antecedents are “events or incidents that must occur prior to the occurrence of the concept.” (Walker & Avant, 2005)

In the case of pregnant women suffering abuse, the healing process which can be obtained from the nursing profession is limited by the fact that the abuse must be known to have occurred. In other words, reporting of the event or events must occur and the patient must be willing to receive treatment in order for the concept to a viable solution or opportunity. Because so much abuse goes unreported, the problem of extracting the necessary information from victims may be the ending of the concept before the concept has even begun.

Consequences are obviously the “events or incidents that occur as a result of the occurrence of the concept.” (Walker & Avant, 2005) Once again the problem with a victim reporting abuse scenarios, the situation may actually become more hazardous as opposed to better. The nursing and medical profession and even the legal aspects of our society are not capable at this time of providing safe havens to abuse victims. The legal system has the authority to jail an abuser if the evidence suggests domestic violence has indeed occurred and the system is well versed in these types of scenarios yet domestic violence to both pregnant and non-pregnant women will continue to occur. “Nearly two-thirds of women who reported being raped, physically assaulted, or stalked since age 18 were victimized by a current or former husband, cohabiting partner, boyfriend, or date.” (Domestic Violence in the United States) These types of statistics say statutory changes and the medical community are outnumbered.

Identify empirical referents related to the concept

Often the contrary belief is that drugs are the true problem which creates the type of abuses inflicted. In regard to societal situation, in many cases drug abuse has ultimately placed a pregnant addict in harms way. But statistics from as recent as the year 2000 show that pregnant women were less likely to have a drug related occurrence than non-pregnant women and that abuse is not linked completely to drug abuse. “Past month (suggesting recent) substance abuse for pregnant and non-pregnant women ages 15-44 reveals some important differences that indicate changes for some women during pregnancy. For the three categories of substance use (cigarettes, binge alcohol, and illicit drugs), the rates of reported recent use were substantially higher for non-pregnant women than for pregnant women. Non-pregnant women were almost twice as likely to report past month cigarette use than pregnant women, although nearly 1 in 5 pregnant women smoke. Binge alcohol use (drinking five or more drinks on the same occasion), reported by 19.9% of non-pregnant women, was more than 5 times higher than the 3.9% of pregnant women who reported binge alcohol use. Illicit drug use in the past month was more than twice as likely to be reported by non-pregnant women (7.7%) compared to pregnant women (3.3%).” (March of Dimes, 2000) (March of Dimes, 2000)

Lacy Peterson’s recent murder in the San Francisco Bay demonstrates that the situation of pregnant women abuse is quite contrary to what the typical American is aware of. The American people were shocked that this young lady was murdered although statistics abound with like scenarios.

Theoretical Framework

To briefly discuss how the theoretical framework of abused pregnant women can be used to assist victims, it is essential to see how the nursing profession can implement hope and care back into the lives of victims in many situations. Domestic violence as a whole is a global problem and there are similarities and patterns for both abusers and the abused. Domestic violence, especially violence that directly impacts pregnant women transcends national boarders, religions, races and even genders. Although abuse of a general nature affects everyone, abuse against pregnant women must label the abusers as men. As a nurse, I hate to admit that it may literally be impossible to find a one hundred percent sure fire way of eliminating domestic violence against pregnant women but nursing theory permits a one on one situation in many cases where miraculous medical or psychological breakthroughs have occurred. Psychologists have demonstrated that there are certain ritualistic methods towards the abused by the abuser prior to an act of domestic violence occurring. Examples include: children as pawns, coercion and threats, denial and blame, economic abuse, emotional abuse, intimidation and isolation. From a nursing perspective, when a victim has come forward, nurse practitioners are in a position to help each individual victim see either the ritualistic or recurring patterns without crossing the line of medical ethics.

Conclusion

In conclusion, this report represented a concept analysis on disclosure with an objective of providing understanding into disclosure. The focus and motivation was to define a foundation for future exploring, measuring, and testing of the ideas for a full dissertation on abused pregnant women. The report outline can be attributed to Avant and Walker’s Strategies for Theory Construction in Nursing and therefore provided a brief discussion of the overall concept and insights into why this topic was selected and how it relates to nursing as well as abused pregnant women. The format then discussed the inherent literature search process and attempted to identify possible uses of the concept including non-nursing literature. Next it attempted to determine the defining attributes of the concept and then to try to construct cases for the concept: Model, Borderline, Related, Contrary, Invented, and Illegitimate. The report then attempted to identify some antecedents and/or consequences of the concept as well as to try to identify empirical referents related to the concept. In conclusion, the report briefly discussed how the theoretical framework used relates to the original concept.

References

Domestic Violence in the United States. National Domestic Hotline. Retrieved on 21 Jan. 2005, from http://pages.ivillage.com/debi_1111/id30.html.

March of Dimes. (2000). Substance Abuse by Pregnancy Status. Retrieved January 21, 2005, at http://www.modimes.org/aboutus/1521.asp

McKenna, H.P. (1997). Nursing Models and Theories p. 144-146. London: Routledge.

Moller-Okin, Susan. (1999) “Is Multiculturalism Bad For Women?” In Okin et al., Is Multiculturalism Bad For Women? Princeton: Princeton University Press, pp 9-24

Olszewski Walker, Lorraine, & Coalson Avant, Kay. (2005). Strategies for Theory Construction in Nursing (4th ed.). New York: Prentice Hall.

Women’s Rural Advocacy Programs. (n.d.). Statistics About Domestic Abuse. Retrieved January 21, 2005, at http://www.letswrap.com/dvinfo/stats.htm

Volpp, Leti (1996) “Working With Battered Women — A Handbook to Make Services Accessible. Parts 1 through 6.” Contemporary Women’s Issues Database

World: Europe, Germany Gets Tough On Domestic Violence. Retrieved on 21 Jan. 2005, from BBC Online Network at http://news.bbc.co.uk/1/hi/world/europe/354288.stm.

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