Implementation and initial analysis of Cardiff Model data collection procedures in a level I trauma adult emergency department

ObjectivesOur understanding of community violence is limited by incomplete information, which can potentially be resolved by collecting violence-related injury information through healthcare systems in tandem with prior data streams. This study assessed the feasibility of implementing Cardiff Model data collection procedures in the emergency department (ED) setting to improve multisystem data sharing capabilities and create more representative datasets.DesignInformation collection fields were incorporated into the ED electronic health record (EHR), which gathered additional information from patients reporting assaultive injuries. ED nurses were surveyed to evaluate implementation and feasibility of information collection. Logistic regression was performed to determine associations between missing location information and patient demographic data.Setting60-bed academic level I trauma adult ED in a large Midwestern city.Participants2648 patients screened positive for assault injuries between 2017 and 2020. 198 patients were omitted due to age outside the range served by this ED. Unselected inclusion of 150 ED nurses was surveyed.Main outcome measuresMain outcomes include nursing staff survey responses and ORs for providing complete injury information across various patient demographics.ResultsMost ED nurses believed that information collection aligned with the hospital’s mission (92%), wanted information collection to continue (88%), did not believe that information collection impacted their workflow (88%), and reported taking under 1 min to screen and document violence information (77%). 825 patients (31.2%) provided sufficient information for geospatial mapping. Likelihood of providing complete location information was significantly associated with patient gender, race, arrival means, accompaniment, trauma type and year.ConclusionsIt is feasible to implement information collection procedures about location-based, assault-related injuries through the EHR in the adult ED setting. Nurses reported being receptive to collecting information. Analyses suggest patient-level and time variables impact information collection completeness. The geospatial information collected can greatly improve preexisting law enforcement and emergency medical systems datasets.

Individual and Environmental Correlates of Adolescents’ Moral Decision-Making in Moral Dilemmas

While extensive research has been conducted on adults’ judgments in moral sacrificial dilemmas, there is little research on adolescents. The present study aimed at: (1) adding further empirical evidence about adolescents’ moral decisions (deontological vs. utilitarian) in sacrificial moral dilemmas and (2) investigating how these moral decisions relate with gender, school grade, emotional traits (callous-unemotional traits), context-related experiences (perceived parental rejection and community violence exposure), and moral-related factors (moral disengagement and universalism value). A sample of 755 Italian adolescents (54.7% females; Mean age=16.45, SD=1.61) attending the second and the fifth year of secondary school took part in the study. Two sacrificial trolley-type dilemmas (where harmful actions promote the greater good) were presented. In the “switch” scenario (impersonal sacrificial dilemma), the choice is whether to hit a switch to save five people killing only one person. In the “footbridge” scenario (personal sacrificial dilemma), the choice is whether to push a large man off a footbridge saving five persons. For each scenario, participants had to indicate whether the proposed action was “morally acceptable” or not. Data were analyzed performing generalized linear mixed models. Our results showed that: (1) Adolescents were more likely to indicate as admissible to hit the switch rather than to push the large man; (2) male adolescents, compared to females, were more likely to say it was morally acceptable to intervene in the footbridge dilemma, whereas younger adolescents said it was morally acceptable both in the switch and the footbridge situations; and (3) higher levels of callous-unemotional traits, perceived parental rejection, and moral disengagement, on the one hand, and lower levels of universalism, on the other hand, were associated to higher admissibility to intervene in the footbridge scenario. Higher community violence exposure was associated with a lower propensity to intervene in the switch scenario. Overall, the present study expands the research on sacrificial dilemmas involving a sample of adolescents. The findings support previous studies concerning the role of emotions in making moral decisions but, at the same, open new perspectives regarding the role of contextual experiences and moral-related factors.

Beliefs as Mediators of Relations Between Exposure to Violence and Physical Aggression During Early Adolescence

This study examined beliefs about aggression and self-efficacy for nonviolent responses as mediators of longitudinal relations between exposure to violence and physical aggression. Participants were a predominantly African American (79%) sample of 2705 early adolescents from three middle schools within urban neighborhoods with high rates of violence. Participants completed measures across four waves (fall, winter, spring, and summer) within a school year. Beliefs supporting proactive aggression, beliefs against fighting, and self-efficacy for nonviolence partially mediated relations between witnessing violence and physical aggression. Indirect effects for beliefs supporting proactive aggression and self-efficacy were maintained after controlling for victimization and negative life events. Beliefs supporting proactive aggression mediated the effects of violent victimization on physical aggression, but these effects were not significant after controlling for witnessing violence and negative life events. The findings underscore the importance of examining the unique pathways from witnessing community violence versus violent victimization to physical aggression.