Human Trafficking in Nepal: Post-Earthquake Risk and Response.

As Nepal mourns the 1-year commemoration of the April 2015 earthquake and its aftershocks that killed more than 8500 people and left thousands injured and displaced, other more hidden repercussions of the resultant chaotic environment need attention: the increased risk of human trafficking. Considering that natural disasters provide a milieu for this illicit trade, there is a need for a robust response from stakeholders such as donors, civil society organizations, and government organizations against human trafficking following disasters such as the Nepal earthquake. Responsibility to prevent and fight trafficking should be explicitly included in the mandate of relief and rehabilitation mechanisms set up at the national level to coordinate the disaster relief response, serving to support populations in both rural and urban areas. (Disaster Med Public Health Preparedness. 2017;11:153-154).

Mothers and midwives perceptions of birthing position and perineal trauma: An exploratory study.

BACKGROUND: Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries. AIMS: To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma. METHODS: A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearson's chi-square test was used to measure association between birthing positions and perineal trauma. FINDINGS: Mothers, n=94 (85%) and midwives, n=108 (98%) reported high rates of lithotomy position for birth. N=63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n=65 (59%). However, a high majority of mothers, n=106 (96%) and midwives, n=97 (88%) reported they would be willing to use alternative positions. Majority of mothers had an episiotomy, n=80 (73%) and n=76 (69%) reported they did not give their consent. N=59 (53%) reported they were not given local anaesthesia for an episiotomy. n=30 (27%) of midwives confirmed they performed an episiotomy without local anaesthesia. CONCLUSION: Care is not based on current evidence and embedded practices, i.e. birthing in lithotomy position and routine episiotomies are commonly used. However, this survey did find a willingness to change, adapt practice and consider different birthing positions and this may lead to fewer episiotomies being performed.

A qualitative study exploring midlife women's stages of change from domestic violence towards freedom.

BACKGROUND: Domestic Violence (DV) remains a significant global health problem for women in contemporary society. Existing literature on midlife women's experiences of domestic violence is limited and focuses on health implications. Leaving a violent relationship is a dynamic process that often requires multiple attempts and separations prior to final termination. The aim of this study was to explore the process of leaving a violent relationship for midlife women. METHODS: This qualitative study involved fifteen women aged between 40-55 who had accessed residential and non-residential community support services for domestic violence within the UK. Community-based support agencies provided these women with access to letters of invitation and participant information sheet explaining the study. The women notified agency staff who contacted the research team to arrange a mutually convenient time to meet within a safe place for both the women and researchers. It was stressed to all potential participants that no identifiable information would be shared with the agency staff. Women were considered survivors of DV if they defined themselves as such. Data were gathered through semi structured interviews, transcribed verbatim and thematically analysed. RESULTS: Midlife women appear to differ from younger women by transitioning quickly though the stages of change, moving rapidly through the breaking free onto the maintenance stage. This rapid transition is the resultant effect of living with long-term violence causing a shift in the women's perception towards the violent partner, with an associated reclamation of power from within the violent relationship. A realisation that rapid departure from the violence may be critical in terms of personal safety, and the realisation that there was something 'wrong' within the relationship, a 'day of dawning' that had not been apparent previously appears to positively affect the trajectory of leaving. CONCLUSIONS: Midlife women appeared to navigate through the stages of change in a rapid linear process, forging ahead and exiting the relationship with certainty and without considering options. Whilst these findings appear to differ from younger women's process of leaving, further research is needed to explore and understand the optimum time for intervention and support to maximise midlife women's opportunities to escape an abusive partner, before being reflected appropriately in policy and practice.

Health Professionals' Responses to Women's Disclosure of Domestic Violence.

This study explored women's experiences of their responses from health professionals following disclosure of domestic violence within a health setting. The existence of health-based policies guiding professionals in the provision of appropriate support following disclosure of domestic violence is only effective if health professionals understand the dynamics of violent relationships. This article focuses on the findings from the interviews conducted with 15 women living in the United Kingdom who disclosed their experiences of domestic violence when accessing health care. Following thematic analysis, themes emerged that rotated around their disclosure and the responses they received from health professionals. The first two themes revealed the repudiation of, or recognition of and failure to act upon, domestic violence. A description of how the health professional's behavior became analogous with that of the perpetrator is discussed. The final theme illuminated women's receipt of appropriate and sensitive support, leading to a positive trajectory away from a violent relationship. The findings suggest that the implicit understanding of the dynamics of violent relationships and the behaviors of the perpetrator of domestic violence are essential components of health care provision to avoid inadvertent inappropriate interactions with women.

An exploratory study: student nurses' perceptions of professionalism.

AIM OF THE STUDY: To explore final year nursing students' perceptions of professionalism using a reflective approach. DESIGN: A phenomenological approach informed the study, and data was collected by a focus group and five individual semi-structured interviews. SUBJECTS: Participants were ten final year student nurses studying on the adult nursing education programme in the United Kingdom. DATA ANALYSIS: Thematic analysis resulted in an extensive list of general statements or 'units of meaning', from which meaningful categories describing a phenomenon evolved. RESULTS: The findings revealed that student nurse's perceived vulnerability, symbolic representation, role modelling, discontent and professional development as elements that informed their own professionalism. Additionally, being able to observe the behaviours of registered nurses appeared to be significant to the student in the development of their own sense of professional identity, using positive and negative role models constructively. CONCLUSIONS: It appears that final year student nurses are cognisant of the impact of practice scenarios and observational influences, affecting their own perceptions of professionalism. They are able to clearly identify and make sense of experiences in practice, and constructively use this knowledge to positively inform their practice.

Women's early relational experiences that lead to domestic violence.

Many perpetrators of domestic violence engage in a perpetual cycle of forming sequential relationships while repeating violent behavior. Their methods of manipulation successfully dominate a partner, the outcome of the relationship being control and violence. This research study was influenced by a feminist standpoint epistemology, and was focused on the narratives of 15 women who chose to talk in great detail about the transition in their respective relationship from love to violence. The findings revealed three tactics, termed the princess effect, feeling vulnerable, and commitment, which were deployed by male perpetrators in the early stages of a relationship. The purpose of these tactics was to successfully engage and retain women, to then exert control, inflict violence, and subjugate them. A description of the initial act of physical violence is provided, revealing the impact of these tactics in meeting the ends intended by the perpetrator.

Stop! Silent screams.

There is evidence to suggest that pregnancy may trigger or exacerbate domestic violence. Domestic violence is recognised to be a significant contributory factor to maternal and fetal morbidity and mortality. The midwife is ideally placed to recognise domestic abuse and offer care, support and information. This article describes and discusses the multi-complex issues surrounding domestic abuse, highlights possible indicators, how to ask questions, the importance of documenting evidence and explores ways that midwives can be responsive to the needs of abused women and their children.

Postnatal disclosure of domestic violence: comparison with disclosure in the first trimester of pregnancy.

AIMS AND OBJECTIVES: This study explored the prevalence rates of domestic violence reported during the first trimester of pregnancy and in the postnatal period. BACKGROUND: Domestic violence is known to have a deleterious effect on the physical and psychological well-being of a woman, with an adverse effect on the unborn child. DESIGN: A validated anonymous and self-administered questionnaire (Abuse Assessment Screen) using five closed questions was used for data collection in all samples. All women were approached alone, and the questionnaire was completed in private. METHOD: Drawn from the same geographical area, this survey collected data from women accessing hospital clinics, in a large university teaching hospital in the UK. RESULTS: Comparing self-reporting rates of domestic violence in the first trimester of pregnancy to the postnatal period yielded statistically significant results (p < 0·01). Only 7·3% booking-in clinic and 8% postnatal women reported violence at some stage in their life, whilst higher rates in pregnancy counselling clinic (35·1%) and early pregnancy unit (26%) were reported. However, the reported rates of domestic violence in the year before the women were pregnant revealed a different trajectory. Lower rates of domestic violence were evident in three samples. CONCLUSIONS: The disparity in disclosure rates of domestic violence suggests that an emotional inhibitory response to disclosure may occur at specific periods of pregnancy and that the timing of asking about domestic violence may be critical to this disclosure. The pandemic nature of domestic violence reflects the need for practice in maternity care to reflect the changing needs of a woman during her gestational experience. RELEVANCE TO CLINICAL PRACTICE: The primary objective of health care providers should be to engage a pregnant woman in a meaningful relationship, gaining her trust to facilitate the disclosure of domestic violence. Hence, whatever the policies for the provision of maternity care, the changing needs of a pregnant woman must be met.

Pregnancy counselling clinic: a questionnaire survey of intimate partner abuse.

CONTEXT: Intimate partner abuse has a significant and detrimental impact on the mental and physical health of a woman. Physical abuse is often associated with sexual abuse. OBJECTIVE: To examine the prevalence and nature of physical and sexual partner abuse experienced by women who request a termination of pregnancy (TOP). DESIGN: Quantitative data collection using an anonymous, self-completed questionnaire. SETTING: A pregnancy counselling clinic located within a large district general hospital in the north west of England. PARTICIPANTS: A sample of 312 women attending the clinic. RESULTS: Three hundred and twelve questionnaires were returned (96.7% response rate). The prevalence rate of intimate partner abuse at some stage in the woman's life was 35.1%; 19.5% had experienced actual physical abuse in the past year; and 3.7% had experienced forced sexual intercourse in the past year. Of the latter, in over half of the cases, this may have resulted in the current pregnancy. A total of 6.6% of women in this study are currently living in fear. DISCUSSION: The anonymity of the survey and the method of implementation encouraged an excellent response rate. The prevalence of physical abuse was higher than that reported in previous studies, however the prevalence of sexual abuse was lower. Up to 2% of requests for TOP could have been due to recent forced sexual intercourse. CONCLUSIONS: Many women requesting a TOP have been, or still are, in violent relationships. Some women may attend with an unwanted conception following sexual assault by their current or previous intimate partner.

A community-based perspective on living with domestic violence.

Women living within a violent relationship suffer from a multitude of somatic and psychological complaints. The constant erosion of their self-esteem undermines their confidence and decision-making abilities, eventually leading to a learned helplessness and apathy. In association with this is the significant deleterious effect on the psychological and physical health of any children witnessing this abuse within the home. Community health care providers such as district nurses, practice nurses and GPs are in close contact with the family and can observe the family dynamics. They are often the only health care professionals in a position to be able to build a rapport with the family. Consequently a survivor of domestic abuse may confide in them, enforcing the health professional to play a pivotal role in empowerment and the initiation of essential support services. This article highlights the detrimental effects of domestic abuse and the necessity to raise awareness within the community forum.

The prevalence rates of domestic abuse in women attending a family planning clinic.

CONTEXT: Domestic abuse has a detrimental impact on the mental and physical health of a woman. The abusive partner may use physical and sexual violence and 'control' the choice of contraception. OBJECTIVE: To examine the prevalence rates of domestic abuse. DESIGN: Data collection using anonymous questionnaire. SETTING: A family planning clinic. PARTICIPANTS: Two hundred and ninety-two women. MAIN OUTCOME MEASURES: The prevalence rate of past and present history of domestic abuse and the nature of the abuse. RESULTS: One in three women experienced domestic abuse at some time in their life. A significant relationship existed between the age of the woman and experiencing abuse within the last year. Women in full-time employment experienced the highest rates of abuse. DISCUSSION: The anonymity of the research and the method of implementation encouraged an excellent response rate. CONCLUSION: During a woman's childbearing years, one-third of women may experience domestic abuse from their partner.

A practical approach to promote reflective practice within nursing.

Although reflective practice has been identified as a valuable tool to help nurses recognise their own strengths and weaknesses, many still find it a difficult concept to embrace. This article dispels some of the myths surrounding reflective practice and offers examples of how it can benefit nurses both on a personal and a professional level.

Domestic violence in nursing curricula.

Domestic violence has serious consequences, which often result in long-term damage to an individual's health, well being and development. Health care providers are ideally placed to detect people who have experienced domestic abuse, as almost everyone accesses the health service at some point in their lifetime. Nursing and midwifery tutors have a pivotal role in educating health care professionals on the subject of domestic abuse. This article reports on a study exploring the current practice and views of tutors who deliver this topic in the curriculum.

Support and education: the role of the domestic violence coordinator.

The domestic violence coordinator is a relatively new role that has evolved due to increased awareness of the long-term health issues that result from domestic abuse. Health professionals have a vital role in the identification, assessment and response to domestic violence. In order to provide this support the professionals themselves require the appropriate knowledge and skills. The domestic violence coordinator's role is multifaceted; it incorporates effective education and training, and provides the essential link between clinical and community environments.