Monday, January 27, 2020

The Role of a Midwife in Domestic Violence Cases

The Role of a Midwife in Domestic Violence Cases Domestic violence and public health The role of the midwife. Why is domestic violence a public health issue for midwives?The latest triennial maternal mortality report (CEMACH, 2004) reveals that for the years 2000-2002 eleven new mothers were murdered, within six weeks of giving birth, by their partners. The report highlights that domestic violence is a risk factor for maternal death from all causes. In this report 14 percent of all the women who died had declared that they were subjected to domestic violence. This translates to 51 women in England, Wales and Northern Ireland over the three year period. If progress is to be made in reducing maternal mortality careful note needs to be taken of all the risk factors.   Risk assessment is currently a means by which the type of care received by the woman in pregnancy and labour is determined. This midwifery role is already well established for antenatal and intrapartum care. Epidemiology Domestic violence has a high prevalence. Crime figures for a single day, 28th September 2000, were obtained and publicised form British police forces. On that day there were 1 300 calls to the police reporting domestic violence. Extrapolating from this there is an incidence of domestic violence every six to 20 seconds. Most of the victims are women. According to Home office figures two women die in Britain each week from violence by either their current or their previous partner (Mirrlees-Black, 1999). A study in London found in a sample of women on antenatal and postnatal wards a 23% lifetime experience of domestic violence. Three percent of these women were encountering domestic violence in the present pregnancy (Bacchus, 2004). The impact of domestic violence What constitutes domestic violence varies tremendously. It does not have to be physical violence. This is problematic. Collection of statistics is hampered by the blurring of the boundaries between the abuse severity. Whilst it can be agued that no level of abuse is acceptable some distinction needs to be drawn. Pregnancy may act as a trigger for domestic violence; it may start at this time or change in nature sometimes becoming mental rather than physical but sometimes being more focussed on blows to the abdomen. The puerperium is a time of particular vulnerability (CEMACH, 2004). The high prevalence of domestic violence impacts economically on society. The costs of dealing with 100,000 women seeking medical help annually due to domestic violence and the fact that of applications for shelter on account of homelessness 17 per cent are caused by domestic violence may be costing London alone approximately  £250 million each year. Support systems are overstretched; there are 7 000 women and children looking for places of safety every day (Seymour, 2001). Physical violence to a pregnant woman increases the risk of miscarriage, premature labour, low birth weight and intrauterine fetal death. Domestic violence may increase the likelihood of a pregnant woman smoking, drinking alcohol or taking drugs with deleterious effects on the pregnancy and fetus. Domestic violence is associated with depression and suicide attempts. Trauma to the abdomen incurs risk of life threatening placental abruption, rupture of the uterus or other internal organs in addition to the fetal risks. Women incurring domestic violence are less likely to be able to access antenatal care, many book late and a significant proportion not at all. They have problems accessing care and often default on visits, change addresses and have no reliable means of being contacted. Often the partner will exercise stifling control over them and accompany them during visits to the midwife, answer questions for them and remain present during examinations (Mezey, 2002). Initiatives to address the problem The Department of Health’s National Service Framework (2004) for Children, Young people and Maternity Services states the importance of identifying victims of domestic violence and includes pointers for recognition and action during pregnancy and recommends that staff should be aware of the importance of these aspects. Some emphasis is put on the supportiveness of the environment and the sensitivity of the enquiry about the abuse. The Government has looked closely at the issue of domestic violence (The Government’s Proposals on Domestic Violence, 2003). Parliament has legislated via the Domestic Violence, Crime and Victims Act 2004. This has extended police powers of arrest for common assault under the Police and Criminal Evidence Act 1984. This has had some effect with a dawn raids to intercept offenders (Bird, 2004). Dimond (2005) argues that to really tackle the issue of domestic violence people in general must become involved and this includes health care providers. It is already the case that following an assault which leads to miscarriage the offender can be charged under s.58 of the Offences against the Person Act 1861 (Bristol Evening Post, 2004). Where the assault leads to premature delivery from which the child dies the charge is one of manslaughter. The Home Office is taking the lead on behalf of the Government on this issue. Specialist domestic violence courts are planned. In Leeds it is pil oting a Domestic Violence Cluster Court. The aim is to make the process of dealing with the perpetrators faster and to make custodial sentences longer. In 2000, the Department of Health advocated routine questioning of pregnant women about domestic violence. The Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and NICE all requested that this should happen. In a position paper in 1999 the Royal College of Midwives recommended that abuse be recognised and documented and also that such women should be given information to choose for themselves what to do.   It is recognised that it is important for a woman to be able to find the help that she needs when she is ready (Smith, 2005). Whilst the woman can be assured of confidentiality it is important that the extent and limitations of this are made clear. For instance if she already has children and there is a risk that they may suffer domestic violence then confidentiality will have to be broken. If there is a real danger to the fetus once it is born then again the confidentiality between the woman and the midwife will have to be broken. Up until the moment of birth the fetus does not have any right of its own in law. In Wales and in Bristol there have been significant projects to screening pregnant women for domestic violence and following through the positive answers. There have also been initiatives in Leeds and also in London. A study done in Bristol (Salmon 2004) and funded by the Department of Health showed that where midwives were trained to ask about domestic violence more women disclosed it. Midwives wanted further training and without this only 10% of midwives would ask about domestic violence by choice. Midwifery training in asking the question increased midwives’ confidence in this area(Baird, 2005). The Bristol research was important to determine the impact of the routine questioning about domestic violence on midwifery education. The multi-agency involvement of the work and education was apparent. A vitally important aspect of the work on disclosure was talking to the woman alone, specifically without the presence of her partner (Merchant, 2001). The question is unlikely to be of benefit if the woman is not asked alone or if there is no effective follow up (Ward and Spence, 2001). Sometimes the only time the abusive partner will allow the woman to be alone is when she goes to the toilet. Therefore posters must be available in this location detailing contact numbers of women’s refuges, social services, victim support etc. Information can also be pre-printed on maternity records so that if a partner sees it it is obviously not aimed specifically at that woman and she is then not likely to suffer further abuse on account of him seeing the information. Another aspect, which might be considered, is to have in the women’s toilet a poster indicating that if the woman is being abused she may mark her routine urine container in some way that alerts the midwife but no one else that she is in danger from domestic violence. Women from ethnic minorities where English is not spoken by the woman pose particular difficulties. It is important to use an inte rpreter who is not a family member. The Bristol study was a pilot to inform about education needs of midwives when asking about domestic violence. It was not designed as a study to gather evidence about whether it is effective to promote disclosure and whether subsequent information and support giving is beneficial in reducing the problem. London based initiatives Mezey studied 892 pregnant women at St George’s Hospital, south London. Midwives were trained to ask the question about domestic violence. Women were more likely to admit to domestic violence when directly questioned about it. Women’s fears of loss of confidentiality or that their children might be removed from them hampered disclosure. Some midwives found asking the question was distressing and some feared reprisal from the woman’s partner. It was clear from the study that midwives cannot tackle this problem alone. Considerable back up from other agencies is vital and all agencies must work together. The strengths of the work and initiatives so far include the understanding and acceptance that whilst midwives play a pivotal role in this opportunity to screen women for domestic violence they cannot tackle the problem alone. It is accepted that training of midwives can enhance the percentage of women abused who disclosure this. Other strategies around enhancing disclosure also have a positive effect. To be critical the major weakness of the initiatives is that they are not of proven benefit. Statistics are always going to be difficult to collect in this area. Concentrating on this problem may be detracting from other important midwifery aspects and studies have not addressed this aspect. Training given to midwives has not been universal and the wider aspects of continuing professional development and training of other members of the multi disciplinary team have not been set up. Just admitting to domestic violence does not mean that the woman’s life is going to improve. To bring the problem out into the open may upset the woman’s family and result in isolating her from them both physically and emotionally and in some situations may do more harm than good. A targeted approach needs to be fostered and work needs to be done to evaluate how we can spot the domestic violence cases where intervention would really make a difference. It is doubted whether this is a midwifery role since skills within the field of criminology would seem appropriate. What improvements could be made? A recommendation of the 2000-2002 maternal mortality report (CEMACH, 2004) is that midwives require adequate training both pre registration and as continuing professional development to ensure that they can effectively assess women who suffer domestic violence. A further recommendation is that all pregnant women should be asked if they suffer domestic violence presently or previously (but that the question be deferred until midwives have received the relevant training and multidisciplinary support services are in place). Asking about domestic abuse is generally done poorly in social history taking (Foy, 2000). The most difficult part seems to be the midwife asking the question about domestic violence (Scobie and McGuire, 1999; Price and Baird, 2003; Mezey et al, 2003). The default position would seem to be that they midwife is reluctant to ask and the patient feels unable to talk about it (Ashton, 2004).   The educational aspect is important. Both theory and practical skills are involved. The work around domestic violence is multidisciplinary and multi-agency and clearly this needs to be reflected in the midwife education and continuing professional development courses (Baird, 2005). There needs to direction from the nursing and Midwifery Council and the Royal College of Midwives about what the training will consist of and what comprises the required level of competency. Education should be of proven benefit to practice. The reluctance to answer the question is not supported by women being offended; generally they accept it (Price, 2004). Approximately 90% of women asked are in favour of being asked (Leeds Inter-Agency Project, 2005). On average a woman will suffer domestic violence 35 times before she contacts the police. This is of concern and highlights the degree to which women are trapped in the violent situation. Factors within themselves, for instance fears of reprisals from the partner, compounded with a lack of confidence in the police, social services and the legal system contribute to this problem. Pressure cannot be put on the woman to leave the violent situation (Bewley C and Gibb, 2001). Initiatives aimed at these problems are needed. How midwives can be involved in this public health initiative Thirty percent of domestic violence towards women starts whilst they are pregnant (CEMACH, 2004). Asking all pregnant women about domestic violence as a routine question has advantages over asking only a selected group, for instance; it helps with the changing attitude to domestic violence; it helps women feel they are not being picked on and it is lees likely to jeopardise the safety of an abused woman (Tacket, 2004). The key areas of involvement of midwives to best support these women include; Asking all women directly whether they have been domestically abused and facilitating disclosure Documentation and allocating those with positive responses to high dependency care Giving information to affected women thereby enabling them to access specialised help Supporting women when they are making a change away from the violent situation Inter-agency working (Hepburn M McCartney, 1997) Peer review Midwives do agree with the concept of questioning pregnant women about domestic violence and approximately 80% also agree that it should be the midwife who does this (Price, 2004). However in clinical practice only about 60% are happy about asking the woman this question (Price, 2004). The reasons the midwives gave for these problems were practicalities such as a lack of time or lack of staff or difficulty getting privacy with the woman and personal problems with asking the question (Leeds Inter-Agency project, 2005). ConclusionWith the increased awareness and increased stance of non-acceptability of domestic violence it is to be hoped that people in general will have a common awareness about how they can seek help. Pregnancy is still going to be a vulnerable time from the point of view of the physical stage of mother and fetus and the fact that such a high percentage of abuse situations develop during pregnancy. Midwives are therefore still going to be pivotal in this area. Another important aspect from the midwifery point of view is that a woman may be better motivated to make a change to her situation whilst she is pregnant. Perhaps the role of the midwife in aspiring to solve the problem of domestic violence will be moving away from just asking the question and giving information (since women will largely already have this knowledge) towards encouraging the woman to make a change that really is for the better. It should be recognised at this stage in time that greater challenges lie ahead and we should plan for them now.   ReferencesArticles Aston G The silence of domestic violence in pregnancy during womens encounters with healthcare professionals. Midwives 2004 vol 7 no 4 April Bacchus L Domestic violence and health. Midwives 2004 vol 7, no 4 April 2004 Baird K, Salmon D and Price SLearning from the Bristol Pregnancy and Domestic Violence Programme British Journal of Midwifery, November 2005, vol 13, no 11 p692-6 Bewley C and Gibb A MIDIRS Midwifery Digest 2001 vol 11 no 2 183-187 Bird S Police hold 150 in domestic violence raids. The Times8 December 2004 Bristol Evening Post 18th December 2004, report on Nycoma Edwards. Dimond B Protecting victims of domestic violence. British Journal of Midwifery February 2005, vol 13, no 2 p105 Foy R et al Antenatal detection of domestic violence. The Lancet 2000 vol 355, p1915 Hepburn M McCartney S Domestic Violence and Reproductive Healthcare in Glasgow. In: Bewley S Friend J Mizey G (eds) Violence Against Women London: RCOG Press, 1997: 233 Leeds Inter-Agency Project (2005) Health and social care project report: promoting good practice in health service responses to women and children experiencing domestic violence Marchant S Davidson L Garcia J et al Addressing Domestic Violence through Maternity Service-Policy and Practice. Midwifery 2001 vol 17 164-170 Mezey G Bacchus L Haworth A et al Midwives’ perceptions and experiences of routine enquiry for domestic violence. Br J Obstet Gynaecol2003 110: 744–52. Price S Routine questioning about domestic violence in maternity settings. Midwives 2004 vol 7, no 4 April   Price S and Baird K Domestic Violence: An audit of professional practice. Pract Midwife2003 vol 6 no 3 15–8 Salmon D Baird K Price S et al An impact evaluation of the Bristol Pregnancy and Domestic violence Programme to promote the introduction of routine antenatal enquiry for domestic violence at North Bristol NHS Trust 2004 www.northbristol.nhs.uk Scobie J McGuire M The silent enemy: domestic violence in pregnancy. British Journal of Midwifery1999 vol 7 no 4 557–62 Seymour J Pregnancy No Protection From UK Epidemic Of Domestic Violence. 1st November, 2001   Panos-UK/1 http://www.panos.org.uk/global/featuredetails.asp?featureid=1039ID=1005 Smith N Training is vital to domestic abuse screening. British Journal of Midwifery Nov 2005 vol 13, no 11 p676 Ward S and Spence A MIDIRS Midwifery Digest 12, 2002; Supplement 1, S15-S17. Papers Mirrlees-Black C Home Office, Domestic Violence: Findings from a New British Crime Survey Self-Completion Questionnaire, London, 1999. Royal College of Midwives (1999) Domestic abuse in pregnancy: Position Paper 19a (London: RCM) Reports CEMACH Why Mothers Die. Confidential enquiry into maternal deaths 2000-2002. RCOG press 2004. London   Department of Health (2000) Domestic violence: a resource manual for health professionals. 2000 London: Department of Health   Ã‚   Department of Health (2004) National Service Framework for Children, Young People and Maternity Services: Part 111 Maternity Standard (London: Gateway ref. 3779) Taket A Tackling Domestic Violence: the role of health professionals. 2004 Home office Development and Practice Report 32 The Government’s Proposals on Domestic Violence. Home Office Safety and Justice: June 2003 Home Office;http://www.domesticviolence.gov.uk Websiteswww.doh.org.ukwww.rcm.org.ukwww.rcog.org.uk

Sunday, January 19, 2020

Divorce: Ensuring the Wellbeing of a Child Essay -- relationships, psy

For my research, I have chosen to explore the discussions regarding the various ways in which children are affected by the divorce of their parents. Divorce is a hard time for all parties involved, but many people are unaware of the full extent of issues that it can cause for those that are not directly involved- the children. Also, many of the negative affects divorce presents can, in fact, persist and become long-term. Most parents realize that their separation takes a toll on their children, but typically, adults are unaware of the ways that their children can potentially be affected by it throughout the rest of their lives. After thorough research in the field, the topics I considered to be most informative and compelling include: how divorce can affect separate children in different ways, the dynamics that are responsible for causing variations in the effects upon children, and how adults who encountered divorce as children are affected in the long run. These subtopics within the field are important because of their specific focus and unique approaches. My intention is to build upon them by adding an extra element of primary prevention in hopes of ensuring the ideal wellbeing for the children involved. This topic and its research are very important because they are relevant to such a large scope of people. According to an online statistic source, in the United States alone, there is one divorce approximately every 36 seconds. That’s nearly 2,400 divorces per day, 16,800 divorces per week and 876,000 divorces a year (â€Å"Thirty-two Shocking Divorce Statistics† par. 4). With about two million marriages each year and nearly a million annual divorces, there is a considerable portion of our country that is affected by d... ...lpGuide, n.d. Web. 27 Apr. 2014. . McCabe, Kristen M. "Sex Differences in the Long Term Effects of Divorce on Children: Depression and Heterosexual Relationship Difficulties in the Young Adult Years." Journal of Divorce and Remarriage 27.1-2 (1997): 123-35. Print. Philpott, Shannon. "Four Things to Keep Stable with Children of Divorced Parents - Mom.me." Mom.me. N.p., n.d. Web. 27 Apr. 2014. . Zill, Nicholas, Donna Ruane Morrison, and Mary Jo Coiro. "Long-Term Effects of Parental Divorce on Parent-Child Relationships, Adjustment, and Achievement in Young Adulthood." Journal of Family Psychology 7.1 (1993): 91-103. Print. Zinsmeister, Karl. "Divorce's Toll on Children." American Enterprise 7.3 (1996): 39-44. Print.

Saturday, January 11, 2020

Analysis of ‘Teenage challenge’ article

Q.- Read the article ‘The Teenage Challenge' and comment on:- * The content of the article. (message) * The language features. * The design features. * Any other aspect you think is relevant. > Structure The article ‘The Teenage Challenge' was published in The Daily Mail, Friday, December 27, 2002. It is divided into two parts/sections, the first section written by Sarah Harris, Education correspondent; and the second by Edward Enfield (Father of Harry†¦). > The content of the article. The article ‘The Teenage Challenge' is divided into two sections and is written in response to Charles Clarke's (education secretary) ideas of introducing the 18 ‘Basic skills'. The first section by Sarah Harris projects both the positive and negative view points, supported by comments from various personalities. Edward Enfield, in the second section is deadly against the education secretary's views and is rather sarcastic in his comments but rarely supported by authoritative opinions. > The language features The title ‘The Teenage Challenge' consists of three words which perfectly suit the conventions about the title. The sub-heading of the first half seems like a continuation as it begins with ‘OR'. The subheading of the second half looks like a sentence rather than a title. The by-line is given in both the sections. In the case of the first section, the designation of the writer (Education Correspondent) Sarah Harris is given, while in the second the Edward Enfield is just identified as a father of Harry, who created Kevin the Teenager. The beginning of the first half is capitalized ‘ANYONE' which catches the reader's attention. This also provides a generalized viewpoint. Throughout the article; we can see many examples of alliteration as well as assonance. These serve to stress the ideas put forward by the writer, e.g.: ‘picking up piles', ‘from their bedroom floor', ‘top five task' and ‘this is his business', ‘traditional parental' are assonance. The alliteration and assonance used in ‘Parents' patience' in the sub-heading of the first half gives it more effect similarly, the alliteration and assonance in the sub-heading of the second half -‘The useful thing would be teaching them how to read'. The paragraphs are kept relatively short, that sometimes a single sentence takes us the whole paragraph, so we can say sentences used mainly are complex and in some cases compound. E.g.: ‘Yet, with the experience of two months as Education Secretary, Charles Clarke reckons parents should be requiring them to do a whole lot more' this is a complex sentence having one main clause ‘Charles Clarke†¦..more' and the subordinate clause ‘Yet with the experience†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.Secretary'. ‘Of course it maybe that teenagers of today are particularly stupid, but I think they are only stupid at intelligent things like reading books' is a compound sentence having two independent clauses joined together by the conjunction ‘but'. Most of the paragraphs seems like a continuation of the previous one, beginning with conjunctions, otherwise called paragraph connectives. E.g.: ‘Yet', ‘like', ‘And'. All throughout the article, there are words in a single speech marks/quotes. This gives a suggestion that somebody else's word not necessarily approved by the writer. E.g.: ‘life skills', ‘nanny state', ‘top five'. When the quotation continues to the next paragraph, the speech marks are not closed but are reopened. ‘As†¦..without help. ‘we†¦adult life. ‘I†¦.old'. To support her viewpoints, Sarah Harris has quoted from different sources. E.g.: ‘Rebecca O'Neil, a researcher', ‘Conservative Education spokesman oraham Brady', all their words adds more authority. Edward Enfield, on the other hand has only given his personal opinions, not at all imbibing other's ideas. The first half of the article henceforth looks more objective, while the second seems subjective. The scientific terminology as well as mathematical terms add weight to this article. E.g.: ‘botulism', ‘proteins', ‘imperials', ‘metric units'. The positive word used by the economist ‘boom' ends the article in an affirmative tone. The quotes are introduced by, e.g.: ‘Conservative education spokesman Graham Brady said' rather than followed by it as in the case of fiction. The use of statistical or numerical data shows how precise the authors are. E.g.: ‘All by the age of 16.', '18 basic activities', '15 other things'. The slang and colloquial language used in the article makes it an informal one and shows the friendly approach of the writers and their effectiveness. E.g. ‘any of this is his business.', ‘he was flipped'. The use of hyphen gives a pause to the reader, as well as to show the breakup of ideas. E.g.: ‘As any parent-or indeed any TV viewer familiar with my son's comic creation-can testify, teenagers are proud to be ‘Kevins'. There are many compound words used especially in the second half, e.g.: ‘not-too-difficult', ‘over-joyed', ‘rave-up'. The use of the rhetorical question ‘why on earth†¦such trivia?' is meant to give a stress on the basic idea it tries to convey. The 18 basic skills put forward by Charles Clarke is introduced by using -ing form of the word. E.g.: ‘cooking', ‘working', ‘cleaning'. The second half is dominated by the use of the negative words, e.g.: ‘shattered†¦.noise†¦.filthy'. the collective noun ‘horde' which normal refers to hooligans shows the uncivilized nature of the youngsters. > The design features: The entire article is enclosed in a rectangular frame. The title ‘The Teenage Challenge' is written in bold, big lettering and stands out from the rest of the copy. The sub-heading of the first half is larger than the text but not as striking as the title. It is also underlined. Whereas, the sub-heading of the second half is bolder but not as the title and is not underlined. The by-line in both the halves is written in bold and in the second section, a close-up photograph of the writer is also given. The picture of the clumsy slouching teenager taken from a close-up, eye-level shot is immediately striking to the reader's eyes. The teenager covers a rectangular frame which has the title ‘Preparing for life in the real world' written in white lettering on a black background. Within the rectangular frame, there are three photographs and a note pad. The photographs are given with a caption. The picture of Prince William, a royal example adds authority. The second picture uses the proverb ‘knowledge is power'. These photographs can be considered as a photo-montage taken from a high-level, close-up shot. The notepad is slightly titled and comes out from the frame which shows the power the youngsters will have once they acquire these 18 Basic Skills. These skills are mentioned in the notepad with numbering and on alternate dark and light backgrounds. > Any other aspect you think is relevant. This is an article written using the code of written language and still graphic images. This is meant for youngsters, their parents and adults who are mostly involved in teenager's education. The purpose of this article is to inform us about Charles Clarke's idea of 18 Basic Skills and persuade the readers to give their opinions and suggestions to it. The article was effective in conveying the idea of 18 Basic Skills. As a reader, I was able to grasp both the positive and negative viewpoints behind introducing these 18 Basic Skills in school curriculum. According to my opinion, the schools must concentrate more on academics rather than the practical skills. The basic skills can be learned at home but they shouldn't be made a criteria for judging the teenagers.

Friday, January 3, 2020

The United States And The Civil War - 851 Words

The word â€Å"freedom† has always been a cornerstone of the numerous transformations of the American society. It is the notion that is found in speeches of both Republican and Democrat politicians, the idea that connected the mind of an affluent Southern plantation owner and that of a radical abolitionist. Generally, the understanding of any period in the United States history as a whole relies heavily on acquiring the knowledge of the way of life, and the patterns of thought of the American public. The meaning of freedom provides a unique insight into social models, and can be considered a crucial factor when examining the impact of the key events in the history of the United States, namely the Civil War. The three speeches by the prominent American politicians and presidents from 1850’s throughout the Civil War era will be compared and analyzed with respect to their definition of freedom in order to demonstrate the different perceptions of this concept in the 19th ce ntury American society. As the Republican Party emerged to dominate the political scene of the 1950’s, a new vision of the American North and its values started to gain increasing influence amongst the members of the Party. William Henry Seward, a senator from New York, describes and summarizes these values in his speech â€Å"The Irrepressible Conflict† that was delivered at Rochester in 1858. The conflict that he refers to is the conflict between two different social and economic systems, between slave labor and freeShow MoreRelatedThe Civil War : The United States1622 Words   |  7 PagesThe Civil War divided the United States with its’ origin in the struggle to preserve the Union from the Confederacy’s succession. 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