Wednesday, 29 April 2015

Are we failing to prepare nursing and midwifery students to deal with domestic abuse? Findings from a qualitative study

Caroline Bradbury-Jones


Domestic abuse is a serious global problem and has greater, negative effects on long-term health than more obvious diseases, such as diabetes. Nurses and midwives are well-placed to recognise and respond to domestic abuse but many lack confidence in this area. There is firm evidence that training can increase the confidence of registered nurses and midwives in responding to domestic abuse. But the issue of undergraduate preparation is significantly under-investigated. We undertook a qualitative study in the UK to investigate student nurses’ and midwives’ knowledge, confidence and educational needs regarding recognition and responses to domestic abuse. We ran eight focus groups with a total of 55 students.

Students in the study viewed the issue of domestic abuse as important and they possessed sound theoretical knowledge of its nature and consequences. However, they lacked confidence in recognising and responding to abuse and they perceived this as a cyclical state of disempowerment that would impact negatively on their practice and on their own ability to support nursing and midwifery students of the future. Two students told us:

I think it perpetuates itself because if we leave not being prepared, then we're going to feel embarrassed or not sure how to talk to our students about it. And then that's probably why they don't want to talk about it, because they [Registered Nurses] feel that ‘oh it's this thing that I should know stuff about - but I don't’.

We've got to the end nearly [of our programme] and like my biggest concerns are how my training has prepared me - or hasn't prepared me – and the feelings of anxiety that I've got. And so it was productive use of my time to come to something like this [focus group], than to just complain and moan and internalise worries that I might have had about the three years that have gone already.

Interactive learning opportunities that engaged with service-users and involved experts from practice were viewed as important educational requirements. Since undertaking the study we have begun to integrate coverage of domestic abuse into the nursing curriculum locally. This is a small step in the right direction, but it needs to be more widespread if we are to avoid the culpability of producing future generations of graduates who are ill-prepared to deal with such an important area of nursing practice.


Caroline Bradbury-Jones, RN, RM, PhD
University of Birmingham, School of Health and Populations Sciences


Reference

Bradbury-Jones, C & Broadhurst, K. (2015) Are we failing to prepare nursing and midwifery students to deal with domestic abuse? Findings from a qualitative study. Journal of Advanced Nursing, DOI: 10.1111/jan.12666












Thursday, 23 April 2015

Young women with a disorder of sex development: Learning to share information with health professionals, friends and intimate partners about bodily differences and infertility

Caroline Sanders

Differences of sex development (DSD) can result in young women’s bodies looking and functioning differently to what is expected within generalised society. Learning to talk about yourself and your body to others can be difficult for all adolescents and it is a normal aspect of psychosocial development. For those young women with DSD understanding their difference can be difficult as their knowledge is often gathered from parents who may not recall or be able to share information.

Our paper describes how a group of these young women started to think about self and others, as important aspects of attachment. There is a need for these young women to master complex medical information that can inform how they understand their bodies at the same time as explore their physical and emotional comfort in sharing information. Nurses and other professionals, within multi-disciplinary DSD teams, have the opportunity to support these young women to move from the theory behind understanding their condition to having the courage and confidence to share aspects of their difference in ways that meet these young women’s needs.


Dr Caroline Sanders, PhD, MBE, PGD, PGC, RN
Alder Hey Children’s Hospital and University of Central Lancashire



Reference

Sanders C, Carter B, Lwin R (2015) Young women with a disorder of sex development: learning to share information with health professionals, friends and intimate partners about bodily differences and infertility Journal of Advanced Nursing doi: 10.1111/jan.1266


Tuesday, 21 April 2015

Disorders of sex development in young women

Roger Watson, Editor-in-Chief

Talking about sex is never easy but if that is in the context of a disorder of sex development, it must be even more difficult. Research reported in an article by Sanders et al. (2015) titled: 'Young women with a disorder of sex development: learning to share information with health professionals, friends and intimate partners about bodily differences and infertility' and published in JAN set out, as the authors explain: 'To understand the experiences of young women with a disorder of sex development when sharing information about their body with healthcare professionals, friends and intimate partners.'

Thirteen women in the UK with a disorder of sex development aged between 14-19 years were interviewed and completed diaries over 6 months.  Sex development disorders included chromosomal disorders, vaginal atresia, where the vagina is either absent or closed, cloacal anomalies, where only one opening is present for gastrointestinal, urinary and reproductive systems, and congenital adrenal hyperplasia, which leads to unusual genitalia in women.

It is especially difficult for young girls to find out about their conditions; most obtained information from their parents.  They also found it difficult to tell friends too much for fear of the details being shared with others.  For some women, normal penetrative sexual intercourse was never going to be possible leading to fears about intimacy and sexual partnership.  Some women would never have children and some of those who could did not want to for fear of passing on their condition.

Concluding the article, in their own words, the authors say: 'Health professionals need to consider taken-for-granted assumptions, such as those relating to sexual intimacy; some of the young women felt that health professionals assumed they would be in heterosexual relationships while some were in same sex relationships. The development of attachment, intimacy and identity are inextricably linked. Health professionals should acknowledge the impact that bodily difference has on young women’s ability to build a secure identity and adjust to the meaning bodily differences have to them and the impact of their infertility.'

You can listen to this as a podcast.


Reference

Sanders C, Carter B, Lwin R (2015) Young women with a disorder of sex development: learning to share information with health professionals, friends and intimate partners about bodily differences and infertility Journal of Advanced Nursing doi: 10.1111/jan.1266


Wednesday, 15 April 2015

What do nurses actually do?

Roger Watson, Editor-in-Chief

We all think we know what a nurse is and most think they know what a nurse does.  But is this the same globally?  Even in one country, the range of what any group of nurses does is wide, ranging from 'basic' care to minor procedures and prescribing. In the UK, for instance, what a nurse does in one hospital may be specific to that hospital and may not apply in another.  This phenomenon is referred to as the 'scope of practice'.  Therefore, it is logical and essential that we study this and, as the authors of this study, Kennedy et al. (2015), say: 'regulatory authorities and nurses should recognize that scope of practice and the associated responsibility for decision-making provides a very public statement about the status of nursing in a given jurisdiction'.  The study to which I refer is titled: 'Comparative analysis of nursing and midwifery regulatory and professional bodies’ scope of practice and associated decision-making frameworks: a discussion paper'; it was carried out by a team in Ireland and is published in JAN.

Twelve international regulatory frameworks were reviewed in detail following a systematic process of retrieval and the sources are summarised in an extensive table.  The study found that the approaches to developing scopes of practice did not emphasise patient choice and focused on the technical rather than the aesthetic aspects of nursing.  The authors conclude: 'Such frameworks are predicated on the practitioner being familiar with legislation and guidelines that regulate and control practice and that may enable or prohibit role expansion. They are also predicated on individuals having sophisticated skills in reflection and self-judgement in relation to their competence, knowledge and skills.'

Listen to this as a podcast.


Reference

Kennedy C, O’Reilly P, Fealy G,  Casey M, Brady A-M, McNamara M, Prizeman G, Rohde D, Hegarty J (2015) Comparative analysis of nursing and midwifery regulatory and professional bodies’ scope of practice and associated decision-making frameworks: a discussion paper Journal of Advanced Nursing doi: 10.1111/jan.12660