'Don't judge me': narratives of living with FGM

Purpose: To facilitate a participant led arts based workshop survivors of FGM in order to explore their experiences and impact of FGM on health and wellbeing. To use the artefacts to inform development of an e-learning resource. Design/methodology/approach: The study utilised a creative narrative approach which included the sharing of personal stories, the creation of pottery models and the sharing of artefacts. A narrative approach was chosen as the methodology for the study as narratives are now well established within qualitative research as a meaningful way in which the voices of participants take precedence over those of the researcher. Six women who are living with FGM agreed to take part. Findings: The composition of the workshop essentially encompassed two main strands i) the creation of a persona and ii) sharing artefacts. These are described in detail with supplementary images included as appropriate. We have not attempted to present the findings of the workshop from the perspective of the researcher but have rather enabled the findings to speak for themselves. Research limitations/implications: There is a paucity of studies which have explored women experiences of living with FGM and the impact on health and wellbeing. The findings suggest that there is further scope for research and practice development which examines the impact of education on professional’s approaches to FGM. Practical implications: Social implications: Originality/value: This study and the wider focus towards the impact of FGM beyond the physical or procedural aspects of FGM offer a contribution to the evolving evidence base in this field

An exploration of the perceptions of emergency department nursing staff towards the role of a domestic abuse nurse specialist: a qualitative study

There is a clear body of evidence which indicates that a substantial number of people who have experienced domestic violence and abuse attend the emergency department (ED). However, many individuals do not receive effective identification or support. The present study sought to explore the perceptions of ED staff about the perceived value and utilisation of a new domestic abuse nurse specialist role that has been created in one ED in the UK. A qualitative design was used and involved sixteen in-depth interviews with a range of practitioners. The findings highlight that staff highly valued the role of the nurse specialist as one which offered support both professionally and personally. However, the study has also drawn attention to the conundrum that surrounds identification and management of abuse and of enquiry more generally. The ED is ideally suited to identify at risk individuals but is not institutionally organised in a way that prioritises the social concerns of their patients and this nursing role is one way that this issue can be addressed. In light of recent UK and global policy directives further research is needed to explore the development and implementation of identification, management and support in the future

From Silence to Voice: A collaborative international partnership to develop a digital resource for use in clinical and education settings about sexual violence from perspectives of students, educators and survivors.

Gender based violence (GBV) – which includes sexual violence - is a significant global public health and societal problem, recognised as a global human rights issue by the World Health Organisation (WHO, 2017). Global estimates indicate that 1 in 3 women experience physical/sexual violence in their lifetime (WHO, 2017). GBV/SV exerts a detrimental impact not only on the lives and health of women, but also those who witness abuse and has been identified as a large scale problem in South Africa with recorded estimates that a woman is raped every seventeen seconds. The impact of GBV/SV on the physical and psychological wellbeing of those who experience abuse is wide ranging. It includes the immediate physical effects for example, physical injury as well as longer term chronic ill health as a result, acute and enduring psychological trauma, mental ill-health, alongside secondary physiological health issues such as gynaecological and sexual health (Feder et al. 2011). It is well evidenced however that healthcare professionals across the spectrum do not respond effectively often due to a lack of knowledge or professional confidence and their own values and assumptions surrounding GBV/SV (McGarry et al. 2015). Education is pivotal, and a proven means to tackle a growing global problem. This includes pre-qualifying healthcare students who are often not exposed to education about GBV/SV within their current curricula. Working with our project partners and key stakeholders in South Africa during 2019, including women who have experienced GBV/SV, the aim of this research was to engage stakeholders in the co-production of a digital e-learning resource to use across multiple healthcare disciplines on GBV/SV. Our aim is to describe the process of an international collaboration, provide the context using survey data and present the digital resource and the evaluations conducted on the application and use within education and clinical settings. References: Feder G, Davies R, Baird K, Dunne D, Eldridge S, Griffiths C, Gregory A, Howell A, Johnson, M., Ramsay J, Garcia-Moreno, C., Armin, A. (2016) The sustainable development goals, violence and women’s and children’s health (WHO) http://www.who.int/bulletin/volumes/94/5/16-172205/en/ (accessed 7.7.18) McGarry J., Baker C., Wilson C., Felton A., Banerjee A, (2015). Preparation for safeguarding in UK pre-registration graduate nurse education. Journal of Adult Protection. 17(6), 371-379 World Health Organisation (2017) Violence against women http://www.who.int/news-room/fact-sheets/detail/violence-against-women (accessed 7.7.18

Domestic violence and abuse: an exploration and evaluation of a domestic abuse nurse specialist role in acute health care services

Aims and objectives: The aim of the present study was to explore the experiences of clinical staff in responding to disclosure of domestic violence and abuse (DVA) and to evaluate the effectiveness of training and support provided by a dedicated Domestic Abuse Nurse Specialist across one acute National Health Service (NHS) Trust in the UK.Background: The impact of DVA is well documented and is far reaching. Health care professionals have a key role to play in the effective identification and management of abuse across a range of settings. However there is a paucity of evidence regarding the constituents of effective support for practitioners within wider non-emergency hospital based services.Design: A qualitative approach semi-structured interviews (n=11) with clinical staff based in one acute care Trust in the UK. Interviews were informed by an interview guide and analysed using the Framework approach.Findings: The organisation of the NS role facilitated a more cohesive approach to management at an organisational level with training and ongoing support identified as key facets of the role by practitioners. Time constraints were apparent in terms of staff training and this raises questions with regard to the status continuing professional development around DVA. Conclusions: DVA continues to exert a significant and detrimental impact on the lives and health of those who encounter abuse. Health care services in the UK and globally are increasingly on the frontline in terms of identification and management of DVA. This is coupled with the growing recognition of the need for adequate support structures to be in place to facilitate practitioners in providing effective care for survivors of DVA.Relevance to clinical practice: This study provides an approach to the expansion of existing models and one which has the potential for further exploration and application in similar settings

Unlocking stories: older women’s experiences of intimate partner violence told through creative expression

INTRODUCTION Intimate partner violence (IPV) exerts a detrimental impact on the lives and health of all who experience abuse. This includes both physical and mental health and wellbeing. The experiences of older women however may be different and these differences may not be recognised or accounted for within existing care provision.AIM To explore the impact of IPV on the lives and health of older women told from the particular perspective of older women themselves as these accounts are largely absence from existing IPV discourse. METHOD An arts based research approach with five older women survivors of IPV through the co-development and organisation of an arts based workshop. The workshop essentially encompassed four main arts strands and included the creation of clay models and poetry. FINDINGS The findings of the study highlight the significant impact of IPV on the lives, mental health and wellbeing of older women. This included feelings of social isolation, inability to trust others and a loss of self-identity

Researching domestic violence and abuse in healthcare settings: challenges and issues

Domestic violence and abuse (DVA) is now recognised as a significant global health and societal issue. Conducting DVA research in healthcare contexts requires the consideration and understanding of a number of practical, methodological and ethical issues. Based on their experiences of working as clinicians and researchers, the authors aim to explore some of the pertinent issues and challenges associated with DVA research conducted in healthcare settings involving patients and/or healthcare professionals or both. A number of ethical, methodological and practical challenges, particularly those associated with research design and data collection, and ethical challenges related to participants and researchers, are explored

Older women, intimate partner violence and mental health: a consideration of the particular issues for health and health care practice

Aims and objectives: The purpose of this meta-synthesis was to explore qualitative evidence in older women with a history of Intimate partner violence (IPV) and their accounts and experiences of mental health. Background Intimate partner violence significantly impacts the health and wellbeing of women who experience it. However, women who experience intimate partner violence do not form a homogenous group and the effect on older women has not been adequately distinguished. While there is a growing body of evidence to address this deficit, studies to date have tended to concentrate on older women’s experiences of intimate partner violence in totality and as such mental health issues have been subsumed as a part of the whole. Design: Meta ethnographic synthesis of qualitative evidence. Methods: A systematic search of PUBMED, Cumulative Index to Nursing and Allied Health Literature (CINAHL), COCHRANE , Medline and PsycInfo, Sci was completed. The search included articles published up until the end of December 2015. Results: The review identified that intimate partner violence exerts a significant impact on the mental health of older women. Iintimate partner violence for women in later life is inherently complex, especially where the boundaries of violence and vulnerability have been blurred historically both within the intimate partner violence discourse and through provision and practice. Conclusions: This paper adds to the developing knowledge and understanding of intimate partner violence for older women as a part of the growing body of evidence of the impact of IPV on the health and wellbeing of those who experience abuse more generally. When age and gender intersect with IPV, there are specific implications and health professionals and service providers need to be aware of these. Relevance to Clinical Practice: Nurses and health care professionals are professionally accountable for the effective management and support of women who have experienced abuse. It is therefore crucial that they are able to understand and identify the possible complexity of presentations of abuse and this includes older women

What are the experiences of seeking, receiving and providing FGM-related healthcare?: perspectives of health professionals and women/girls who have undergone FGM: protocol for a systematic review of qualitative evidence

Introduction: Female Genital Mutilation (FGM) is an issue of global concern. High levels of migration mean that healthcare systems in higher-income western countries are increasingly being challenged to respond to the care needs of affected communities. Research has identified significant challenges in the provision of, and access to, FGM-related healthcare. There is a lack of confidence and competence among health professionals in providing appropriate care, suggesting an urgent need for evidence-based service development in this area. This study will involve two systematic reviews of qualitative evidence to explore the experiences, needs, barriers and facilitators to seeking and providing FGM-related healthcare in high income (OECD) countries, from the perspectives of: (1) women and girls who have undergone FGM and (2) health professionals. Review methods: Twelve databases including MEDLINE, EMBASE, PsycINFO, ASSIA, Web of Science, ERIC, CINAHL, and POPLINE will be searched with no limits on publication year. Relevant grey literature will be identified from digital sources and professional networks. Two reviewers will independently screen, select and critically appraise the studies. Study quality will be assessed using the JBI-QARI appraisal tool. Findings will be extracted into NVivo software. Synthesis will involve inductive thematic analysis, including in-depth reading, line by line coding of the findings, development of descriptive themes and re-coding to higher level analytical themes. Confidence in the review findings will be assessed using the GRADE-CERQual approach. Findings will be integrated into a comprehensive set of recommendations for research, policy and practice. Dissemination: The syntheses will be reported as per the ENTREQ statement. Two reviews will be published in peer-reviewed journals and an integrated report disseminated at stakeholder engagement events

Collaborative action research: Making it happen

Session - Head and Neck CancerBackground: Treatment of NPC is mainly guided by TNM stage. This study aims to evaluate if the active tumor volume delineated as BTV on PET scan is a predictor of local disease control. Methods: This is a retrospective review of all patients who had baseline PET scan performed before treatment in our center from Aug., 2010 to Mar., 2013. Patients with distant metastases at diagnosis were excluded. Total 77 patients were included. The BTV were automatically delineated by a signal to background ratio method we reported before. All patients completed radiotherapy (RT) with intensity modulated radiotherapy to at least 70Gy to primary tumor. 7 patients had RT alone and 70 patients had chemotherapy (cisplatin or carboplatin) concurrent with RT with either additional induction or adjuvant chemotherapy. Local control was assessed by endoscopy and biopsy at 10 weeks after completion of RT. Local failure include patients with persistent disease in NP after RT and those who had local relapse after initial disease remission. Results: T stage distributions of the group were 20 T1, 7 T2, 35 T3 and 15 T4. The BTV ranged from 2.68 to 147.5cc with a median of 14.4cc. BTV in general increase with T stage with mean BTV of 12.9, 13.6, 26.3 and 40.7cc respectively for T1, 2, 3 and 4 respectively. Median follow up of the group were 32.8 months. There were 2 patients with persistent loco-regional disease after RT and another 2 patients with NP relapse. Mean BTV for patients with local control were 22.4cc compared with 61.5cc among patients with local failure (t-test, p: 0.002). 4 years local control rates (LCR) according to T stage were 100% for T1 and T2, 91.3% for T3 and 50% for T4. Patients with BTV 15cc are at risk of local failure and should be considered for radiation dose escalation