Archive for the ‘Violence Against Women’ Category

Wife beating/Wife battering

January 5, 2012

Violence against women has been a long-standing problem and unfortunately been incorporated as an accepted practice in some cultures. The two terms are not interchangeable but are two separate concepts of unacceptable behavior ranging from physical, sexual and emotional abuse as well as emotional deprivation against a spouse or significant other. Wife beating, sometimes thought to be more frequent, is physical aggression that occurs in 85% of industrialized countries according to the text. On the other hand, wife battering is repeated assault with the intent of the abuser to maintain complete control of the female. This situation escalates in severity and frequency and could lead to homicide. Control issues or cultural beliefs may be some of the factors that lead to these situations. For example, the Hispanic culture has the very strong machismo trait of male domination and the Native Americans are also the domineering males although, interestingly, they are a matriarchal society in that the Clan Mothers have a voice in many important issues, at least in the Iroquois Nation here in New York State with whom I have many close friends. Both beating and battering cause physical and mental problems, and should raise a flag of suspicion for the forensic trained nurse. Both require assessment and intervention to prevent the female from becoming a statistic. According to the text Forensic Nursing by Lynch, 49 studies from 36 countries showed the highest prevalence (up to 52%) of wife beating/wife battering among the Arabs, Palestinians, in Nicaragua, Korea and New Zealand. “Other relatively high prevalence areas included Antigua, Barbados, Egypt, Ethiopia, Bangladesh, India, Kenya, Nigeria, Papua New Guinea, Uganda, Turkey and [surprisingly] the UK” Lynch and Duvall (p. 54, 2006). The US, Switzerland, Canada, Philippines and South Africa were much less at 20% to 30%. Norway, Paraguay, Puerto Rico, Cambodia, South Africa and Zimbabwe were only between 10 and 20%. Being a native Norwegian, I can speak to this, since Scandinavia is largely a matriarchal society, based on its Viking heritage. I suppose this stems from the days when the women were left on their own to raise their large families while the men went to sea and therefore had to become independent! References Lynch, Virginia A. and Duvall, Janet Barbara. (2006). Forensic Nursing. (p.56-58). Elsevier Mosby: St. Louis.

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Death and birth control

December 4, 2011

Forensic nurses are regularly involved with examining the dead and helping to determine the cause of death. It can be important in the case of a deceased female to have a record of contraceptive use and past abortions. These birth control measures can affect the body system by causing hypertension, thromboembolic disorders, glucose intolerance, or hormone changes. In abuse cases it is helpful to know if the woman was on her menstrual period to help identify bleeding as natural or a result of trauma.

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Women’s Health and Fertility Concerns

August 19, 2009

A few of these chapters brought back memories of my four-year experience with infertility some ten years ago. Keeping my follicular and luteal phase exactly on schedule before each of the seven inseminations, which were followed by four Invitro procedures, created a world-wind of anxiety and hope. With many fertility medications also taken over this timeframe, precautions, side-effects and possible future cancer diagnoses were discussed with my fertility doctor. According to Lehne, (2007), "Regardless of whether estrogens cause breast cancer, there is no question they promote the growth of certain cancers that have estrogen receptors" (Pg. 705). Other side effects that remain vivid in my mind included hot flashes, swollen and sometimes very painful ovaries resulting in ovarian hyperstimulation syndrome, mood swings and weight gain. According to Lehne (2007), "Mild to moderate ovarian enlargement is common, occurring in about 20% of patients. This condition is benign and resolves spontaneously after discontinuing drug use" (Pg. 740). Unfortunately, I was one of those patients experiencing ovarian hyperstimulation syndrome and it did resolve itself once the drugs were eliminated. Frequent sonograms were necessary to monitor my ovarian enlargement and egg stimulation. The drug mostly responsible for this significant discomfort is human chorionic gonadrotropin (hCG). During this drug induced time span, I was diagnosed with painful gallstones resulting in a cholecystectomy at the age of 32. Lehre (2007) noted, "The incidence of cholecystectomy among hormone therapy users was 48% higher than among nonusers" (Pg. 713). After reading this section with regard to hormone therapy for menopausal women, a prospect on which my fertility doctor did not comment, I concluded that the fertility estrogen-based drugs may have indeed contributed to the gallstone diagnosis. Lehne (2007) stated, "Birth control can be accomplished by interfering with the reproductive process at any step from gametogenesis to nidation (implantation of a fertilized ovum)" (Pg. 720). Using the pill for the regulation of my cycle was a mandatory part of the Invitro procedure, as well as drawing daily blood to monitor and evaluate levels to determine when I would be ready for retrieval of my harvested eggs. After finally becoming pregnant after the fourth Invitro, memories of not enduring these fertility drugs was such a relief. Fifteen months later, I became pregnant naturally with my second child without any medical intervention. When looking back on why and how hormone levels are effected, it seems clear that stress and how to manage it, can have a significant impact on our human body. Over a four-year infertility journey that created uncertainty as to exactly why I was not becoming pregnant, stress was mentioned as a possible factor. While a meditation course was also offered to all infertility patients prior to Invitro procedures, questions on marital relationship difficulties were never discussed. Though some patients are in desperate need of fertility drugs to become pregnant, how many of these women are counseled for stress that results from abusive relationships? It is my hope to clinically address the interrelationship between infertility and domestic violence issues, suggesting evaluation of spouse(s) personality type. This approach might help determine the real causes of infertile patients prior to their receiving a prescription for infertility drug treatment. References Lehne, R. A. (2007). Pharmacology for Nursing Care (Sixth Edition). Pgs. 70

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Forensic Nurses Helping Abused, comment

June 30, 2009

The SANE nurse, for me, was always a godsend. As a male working nights with only one other RN on duty, it was a relief for me to be able to call in reinforcements. Not that I couldn’t or wouldn’t care for these women. I have and will continue to do so without question. I have, however, noticed a trend in rape and abuse victims to have a "decreased" capacity for trust, even though I am a nurse. I always was non-judgemental, coming from abuse myself, and offered as much safety and trustworthyness as I was able. My major downfall; being male during a time when a female would, by her very presence, offer comfort and safety. Having a SANE allowed me to better care for a patient population that is difficult even for female RNs.

Original Post:
June 15, 2009
Title; Forensic Nurses Helping Abused
Who doesn’t know someone that keeps going back to an abusive relationship? They wear you down with their drama and pain, but keep going back. They want to believe that the person they need to leave will change. Repeated beatings, stealing, sleeping around with other people, using drugs and/or alcohol. And then abusing the children that are almost always another factor in the morass of their lives. And the abused woman lets them. This is where society blames the victim. Is it fair? No. Is it a normal response? Yes. Our capacity to absorb others pain is not limitless. And being the third party sets some distance for more objective thinking than the victim is capable of. Of course they eventually alienate all their friends and family. Then they are isolated as they abuser wants. Why are women so stupid? They expose their children to men they don’t know and leave them in their care. They go and move in with a man that has had multiple wives disappear or die with no explanation. They date and co-habitate with men that have got off on murder charges with technicalities…..why are women so stupid? Recognizing these women is not always easy. They are not always of the lower socio-economic status. They are not always uneducated. The one common denominator is low self esteem. No woman that valued herself as worthy would tolerate that kind of behavior. This is probably one of the most common cases that the forensic nurse deals with in the emergency room. How frustrating and heart wrenching to see someone that has allowed their self to be so mistreated. It would take a certain amount of distancing to deal with this on a regular basis. Could they render a real service and save lives? Of course. But what a challenge. The forensic nurse would also be the one to help organize the appropriate services around this patient. Legal for protection and restraint orders. Social to assist with placement (hiding at times) and a combination of social and psychiatric to deal with the remainder of this person’s ego, should any remain. Children involved? Then so CPS will be involved also. It remains that this could be a hugely rewarding, though challenging job.

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Forensic Nurses Helping Abused Women

June 15, 2009

Who doesn’t know someone that keeps going back to an abusive relationship? They wear you down with their drama and pain, but keep going back. They want to believe that the person they need to leave will change. Repeated beatings, stealing, sleeping around with other people, using drugs and/or alcohol. And then abusing the children that are almost always another factor in the morass of their lives. And the abused woman lets them. This is where society blames the victim. Is it fair? No. Is it a normal response? Yes. Our capacity to absorb others pain is not limitless. And being the third party sets some distance for more objective thinking than the victim is capable of. Of course they eventually alienate all their friends and family. Then they are isolated as they abuser wants. Why are women so stupid? They expose their children to men they don’t know and leave them in their care. They go and move in with a man that has had multiple wives disappear or die with no explanation. They date and co-habitate with men that have got off on murder charges with technicalities…..why are women so stupid? Recognizing these women is not always easy. They are not always of the lower socio-economic status. They are not always uneducated. The one common denominator is low self esteem. No woman that valued herself as worthy would tolerate that kind of behavior. This is probably one of the most common cases that the forensic nurse deals with in the emergency room. How frustrating and heart wrenching to see someone that has allowed their self to be so mistreated. It would take a certain amount of distancing to deal with this on a regular basis. Could they render a real service and save lives? Of course. But what a challenge. The forensic nurse would also be the one to help organize the appropriate services around this patient. Legal for protection and restraint orders. Social to assist with placement (hiding at times) and a combination of social and psychiatric to deal with the remainder of this person’s ego, should any remain. Children involved? Then so CPS will be involved also. It remains that this could be a hugely rewarding, though challenging job.

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Pain and Violence

June 1, 2009

When I first started nursing in the 80’s you really didn’t hear too much about pain assessment and management. It wasn’t until 2000 when Joint Commission on Accreditation of Health care Organizations issued pain standards as criteria for accreditation of hospitals. In 2001 JCAHO began scoring this standard as part of its survey. Nurses and Healthcare professionals were then all being educated on the importance of pain management.
There are not always clear distinctions among the different types of pain. Even though there is several ways to categorize pain. Acute pain has a recent onset. It is usually self limiting. Chronic Pain may be intermittent or continuous. The pain lasts more than six months. Referred pain is described as pain felt in another site other than the site of the injury. Then there is phantom pain. This is pain that a patient thinks he/she feels in an extremity that has been amputated.
When dealing with a patient who could be a victim of violence. You need to keep an open mind and observe the patient and listen. For a patient may have chronic pain due to the violence that was inflected on them, but they may not want to tell you. The patient may present as depressed, withdrawn with low self esteem.
This is where not only education regarding pain comes into play but also education regarding women who may have been a victim of violence. Violence, torture, different cultures, their beliefs and rituals these are topics I feel have grown in recognition as pain management has. Though we need to realize how these are all integrated and could affect our patients. Education due to our changing society is so important to our Healthcare and law enforcement professionals. Even thought I feel we have come a long way regarding the education of pain management we have a long way to go regarding education of violence.

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Violence against women

May 26, 2009

Any act of gender based violence that results in or is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life. This is the United Nations definition of violence against women. There are many forms of violence, including sexual, physical, or emotional abuse by an intimate partner; physical or sexual abuse by family members or others; sexual harassment and abuse by authority figures; trafficking for forced labor or sex; and such traditional practices as forced or child marriages. Systematic sexual abuse in conflict situations is a form of abuse against women. The scope of the problem is a lot bigger than we think. Especially in foreign countries such as Africa nd India. About 5,000 women are murdered by family members in the name of honor each year worldwide. Trafficking of women and girls for forced labor and sex is widespread. Worldwide, up to one in five women and one in ten men report experiencing sexual abuse as children. Children who experiences sexual abuse are much more likely to encounter other forms of abuse. This also leads to risky behaviors such as first sex at an early age, multiple partners and unprotected sex. Each risk increases the rick of health problems. Interventions need to be made. We need to increase education and opportunities for women and girls, improving their self esteem and negotiating skills, and reducing gender inequities in communities. Advocacy for victims, better awareness of violence and its consequences among health workers and wider knowledge of available resources form abused women (including legal assistance, housing and child care), this can lessen the consequences of violence.

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