Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning

INTRODUCTION

Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes.

MATERIALS AND METHODS

A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge.

RESULTS

Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women.

CONCLUSION

Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Parental Worries, Child Maltreatment Risk and Empowerment: How Are They Noticed in Child and Family Services?

Parental empowerment has been related to their well-being and self-efficacy. Learning more about the signs describing child maltreatment risk are crucial for the welfare of children and families. The aim of this study was to assess the risk of child maltreatment (CM) and related worrying factors of parents and associations between the CM risk, worries and parental empowerment. The study is based on self-report surveys administered to parents in primary health care and hospital settings. The risk of CM and related worrying factors were measured by the Brief Child Abuse Potential Inventory (BCAP) from 453 parents. Family empowerment was measured by The Generic Family Empowerment Scale (G-FES). Parents expressed worries such as loneliness and distress (20%), feelings of persecution (9%), family conflict (17%), rigidity (21%) and financial insecurity (4%). The BCAP found 27 parents with increased risk. Parents with CM risk expressed more empowerment in connection to services for their child and family. It is crucial to discuss worries in child and family services before they raise the risk level. Tools such as the BCAP are useful in systematically identifying the child maltreatment risk and parental worries under discussion, offering possibilities for preventing child maltreatment and increasing well-being of children.

Feasibility and implementation of Safer Kids - A parenting program to reduce child abuse

BACKGROUND

Child abuse is a world-wide problem causing long-term suffering for children and large costs to society. Parent-training programs have been shown to reduce harsh parenting but more research on parenting programs specifically addressing child abuse is needed.

OBJECTIVE

This study aimed at assessing the feasibility, implementation, and preliminary effectiveness of Safer Kids (SK); a structured parent-training program delivered immediately after parents are reported for child abuse.

PARTICIPANTS AND SETTING

Caregivers were eligible if they had been reported for child abuse to the Swedish social services and their child was 3-12 years old.

METHODS

Families were allocated to SK or intervention as usual (IAU) through a quasi-experimental design. Multilevel analyses and a Cox Proportional Hazard Model were used to assess between-group differences in risk factors for abuse and further child welfare reports.

RESULTS

In total, 67 families participated. SK was successfully implemented as an early-start intervention and most families completed the intervention. All agencies continued working with SK two years after the study, indicating sustainability of implementation. SK was more effective than IAU in reducing further child welfare reports up to 18 months from baseline. However, analyses of parent and child rated risk factors of re-abuse (abuse potential, wellbeing, and parent-child relationships) indicate none to small differences between conditions.

CONCLUSIONS

SK can be successfully implemented within the social services and may be effective in reducing occurrence of further child welfare reports. The effects of SK need to be further evaluated in a randomized controlled trial.

Identification of Child and Youth Maltreatment as Experienced by Prehospital Emergency Care Providers

This mixed method study explores 200 prehospital emergency care providers' experiences of identifying child and youth maltreatment. The data were collected in Finland in 2019-2020 using an online survey tool and analysed using SPSS statistics and inductive content analysis. Respondents had encountered signs of physical and psychosocial maltreatment, and family challenges, contexts, and economic and social problems indicative of maltreatment. It is important for the early intervention and prevention of long-term mental health problems that prehospital emergency care providers receive continuing education on the identification of child maltreatment.

Decolonising violence against women research: a study design for co-developing violence prevention interventions with communities in low and middle income countries (LMICs)

BACKGROUND

There has been substantial progress in research on preventing violence against women and girls (VAWG) in the last 20 years. While the evidence suggests the potential of well-designed curriculum-based interventions that target known risk factors of violence at the community level, this has certain limitations for working in partnership with communities in low- and middle-income (LMIC) countries, particularly when it comes to addressing the power dynamics embedded within north-south research relationships.

METHODS

As an alternative approach, we outline the study design for the EVE Project: a formative research project implemented in partnership with community-based researchers in Samoa and Amantaní (Peru) using a participatory co-design approach to VAWG prevention research. We detail the methods we will use to overcome the power dynamics that have been historically embedded in Western research practices, including: collaboratively defining and agreeing research guidelines before the start of the project, co-creating theories of change with community stakeholders, identifying local understandings of violence to inform the selection and measurement of potential outcomes, and co-designing VAWG prevention interventions with communities.

DISCUSSION

Indigenous knowledge and ways of thinking have often been undermined historically by Western research practices, contributing to repeated calls for better recognition of Southern epistemologies. The EVE Project design outlines our collective thinking on how to address this gap and to further VAWG prevention through the meaningful participation of communities affected by violence in the research and design of their own interventions. We also discuss the significant impact of the COVID-19 pandemic on the project in ways that have both disrupted and expanded the potential for a better transfer of power to the communities involved. This article offers specific strategies for integrating Southern epistemologies into VAWG research practices in four domains: ethics, theories of change, measurement, and intervention design. Our aim is to create new spaces for engagement between indigenous ways of thinking and the evidence that has been established from the past two decades of VAWG prevention research and practice.

Perspectives of Victims of Gender Violence

The purpose of the current study was to explore the experiences of women who have been affected by violence and received mental health care. A qualitative phenomenological design was used with in-depth interviews and personal letters in a sample of 29 women from a public mental health center of Madrid, Spain, who were affected by physical, mental, and/or sexual abuse. The analysis revealed three themes: (1) Living With Fear; (2) Feeling Guilty; and (3) Experiencing the Imposition of So-Called "Womanly Duties" (i.e., being a maid, babysitter, and/or sexual slave). The current study highlights the importance of developing educational programs for the prevention of abuse. [Journal of Psychosocial Nursing and Mental Health Services, 58(6), 30-39.].

Experiences of Family Violence Committed by Relatives With Severe Mental Illness: A Grounded Theory

In forensic psychiatry, family violence perpetrated by a loved one suffering from severe mental illness is a significant problem thought to affect nearly half of families. To examine this poorly documented issue, a qualitative study using a grounded theory research strategy was conducted with family members who have experienced violence committed by a relative with severe mental illness. Semistructured interviews were conducted with 14 participants who had experienced this type of violence. The works of poststructuralist thinkers Jacques Donzelot and Michel Foucault inform the theoretical framework. Qualitative analysis of the data led to the emergence of five major themes: medicolegal apparatus, experience of violence, family's responsibility toward the violent relative, exclusion and stigmatization, and suffering and resilience. The main results of this qualitative study indicate that families are governed through specific mechanisms, including instrumentalization of the family's role and transfer of the violent person's care to the family. Obstacles preventing families from being included in their relative's care were also raised. This research contributes to nursing by shedding light on clinical interventions and health policy in family care. It also offers insight into the provision of appropriate quality care in particularly complicated family situations.

Qualitative Research on Interpersonal Violence: Guidance for Early Career Scholars

The purpose of this article is to offer early career violence scholars guidance on critical aspects of qualitative research, including methodological integrity and research procedures. Throughout this article, we center our discussion on issues of methodological fit, flexibility, safety, and ethics. We overview paradigmatic frameworks that guide methodological decisions and discuss reasons why researchers might choose to use qualitative methods. We then address decisions around recruitment, sampling, and saturation as well as predata collection preparations for conducting interview-based studies. Participant and research team safety and ethics are emphasized, as these issues should be at the core of all decisions in interpersonal violence research. Along with examples from the field of interpersonal violence, we provide references to relevant resources on paradigmatic frameworks, specific qualitative research approaches, and safety and ethics. Throughout, we draw from our lessons learned as qualitative researchers, teachers, and mentors who study intimate partner violence and young adult children exposed to marital violence.

Continuation of domestic violence and changes in the assessment of family functioning, health, and social support in Finland

Our aim in this comparison study was to describe the continuation of domestic violence and to assess changes in the association among family functioning, health, and social support for participants who have or have not experienced violence for the years 2012 and 2015. We collected the data using a family functioning, health, and social support (FAFHES) questionnaire. We collected the baseline questionnaires (N = 188) from patients who visited a Finnish central hospital and mailed the follow-up survey (N = 71). The prevalence of violence remained constant. However, the violence varied and changed. Our findings should encourage health care professionals to better identify and intervene in violence.

Childhood experiences of female family-violence perpetrators

PURPOSE

To explore the childhood experiences of women who have perpetrated family-violence and voluntarily sought help.

DESIGN AND METHODS

The qualitative design includes in-depth, unstructured individual interviews with 19 women who have perpetrated family-violence.

FINDINGS

The categories of maltreatment exposure, parental capability, and a role of the sensitive, good girl are identified and described in this article.

PRACTICE IMPLICATIONS

The findings provide guidance for nurses who encounter families at risk of female family-violence perpetration and for those developing preventive interventions for female family-violence perpetrators whose family-of-origin issues are essential in processing issues of self.

The ethics of researching intimate partner violence in global health: A case study from global health research

There has been an increase in attention to intimate partner violence (IPV) as a health issue that contributes to the spread of HIV, physical and emotional stress, depression, substance use, serious injuries, and higher rates of mortality in low-income settings. This paper explores the ethical implications raised by research on IPV by global health scholars. Drawing on Hedgecoe's work on critical bioethics to analyse a qualitative study of IPV in Rwanda, this paper discusses the risks and benefits of conducting research on IPV as part of the global health agenda. We discuss ethical issues that have become evident through our work in this area, including: raising IPV as an issue of concern in women's lives in settings where economic support for women experiencing IPV may not exist; recording interviews and focus group discussions in contexts with significant government surveillance; ethical tensions in appropriating local voices in ways that position women as 'victims' of violence; and the risks associated with framing IPV as a global health issue separate from feminist advocacy. We recommend more tailored approaches to ethics in IPV research, which considers the specificity of the social, cultural and economic context.

The family health, functioning, social support and child maltreatment risk of families expecting a baby

AIMS AND OBJECTIVES

To describe the family health, functioning, social support and child maltreatment risk and associations between them in families expecting a baby.

BACKGROUND

Finland was one of the first countries in banning corporal punishment against children over 30 years ago. Despite of this, studies have shown that parents physically abuse their children. In addition, professionals struggle in intervention of this phenomenon. Abusive parents should be recognised and helped before actual violent behaviour.

DESIGN

A follow-up case-control study, with a supportive intervention in the case group (families with a heightened risk) in maternity and child welfare clinics. The baseline results of families are described here.

METHODS

Child maltreatment risk in families expecting a baby was measured by Child Abuse Potential Inventory. The health and functioning was measured by Family Health, Functioning and Social Support Scale. Data included 380 families.

RESULTS

A total of 78 families had increased risk for child maltreatment. Heightened risk was associated with partners' age, mothers' education, partners' father's mental health problems, mothers' worry about partners' drinking and mothers' difficulties in talking about the family's problems. Risk was associated with family functioning and health. Families with risk received a less support from maternity clinics. Families with child maltreatment risk and related factors were found.

CONCLUSIONS

This knowledge can be applied for supporting families both during pregnancy and after the baby is born. Professionals working with families in maternity clinics need tools to recognise families with risk and aid a discussion with them about the family life situation. The Child Abuse Potential, as a part of evaluating the family life situation, seems to prove a useful tool in identifying families at risk.

RELEVANCE TO CLINICAL PRACTICE

The results offer a valid and useful tool for recognising families with risk and provide knowledge about high-risk family situations.

Women’s experiences of perpetrating family violence: a qualitative study

Female-perpetrated family violence is a difficult phenomenon to understand, as it does not easily conform to normative, gendered expectations of women. However, women can sometimes perpetrate family violence against their children and spouses. The aim of this study is to describe and make visible women’s experiences of perpetrating family violence. Nineteen women were interviewed about their experiences of perpetrating family violence. The data were analysed with an inductive content analysis and three categories emerged: the threat of losing the sense of self, acknowledging harming behaviour and challenges in obtaining help. These categories describe women’s conception of self, of their feminine identity and of gender role expectations in a family violence perpetrator context. If female-perpetrated family violence were acknowledged as a part of women’s behaviour this would reflect a shift in society’s notions of gender roles. Results of the study may be used by nurses when encountering women who have perpetrated family violence or in the development of nursing policies aimed at enhancing the wellbeing of the family.

How public health nurses identify and intervene in child maltreatment based on the national clinical guideline

Objectives. To describe how Finnish public health nurses identify and intervene in child maltreatment and how they implement the National Clinical Guideline in their work. Design and Sample. Cross-sectional survey of 367 public health nurses in Finland. Measures. A web-based questionnaire developed based on the content areas of the guideline: identifying, intervening, and implementing. Results. The respondents reported they identify child maltreatment moderately (mean 3.38), intervene in it better (4.15), and implement the guideline moderately (3.43, scale between 1 and 6). Those with experience of working with maltreated children reported they identify them better (P < 0.001), intervene better (P < 0.001), and implement the guideline better (P < 0.001) than those with no experience. This difference was also found for those who were aware of the guideline, had read it, and participated in training on child maltreatment, as compared to those who were not aware of the guideline, had not read it, or had not participated in such training. Conclusions. The public health nurses worked quite well with children who had experienced maltreatment and families. However, the results point out several developmental targets for increasing training on child maltreatment, for devising recommendations for child maltreatment, and for applying these recommendations systematically in practice.