RECENT TRENDS IN RESPONSE TO CHILD VICTIMIZATION

Abstract

This chapter serves as an introduction to the many roles of health care professionalsin the assessment, care, and treatment of child victimization. It concentrates on those professionals caring for the physical health of victims of child abuse and neglect, although there are many similarities between child maltreatment and other family violence victims. In reviewing the health impact of maltreatment and the historical contributions of health care professionals, it discusses the roles that health care disciplines play in clinical care, training, research, and advocacy and their interaction with the community's child welfare, legal, and criminal justice systems.     

Disembodied Souls or Soul-Less Bodies: Spirituality as Fragmentation

SUMMARY

‘Soul’ and ‘body’ are two linguistic expressions of one and the same reality, the human being. In pastoral care, aged care, and palliative care the stated aim is always to care for the whole person. An increasing focus on ‘spirituality’ has also led to objectifying and measuring what is ultimately beyond calculation. To care for each person as an ‘ensouled body’ and ‘embodied soul’ is to acknowledge we are in the service of one another. In entering one another's stories, words like impose, define, and manage are replaced by trust, love, and faithfulness. Measurable outcomes are then replaced by risk, ambiguity, and mystery: the heart and soul and body of human care.     

Les effets du port du masque sanitaire sur les jeunes enfants en lieux d’accueil collectif

IntroductionMandatory for professionals working in collective care facilities with children aged 3 months to 3 years, the wearing of a mask modifies information that is crucial for verbal and non-verbal communication, which is essential for social development.ObjectiveAn exploratory survey aims to collect the perception of these professionals of the children's reactions to the wearing and removal of the mask.MethodIn mid-December 2020, 586 people recorded 895 observed reactions to the wearing of masks and 793 to their removal in a questionnaire posted on a site dedicated to early childhood professionals.ResultsThe content analysis of the discursive corpus indicates that 75% of the observations on the wearing of the mask mainly concern problems in interactional experiences and difficulties in language activities, with 25% indicating no notable reaction in the children. When the mask is removed, more than half of the observations refer to positive effects: improved relational exchanges, better involvement in activities, particularly language activities, positive emotional reactions, etc. The testimonies also evoke an ostensible attentional activity to the (re)discovery of the adult's whole face, negative emotional reactions and sometimes a non identification of the adult.ConclusionThe majority of professionals perceive difficulties in the areas of language communication and social-emotional interaction. The overall data, although not conclusive due to the inherent limitations of the method used, are consistent with the results of other studies on the effects of wearing a mask on speech and social perception.     

The ‘Connection’ Health Care Providers Make with Dying Patients

SUMMARY

The literature confirms illness and hospitalisation can become spiritual encounters for patients and their families. Further, it has been established that both patients and their families are better equipped to deal with loss and change if they have a healthily developed spiritual sense of self. The aim of the study sought to determine the benefit or otherwise of a previous model of spiritual care. It asked ‘from the perspective of the nurse and other health care providers, what constitutes spiritual care giving?’ An ethnography was undertaken where data consisted of field notes, interviews, records, and diary entries. This paper reports on interview data, from which themes were derived. The major theme titled their space is expressed via a new model of spiritual care. It was shown that when caring for patients and their relatives, nurses and other health care professionals enter the world of the other to determine the other's needs. In so doing they typify agapé (altruistic love), where the individual cares for a complete stranger as if that stranger were family. This connection with the patient and their family is the foundation for spiritual care.     

Children's perceptions and experiences of care giving: A focus group study

The stress of care giving for spouses and adult children has been extensively documented in the empirical literature. More recently attention has been paid to children's involvement in family care giving. Qualitative studies in the social welfare field have highlighted the social restrictions caring places upon children. There remains a need, however, to understand what children are thinking and feeling in an effort to cope with their care-giving demands. This study used a focus group methodology and individual interviews to explore the experiences of 17 young carers aged between 10 and 16. Thematic analysis was employed to identify themes relating to the nature of stressors, their appraisal of them, and the coping strategies they use to manage the task of caring.     

The “religiosity gap” in a clinical setting: experiences of mental health care consumers and professionals

ABSTRACT

In Western countries, professionals in mental health care (“professionals”) tend to be less religious than “consumers”. This qualitative study explores the meaning of this “religiosity gap” for professionals and consumers in mental health care. Both a regular, secular and a Christian clinic in the Netherlands participated in this study. Content analysis was applied to 35 consumer interviews and 18 interviews with professionals. Consumers reported negative experiences (e.g., perceived disrespect and a lack of confidence) and/or negative expectations (e.g., misunderstanding and misinterpretation) related to a religiosity gap. They also mentioned advantages of a “religiosity match”, like safety and confidence and appreciated professionals’ religious/spiritual self-disclosure. Professionals in secular care setting tended to avoid religion and spirituality. In both clinics, they tended to neutralise religious/spiritual differences and be reticent in self-disclosure. Professionals are recommended to recognise the relevance of a religiosity gap and to consider different strategies in approaching religion/spirituality.     

Reflective team and process-oriented supervision – a case study on differences

To meet the Swedish healthcare legislation’s requirements for evidence-based care, a work model for reflection has been developed, called a reflective team (RT). Because this RT model can be perceived as either a competitor of or a complement to caring supervision, this case study aims to explore what distinguishes these two in psychiatric care. Five members of one RT who are psychiatric nurses with previous experiences in caring supervision were interviewed. The transcribed interviews were analysed according to phenomenography. The findings reveal three qualitatively separated categories, which describe differences in focus, competencies, and relationships between confirmation and demands. It is concluded that an RT by no means replaces supervision. Instead, both can contribute to care improvement by complementing each other and increasing the professionalism of psychiatric nurses.     

Relational suffering and the moral authority of love and care

Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering’s tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant’s lived experience. But what if this is not the best question? What if instead of asking “can this infant suffer?” the discourse is broadened to ask “is there suffering here?” This latter question demands attention to patients’ subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients’ experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context.

     

Police intervention in riots: The role of accountability and group norms. A field experiment

This study explores the role of perceived accountability in riot police action. The basic hypothesis is that accountability, provided that non-violent norms are made salient, will lessen the chances of escalation of a conflict between police and demonstrators. Four platoons participated in a field experiment conducted at the Dutch Riot Police Academy, in which they played a riot simulation. In a 2 × 2 design, the effects of accountability and Department on attitudes and norms concerning the action of ‘police’ and ‘demonstrators’ were tested. Measurements were made before and after the simulation. Internal analysis, involving redefined accountability categories, provided support for our hypothesis. That is, perceived accountability proved to be related to a heightened public self-awareness, a less extremely positive evaluation of fellow group members, and less intergroup differentiation. The limitations of an internal analysis are discussed, as well as the importance of the nature of organizational norms and of the accountability forum in predicting the effect of accountability.     

How Norms (Might) Guide Belief

Abstract

Belief normativism is roughly the view that judgments about beliefs are normative judgments. Kathrin Glüer and Åsa Wikforss (G&W) suggest that there are two ways one could defend this view: by appeal to what might be called ‘truth-norms’, or by appeal to what might be called ‘norms of rationality’ or ‘epistemic norms’. According to G&W, whichever way the normativist takes, she ends up being unable to account for the idea that the norms in question would guide belief formation. Plausibly, if belief normativism were true, the relevant norms would have to offer such guidance. I argue that G&W’s case against belief normativism is not successful. In section 1, I defend the idea that truth-norms can guide belief formation indirectly via epistemic norms. In section 2, I outline an account of how the epistemic norms might guide belief. Interestingly, this account may involve a commitment to a certain kind of expressivist view concerning judgments about epistemic norms.     

Care Versus Control: The Identity Dilemmas of UK Homelessness Professionals Working in a Contract Culture

UK voluntary and community sector organizations (VCOs) play a key role in caring for homeless people. However, there are widespread concerns about the impact of increasing government contracting on the quality of their services. This paper examines understandings of homelessness and identities as homelessness professionals, as expressed by VCO professionals. By so doing, it considers how ‘partnership working’ enables or undermines their capacities to care. The paper uses 24 in‐depth interviews and four focus groups with London‐based homelessness professionals. Professionals expressed deep tensions in their experience of their role. On one hand, they reported a deep ethical commitment to care and to develop quality supporting relationships to respond to their clients' complex needs. On the other, their capacity to care was undermined by their dependence on statutory resources and the controls this involved over the way VCOs delivered care. Professionals had to adjust to statutory monitoring frameworks and hard performance targets, which detached them from the human and intimate encounter with their clients and constrained their person‐centred caring interventions. The findings highlight the contradictory nature of contemporary systems of ‘joined up’ welfare that neglect the very human and complex nature of the issues that they were originally created to address. Copyright © 2013 John Wiley & Sons, Ltd.     

Les dispositifs groupaux à l’hôpital et en EHPAD durant la crise de la Covid-19. Quelles demandes,quelles offres,quels apports ?

IntroductionThe COVID-19 crisis has exacerbated the demand for group arrangements dedicated to healthcare professionals and more widely hospital and medicosocial staff.ObjectiveThis article attempts to shed light on the issues at stake in the opening of group settings, between supply and demand, as well as their main organizational and psychological contributions and limitations, through the synthesis of multiple feedbacks from group arrangements carried out by clinical psychologists and researchers during the COVID-19 pandemic.MethodSix female researcher-clinicians met to discuss their experiences in setting up group care facilities. The analysis of the feedback used the concepts of work psychodynamics and group psychoanalysis, making it possible to bring out the organizational and psychological characteristics of group arrangements dedicated to professionals in the healthcare sector.ResultsOur results show that the group arrangement, by allowing the sharing of experiences, helps the mutual recognition between professionals, and thus new identifications in order to avoid the fragmentation of work collectives. The most central point seems to be the capacity of group arrangements to deal with the aggressiveness and anger felt when facing the powerlessness to act in crisis situations. The limits of these groups concern their difficulty in allowing individual rather than collective words to be expressed, and the risk of being the site of a repetition of the trauma for the professionals who sometimes attack or flee from these mechanisms, for fear of what they might bring back to the surface.ConclusionSeveral points of vigilance and recommendations from the experiences reported in this article are explained, in order to enlighten and guide future group facilitators when offering group arrangements built with and for professionals in the healthcare field.     

The Will to Care: Performance,Expectation, and Imagination

This article addresses the world's contemporary crisis of care, despite the abundance of information about distant others, by exploring motivations for caring and the role of imagination. The ethical significance of caring is found in performance. Applying Victor Vroom's expectancy theory, caring performances are viewed as extensions of rational expectations regarding the efficacy of actions. The imagination creates these positive or negative expectations regarding the ability to effectively care. William James's notion of the will to believe offers a unique twist on rational expectations in that he regards humans as having the capacity to work within uncertainty to take decisive action. Applying this idea to caring performance is, this article argues that people can have the will to care, beyond strict rational calculations or limits of social norms. Historically, caring has been associated with the imagination's ability to empathize, but the will to care offers another role for the imagination in envisioning effective action. Given the significance of the imagination for ethical behavior, this article explores the implications for cultivating care in terms of what educating for care might look like. The work of feminist care ethicists, particularly Nel Noddings, is discussed, and contemporary case examples of caring performances are investigated.     

Towards a Theory of Pure Procedural Climate Justice

A challenge for the theorising of climate justice is that even when the agents whose actions are supposed to be regulated are cooperative and act in good faith, they may still disagree about how the burdens and benefits of dealing with climate change should be distributed. This article is a contribution to the formulation of a useful role for normative theorising in light of this bounded nature of climate justice. We outline a theory of pure procedural climate justice; its content, function in relation to international climate diplomacy, and justification. The theory is ‘pure' in the sense that it does not rely on an independent criterion of what are just outcomes in negotiations of climate responsibilities. Rather, it specifies procedural fairness norms, such as transparency, reciprocity and participation, which make the process of negotiation fair independently of which account of substantive climate justice happens to be correct. Such procedural fairness norms are justified in part by being expressions of an ideal of a reasonable negotiator, an ideal which itself commands respect. They are also justified as means to an effective coordinated response to dangerous climate change in virtue of their capacity to create trust, predictability and accountability.     

Qu’est-ce que les professionnels dévoilent d’eux-mêmes dans la relation thérapeutique avec les personnes atteintes de schizophrénie ?

IntroductionHealth professionals’ self-disclosure is a common practice, but there is still controversy regarding when it is appropriate, what the extent and content of self-disclosure should be, and what the clinical consequences are.ObjectivesThis qualitative study aimed to investigate self-disclosure in health and social-care professionals.MethodThirteen in-depth interviews with group leaders of an intervention to improve pleasure and motivation in schizophrenia. The interviews were subjected to thematic analysis.ResultsProfessionals describe their personal disclosures as authentic sharing of lived experiences. From a content point of view, professionals select simple events from their personal or professional life, which they find easy to share with patients, in a group. The selection criteria for these experiences mainly concern the therapeutic value and are formulated in terms of relevance of the content and the usefulness envisioned for the patient as well as authenticity. Self-disclosure generates a redefinition of the places in interaction and a more egalitarian relationship.ConclusionSelf-disclosure is found to be a tool for developing and maintaining the therapeutic relationship. Further studies of the phenomenon would be useful to design training and supervision for professionals.     

Accountability and Community on the Internet: A Plea for Restorative Justice

In this article, I analyze norm enforcement on social media, specifically cases where an agent has committed a moral transgression online and is brought to account by an Internet mob with incongruously injurious results in their offline life. I argue that users problematically imagine that they are members of a particular kind of moral community where shaming behaviors are not only acceptable, but morally required to ‘take down’ those who appear to violate community norms. I then demonstrate the costs that are associated with this strategy; the most worrisome being those that distort the nature of moral dialog and the purpose and effectiveness of accountability practices online, creating a vitriolic and polarising online environment. Because of these negative consequences, I suggest that we ought to hold others accountable for restorative ends. I argue that restorative accountability practices can help us cultivate new norms online that rely less for their enforcement upon negative acts such as shame, and more upon positive acts that focus upon the most appropriate way to make amends to the victim(s) and the community. In this sense, restorative accountability incorporates important elements from the ethics of care, a relational ethics that values creating, promoting, and restoring good social and personal relationships. I conclude by arguing that accountability practices premised on the ethics of care produce better outcomes for the victim(s) of a moral violation, the transgressor, and the community.     

Living in the mo(ve)ment: An ethnographic exploration of hospice patients’ experiences of participating in Tai Chi

PurposeTai Chi is increasingly being used as a complimentary therapy in hospice care to help patients self-manage multiple and complex health needs. However, currently there is limited understanding of Tai Chi from patients’ perspective, including what participation in this mindfulness based movement (MBM) exercise means to their experiences of living with an advanced, incurable disease. The purpose of this study was to explore outpatients’ lived experiences of hospice-based Tai Chi in relation to mindfulness.Methods19 participants (15 females; 4 males, aged between 50 and 91 years old) with a range of advanced, incurable diseases (cancer, COPD, pulmonary fibrosis, pulmonary arterial hypertension) who attended day therapy at a local hospice took part in Tai Chi sessions. Using a focused ethnographic approach, multi-methods including 17 semi-structured interviews (averaging 40 min), participant observations (equating to 200 h spent in the day therapy unit), and informal conversations were used to collect data over a 6 month period. Data was analysed using a thematic framework approach.ResultsFour main themes were constructed that demonstrated participants’ lived experiences of mindfulness during participation in hospice-based Tai Chi sessions. Main themes included: (1) mind-body respite; (2) being present with others; (3) tranquil and therapeutic atmosphere and; (4) physical limitations.ConclusionTai Chi may be an important therapeutic strategy for helping patients with advanced, incurable disease experience mindfulness. The findings of this study support the use of MBM exercises such as Tai Chi as a non-pharmacological adjunct to conventional treatments within palliative care settings.     

Living with Hereditary Haemorrhagic Telangiectasia: stigma,coping with unpredictable symptoms,and self-advocacy

Abstract

Objective: Hereditary Haemorrhagic Telangiectasia (HHT) is a genetic condition causing frequent nose bleeds, skin lesions (telangiectasia) and arteriovenous malformations. Approximately, 50% of people experience life-threatening HHT symptoms including haemorrhages in the brain, lungs and liver. This study aimed to gain a qualitative understanding of the psychosocial impact of HHT over time. Design: Using a phenomenological framework, a rigorous narrative analysis was performed on 20 semi-structured interviews with individuals with HHT aged 20s–60s. Main outcome measures: Qualitative themes explaining life experiences prior to and following a clinical diagnosis of HHT. Results: Narratives highlighted four psychosocial themes: (i) the psychological impact of visible symptoms was significant and related to experiences of social stigma, (ii) individuals struggled to identify triggers of symptoms in order to reduce unpredictability, (iii) an illness identity was rejected by minimising HHT when talking about the present self, and by positive reframing as ‘lucky’ and (iv) self-advocacy was necessitated due to lack of expert coordinated care. Conclusion: HHT has a demanding impact on social, physical and psychological well-being. These findings have significant implications for health care, as narratives about interactions with health professionals often used the terms ‘frustrating’ and ‘not being heard’.     

Transgender Primary Medical Care

SUMMARY

Transgender medical care involves addressing general medical conditions and those related specifically to transgender issues. This article summarizes existing research in transgender medicine and provides guidance for family physicians and nurses in adapting standard primary care protocols relating to health maintenance, acute illness, and chronic disease management to address trans-specific clinical oncerns. Trans-specific issues in physical examination, health history, interpretation of laboratory tests, vaccination, screening, and treatment are explored, and the role of the primary care provider in caring for patients undergoing hormonal or surgical change is discussed.