Purpose

Intimate partner violence (IPV) during the breastfeeding period endangers women's health and well-being. From a caring science perspective, it may be understood as suffering, potentially reduced through caring. This study aims to describe the meaning of caring, as experienced by women exposed to IPV during the breastfeeding period.

Methods

Nine women with experience of IPV during the breastfeeding period participated in lifeworld interviews, analyzed phenomenologically following the methodological principles of reflective lifeworld research (RLR).

Results

Caring, as experienced by women exposed to IPV during the breastfeeding period, means a potential existential refuge, further described by the constituents: an encounter requiring mutual invitation and trust; an opportunity to rediscover oneself when reflected in another's gaze; being met with insight influences the experience of exposedness; the possibility to get a break from exposedness; and being alleviated from loneliness when confirmed.

Conclusions

For care to be caring in this context it needs to be lifeworld-led and based on insights into the existential situation of breastfeeding women exposed to IPV. Through an encounter of mutual invitation and trust, caring has the potential to be an existential refuge, enabling rest, confirmation, reflection and escape from loneliness.

Aim

To evaluate child-nurse emotional communication during needle procedures using a child-centered intervention versus a control group.

Methods

A controlled, video-observational study, incorporating 66 children and seven nurses was conducted. Data were collected using video-recordings of child-nurse communication during needle procedures when receiving standard care (control group) or standard care plus the i Can Choose intervention (intervention group).

Findings

Children expressed their unpleasant emotions mostly non-verbally. Compared to children in the intervention group, those in the control group more often expressed vague or unspecified words to describe an emotion (χ2(1) = 14.4, p < 0.001). The nurses' focus and overall communication style varied between the groups. When using i Can Choose, nurses provided more space to children's communication preferences. This seemed to increase children's involvement during the needle procedure.

Conclusion

Communicating with the child, the so-called communicative interaction, instead of to the child, can play a critical role in children's handling of fear and pain related to needle procedures.

Purpose

Intimate partner violence is a global health issue with physical, mental, and existential impacts. It affects women throughout their lives, including the breastfeeding period. Gaining an understanding of existential dimensions could potentially inspire individualized, health-oriented care. This study aims to explain and understand women’s lived experience of intimate partner violence during the breastfeeding period.

Methods

A lifeworld hermeneutic approach guided the interpretative analysis of nine lifeworld interviews and forty-nine written lifeworld stories of women exposed to intimate partner violence during breastfeeding.

Results

The interpretations show that intimate partner violence during the breastfeeding period means to breastfeed under attack in an objectified and provocative female body while feeling abandoned and entrapped in an incomprehensible reality. The interpretations are abstracted into a main interpretation: being forced into an existential exile that entails an ambiguous passive-active resistance.

Conclusions

Exposure to intimate partner violence during breastfeeding is a forced existential exile in a vulnerable situation. Women are forced into unauthentic lives, where their whole being is questioned, and active resistance is inhibited by limited freedom. Awareness of the lived experience of IPV during breastfeeding is essential for healthcare professionals to help reduce the suffering and enhance the health and well-being of women exposed to IPV.

Background: One in three women experiences intimate partner violence during her lifetime. Intimate partner violence causes physical, psychological, and sexual harm, jeopardising human rights, global sustainability, and the health and well-being of women and children. Qualitative research on intimate partner violence and breastfeeding is sparse, but both breastfeeding and exposure to intimate partner violence have previously been shown to evoke existential questions. Women experiencing intimate partner violence seem to doubt their ability to breastfeed and have a shorter breastfeeding duration. The aim of the study is to explain and understand women’s lived experience of intimate partner violence manifestations during the breastfeeding period.

Methods: The study employs a lifeworld hermeneutical approach, grounded in caring science and existential philosophy. The data comprises forty-nine written lifeworld stories and nine lifeworld interviews by women with lived experience of intimate partner violence during breastfeeding. Kelly’s feminist theory, ‘The continuum of violence’ underpins the main interpretation.

Results: The seven interpreted themes of intimate partner violence manifestations during breastfeeding show that women are being: accused, devalued, neglected, controlled, opposed, forced to adapt, and punished. The main interpretation suggests that the manifestations form a multidimensional continuum. The manifestations are intertwined and hold different meanings for different women, existing due to patriarchal structures that uphold female oppression and objectification.  The woman-child intimacy and dependency change the intersubjective power balance of the partner relationship, which provokes some partners.

Conclusion: The study shows that the breastfeeding period, intertwined with motherhood and female embodiment, implies a particular vulnerability to intimate partner violence. Carers need to be aware of this to avoid exacerbating the vulnerability.

Potential impact or clinical relevance: The findings are valuable for informing healthcare professionals about how to recognise signs indicating that breastfeeding women under their care may be experiencing intimate partner violence. Highlighting women’s lived experience provides a basis for care improvement. In a Nordic context, the study also encourages reflection on the discourse surrounding equal parenting and partner involvement, given that not all partner relationships are healthy.

The purpose of this study was to translate and validate a questionnaire to be used by children with chronic diseases during procedures. Specific research questions were as follows: Is the translated versions reliable? Is there a correlation between VCM and another questionnaire measuring discomfort to enhance the validity of VCM? The three versions of Visual CARE measure (VCM) were translated following the principles of good practice for translation and cultural adaptation of patient-reported outcome measures, according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Cognitive debriefing interviews with children, parents, and healthcare professionals were carried out. The correlation between empathy and discomfort was evaluated using DISCO-RC. The final versions of VCM were administered to children and their parents after a needle procedure or a nasal tube insertion. The Cronbach’s alpha was 0.89 for the 5Q version, 0.93 for the 10Q version, and 0.96 for the 10Q-Parent version, which implies high internal consistency. The intra-class correlation was 0.623 for VCM 5Q, with a mean difference of 1.35 and an ICC of 0.767 for VCM 10Q, with a mean difference of 1.17. This is considered a good agreement between children’s and their parents’ assessments. A significant difference in the children’s reports could be seen when experiencing high discomfort as opposed to low discomfort.

Conclusion: VCM is a useful Patient-Reported Experience Measure (PREM) that can help enhance the quality of care for children in a paediatric setting by capturing their perception of the empathy shown.

Background: Children are a relatively marginalized group when doing research in the context of illness, young children particularly so. This even though children can and should contribute their point of view in providing evidence-based care. This article contributes the experiences of Nurse Researchers in gathering research data in Sweden on the lived experiences of children undergoing needle-related medical procedures, living with home mechanical ventilation or undergoing treatment for cancer.

Methods: Nine published articles from four unique Swedish PhD dissertations in Caring Science formed the basis for the present paper where various open and critical qualitative approaches for gathering data were used.

Results: Accessing and interpreting the lived experiences of ill children in healthcare research presents methodological, ethical, and cultural challenges. As with health care contexts in other countries, capturing the ill child’s experiences in Sweden requires several different methods. Health researchers in Sweden must navigate a complex landscape of communication barriers, emotional and psychological challenges, and structural issues within the healthcare system to effectively access and understand the lived experiences of children.

Conclusions: This paper adds to the knowledge base of research with a focus on gathering the experiences of children with illness within a Swedish health care context. These insights underscore the importance for all researchers of using child-friendly, inclusive methods to understand children’s lived experiences thus ensuring their voices are heard and respected in health research. Children’s and families’ inability to speak the native language of a country cannot be a hinder for inclusion, but rather be encouraged. 

Background

One in three women will experience Intimate Partner Violence (IPV). Exposure during breastfeeding endangers women’s and children’s health and wellbeing, negatively affects breastfeeding, and violates human rights and global sustainability goals. Previous qualitative studies have demonstrated that existential aspects are crucial in the separate experience of both IPV and breastfeeding. However, there is a lack of studies examining the meaning of the concurrent experience of these phenomena. An enhanced understanding of the experience of IPV manifestations during the breastfeeding period may inform the provision of care and support for women exposed to IPV. Accordingly, the study aims to explain and understand women’s lived experience of IPV manifestations during the breastfeeding period.

Methods

The study adopts a lifeworld hermeneutic approach based on Reflective Lifeworld Research. Data collection was conducted between June 2022 and August 2023. Swedish women with experience of the phenomenon IPV manifestations during the breastfeeding period participated either through written lifeworld stories (forty-nine women) or lifeworld interviews (nine women). Data were analysed interpretatively. The main interpretation was inspired by Liz Kelly’s theory ‘The continuum of violence’.

Results

The results show that women experience IPV manifestations during breastfeeding in terms of being accused, devalued, neglected, controlled, opposed, forced to adapt, and/or punished. The main interpretation suggests that the manifestations are intertwined within a multidimensional continuum where the most frequent IPV manifestations are less commonly recognised as violence. The main interpretation further illustrates that the continuum is dependent on both the subjective lifeworld of the woman and the patriarchal context in which it exists. In relation to the patriarchal context, the breastfeeding intimacy within the mother–child dyad is pivotal to explaining and understanding the phenomenon.

Conclusions

The breastfeeding intimacy within the mother–child dyad seems to change the intersubjective power balance in the partner relationship and provoke partners, making breastfeeding women especially vulnerable to IPV. Knowledge of breastfeeding women’s lived experience of exposure to IPV is central for carers to strengthen their ability to support women’s health and wellbeing.

BREASTFEEDING AND EXPERIENCED EXPOSEDNESS IN PARTNER RELATIONSHIP

Ida Gustafsson RN, RM, Lecturer, PhD-student

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Gunilla Carlsson RN, PhD, Professor

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Katarina Karlsson RN, PhD

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Aleksandra Jarling RN, PhD, Lecturer

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Lina Palmér RN, RM, PhD, Associate Professor, Docent

Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden

Background: About 110 000 children are born in Sweden annually. The vast majority of their mothers wish to breastfeed, and also initiate breastfeeding. An important factor for continued breastfeeding is support, especially from the partner. It is likely that lack of support can lead to perceived vulnerability in the partner relationship. Intimate partner violence (IPV) during pregnancy is in Sweden nearly as common as gestational diabetes and the frequency seems to rise postpartum. IPV is multifaceted and encompasses many types and degrees of violence. In a caring science perspective the experience of vulnerability and/or exposedness in partner relationship during breastfeeding (or breastfeeding desire) risks negatively affecting womens health and well-being, regardless of the reason or degree of exposedness. For care to be caring - that is, support health and well-being - knowledge is needed from the perspective of the exposed women. Previous lifeworld theoretical research has shown that breastfeeding may be experienced as an existential challenge and that exposedness to violence during the childbearing period means a long-lasting embodied experience. In this project, these two phenomena are intertwined into a common phenomenon - Breastfeeding in case of experienced exposedness in a partner relationship.

Aim: The purpose of the PhD-project is to develop in-depth knowledge of existential meanings of breastfeeding in case of experienced exposedness in a partner relationship (Study 1-2), and what it means to be cared for (Study 3), as well as to give care and support in this context (Study 4).

Methods: The project has a reflective lifeworld approach. Data has been collected through lifeworld interviews and written lifeworld stories and will be analyzed using a phenomenological or hermeneutical approach.

Results & Conclusion: The results and conclusions of the first study are expected to be completed in the summer of 2023 and will be presented at the conference.

Children continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020–2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.

Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child.

What is Known:

• Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care.

• Professionals report uncertainty and tensions in applying evidence-based practice to children’s procedural care. What is New:

• This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives.

• The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.