Monday, 30 November 2015

Forced marriage: What can health professionals do? (30 November 2015)

Zlakha Ahmed

Forced marriage can affect both women and men, although men are affected in lower numbers. A forced marriage is one in which one or both parties do not consent to the marriage, but are coerced into it (Chantler 2012). Duress can include physical, psychological, financial, sexual and emotional pressure. In cases of vulnerable adults who lack the capacity to consent to marriage, coercion is not required for a marriage to be forced. Forced marriage is regarded as a form of domestic abuse and, depending on age, child abuse. Most cases involve young women and girls aged between 10 - 30 (Alijah & Chantler 2015, Quek 2013).

An aspect of forced marriage is Honour-based violence. The terms “honour-based violence” or

“Izzat” [Honour] embrace a variety of crimes of violence, including assault, imprisonment and murder where the person is being punished by their family or their community for actually, or allegedly, undermining what the family or community believes to be the correct code of behaviour.

Many victims as well as health care professionals may assume that health professionals cannot help them. For this reason, it is unlikely that a victim will present to a health professional as going through or gone through a forced marriage. However, if a health professional is aware of forced marriages and the ways in which victims can be helped, they are in an ideal position to provide early and effective intervention. They can offer practical help by providing information about rights and choices. They can also assist victims by referring them on to the police, social care services, support groups, counselling services and appropriate support groups.

An encounter with a health professional may be the only opportunity some women have to tell anyone what is happening to them. To prevent this type of domestic abuse it is imperative that health professionals are prepared to use these limited opportunities to openly discuss the issues around forced marriage (Foreign & Commonwealth Office and Home Office 2013). There will be occasions when an individual does not mention forced marriage, but presents with signs or symptoms, which, if recognised, may indicate to the health professional that they are within a forced marriage or under threat of one. Women may have unexplained injuries, be depressed, anxious or self-harming. Some women may attend for a completely different reason and mention in passing that there are “family problems” – with careful questioning, they may disclose more.

As health professionals, you can use the experience and expertise of the forced marriage unit to help support you in dealing with this issue. You can offer information and support to individuals who: fear that they are going to be forced into a marriage (in the UK or overseas); or fear for a friend or relative who may be forced into a marriage (in the UK or overseas); have already been forced into a marriage and want to consider their next steps. Health care professionals can help by providing information about existing networks, including social care services, police, health and non-governmental organisations. Providing information on how to seek legal remedies in the UK and overseas may also be helpful (Foreign & Commonwealth Office and Home Office 2013).

The above has been adapted from the Government Forced Marriage Guidelines for Health professionals


Alijah, Z., & Chantler, K. (2015). Forced Marriage Is a Child Protection Matter. Domestic Violence and Protecting Children: New Thinking and Approaches, 97.

Chantler, K. (2012). Recognition of and intervention in forced marriage as a form of violence and abuse. Trauma, Violence, & Abuse, 13, 176-183.

Foreign & Commonwealth Office and Home Office (2015). Information and practice guidelines for professionals protecting, advising and supporting victims. (Accessed 27 November 2015)

Quek, K. (2013). A Civil Rather than Criminal Offence? Forced Marriage, Harm and the Politics of Multiculturalism in the UK. The British Journal of Politics & International Relations, 15, 626-646.

Author’s profile

Zalkha Ahmed holds a Higher National Diploma in Business studies, a Certificate in Education and a Post Graduate Diploma in Youth and community. She is the founder of Apna Haq organisation that supports black and ethnic minority women on issues of domestic and sexual violence.

Forced marriage (30 November 2015)

Khatidja Chantler

Forced Marriage is practised in a wide range of communities in the UK and globally. It is recognised as an abuse of human rights both nationally and internationally. Forced Marriage has also been a feature of many orthodox religious communities and of ‘shotgun’ marriages in the West (Hester et al. 2007, Chantler & Gangoli 2011).

The UK government’s definition of forced marriage includes two key elements: duress and lack of full and free consent to marry. Duress refers to physical, sexual, emotional or financial abuse that is brought to bear on the victims which impacts on their ability to give full and free consent to marry.

The Government in England and Wales created the Forced Marriage (Civil Protection) Act 2007, implemented in 2008. This enables the victim or a relevant third party to apply to specific courts in England and Wales to apply for a forced marriage protection order. It applies to both children and adults. The terms of the order are individualised to the victim’s specific context. This legislation also heralded the statutory multi-agency guidance (including health workers) on forced marriage that offers explicit information on how to handle cases of forced marriage. Similar legislation was introduced in Scotland: Forced Marriage etc (Protection and Jurisdiction) (Scotland) Act 2011. In 2014, forcing someone to marry became a criminal offence in the UK.

Understanding forced marriage and its complex dynamics is central to effective intervention. Forced marriage is frequently conceptualised as a purely ‘cultural’ issue (Brandon & Hafiz, 2008) which renders it difficult to intervene in. One potential explanation of this is ‘race anxiety’ (Chantler et al. 2001, Chantler & Gangoli 2011). ‘Race anxiety’ refers to practitioners and institutional concerns to avoid being labelled culturally insensitive or racist. This anxiety appears to prevent practitioners from conducting appropriate assessments of risk in abuse situations. Our forced marriage research highlights the importance of attending to structural factors such as poverty, unequal gender relations, heteronormativity and immigration issues in understanding and responding to forced marriage (Hester et al. 2007). Gill and Sundari (2011) discuss forced marriage as a human rights and social justice issue. Culture is a feature of forced marriage and in domestic abuse more generally; however issues of power and control are central to understanding diverse forms of abuse including forced marriage.

Natcen (2009) estimated between 5000-8000 cases of forced marriage in 2008 and highlighted the difficulties of establishing what counts as a ‘case’ of forced marriage. This was also raised as a challenge in Hester et al’s study and illustrates both the challenges of accurately measuring prevalence as well as practice issues related to the recognition of and intervention in forced marriage. Importantly, the recent introduction of the criminalisation of coercive control is also highly relevant to forced marriage. As in other forms of abuse, coercive control is difficult to evidence yet is a central and perhaps unrecognised feature of forced marriage.


Brandon, J., & Hafez, S. (2008). Crimes of the community: Honour based violence in the UK. London, UK: Centre for Social Cohesion

Chantler, K., E. Burman, Batsleer, J. and Bashir C (2001) Attempted Suicide and Self Harm (South Asian Women), Manchester: MMU, Women’s Studies Research Centre

Chantler, K. and Gangoli, G. (2011) Domestic Violence in Minority Communities: Cultural Norm or Cultural Anomaly? In R. Thiara, M. Schroettle & S. Condon (eds): Violence against Women and Ethnicity: Commonalities and Differences across Europe. Verlag Barbara Budrich, Leverkusen, Germany.

Gill A. and Sundari, A. (eds.) (2011): Forced Marriage: Introducing a Social Justice and Human Rights Perspective. Zed Books, London

Hester, M., Chantler, K., Gangoli, G., Devgon, J., Sharma, S., & Singleton, A. (2007). Forced marriage: The risk factors and the effect of raising the minimum age for a sponsor, and of leave to enter the UK as a spouse or fiance´(e).University of Bristol School for Policy Studies,

Natcen (2009). Forced marriage: Prevalence and service responses:

Author's Profile

Dr Khatidja Chantler is Reader and founder member of the Connect Centre for International Research on Interpersonal Violence and Harm in the School of Social Work, Care and Community, UCLAN. She has conducted research for various funders and her areas of research expertise focus on gender based violence, gender, ethnicity, self-harm and qualitative methods. Her publications include numerous peer-reviewed journal articles, book chapters and co-authored books (Domestic Violence and Minoritisation: supporting women towards independence, 2002; Attempted Suicide and Self Harm (South Asian Women, 2001) and co-edited books (Gender and Migration: Feminist perspectives, 2010). She has a professional background in community development and therapeutic counselling and she is a clinical supervisor.  

Saturday, 28 November 2015

Female Genital Mutilation: A Hideous Crime (29 November 2015)

Carol McCormick, FGM specialist midwife

Female Genital Mutilation (FGM) sometimes referred to as female genital cutting or female circumcision is the cultural practice of cutting off parts of the external female genitalia, which is usually performed on very young girls. It is classed as torture by the World Health Organisation (2104) and is a harmful practice that can cause significant morbidity and even mortality. Evidence suggest that approximately 100-140 million girls/ women, across the world, have been subjected to this abusive practice and that around 3.3 million girls are at risk of FGM each year (World Health Organisation, 2012). It is against the law in many countries including the UK (Creighton & Liao 2013) where it carries a penalty of up to 14 years imprisonment. The short term physical and psychological consequences of FGM include haemorrhage, flashbacks and even death. In the UK, we mainly see the long term consequences such as chronic infection, but the most common long term physical consequence of FGM is difficulties in childbirth (Berg & Underland 2013). For years the front line staff on labour wards have been seeing increasing numbers of women with FGM attending in childbirth. These staff are often ill equipped and not trained to deal with the situation to the detriment of women.

In recent years many initiatives have been developed to educate and support staff and improve the care of childbearing women who have undergone FGM and to protect their female children from the practice.

At present we do not know the numbers of girls and women in the UK who have undergone FGM so a large initial part of addressing FGM in the UK is to look at the demography/prevalence of the practice. We now have professional duty to complete an FGM Enhanced Dataset Information Standard for all women/girls seen with FGM. This is to support the national FGM prevention programme. The health care professional has to access the database of the Health and Social Care Information Centre (HSCIC) Information Centre. As the information to be submitted is patient identifiable some practitioners have been reluctant to embrace this and have not yet begun to comply, leaving themselves vulnerable to professional actions being taken from their college or the Nursing and Midwifery Council (NMC) or General Medical Council (GMC). In addition to mandatory reporting there is also new legislation that allows UK residents who 'habitually abide' in the UK to be prosecuted under the Serious Crime Act 2015, the act also legislates to protect the anonymity of victims of FGM by publications that could identify them. Section 3A of the Act makes it an offence for anyone with parental responsibility to fail to protect a girl from FGM and section 5A provides a framework to protect a girl at risk of FGM. For health care professionals under section 5B of this Act it is now a statutory duty to notify the police if they discover the act of FGM has been performed on a girl who is under 18 years of age.
FGM map

With the aim of zero tolerance of FGM globally we must take the initial steps of identifying the breadth of this practice if we are to aim our limited resources where it can make the most impact in preventing our global children undergoing this harmful cultural practice. We CAN end FGM if commit to tackle it as interdisciplinary team.

Carol McCormick is a nurse and graduate midwife with the diploma in tropical medicine and postgraduate law degree who also works as an expert witness. Whilst working in the Middle East and Africa she gained hands-on experience in dealing with FGM. On return to the UK she worked in Nottingham as the consultant midwife in intrapartum care. She has run the female genital mutilation service in Nottingham for the past 14 years.


Berg RC, Underland V (2013) The obstetric consequences of female genital mutilation/cutting: a systematic review and meta-analysis. Obstetrics and gynecology International Article ID 496564

Creighton, S. M., & Liao, L. M. (2013). Tackling female genital mutilation in the UK. BMJ 347:f7150

World Health Organization (2014). Female Genital Mutilation. (Accessed 25 November 2015)

World Health Organization (2012). Female Genital Mutilation. Understanding and Addressing Violence Against Women, World Health Organization, Geneva, Switzerland available at (Accessed 25 November 2015)

Friday, 27 November 2015

Acid Attacks (28 November 2016)

Parveen Ali, Guest Editor

‘I spent six months in hospital. I was so depressed because I was in a closed room and my whole body was bandaged up, so I couldn’t move. It felt like I was in a cage’
(Neela Amina Khatun, Acid attacks... a survivor's story)

A vicious and damaging form of violence against women is acid violence. It involves throwing or pouring acid onto a person with an intention to kill or injure them (Waldron et al. 2014). In such instances, sulphuric or nitric acid or bleach is thrown or poured on victims face or body, resulting in severe skin burn, damage to eyes, ears and facial bones causing in disfigurement. It results in damaging the ability to speak, eat, drink, see and hear. The higher survival rate among victims of acid attack means that the victim has to live with long term physical, psychological, social and economic consequences. The victims may have to go through a series of surgical procedures resulting in additional complexities and the burden on the victim and their family (Mannan et al. 2006). The impact of acid attack is such that the victims often find it very difficult to return to a normal life. For instance, the permanent disfigurement resulting from acid attacks is associated with stigma, fear, anxiety, depression and post-traumatic stress disorders.

Acid violence is prevalent in many parts of the world. According to the Acid Survivors Trust International, every year approximately 1500 acid attack are committed globally. Acid attacks used to be common in the US, UK, and Europe in the 19th century, though the incidence has decreased now (Welsh 2009). Some high profile acid attacks have also been reported in Bulgaria and Greece (Welsh 2009). However, the incidence of acid attacks is reported to be much higher in the developing countries (Olaitan & Jiburum 2008) such as Bangladesh, India, Cambodia, Pakistan, Iran, Afghanistan, and parts of Africa. The highest incidence of acid attack is reported to be 83% in Cambodia (Micheau et al. 2004) and 92% in Bangladesh.

Evidence suggests that an overwhelming majority of victims of acid attacks are women aged 13-35. The motives behind committing such a heinous crime include refusal of a marriage proposal or approaches by a lover. The attacker usually aims to do disfigure the victim’s face and body to destroy their prospects of marriage or future relationships. Other motives include marriage problems, illicit relationships and extramarital affairs, divorce, or property and land disputes or political or religious reasons. In the majority of cases, the attacker is known to the victim, and this may be a reason that the crime is not often reported to police and law enforcement organisations.

Preventing such crimes is essential and lesson needs to be learned from countries such as Bangladesh, where appropriate efforts have resulted in a reduction of the incidence rate of acid attacks. Strategies such as raising awareness about the crime through community and media mobilisation, engaging youth to stop acid violence, engaging with and sensitizing acid sellers and users, appropriate implementation of the acid control act and capacity building of health care professionals have been helpful (Acid Survivor Foundation 2013). It is also important to explore perpetrator's perspective as it can help identify motives, characteristics of perpetrators


Action Aid (2011). Acid Attack. A survivor’s story. (Accessed 22 November 2015)

Acid Survivor Foundation (2013). Annual Report 2013. Available at (accessed 27 November 2015)

Mannan, A., Ghani, S., Clarke, A., White, P., Salmanta, S., & Butler, P. E. M. (2006). Psychosocial outcomes derived from an acid burned population in Bangladesh, and comparison with Western norms. Burns, 32, 235-241.

Micheau, P., Lauwers, F., Vath, S. B., Seilha, T., Dumurgier, C., & Joly, B. (2004). Caustic burns. Clinical study of 24 patients with sulfuric acid burns in Cambodia. In Annales de chirurgie plastique et esthetique, 49, 239-254.

Olaitan, P. B., & Jiburum, B. C. (2008). Chemical injuries from assaults: An increasing trend in a developing country. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India, 41, 20.

The Acid Survivors Trust International (2015). Acid Violence. Why it happens. (Accessed 25 November 2015)

Waldron, N. R., Kennifer, D., Bourgois, E., Vanna, K., Noor, S., & Gollogly, J. (2014). Acid violence in Cambodia: The human, medical and surgical implications. Burns, 40, 1799-1804.

Welsh, J. (2009). ’ It was Like Burning in Hell’: A Comparative Exploration of Acid Attack Violence. ProQuest. Available at (Accessed 28 November 2015)

Thursday, 26 November 2015

Sexual and street harassment (27 November 2016)

Parveen Ali, Guest Editor

'Not a single day goes by that I am not leered at, growled at, spat on, stalked or called a “fuhus” (prostitute). A couple of months ago, I was assaulted by a group of teenage boys 20 feet from my front door. Though I’ve never been raped, I am violated every day by strangers on the street. And I am merely one of millions of women who endure sexual harassment and assault in public spaces from Cairo to Istanbul to New York, the birthplace of the international anti-street harassment movement' (Alyson Neel, 2013)

Sexual violence refers to ‘any sexual act, attempt to obtain a sexual act, unwanted sexual comments, or advances, or acts to traffic or otherwise directed against a person’s sexuality using coercion, by any person, regardless of their relationship to the victim in any setting, including but not limited to home and work’ (World Health Organisation 2011). Sexual violence is committed by intimate partners, non-partners (strangers, acquaintance or family member). Evidence suggests that the majority of women subjected to sexual violence are likely to know their perpetrator. Sexual violence is also a common phenomenon in situations of war and other form of humanitarian crises.

Sexual harassment and street harassment are two common forms of gender based violence that affect the lives of millions of women in private as well as the public sphere of life. Such acts are experienced in places, considered safe, such as the workplace, schools, colleges and universities. The perpetrators may include co-workers, peers and teachers. Street harassment, on the other hand, is experienced by a vast majority of girls and women while on the way to and from school and work. Acts such as verbal comments, leering, unwanted touching and physics, contact, coercing individual into complying with sexual demands and stalking. Evidence suggests that 40-50% of women in European countries are subjected to sexual harassment at work. Prevalence of sexual harassment in Asian countries including Japan, Malaysia, Philippines, and South Korea is reported to be 30-40% (UNIFEM 2010). Despite, high prevalence, sexual harassment often remains unreported due to family pressure, stigma, lack of available reporting mechanism, and fear of repercussions. It is often the victim who gets blamed for sexual harassment and, therefore, has to suffer a negative impact (UNIFEM 2010).

The vast majority of nurses and health care professionals are women and, therefore, it is no surprise that many of them are exposed to sexual harassment. A recent systematic review highlights that nearly 40% of nurses are exposed to bullying and 25% of nurses are subjected to sexual harassment in various countries. The countries include Australia, Bahrain, Belgium, Canada, China, Denmark, Egypt, England, Finland, France, Germany, Iceland, Iran, Iraq, Ireland, Israel, Italy, Japan, Jordan, Kuwait, New Zealand, Netherlands, Norway, Philippines, Poland, Portugal, Saudi Arabia, Scotland, Slovakia, Spain, Sweden, Switzerland, U.S., Taiwan, Thailand and Turkey (Spector et al. 2014).

Factors such as traditional social and gender norms, status of women, availability and implementation of appropriate policies, and legislations may impact on the prevalence of sexual violence including sexual harassment. Sexual and street harassment need to be incorporated in policy and legislation aimed at averting and responding to sexual violence. Reporting of such incidence should be encouraged. In addition, increasing awareness and training about how to deal with sexual harassment may help women deal with situation. Appropriate support from colleagues, friends and family members is invaluable and can help women develop their confidence.


Spector, P. E., Zhou, Z. E., & Che, X. X. (2014). Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies, 5, 72-84.

UNIFEM, (2010). The Facts: Violence against Women & Millennium Development Goals., UNIFEM, New York. (Accessed November 22, 2015)

World Health Organisation. (2011) Violence against women – Intimate partner and sexual violence against women. Geneva, World Health Organization.

World Health Organisation (2012). Understanding and addressing violence against women. Sexual Violence. Available at (Accessed November 22, 2015)

Wednesday, 25 November 2015

What constitutes intimate partner violence? (26 November 2016)

Parveen Ali, Guest Editor

'By the time I was finally able to leave, I had been with Daniel for 30 years. He was never punished for the way he treated me and I have heard that he is now hitting his new girlfriend. I try not to think about him anymore. It was a very long and painful journey, but I now know that there is nowhere for me to go but up and I am looking to the future’ (Christine’s Story).

Intimate partner violence (IPV) is the most common form of violence against women experienced by women. The World Health Organization (2012) defines it as ‘any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship’. It can take various forms such physical, psychological abuse and coercive behavior.

Physical abuse: Refers to the use of physical force to inflict pain, injury or physical suffering to the victim. Examples include slapping, beating, kicking, pinching, biting, pushing, shoving, dragging, stabbing, spanking, scratching, hitting with a fist or something else that could hurt, burning, choking, threatening or using a gun, knife or any other weapon Acts of physical violence, such as slapping, hitting, kicking and biting.

Sexual abuse: Refers to physically forcing a partner to have sexual intercourse who did not want it or forcing a partner to do something that they found degrading or humiliating.

Psychological abuse: Refers to the use of various behaviours intended to humiliate and control another individual in public or private. Examples include, name calling, constantly criticizing, blackmailing, saying something or doing something to make the other person feel embarrassed, threats to beat women or children, monitoring and/ or restricting movements, restricting access to friends and family, restricting economic independence and access to information, assistance or other resources and services such as education or health services.

IPV is a grave reality that women in all parts of the world face (Ali et al. 2014). I acknowledge that IPV can be perpetrated by women against their male partners, and that it can happen in same sex relationships, but the number of women affected by IPV resulting in injuries and other health consequences is far greater. The prevalence of IPV differs between countries and between studies due to the variations in the definition of IPV and the social and cultural context. Available evidence suggests that approximately 35% of women worldwide have experienced IPV at some point in their life, athough, in some countries, the prevalence of IPV is reported to be 70% (World Health Organization 2013). A study conducted in 28 European countries, involving 42,000 women participants estimated that 13 million women experienced physical violence and 3.7 million women experienced sexual violence in one year. The study also reported that 43% experienced some form of psychological IPV (European Union Agency for Fundamental Rights 2014).

IPV has extensive physical and psychological consequences, some with lethal outcomes. Preventing IPV requires an understanding of IPV risk factors pertaining to perpetrators and victims. Such understanding can help develop preventive strategies focusing on victims as well as perpetrators. It requires a multidisciplinary approach. Healthcare professionals, especially nurses are well placed to play an important role in prevention of IPV in contributing to early identification of IPV victims. This can be done by ensuring victims are provided with appropriate opportunities and supportive environment (privacy, confidentiality) to disclose their experiences of violence. Active listening, empathetic and nonjudgmental attitude and an awareness of one’s own values and beliefs related to IPV, prejudice and biases is necessary to provide appropriate care. Nurses and other health care professionals need to be appropriately prepared to identify, assess, respond and provide appropriate care to IPV victims.


Ali, P. A., Naylor, P. B., Croot, E., & O’Cathain, A. (2015). Intimate Partner Violence in Pakistan A Systematic Review. Trauma, Violence, & Abuse, 3 299-315

European Union Agency for Fundamental Rights (2014). Violence against women: an EU-wide survey. Available at (Accessed November 20, 2015)

World Health Organization (2012). Understating Violence against women. Intimate partner violence. Available at (Accessed November 20, 2015)

World Health Organization, Department of Reproductive Health and Research, London School of Hygiene and Tropical Medicine, South African Medical Research Council (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. Available at (Accessed November 20, 2015)

Corridor talk in hospitals

Roger Watson, Editor-in-Chief

Despite the 'official' opportunities for exchange of information a great deal takes place 'in passing' in the corridors and this study from Switzerland by Gonzalez-Martinez et al. titled: 'Hospital staff corridor conversations: work in passing' and published in JAN had two aims: 'to document the prevalence of corridor occupations and conversations among the staff of a hospital clinic, and their main features' and 'to examine the activities accomplished through corridor conversations and their interactional organization'. Fifty-nine hours of conversation was video-taped and analysed for the study. Conversations in corridors are short and staff rarely stop to have them; they are conducted 'on the hoof'. Mostly staff talk about professional issues and if more that two staff are present they are more common.

There has been previous work on corridor conversations, which is reviewed in the article, but, as the authors explain, unlike their study, these studies did: 'not provide quantitative evidence of the prevalence of corridor conversations or detailed analysis of the diversity of interaction configurations and the activities being accomplished in this way'. Much work remains to be done in this area, especially related to how well such corridor conversations are related to performance. However, as the authors conclude - in these days where the trend is towards: 'the push for technology-mediated means of distant communication, the study reminds us that impromptu co-present conversation remains an information-rich, rapid and flexible form of organizational communication'.

Listen to this as a podcast.


Gonzalez-Martinez E, Bangerter A, LĂȘ Van K, Navarro C (2015) Hospital staff corridor conversations: work in passing Journal of Advanced Nursing doi: 10.1111/jan.12842

Violence against women: the scope of the problem (25 November 2016)

Parveen Ali, Guest Editor

Violence against women (VAW) and girls is a pandemic affecting millions of girls and women across the globe with no distinction between culture, religion, social class, income or education.

The United Nations (1993) defines VAW as ‘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’ (General Assembly Resolution 48/104 Declaration on the Elimination of Violence against Women, 1993). It happens in public as well as private space. It happens at home, in the street, in the office, in peace and in war. It takes many forms, including physical, psychological and sexual abuse. It affects girls and women of all ages, in the form of female infanticide female genital mutilation, child marriage, grooming, trafficking, forced marriage, honour killing, domestic violence and intimate partner violence. VAW is associated with grave physical, emotional and mental health consequences. It not only has an impact on the lives of women victims of violence but also has negative impact on children and families.

In the past few decades, a lot has been done to highlight the issue and to attract the attention of policy makers and practitioners at national and international levels. As a result, many countries have developed laws against VAW; however, implementation of such laws remains challenging. There is a need to change societal and cultural norms, which do not condemn VAW. There is a need to mobilize people in every walk of life to play their role in prevention of VAW.

25 November is celebrated as an International Day for the Elimination of Violence against Women. This year, the United Nations has invited the world to an ‘orange your neighbourhood’ campaign with ribbons, flags and events for 16 days. The ‘16 days of activism’ will end on 10 December 2016 on Human Rights Day.

The special focus for this year is prevention. Health care professionals, especially nurses, can play a very important role in this regard, as they provide health care services to people in various settings in all health care systems. Recognizing this and to highlight role of nurses and health care professionals and to play our part in ‘16 days of activism’, JAN has decided to run a series of JAN interactive entries from 25 November -10 December 2016 followed by the launch of a special virtual issue of JAN on 'violence against women'. I am privileged to contribute to this activity. During the 16 days, through interactive blogs, we will explore various issues related to VAW. Expert health care professionals, researchers and academics from various disciplines and settings will share their views about aspects of VAW. We will explore intimate partner violence, its aspects (physical, sexual, psychological) and its impact. We will look at the issue of sexual and street harassment, acid violence, honour based violence, forced marriages, female genital mutilation, impact of violence on children and adolescents. We will also explore experiences of women from minority ethnic communities, VAW affecting women in old age, the role of men in reducing VAW, violence against men, the role of health care professionals and future research priorities, I look forward to the coming 16 days and hope that my colleagues will be able to contribute to these activities by sharing their views.

Saturday, 21 November 2015

Violence against women

Roger Watson, Editor-in-Chief

All violence is reprehensible but violence against women is in a category of its own. Women have been exploited by men and by male dominated societies for as long as history records and, as we will see in the forthcoming series of JAN interactive entries, it takes many forms from male perpetrated domestic violence to societal violence in the shape of female genital mutilation.

Dr Parveen Ali
25 November International Day for the Elimination of Violence against Women and we will be running a series of JAN interactive entries from 25 November through to 10 December 2016 followed by the launch of a special virtual issue of JAN gathering articles on violence against women together.  For a period these will be free to download.  Both the JAN interactive series and the JAN special virtual issue will be edited by Parveen Ali from the University of Sheffield, UK. Parveen is an expert on interpersonal violence and has studied this in the Pakistani community in Pakistan and England.

Tuesday, 17 November 2015

World Prematurity Day

Rita H. Pickler, Editor, JAN

On November 17, 2015 as part of Prematurity Awareness Month, we will observe the fifth World Prematurity Day. I hesitate to say we will “celebrate” the day. It is difficult for me to say, after over 30 years of caring for, teaching about, and studying preterm infants, that we should celebrate prematurity. Prematurity, which occurs in 15 million births and causes 1 million deaths yearly in addition to leaving many surviving infants with years of complicating health problems including cerebral palsy, vision and hearing loss, and intellectual disabilities, is the single most important unsolved health problem in the world. We should not celebrate it. We should, however, think about and consider ways to prevent it; that is of paramount importance.

For indeed, World Prematurity Day is important for raising awareness of the global scourge of early birth. In my own country, the United States, prematurity rates continue above 10%, with higher rates for ethnic and racial minorities. Our embarrassingly high rate of prematurity prompts frequent calls for more research and targeted interventions aimed at preventing preterm birth. At the moment, full prevention is not in sight. Thus, we must also continue to raise awareness to the fact that many infants who survive prematurity have significant long term sequelae that may not be known until the survivor is well into adulthood. Some of these long-term complications are the result of our usually well-intentioned, but nonetheless misdirected, care during the early weeks following birth. We are slowly learning that everything we do – how we handle, hold, and treat – matters with these very small and fragile infants.

And while not a new awareness, we are more focused than ever before on the effect of a preterm birth on the entire family. While we have generally embraced family-centered care in our neonatal intensive care units, the truth is that we do not have the time or knowledge we need to fully address parent and family needs. Thus, many parents may feel unwanted or unneeded during their infant’s hospitalization (i.e. Lee, Wang, Lin, & Kao, 2013). Parents may feel unprepared to take home their infant and once home (i.e. Chen, Zhang & Bai, 2015), they may feel unsupported in their efforts to care their child (Dellenmark-Blom & Wigert, 2013).

World Prematurity Day has evolved into a day to raise awareness for the challenges of preterm birth. Along with countless thousand others, I invite you to join in observing the day and to consider ways that we can prevent prematurity while at the same time providing care to preterm infants and their families in ways that promote the best possible outcomes.


Chen Y., Zhang J. & Bai J. (2015) Effect of an educational intervention on parental readiness for premature infant discharge from the neonatal intensive care units. Journal of Advanced Nursing doi: 10.1111/jan.12817

Dellenmark-Blom M. & Wigert H. (2013) Parents' experiences with neonatal home care following initial care in the neonatal intensive care unit: a phenomenological hermeneutical interview study. Journal of Advanced Nursing 70(3), 575–586.doi: 10.1111/jan.12218

Lee T.-Y., Wang M.-M., Lin K.-C. & Kao C.-H. (2013) The effectiveness of early intervention on paternal stress for fathers of premature infants admitted to a neonatal intensive care unit. Journal of Advanced Nursing 69(5), 1085–1095. doi: 10.1111/j.1365-2648.2012.06097.x

Wednesday, 11 November 2015

Eating in dementia

Roger Watson, Editor-in-Chief

I have to admit to a conflict of interest in promoting this article. Not only is the area of eating in dementia my own field of research, my work is cited in the article. The article in question comes come the USA and is by Liu et al. and titled: 'Factors associated with eating performance for long-term care residents with moderate-to-severe cognitive impairment'. It is published in JAN. Eating difficulty (in this field usually referred to as 'feeding' difficulty) in older people with dementia is one of the unsolved issues in care of older people. While many people are peripheral to the issue: physiotherapists, nutritionists, occupational therapists and physicians, the issue of feeding difficulty is one that lies largely in the nursing domain. Nearly 70% of older people in nursing homes have some form of dementia and 65% of those have severe impairment in the ability to self-feed and require assistance.

The stated aim of this study was: 'to examine the association of specific personal and environmental factors with eating performance among long-term care residents with moderate-to-severe cognitive impairment'. Data were gathered secondarily from two randomised controlled trials involving older people with dementia and a range of standard cognitive screening and activity of daily living and agitation instruments were used. The results showed that some patient characteristics were not associated with feeding difficulty, including: age, gender, race, marital status, education and years living in the long-term care facility. On the other hand: sitting balance, type of long-term care facility, cognitive impairment and physical capability were significantly associated. It was a surprise to me that depressive symptoms and agitation were not associated with feeding difficulty. The authors concluded: 'This study provided additional information to support the association of eating performance with cognitive impairment and physical capability that can help guide future clinical practice and intervention research. Efforts should be made to reduce the impact of cognitive decline on eating performance and to promote physical capability for optimizing eating performance'.

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Liu W, Galike E, Boltz M, Nahme E-S, Lerner N, Resnick B (2015) Factors associated with eating performance for long-term care residents with moderate-to-severe cognitive impairment Journal of Advanced Nursing doi: 10.1111/jan.12846

From practice to academia

Roger Watson, Editor-in-Chief

The transition from nursing student to staff nurse has been studied quite intensively but the transition from the clinic to academia less so. Australia, in common with many countries, has a severe shortage of nursing academics and in the UK it is proving very hard to fill senior academic posts. This study from Australia and the UK by Logan et al. titled: 'Transition from clinician to academic: an interview study of the experiences of UK and Australian Registered Nurses' and published in JAN aimed to: 'explore and compare the experiences of nurses in Australia and the UK as they moved from clinical practice into higher education institutions'. Interviews were held with 14 nurse educators and a thematic analysis carried out. As stated by the authors: 'The transition into universities of the education of the ‘minor professions’, including teaching, social work and professions allied to medicine, has not always been seamless, due, in part, to the inherent tension between intellectual knowledge and the experiential learning in practice needed to meet the demands of professional practice, as in nursing. Many nurses enter academia without higher level research qualifications: only 4% join their university with doctoral qualifications. While honing new teaching skills they must simultaneously develop their research profile'.

The findings of the study are presented under four themes: 'adapting to change, external pressures, teaching and progress up the academic ladder.' In terms of the external forces and the limited resources, what one participant said will be familiar to many nurses in universities: 'I think we’d like to be research intensive, but. . . I don’t see how we can be research intensive because particularly for me, I sometimes feel subsumed by the undergraduate programme and the other programmes that I contribute to. . .In the Times Higher. . .the most successful professors in the universities, including this university, are the ones who don’t do any teaching, they just do research'. As stated by the authors: 'The position of practice disciplines in universities, such as nursing, has long been precarious', and this is reflected in the findings. In conclusion, the authors say: 'More resources, including academic time, systems of support and mentorship are needed for nurses to progress to postdoctoral research and justify nursing’s place amongst academic departments'.

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Logan PA, Gallimore D, Jordan S (2015) Transition from clinician to academic: an interview study of the experiences of UK and Australian Registered Nurses Journal of Advanced Nursing doi: 110.1111/jan.12848