Triggering Rage: Unresolved Trauma in Women’s Lives

Trauma and the perinatal period: A review of the theory and practice of trauma-sensitive interactions for nurses and midwives

AIM

With high rates of trauma in the population, known links between trauma and perinatal distress, and the intimate and close nature of the nursing and midwifery roles, ensuring awareness and understandings of trauma is crucial for guiding practice. This paper aims to explore the relationship of trauma to the perinatal period, based on theory and practice, to consider on how nurses and midwives can deliver trauma-sensitive interactions.

DESIGN AND METHODS

This discursive discussion draws on relevant research from the fields of trauma therapy, attachment theory and nursing and midwifery practice to consider elements of trauma-sensitive practice in the perinatal period.

RESULTS

Nurses and midwives can foster safety for people who have experienced trauma through noticing and responding to triggers, supporting awareness of attachment and its relationships to trauma, undertaking psychosocial screening with care, supporting linearity and cohesion in narratives and developing collaborative care plans that maximise safety and agency. For nurses and midwives, understandings of the relationship between trauma, pregnancy, birth, early parenting and distress is crucial for effective care delivery. Delivering perinatal nursing or midwifery care of any kind, without universal trauma precautions risks reinforcing, misinterpreting or re-enacting dynamics of trauma. To be trauma-sensitive in this period requires nurses and midwives to have awareness of the dynamics of trauma in relation to pregnancy, birth and attachment.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This paper fills a gap in the translation of theory to practice for trauma-sensitive care in the perinatal period, with a focus on the therapeutic relationship formed by nurses and midwives. The findings highlight that nurses and midwives can foster safety for people who have experienced trauma within their practice, when they hold a robust understanding of the relationship between trauma, pregnancy, birth, early parenting and distress.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Disconnected lives: Women with intellectual disabilities in conflict with the law

BACKGROUND

Women with intellectual/developmental disabilities in conflict with the law experience childhood trauma, substance abuse and intimate partner violence but continue to have difficulty accessing appropriate therapeutic services, both within correctional settings and upon discharge. The aim of this study is to explore women's service needs and to critically assess whether the available services are meeting their identified needs.

METHOD

Semi-structured interviews were conducted with 16 women with intellectual/developmental disabilities who were in the Special Needs Unit of a women's correctional centre from December 2014 to March 2015.

RESULTS

Women with intellectual/developmental disabilities struggle to manage the impact of intergenerational trauma, exacerbated by issues of substance abuse and addiction, poor coping skills and minimal education, all of which impact their sense of well-being.

CONCLUSIONS

This study highlights the need for increasing trauma treatment for women with intellectual/developmental disabilities, and emphasizes the need for accessible intervention to facilitate coping, trauma processing and community integration.

Characteristics of Violent Crime Committed by Female Prisoners

This study expands limited existing knowledge of the characteristics of violent crimes for which women in state prisons are incarcerated. An analysis was conducted utilizing survey data collected from female state prisoners by the U.S. Department of Justice for the Survey of Inmates in State Correctional Facilities, 2004. The randomly selected, national sample consisted of 866 female state prisoners. Results suggest that the majority of the violent offenses occurred within the context of a relationship with the victim, most often in a domestic setting, and were influenced by the presence or absence of co-defendants. In addition, the use of weapons was infrequent and often defensive. Implications for practice in violence prevention, prison-based, and reentry services are discussed.

Disclosure of intimate partner violence in current marital/partner relationships among female university students and among women at an emergency department

Detecting intimate partner violence (IPV) might empower women to start working on the impact that the abuse experience has had on their lives. Little, however, is known about disclosure of abuse in community and in clinical settings. The purpose of this study was to explore whether there was a difference in the disclosure of abuse experience among women who were attending the emergency department (ED) at Landspitali University Hospital or were located at a university site, that is, at the University Square at the University of Iceland. A cross-sectional research design was used. Data were collected at the same time in 2009 over a period of 9 months from N = 306 women ranging in age from 18 to 67 years (n = 166 at the University Square and n = 140 at the ED). A significantly higher proportion of the women at the ED reported that they were victims of IPV in their current marital/partner relationship and scored higher on the Women Abuse Screening Tool total scale than the women at the university site. This gave a clear indication that the women at the ED experienced significantly more frequent and more severe IPV in their current marital/partner relationship compared with the women at the university site. Identifying IPV in primary and clinical settings might, therefore, function as a protective factor if these women are offered appropriate first response and interventions.

Webs of causation in violent relationships

RATIONALE, AIMS AND OBJECTIVES

Predictors of intimate partner violence (IPV) include husband, wife and relational characteristics. However, we know little about the proximal, day-to-day triggering of abusive events. The purpose of the study was to analyse the daily temporal relationships among environmental, relational and violence variables in violent marital relationships.

METHOD

Two hundred adult primary care women who experienced violence in the previous month were recruited from six primary care clinics. Women completed daily assessments of household environment, marital relationship and violence using telephone interactive verbal response for 12 weeks. Same-day correlates were sought using cross-correlations among the environmental, relational and violence factors. Prior-day and prior-week associations were sought using vector autoregressions.

RESULTS

Except for wife's alcohol intake, all household environment and relationship factors demonstrated significant same-day correlations with IPV. However, prior-day violence by the husband, hassles, lack of husband's alcohol intake, emotional upset and marital distance were significantly related to current husband-perpetrated violence. Wife's violence depended upon her prior-day violence and alcohol intake only. All factors were related to husband-perpetrated violence in the subsequent week. Only wife's alcohol intake and husband's seeking forgiveness did not feedforward. In addition to the presence of multiple interdependent factors, circular causality was noted for marital distance and feeling upset.

CONCLUSIONS

IPV was due to multiple interdependent factors, feedforward dynamics and circular causality as expected in complex systems. The complex dynamics imply that simple interventions may have little chance of success, but understanding couple-specific dynamics may allow women to recognize high-risk prior-day profiles and take preventive action.