• Cervical cancer screening in Nepal: Ethical considerations

      Gyawali, Bishal; Keeling, June J.; van Teijlingen, Edwin; Dhakal, Liladhar; Aro, Arja R.; University of Southern Denmark ; University of Chester ; Bournemouth University ; Health for Life Project, Nepal ; University of Southern Denmark (DovePress, 2015-01-16)
      Cervical cancer is the leading cause of cancer deaths for women worldwide. Cervical screening and early treatment can help to prevent cervical cancers. Cervical screening programs in Nepal are often associated with a number of socioeconomic, cultural, and ethical challenges. This paper discusses some central ethical challenges in providing cervical cancer screening in the Nepalese context and culture. It is necessary to address these challenges for successful implementation of such screening programs.
    • Domestic violence: A multi-professional approach for healthcare practitioners

      Keeling, June J.; Mason, Tom; University of Chester (Open University Press, 2008-05-01)
      This book takes a multi-agency approach to domestic violence and looks at a large range of issues that impact on those working in the health and social care fields. It begins with identification of situations where abuse may occur, including intimate partner violence, child and adolescent abuse, same-sex violence and elderly abuse. The book considers the commonalities for survivors of abuse - such as the right to feel safe and protected from violence - and evaluates how health and social care professionals can work towards a positive outcome for all of the individuals involved.
    • Effective educational strategies

      Keeling, June J.; University of Chester (McGraw-Hill, 2008-05-01)
      This book chapter discusses some of the issues incumbent on educators when developing educational programmes for health care providers on intimate partner violence. It focuses on curriculum development, group work, and assessment strategies.
    • Eight simple rules for writing in health and social care

      Chapman, Hazel M.; Keeling, June J.; Williams, Julie; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      This chapter highlights eight simple rules for writing in health and social care - write, plan your writing, proofread and edit your writing, look it up, reflect, record the care you give, prepare, and enjoy yourself.
    • Eight simple rules for writing in health and social care

      Chapman, Hazel M.; Keeling, June J.; Williams, Julie; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      Writing is a creative process. It transforms your own view of the world and enables you to grow and develop. This is why it is so commonly used as an assessment method, as educationalists use it to help you develop a more sophisticated understanding of your field in health and social care. In this book we have attempted to provide you with simple tools to improve your writing skills and achieve your professional goals. We have aimed to inspire you with insights into how you can use writing to help you think more deeply and flexibly about the world and how that knowledge can improve you as a practitioner. While writing and learning are refined over many years, there are some ideas in this book that can change your thoughts, feelings and behaviours quite simply and quickly, and open your mind to the simple pleasure of writing. In this concluding chapter we highlight a few of these hints and tips, and guide you to the relevant chapters to read more about them. We have identified eight simple rules for writing in health and social care. help you develop a more sophisticated understanding of your field in health and social care. In this book we have attempted to provide you with simple tools to improve your writing skills and achieve your professional goals. We have aimed to inspire you with insights into how you can use writing to help you think more deeply and flexibly about the world and how that knowledge can improve you as a practitioner. While writing and learning are refined over many years, there are some ideas in this book that can change your thoughts, feelings and behaviours quite simply and quickly, and open your mind to the simple pleasure of writing. In this concluding chapter we highlight a few of these hints and tips, and guide you to the relevant chapters to read more about them. We have identified eight simple rules for writing in health and social care.
    • Exploring Nigerian obstetricians’ perspectives on maternal birthing positions and perineal trauma

      Diorgu, Faith; Steen, Mary; Keeling, June J.; Mason-Whitehead, Elizabeth; University of Chester (Royal College of Midwives, 2016-05-26)
      Abstract Background. Evidence recommends encouraging expectant mothers to adopt birthing positions that will assist them in having a normal physiological birth. Upright birthing positions have been shown to have good birth outcomes and assist women to give birth normally. However, adopting the lithotomy position with legs flexed and supported with hands has become an entrenched clinical birthing practice in Nigeria and is associated with an increased risk of a routinely performed episiotomy. Hospital protocols have supported this medicalised approach to how women give birth, with little regard to woman-centred care. Nevertheless, Nigerian obstetricians’ perceptions and experiences on birthing position and perineal trauma have received minimal recognition and research. Aim. To explore perceptions and experiences of Nigerian obstetricians regarding maternal birthing position and perineal trauma following childbirth, and to gain insights as to whether obstetricians’ clinical decisions and practice were influenced by evidence. Methods. A descriptive qualitative study was conducted involving a purposive sample of eight obstetricians recruited from two referral hospitals in the Niger Delta region of Nigeria during November 2014. Data were collected using an interview schedule and a thematic analysis was undertaken. Data analysis was guided by Braun and Clarke’s (2006) six-stage thematic framework. Interviews were transcribed in full and categorisation of the data achieved with several in-depth readings of the transcripts. Data saturation was reached with the facilitation of the second focus group interview as no more emerging themes were identified. The study obtained ethical approval from the health and social research ethics committee at the University of Chester in the UK, and also from the study hospitals in the Niger Delta region in Nigeria. Results. Six participants were doctors undertaking obstetric specialist training and two were consultant obstetricians. The following core themes emerged: entrenched practice, lack of insight for evidence, embracing woman-centred care and professional dominance. An overall finding demonstrated a willingness to support mothers in their choices of birthing position and involved reflections on the indications for an episiotomy and incidences of perineal injuries. The findings also indicated that the obstetricians were prepared to consider woman-centred care in relation to birthing position and perineal trauma. Conclusions. This study has enabled some Nigerian obstetricians to reflect upon their perceptions and experiences of their clinical decisions and practices concerning birthing position and perineal trauma. Their current practice was frequently not supported by evidence. However, it emerged that there was a willingness to listen to women and adopt clinical birthing practices and perineal care that would respect choices based on contemporary evidence. Adopting a woman-centred approach would also enable Nigerian midwives working in the two study hospitals to support women to give birth in a position of their choosing and reduce the risk of a routinely performed episiotomy
    • Health professionals’ responses to women’s disclosure of domestic violence

      Keeling, June J.; Fisher, Colleen; University of Chester ; University of Western Australia (SAGE, 2014-10-20)
      This study explored women’s experiences of their responses from health professionals following disclosure of domestic violence within a health setting. The existence of health based policies guiding professionals in the provision of appropriate support following disclosure of domestic violence is only effective if health professionals understand the dynamics of violent relationships. This paper focuses on the findings from the interviews conducted with fifteen women living in the UK who disclosed their experiences of domestic violence when accessing healthcare. Following thematic analysis, themes emerged that rotated around their disclosure and the responses they received from health professionals. The first two themes revealed the repudiation of, or recognition of and failure to act upon, domestic violence. A description of how the health professional’s behaviour became analogous with that of the perpetrator is discussed. The final theme illuminated women’s’ receipt of appropriate and sensitive support, leading to a positive trajectory away from a violent relationship. The findings suggest that the implicit understanding of the dynamics of violent relationships and the behaviours of the perpetrator of domestic violence are essential components of health care provision to avoid inadvertent inappropriate interactions with women.
    • Introduction - "How to write well: for students of health and social care"

      Keeling, June J.; Williams, Julie; Chapman, Hazel M.; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      The aim of this book is to demystify academic writing for undergraduate students in health and social care education. You are probably required to submit several assignments throughout your programme of study, which may take different formats such as a written essay, a poster or a dissertation. The allocation of marks for your assignments will be primarily dependent upon two factors: content and academic writing. This book focuses on the many aspects that impact on the quality of academic writing and will help you to develop the essential skills required for your undergraduate level study and to achieve success. Academic writing is a skill that develops with practice and therefore the book takes you through a step-by-step guide of how to improve your academic writing, thereby enabling you to improve your own writing skills.
    • Perspectives on supporting fathers affected by postnatal depression and a history of violence

      Keeling, June J.; Laws, Thomas; University of Chester; University of Salford (Mark Allen Healthcare, 2018-01-23)
      Intimate partner violence during the perinatal period is a significant public health problem that remains under-screened, under-diagnosed and under-treated. The establishment of evidence based guidelines to aid Health Visitors in providing provide support for couples experiencing violence has been hampered by the complex interplay between maternal and paternal mental health problems and violence. Our study explored the experiences of UK fathers voluntarily engaged with services designed to redeem their ideation to violence. The findings indicate that a tendency to violence was increased by stresses associated with the transition to parenthood. Men felt pressured by concerns for their partners' mental health, changes to their relationship with the mother, sleep disturbances and the burden of infant care they assumed when the mother could no longer cope. Health Visitors are ideally situated to assess for factors linked to the emergence of violence and pre-empt the support needed to minimise its occurrence.
    • Pregnancy counselling clinic: A questionnaire survey of intimate partner abuse

      Keeling, June J.; Birch, Linda; Green, Pauline; University of Chester ; University of Chester ; Arrowe Park Hospital (BMJ Publishing Group, 2004-07-01)
      This article discusses a study of the prevalence and nature of physical and sexual partner abuse experienced by women who request a termination of pregnancy (TOP). 312 questionnaires were completed by women attending a pregnancy counselling clinic located within a large district general hospital in the north west of England.
    • Presenting your writing in different formats

      Ridgway, Victoria; Keeling, June J.; University of Chester (McGraw-Hill / Open University Press, 2013-09-03)
      This chapter explores the following topics: essays, oral presentations/examinations, poster presentation, dissertation structuring and writing, portfolio development and finally writing for publication. With key tips for each, the chapter address these concepts in detail.
    • A qualitative study exploring midlife women’s stages of change from domestic violence towards freedom

      Keeling, June J.; Smith, Debra; Fisher, Colleen; University of Chester; University of Central Lancashire; The University of Western Australia (BioMed Central, 2016-03-08)
      Background Domestic Violence (DV) remains a significant global health problem for women in contemporary society. Existing literature on midlife women’s experiences of domestic violence is limited and focuses on health implications. Leaving a violent relationship is a dynamic process that often requires multiple attempts and separations prior to final termination. The aim of this study was to explore the process of leaving a violent relationship for midlife women. Methods This qualitative study involved fifteen women aged between 40–55 who had accessed residential and non-residential community support services for domestic violence within the UK. Community-based support agencies provided these women with access to letters of invitation and participant information sheet explaining the study. The women notified agency staff who contacted the research team to arrange a mutually convenient time to meet within a safe place for both the women and researchers. It was stressed to all potential participants that no identifiable information would be shared with the agency staff. Women were considered survivors of DV if they defined themselves as such. Data were gathered through semi structured interviews, transcribed verbatim and thematically analysed. Results Midlife women appear to differ from younger women by transitioning quickly though the stages of change, moving rapidly through the breaking free onto the maintenance stage. This rapid transition is the resultant effect of living with long-term violence causing a shift in the women’s perception towards the violent partner, with an associated reclamation of power from within the violent relationship. A realisation that rapid departure from the violence may be critical in terms of personal safety, and the realisation that there was something ‘wrong’ within the relationship, a ‘day of dawning’ that had not been apparent previously appears to positively affect the trajectory of leaving. Conclusions Midlife women appeared to navigate through the stages of change in a rapid linear process, forging ahead and exiting the relationship with certainty and without considering options. Whilst these findings appear to differ from younger women’s process of leaving, further research is needed to explore and understand the optimum time for intervention and support to maximise midlife women’s opportunities to escape an abusive partner, before being reflected appropriately in policy and practice.
    • Stop! Silent screams

      Steen, Mary; Keeling, June J.; University of Chester (Ian Heslop, 2012-02-01)
      There is evidence to suggest that pregnancy may trigger or exacerbate domestic violence. Domestic violence is recognised to be a significant contributory factor to maternal, fetal morbidity and mortality. The midwife is ideally placed to recognise domestic abuse and offer care, support and information. This article describes and discusses the multi-complex issues surrounding domestic abuse. It highlights possible indicators, how to ask questions, the importance of documenting evidence and explores ways that midwives can be responsive to the needs of abused women and their children.
    • Using a feminist standpoint to explore women’s disclosure of domestic violence and their interaction with statutory agencies

      Mason, Tom; Keeling, June J. (University of ChesterUniversity of Chester, 2011-11)
      This thesis explores women’s disclosure of domestic violence, and is based on the findings of two research studies. The first study explored prevalence rates of domestic violence reported by women following childbirth. The subsequent narrative study explored women’s experiences of disclosure and their interactions with statutory agencies. The research was influenced by a feminist epistemology, recognizing the marginalisation of the women’s experiences from a subjugated relationship, addressing the power relationship between the researcher and participants and because of the significant disparity between gendered lives. The study was conducted in two parts. A survey of five hundred women in the immediate postnatal period within a large NHS Hospital participated in the first part of the study. The second study involved narrative interviews with fifteen women living within their own community who talked about their experiences of domestic violence and issues surrounding disclosure. Women’s stories about disclosure including the responses they received were influenced by cultural narratives. The theories of social power have been utilized as an explanatory framework and provide the theoretical basis of the analysis. The study found low levels of disclosure at two specific points along the pregnancy/childbirth continuum; during booking in clinic and in the immediate postnatal period. Furthermore, the findings revealed three specific tactics used by perpetrators to engage women in the early relational stage with the intentionality of exerting control and subjugation. These have been termed feeling special, feeling vulnerable and commitment. Whilst women talked of coercion and subjugation by their partners, they also talked of how their interactions with statutory agencies limited their agency. The significance of this study is that the thesis was able to challenge contemporary policies developed by statutory agencies in the provision of support to women who experience domestic violence. The thesis develops some understanding of the nature and role of cultural narratives and patterns of disclosure before suggesting new directions to further advance the findings presented. Finally, the thesis proposes recommendations to improve training for statutory agencies in providing a response to women disclosing domestic violence, suggesting a new direction in thinking about the facilitation of this training.
    • Women’s narratives on their interactions with the first response police officer following an incidence of domestic violence in the UK

      Keeling, June J.; Van Wormer, Katherine; Taylor, Paul J.; University of Chester ; University of Iowa ; University of Chester (OMICS Group International, 2015-06)
      Historically police responses towards the treatment of domestic disturbances regard them as a noncriminal problem. Recent changes to societal and Criminal Justice System attitudes to domestic violence now places an emphasis on first response officers to effectively deal with offenders, manage victim safety and gather evidence. This study explored fifteen women’s interactions with the attending first response police officer following an episode of domestic violence within the home. A qualitative approach using unstructured narrative interviews was chosen to ensure that each woman remained in control of the research interview. Thematic analysis revealed three main themes concerning power relations and officer attitudes, suggesting that personal and cultural factors may negatively impact on officers’ handling of complaints of partner assault, offsetting policy initiatives that guide officers in engaging with victims of domestic violence. The order of the themes reflects the sequential nature of the women’s dialogue. The first theme explores the initial police response, followed by the women’s narratives around feelings of personal disregard for their experiences and evidential considerations. The final theme explores the police response to retraction of statements. Women’s interactions with first response officers following domestic violence illuminates societal issues previously unmentioned. Making womens’ stories visible provides an important insight, contribution and opportunity to examine first response officer’s responses to domestic violence. Integrating the voices of the women (service users) themselves, is arguably an advantageous consideration towards continuing professional development training for all first response police officers.