Elizabeth Mason-Whitehead

Special observations in forensic psychiatric practice: Gender issues of the watchers and the watched

Special observations in psychiatric practice may create tensions for both the patient under surveillance and the staff undertaking the procedure. This study reports on special observations undertaken in forensic settings focusing specifically on the gender-sensitive issues. The aim of the study was to investigate the specific gender issues relating to special observations in relation to those under the procedure and those engaged in observing. Three medium secure units in the UK formed the sampling frame, and the population studied was eight female and seven male clinical Registered nurses. Semi-structured interviews were conducted, audio-tape-recorded and transcribed for analysis. The analysis involved a Grounded Theory approach to explicate categories and formulate two overarching themes: (1) the psychosocial fusion; and (2) the private as spectacle. There are implications for practice in relation to policy formulation and the implementation of special observations following risk assessment and individual skill identification. It is concluded that gender issues are extremely important for all concerned in this intrusive practice.

Mothers and midwives perceptions of birthing position and perineal trauma: An exploratory study.

BACKGROUND Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries. AIMS To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma. METHODS A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearsons chi-square test was used to measure association between birthing positions and perineal trauma. FINDINGS Mothers, n=94 (85%) and midwives, n=108 (98%) reported high rates of lithotomy position for birth. N=63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n=65 (59%). However, a high majority of mothers, n=106 (96%) and midwives, n=97 (88%) reported they would be willing to use alternative positions. Majority of mothers had an episiotomy, n=80 (73%) and n=76 (69%) reported they did not give their consent. N=59 (53%) reported they were not given local anaesthesia for an episiotomy. n=30 (27%) of midwives confirmed they performed an episiotomy without local anaesthesia. CONCLUSION Care is not based on current evidence and embedded practices, i.e. birthing in lithotomy position and routine episiotomies are commonly used. However, this survey did find a willingness to change, adapt practice and consider different birthing positions and this may lead to fewer episiotomies being performed.

PWE-055 Stigma in inflammatory bowel disease: building resilience

Introduction A stigma is a deeply discrediting attribute, often contravening social norms and viewed by others as undesirable.1People with IBD endure symptoms of diarrhoea and urgency, and 74% have some experience of faecal incontinence (FI).2IBD and related FI may lead to stigma through violation of social hygiene rules. Method This qualitative study aimed to: a) understand the experience of stigma in people with IBD and whether stigma derives from the bowel disorder diagnosis or from related FI; b) understand how stigma affects social, personal and emotional wellbeing, and how people with IBD manage these issues. Using purposive stratified sampling, 40 members of a UK IBD charity were recruited. Participants self-identified as having FI or not, and feeling stigmatised or not. Stigma was described as: being, or feeling that you are being treated differently, feeling ashamed or guilty, worrying that others will find out about your illness, or that others will think badly of you because of your illness. Unstructured individual interviews took place in participants’ homes. Data were analysed using an interpretive method. Results Three themes emerged: Being in and out of control (emotional command of one’s situation), Relationships and Social Support (intimate, family and professional helping networks), and Mastery and Mediation (adjusting to/balancing demands of IBD and life). Stigma arises from both IBD and FI due to socio-cultural demands of physical control over bodily functions, causing distress and social isolation. Attitudes towards bodily fluids and functions learnt in childhood, personality, humour, mental health, and perspective affect the stigma experience. Adults who create robust support networks, develop a sense of emotional control, and gain mastery of their situation are more likely to become stigma-resilient over time. Conclusion Clinicians can identify the stigma-vulnerable by asking patients about childhood attitudes towards bodily functions, and assessing personality and self-efficacy mechanisms. Patients can be more rapidly helped towards stigma-resilience and normalisation by learning to assess disease-related risks, e.g. incontinence, and make contingency plans (achieving emotional control), by learning how to tell others about IBD to secure their help (actively seeking supportive relationships), and by learning to do things differently in order to achieve tasks (mastery of IBD and life). Further research is needed to develop stigma-reduction strategies to improve quality of life for people with IBD. Disclosure of interest None Declared. References Goffman E. Stigma: Notes on the management of a spoiled identity. Englewood Cliffs: Prentice-Hall Inc.; 19632 Norton C, Dibley L, Bassett, P. Faecal incontinence in inflammatory bowel disease (IBD): associations and effect on quality of life. J Crohn’s Colitis. 2013;7(8):e302–311