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Concept Analysis: Disclosure Disclosure: a brief discussion of the concept. Disclosure has always been a difficult question. The definition of word disclosure can vary depending on the context. Disclose, in relation to personal health information in the custody or under the control of a health information custodian or a person, means to make the information available or to release it to another health information custodian or to another person, but does not include to use the information, and disclosure has a corresponding meaning; (divulge, divulgation) (PHIPA, 2004).
Disclose and Disclosure means the release of, transfer of, provision of, access to, or divulging in any manner, of Protected Health Information outside of clinics or to persons other than its workforce members. Disclosure means a release to persons or entities other than to the patient who is the subject of the information (Use and Disclosure Policy, 2003) In ordinary language use by Legaldefinitions. com, disclosure means to make something known that was previously unknown. How can it be related to nursing and abused pregnant women? We know that sexual and psychical violence against women has become a public problem. Eileen R.
Giardino in Uncovering Abuse in the Pregnant Woman writes that between 9 % and 25 % of pregnant women are battered; of those who are assaulted before pregnancy, almost half can expect to be attacked again afterward. Yet, small quantity of women informs medical institutions or their physicians regarding abuse. Thats why the role of nurses in disclosure of abused pregnant women is so important. Their help can be critical in identifying the first signs of abuse as well as screening, asking questions and helping to prevent abuse in the future. Sometimes women dont tell their physicians about abuse, because they are afraid that reporting may bring to awful results, escalating violence. Some nurses simply dont ask their patients regarding abuse during pregnancy due to different reasons.
Sometimes pregnant women might have told about abuse but they were never asked about it. Some women think that they dont have any way out due to financial dependence, etc. Some women think that disclosure of abuse can endanger their safety and worsen current situation. Nurses can disclose both physical and psychological signs of abuse, such as burns, bruises, cuts, abrasions, etc depression, changes in mood, anxiety, stress, nervousness and other psychological signs. As far as nursing supposes regular screening health of pregnant women, nurses are able to disclose direct and indirect signs of abuse.
Uses of disclosure, including non-nursing literature. Lets determine the definitions and attributes of disclosure with help of literature sources (nursing and non-nursing literature). What are general definitions of disclosure in non-nursing literature? What is the meaning of this concept? IDVFN characterizes disclosure as The release of relevant information (IDVFN Financial Glossary Website). Wordnet Dictionary defines disclosure as the speech act of making something evident, whereas Websters 1913 Dictionary says that disclosure is: 1.
The act of disclosing, uncovering, or revealing; bringing to light; exposure. He feels it [his secret] beating at his heart, rising to his throat, and demanding disclosure. -- D. Webster. 2. That which is disclosed or revealed. Were the disclosures of 1695 forgotten? -- Macaulay. (Hyperdictionary. com Website) Unauthorized disclosure means an exposure of information to individuals not authorized to receive it. [INFOSEC- 99 ] (ATIS Website).
Searchsecurity. com provides us with another definition of disclosure: Vulnerability disclosure is the practice of publishing information about a computer security problem, and a type of policy that stipulates guidelines for doing so. (Searchsecurity. com Website). According to Thesaurus Dictionary (2000), synonyms for disclosure are revelation, acknowledgement, admission, announcement, broadcast, confession, declaration, discovery, divulgence, expose, exposure, leak, publication, uncovering. Disclosure can relate to discovering any physical or psychological signs, changes, etc.
Defining attributes related to abused pregnant women. It is quite difficult to give definition to abuse. Actually, it is a cycle of power and control that mounts a physical, sexual, and / or psychological assault (Angeles, Th. , 2002). According to Theodora Angeles (2002), abuse can be physical, emotional, or sexual, or any combination of the three. What begins as name calling and belittling can escalate to physical violence. How can you disclose abuse?
What attributes you can find out? These can be physical marks on the body, but not necessary. Sometimes woman doesnt have physical marks, but her pain or injury can witness of abuse. Low self-esteem, depression, stress, helplessness can be the signals of abuse, caused by threats of violence and words. Unwilling or forced sex acts are also related to abuse, although they often stay unreported. Abuse is an attempt to gain control over the other person.
When a woman experienced abuse from her partner during the last year, she has a risk to be abused during her pregnancy. Other factors, which can be signals of abuse risk, are prior abuse by partners, unplanned pregnancy, abuse in the childhood, social and economical factors (unemployment, etc). Marjorie McIntyre and Elizabeth Thomlinson in Violence and Abuse: Ending the Silence recognize attributes of abuse as follows: Physical signs: hitting, beating, slapping, using a weapon, forcibly restraining, etc. Sexual: forcing to have sexual intercourse or to perform sexual acts; Psychological: name calling, verbally degrading, creating atmosphere of fear, using threats, etc.
Financial: extorting funds or property, forcing another to become dependent or stop working, withholding money, etc; Social: Forced isolation from other members of family, friends, checking and monitoring phone calls, meetings, connection with other people, etc. Physical neglect: failing to provide food, clothing, medical care, etc. Yet, which attributes can be called the defining for disclosure? Changes in behavior (fear, stresses, extreme nervousness, etc. ) can be determined as defining attributes, social changes (isolation from other members of society) and physical changes (such as bruises, injuries, which cannot be explained in a normal way, etc).
Disclosure of abused pregnant women. A model case. Lets examine model case and other additional cases to demonstrate the concept of disclosure related to abuse during pregnancy. This model case demonstrates all defining attributes of disclosure related to abuse during pregnancy. Julia, a young woman 22 years old, became pregnant. A nurse noticed signs of bruises on Julia's body during one of medical screenings.
Julia confused and said that she got bruises because she fell down. Yet, the bruises were big and symmetrical as if they were caused by dint. The nurse suspected that woman is abused during pregnancy and decided to talk with her. During the talk nurse tried to calm Julia down and explain that she is not guilty and she doesnt have to be shamed. She found out that Julia experienced abuse during her childhood. She already had a son six months old and her present pregnancy was unwilling.
Young woman was very nervous and her physical state also wasnt good. She didnt gain enough weight during pregnancy. She lost her job several months ago, when her husband insisted on it. He forced her to become a housewife and to dedicate all her time to him. He forbade her to meet the relatives and friends. In such a way we can see the main signs that disclosed abuse during pregnancy: physical, psychological and social changes.
The nurse tried to calm Julia down and proposed her a way out. It was very difficult to take decision, because Julia was afraid of her husband and her financial situation wasnt very good. Yet, she asked for help and left her husband. She didnt want her kids growing up with him. Julia got social support and her parents helped her to survive. In such a way a nurse noticed the signs of abuse and disclosed it.
She was attentive and friendly, helping woman to confess about domestic abuse during pregnancy period. Borderline case. It is the example that has several defining attributes, but not all of them. Maggie, a 35 -year-old pregnant woman is extremely nervous during her pregnancy. She is trembling from fear when her husband is approaching to her.
When he is in the office, she feels good, but when he comes back, she doesnt feel well. Her emotional state is gradually becoming worse. Her husband proposes her to leave her job in order to dedicate all her time to him and to their future child. He also doesnt like Maggie's friends and asks her to break with them.
The situation becomes worse. This is a borderline, because we dont see all defining attributes that allow us to disclose abuse during pregnancy. However, Maggie seems to experience emotional abuse form her husband. Although he doesnt make attempts to abuse her physically, he tries to isolate her from friends and to limit her contacts. Contrary Case. In accordance to Walker and Avant (1983), a contrary case is used to describe what the concept is not.
During one of medical screenings a nurse found out the symptoms of stress of her pregnant patient, Maria. Nurse asked Maria about the reasons and Maria replied that husband shouts on her. During the talk Maria said that he offends her. A husband is jealous to a future child because he is afraid that Maria will focus her attention on baby.
He started to shout on her and beating her. A nurse spoke with Maria's husband and explained that it is very dangerous to abuse woman during pregnancy and that Maria will not stop loving him because of a child. She said that a child on the contrary, will strengthen their family. The husband understood the importance of situation and stopped shouting on Maria.
In this case the husband has completely abstained from abuse. The cause of fear was the reason of his bad attitude, not the abuse. Related case. A pregnant woman confessed to her nurse that her husband constantly abuses her, shouting on her, calling her bad names and forbidding her to communicate with relatives. He has become very irritated. Nurse spoke with the husband and found out that hes lost his job.
He became nervous because he didnt know how he can find a way out. A nurse advised him to apply for a job. A husband got a job in a week and his relation to pregnant wife changed. Although the husband abused his wife, he was able to return to normal life. His wife didnt experience changes in behavior or in her social position.
Illegitimate case. A nurse noticed bruises and small injuries during medical screening of Sarah, a 25 -year-old pregnant woman. She also noticed emotional changes. A woman was very nervous and looked very upset. Sarah didnt want to speak with a nurse. During the talk nurse disclosed that husband constantly abused Sarah during her pregnancy.
Sarah was economically dependent on her husband. Yet the nurse reported on abuse and Sarah's husband was taken to prison for cruel attitude and abuse of pregnant woman. The situation worsened because Sarah didnt have funds to survive and had to go to shelter. In this case the nurse should realize all the consequences of disclosure, which was used improperly and illegitimately.
She should find another way to help a patient. Identifying Antecedents and Consequences. According to Walker and Avant, antecedents are the events or incidents that happen before the concept. Although it is quite difficult to specify all antecedents, there are several factors, which influence the concept of disclosure related to abuse of pregnant women. First of all, these are the factors of potential risk: 1) woman had experience of abuse during her childhood; 2) aggressive partner / husband ; 3) sudden changes in behavior; 4) emotional changes; 5) physical changes, injuries and other physical traumas, etc. All these are warning signals that can be the reason of abuse.
Attentive attitude of nurse to her patient also can be an antecedent to disclosure. Quite often women are afraid to speak about abuse. Sometimes nurses are so busy that they dont have time to listen to the women. So, the response of nurse to initial disclosure can be very effective for further disclosure. Nurses can ask to fill in the questionnaire and answer the questions about abuse. In such a way answers can be the reason to encourage further disclosure.
Sometimes women are not ready for disclosure because they dont know that what they experienced was an abuse. So, correct information can be also very important. The limitations to disclosure related to abused pregnant women are as follows: 1) fear of escalating violence or death caused by the perpetrator; 2) psychological vulnerability factors such as low self-esteem, shame, embarrassment, felt responsibility for the abuse, and guilt for staying in the relationship; 3) fulfillment of family responsibilities, such as protection of children and keeping the family together; 4) economic and accessibility barriers to healthcare services; 5) fear of police involvement and mandatory reporting. () According to Walker and Avant (1995), the consequences are the events that happen as results of the concept. The results and consequences of disclosure related to abused pregnant women can be different. First of all, it can leave lasting psychological effects. Some woman can experience difficulties, because of their unstable financial situation.
In each case the nurse should realize all the consequences of the disclosure. Sometimes even if a woman made a disclosure, medical institutions dont have services to respond. Nurses should be aware that there is possibility that disclosure can endanger current situation. We can assume that the consequences of disclosure can relate to critical attributes. For examples, woman can experience worsening of situation relating her social, physical, psychological or economical position.
As a result of this, a woman can experience difficulties, losing important parts of her life. The empirical referents and theoretical framework. Walker and Avant write: If we are to measure this concept or determine its existence in the real world, how do we do so? (p. 35). The empirical referents present how the critical attributes exist in reality, as far as critical attributes coincide with empirical referents.
Changes in social life are the empirical indicators. It is also can be evidenced by critical changes in life. A nurse can notice it and undertake necessary measures. Behavioral changes are more difficult to notice, because such emotions as nervousness and others can be associated with usual behavior of woman during pregnancy. The concept of disclosure related to abused pregnant women was chosen because it is a serious problem in our society.
It is a concern that requires a response at an interdisciplinary level, best achieved through a population health perspective, using the principles of women-centred health care. Such a fundamental shift however presents major dilemmas for medial and social service, and requires nurses and physicians to understand and address their own anxieties and the affects of these on their practice. (Gate, E. , 2002) Bibliography: ATIS Website. Unauthorized disclosure. Retrieved January 31, 2005. web Community Survey Project: Factors that influence disclosure of domestic abuse to providers. Retrieved January 31, 2005.
web Gate, E. (2002) Violence Against Women During the Perinatal Period: Literature Review. Copyright 2002 - 2005. Northern Family Health Society. Retrieved January 31, 2005. web Giardino, E. R. (2005).
Uncovering Abuse in the Pregnant Woman. Retrieved January 31, 2005. web Hyperdictionary. com Website. Disclosure. Retrieved January 31, 2005.
web IDVFN Financial Glossary Website. Disclosure. Retrieved January 31, 2005. web Legaldefinitions.
com Website. Retrieved January 31, 2005. web Personal Health Information Protection Act, 2004 S. o. 2004, chapter 3 Schedule A. Retrieved January 31, 2005.
web Searchsecurity. com Website. Vulnerability disclosure. Retrieved January 31, 2005.
web Thesaurus Dictionary. Second Edition. HarperCollins Publishers, 1993, (reprinted 2000). Thomlinson, E. (2005).
Violence and Abuse: Ending the Silence. Retrieved January 31, 2005. web Use and Disclosure of Protected Health Health Information. Approved by Mayo Jacksonville Administrative Committee. March 5, 2003. Retrieved January 31, 2005 web Walker, L.
O. , & Avant, K. C. (1995). Strategies for theory construction in nursing (3 rd ed. ). Norwalk, CT: Appleton & Lange.
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Research essay sample on Low Self Esteem Violence Against Women
