Transcript COUNTRY EXPERIENCES ON ADOLESCENT REPRODUCTIVE …

Bulgaria
Assist. Prof. Petya Trendafilova, MPH, RN
Faculty of Public Health, Medical University - Sofia
Pepa Vassileva
Daniela Gerassimova
National Health Policy Directorate, Ministry of Health
Bucharest, 9-10 January, 2008
Bulgaria
Demographic data
 Population: 7 718 750
- male - 4 269 998
- female - 4 399 271
 Age groups:
- under working age: 14.8%
- working age: 62.4%
- retirement age: 22.8%
 Life expectancy: 72.55 yrs
 Birth-rate: 9.2%
 Mortality rate: 14,6%
 Population growth: -5,4%
Child registered cases of
violence
2001 - 2006
2500
2000
1500
1000
500
0
2001
2002
2003
2004
2005
2006
Child violence according to the
place of perpetration
Child violence
in general
Family
Violence (IPV)
Street
violence
Violence in
educational
institutions
Violence on
public places
Violence in
specialized
2001
2002
2003
2004
2005
2006
75
632
1995
2181
1429
1742
47
420
1614
1487
1103
1435
62.7%
66.5
81%
68.2
77.2%
82.4%
60
80
188
119
112
9.5%
4%
8.6 %
8.3%
6.4%
9
78
206
311
114
110
12%
12.4
10.3%
14,3%
8%
6.3%
8
40
36
45
43
69
10.7
6.3%
1.8%
2.1%
3%
4%
11
34
59
150
50
16
14.7
5.3%
2.9%
6.8 %
3.5%
1%
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Hot Telephone Line for IPV:
+359 2 981 76 86
Statistics
15 487
accepted calls since 1998
2500
2000
1634
1500
1061
1000
500
0
1776
1954
1687
1821
1522
1482
1328
1222
Gender and IPV
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Gender role and identity usually
include gender inequality in rights and
misbalance of power between men and
women.
Violence against women and its
acceptance in society as a whole is one
of the manifestations of gender
inequality.
Attitude of civil society toward IPV
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NCSPO in Bulgaria announced the results from a
comparative study of the public opinion towards
IPV and according to it 53,7% of people think
that the problem is personal and there is no
need to be taken any actions to prevent IPV.
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Public opinion states that the reasons for IPV
could be: financial problems, unemployment,
bad upbringing/behavior model, violence in the
childhood period, stress, professional problems,
non-punishability of domestic violence, violence
that can be seen on TV etc.
Working with people
experienced domestic violence
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Police Departments
Social workers
NGOs
(Emergency) medical care personnel
Prosecutors
Courts
- under The Family Code
The Law on protection against DV
The Law on child protection
Basic nursing preparation
programs in Bulgaria
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BSN - 4-year University - 1940 h = 159
credits (not include practice hours)
Practice Clock Hours for BSN;
- Clinical practice – 1860 h = 61 credits
- Before graduate probationary period –
800 h = 20 credits
Significant changes in the
nursing curriculum
Since 2007 in Bulgaria:
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In 2010 the first graduate students will become
nurses with university bachelor degree.
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All the other nurses, who already have a college
diploma, confer by a law the same status as the
new students.
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Before 2007 the curriculum did not correspond
with EC Directives 77/452/EO and 80/154/EO to
cover 4600 academic hours = 240 credits.
IPV Definition
Intimate partner violence (IPV) is essentially a
pattern of behavior which is characterised by:
 the exercise of control and the misuse of power by one
person, usually a man, over another, usually a woman,
within the context of an intimate relationship. (Greater
London Authority 2001)
It could include:
 physical, sexual, emotional, and financial abuse, and the
imposition of social isolation and is most commonly a
combination of them all (Addressing Intimate Partner
Violence - Guidelines for Health Professionals in
Maternity and Child Health Care).
Responsibilities of health
professionals
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recognize violence
bring up the issue of violence
interview, support and advise the victim
assess the dangerousness of the situation
carry out a careful medical examination and
statement
document the impact of violence (injuries,
psychological impact, etc.)
talk about the children
report the violence in accordance with child
protection laws
refer victims to other help providers
co-ordinate co-operation with other professionals
Specific role of health
professionals
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The role of health professionals is crucial in
identification of and assistance to victims
of IPV.
The specific role of health professionals is in
identifying victims of violence and in initiating
a process of ending this violence. It is
therefore important that they co-operate
with other help providers and authorities.
To better meet the needs of IPV victims,
medical professionals should receive training
not only on the physical consequences of
intimate partner violence but also
appropriate training and adequate
intervention strategies.
Need of professional training on
violence (IPV)
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Ensuring special training on violence for professionals confronted
with violence (IPV):
- to give them the means to detect and manage crisis situations
and improve the manner in which victims are received, listened
to and counselled (concept of gender, all forms of violence, the
situation of victims, their coping and support needs, influence of
violence on health, appropriate tools for identification of victims of
violence, means for securing evidence of violence; methods of
consultation, rehabilitation, and/or reintegration into society);
- to raise awareness and change attitudes regarding domestic
violence (IPV)
Initial vocational training on a compulsory basis: academic course
of education required to enter a profession including specific training on
violence IPV) offered to all students - nurses and midwives;
Further education: recommend The Associations of Health
Professionals to organize further specific in depth education on violence
(specifically on methods of prevention and intervention).
The challenge to teach IPV
Violence against women puts a heavy burden on the
health system, it reduces:
 women’s working capacities;
 the quality of their lives and their lifespan.
In highly developed countries like the US partner abuse is
the most common reason for injuries in women.
Violence does not stop during pregnancy. The time of
pregnancy and after delivery can pose an even greater
threat to women to be afflicted by intimate partner
violence.
The real challenge is to develop tools and methods for
teaching and mentoring the students about such a
sensitive issues as gender based violence is.
IPV and practice training of
nursing students
Recognising violence:
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Indicators of physical violence:
- Injuries: bruises, wounds, bone fractures, concussions, tooth
injuries, scalp injuries, internal injuries, miscarriages, eardrum
ruptures, burns; Severity of injury ranges from minimal tissue
damage, broken teeth and bones to permanent injury and death;
Indicators of sexual violence: any non consensual sexual
activity including sexual taunts and jokes, staring and leering,
unwelcome comments, indecent exposure, offensive phone calls,
unwanted sexual propositions, forced viewing of or participation
in pornography, unwanted touching, coerced sex, rape, incest,
performance of forced sexual acts which the woman finds painful
or humiliating, forced pregnancies, trafficking in women, and
their exploitation by the sex industry;
Indicators of financial violence: poverty, homelessness, debts,
unable to provide food and necessities for the family, unpaid
bills/inability to pay bills, inadequate food/clothing, unexplained
discrepancy between income and living conditions;
IPV and practice training of nursing
students
Psychological trauma caused by violence:
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Acute trauma reactions - shock reactions:
- Observable behavior/symptoms;
- Emotional/cognitive symptoms
- Long Term Symptoms (PTSD (Post-Traumatic Stress
Disorder)
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Consequences of trauma - the impact of trauma makes
it very difficult for women to leave a violent partner:
- this model of behavior produces emotional bonds and
reduces the victim’s ability to make decisions
independently
Teaching skills of teachers in health
care sector
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Develop pedagogical skills to teach IPV;
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Meet new challenges originated from practical
work in health care sector both at national and EU
level;
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Develop tools and methods for teaching and
mentoring the nursing students about gender
based violence;
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Develop teachers’ involvement in curriculum
development in teaching IPV.
Teaching IPV in curriculum of
nursing students
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What has been done?
Elective courses – topics: How to interview patients (special
attention to IPV victims); Children psychology and
pedagogical approaches; Course of psychotherapy for victims
of IPV.
What should be done?
We have to provide the health professionals with support to
recognize violence at an early stage and prevent further
violence.
Development needs: to protect children as well as primary
prevention of violence occurring in the family; to be given
adequate support in case of IPV; special training on IPV, its
consequences for women and children and on how to use
different tools to prevent IPV.
Problems: Implementing compulsory IPV training courses in
the curriculum of nursing education; A lack of special training
and teaching tools for teachers on IPV (teachers have not
received advanced training on IPV).
Relevance of the project proposal
for the nursing curriculum
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Estimation of the relevance of the project for the
curriculum development work.
Violence against women is a phenomenon which has
constantly evolved with the passage of time but which
remains more present than ever within our society.
The family environment is the scene of the most
violence of all types against women and children.
The health professionals, especially nurses should
participate in solving problems connected with IPV.
Violence against women is a very sensitive issue to
teach as it is sensitive to handle in health care
organizations’ everyday practice. Therefore the
teachers/trainers, students and health care
professionals need special knowledge and skills
for their everyday work.
Training, supervision and other
support for health professionals
Ways to maintain professionalism and well being:
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Knowledge the causes and impacts of violence against women
and children;
Networking of public authorities and other social partners:
violence issues require collaboration between different
authorities and development of a network;
Supervision should be self-evident for everyone working in a
caring profession, but it is especially important for those working
with violence;
Consulting: it is recommended that health professionals can
turn to an experienced person in their own field or to a special
expert of another field regarding specific questions like legal
issues;
Continuous training: help providers should receive special
training on the methods in violence prevention in addition to
their professional education.
Expected outcomes
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More effective cooperation between the government,
medical universities and the civil society;
The implementation of united standards and criteria
for health care professionals for work with people
experienced IPV;
Awareness-raising activities targeted to a specific
audiences;
Increased capacity for adequate response and
professional development of health care professionals by
implementing the new training programmes teaching
IPV issues;
Increased knowledge on violence (IPV) and
aggression – reasons, consequences and opportunities
for help and support on a national and EU level.
THANK YOU !