Situation Simulation in Nursing | Research

Situation Simulation in Nursing | Research INTRODUCTION Background In nursing education, simulation is a mainstay for clinical learning (Tanner, 2006), particularly in the areas of safety, problem solving, and communication (Durham Alden, 2008). Also simulation-based education leads to improved self-confidence in performance (Cant and Cooper, 2010) According to Jefferies (2005), successful learning using simulation requires alignment of the design, teaching activities, competencies, and learning outcomes. The case scenario, including simulations of actual clinical problems, provides an interactive learning environment, engaging students in the learning process and encouraging them to make connections between and among concepts. Environmental interactivity and feedback typically is achieved through the use of a high-fidelity patient simulator supplemented with role-play techniques (Good, 2003). Although simulation has been used successfully, more recently, in medical and nursing education programs (King Reising 2011; Tan, Ti, Ho, Lee, 2002), its use as an evaluative tool is still not fully developed. Student performance evaluation is a very important step during simulation-based practice. There is limited research in the use of simulation in nursing education and the evaluation of student competency (Reed, 2010). The instrument, developed by Jenkins (1985), is a self-report measure in which respondents are asked to identify processes or strategies used in deriving clinical decisions. Because one used for evaluating the quality, the validity of a general self-report measure would be questionable. Faculty evaluation of student performance was found to be the primary evaluation method, with student report of performance second and evaluation of videotaped performance third (Nehring Lashley,2004). Radhakrishnan et al.(2007) described using simulation to evaluate clinical skill performance in several areas: safety, basic assessment, prioritization, problem-focused assessment, ensuing interventions, delegation, and communication. Lasater (2007) also developed Lasater Clinical Judgment Rubric (LCJR) based on Tanner’s Clinical Judgment Model (noticing, interpreting, responding, and reflecting). The LCJR defines what is meant by noticing, interpreting, responding, and reflecting with 11 dimensions with four scale levels. Although, LCJR has relevance for all clinical contexts, including acute care, long-term care, and community health (Lasater, 2007), for simulation evaluation with emergency situation such as asthma, competency evaluation in clinical decision making should be undertaken. It is reported in both the nursing and medical literature (Edwards, 2007; Ottestad, Boulet, Lighthall, 2007) that real-time observation may be necessary to appropriately evaluate clinical decision making because it can reveal contextual and communication factors that may not otherwise be uncovered. Furthermore, to enhance the effectiveness of simulations in nursing education, a reliable and valid evaluation instrument is needed to measure students’ performance. Asthma mostly leads to emergency conditions because it shows spasmodic respiratory relapses and unpredictable occurrences. Especially, if asthma continues for a long time, it can progress into chronic lung disease and patient can experience suffering (Ko et al., 2010). Therefore it has to be considered as first priority problem in nursing care and nursing students must be prepared to provide emergency nursing care with high-fidelity simulation experiences for caring patients with asthma. Accordingly, simulation modules may help to provide a comprehensive understanding of asthma and asthma management. The purpose of this article are ; (a) to develop a scenario for patients with asthma for simulation education of nursing students, (b) to develop the evaluation checklist, and (c) to evaluate students’ performances. METHODS Design This study is a methodological study to evaluate students’ performance according to developing and applying of simulation scenario for patients with asthma in emergency units. Context and Participants The study was conducted at a regional school of nursing that offers a Bachelor of Nursing program in South Korea. In 2013, following ethics approval, third year (N=112) nursing students undertaking their first simulated learning experience were informed about the study. Total participants were divided 28 groups and the member of each group was 4 students (the role of doctor, nurse1, nurse2, family). The allocation of team and participants` role was assigned by randomization. The participants ages ranged from 20 to 24 years. The majority of students (88.9%) were women. Development process of asthma scenario with algorithm and evaluation checklist nursing journals (Poirier et al., 2000; Sarrell et al., 2002; Walsh et al. 2006). Issues included signs and symptoms of dyspnea, coughing with sputum, and anxiety related to the validity of the simulation evaluation by expert review. This scenario was based on a real dyspnea case with asthma that had occurred in emergency center of general hospital. To evaluate student performance in simulation, a team of researcher developed a template of an evaluation tool to include key elements from simulation course objectives. The following three main contents were identified: patient safety (infection control and error identification), communication, and critical thinking related to patient assessment, problem identification with nursing diagnosis, and intervention with evaluation. The items of evaluation checklists were selected, reviewed, and analyzed by 9 expert panel including 2 internal medicine doctors, 3 emergency center nurses, and 4 nursing educators. All items of checklist include a core set of key behaviors expected in this simulation course. The evaluation checklist based on three main contents (patient safety, communication and critical thinking) was formulated according to nursing process Finally, 4 items were deleted and 24 items reached by consensus (Table 1). The preparation subdomain consisted of three checkpoints, while the assessment subdomain was divided into seven checkpoints. Three nursing problems were included in the problem identification subdomain. The intervention with evaluations subdomain consisted of eleven checkpoints (Table 1). The evaluation checklist score was based on a 3-point Likert scale (1: not fulfill, 2: partially fulfill, 3: fulfill). The higher the evaluation checklist score, the higher the performance rating. Content validity is an important part of scale development because the results gained from an instrument with high representative nature are more reliable (Waltz Bausell, 1981). Content Validity Index (CVI) is a commonly used indicator of scale validity and in particular content validity. A content validity test was conducted with 10 nurses who worked in a medical-surgical unit in one of the three general hospitals sampled; each had at least three years of experience in the unit. According to Lynn (1986), an expert panel ideally includes about ten people. Each expert checked validity using the 4-point Likert scale; 1 means ‘not validate at al’, 2 means ‘not validate’, 3 means ‘validate’ and 4 means ‘very validate’. There were 24 items in total; the mean score of each item ranged from 3.30 to 3.90. The results of the Content Validity Index were above 80% (Waltz Bausell, 1981). Data collection A 20 minute scenario requiring students to use their clinical reasoning ability to identify and respond to a deteriorating ‘patient’ with asthma was presented. Four nursing students were engaged in the simulation at the same time. One operator and one instructor observed the simulations from the control room. Evaluators had simulation exercise for conformity degree of evaluation using two group students selected for evaluation practice. The evaluation of students’ performance was completed two times, immediately following simulation practice and reviewing of video-recording by two instructors. For accurate evaluation, evaluators rechecked and discussed item by item to decrease evaluation bias replaying video. Their performance was evaluated as a group. Data analysis method Collected data were analyzed using SPSS 18.0 for Windows (SPSS Inc, Chicago, IL) to calculate descriptive and t-test statistics for the evaluation checklist. RESULTS Algorithm with a scenario of simulation-based asthma management The simulation-based asthma scenario in this study was developed to identify and solve patient’s problems applying nursing skills and utilizing critical thinking. Development of this scenario was based on a real dyspnea case with asthma that had occurred in an emergency center. 1. Learning objective Learning objectives were formulated as follows: Explain pathophysiology of asthma Assessment of asthma patient Explain medication and effects of asthma drug Identified nursing diagnosis based on critical thinking Effectively communicate with the patient and colleague Implementation of evidenced based adequate nursing interventions 2. Development of a simulation-based asthma scenario The contents of scenario based on four steps was formulated; preparation, assessment, problem identification, interventions and evaluation. The preparation subdomain was consisted of the preparation content that should be cared for patients who admitted to emergency unit. The assessment subdomain were included in check the chief complaint, identify symptom related to chief complaint (dyspnea pattern, cyanosis, delayed expiration, pallor, color of mucus membrane, check SpO2, identify vital signs, auscultate respiratory sounds, check EKG rhythm with cardiorespiratory monitoring equipment), and identify past history. Problem identification subdomain organized that student can be present nursing diagnosis related to asthma; 1) Ineffective airway clearance related to excessive secretion, 2) Ineffective breathing pattern related to airway obstruction, 3) Anxiety related to dyspnea. Intervention and evaluation were organized focusing on the nursing process for dyspnea care(high fowler`s position), encourage of deep breathing (pursed-lip breathing, abdominal breathing), notify doctor and receive treatment order, administration of O2 and medication, nursing care for dyspnea control(drainage sputum with coughing), reassess patient`s condition(vital signs repeatedly, SaO2, EKG monitoring, respiratory status, physical examination, , SpO2, ABGA), educate coping behavior when symptoms are aggravated(deep breathing, coughing, drinking water, and aging nurses), support patient and family with therapeutic communication(explain easy, listening, relieve anxiety, communicate clearly with peers), arrange materials and instruments and wash hands, and record the nursing implementations. 3. Development of algorithm The algorithm proceeded as follows: patient safety (Step 1) and critical thinking and communication(Step 2)(Figure 1). Evaluation checklist The evaluation checklist consisted of four subdomains based on nursing processes: preparation, assessment, problem identification, intervention, and evaluations. The mean score of each subdomain is shown in Table 1. Table 1. Means of Items of Developed Evaluation Checklist The total mean score of the evaluation checklist was 2.39 ( ± .15). The mean score of each subdomain was as follows: preparation 2.05( ±.49), assessment 2.52 ( ± .33); problem identification 2.74 ( ± .33); intervention and evaluation 2.22 ( ± .30). The interobserver reliability between evaluators (Cohen`s Kappa score) was 0.949 % and there were no statistical significant differences among each item. The evaluation of students’ performance In the subdomain of preparation, students showed the highest mean score in the item ‘identify patient by name care and asking’ (2.46 ±.54) while the lowest item was ‘introducing self to the patient his/her parent(s)’ (1.68 ±.86). In the subdomain of assessment, the strong practice areas that student was well done were ‘identify vital signs’ (2.93 ±.26) while the lowest mean score was ‘auscultate respiratory sounds’ (2.11 ±.73). In the subdomain of problem identification, the highest mean score was ‘ineffective breathing pattern related to airway obstruction’ (2.93 ±.83) while the lowest mean score was ‘ineffective airway clearance related to excessive secretion’ (2.55 ±.74). In the subdomain of interventions and evaluations, the highest mean score was ‘notify doctor and receive treatment order if needed’ while the lowest mean score was ‘educate coping behaviors when symptoms are aggravated’ (1.93 ±.60). DISCUSSION In this study, the contents of simulation was formulated with asthma situation which is the most high frequency and required nursing care with education to improve an appropriate coping ability of nursing students. For this, the 3rd year students who have experienced only theoretical learning about respiratory care were selected to identify clinical performance ability according to learning objectives. So, the contents of scenario in this study was focused to achieve clinical performance ability of nursing students with three main contents (patient safety, communication and critical thinking) There are few studies which was dealt with respiratory problem. A simulation scenario for emergency care of patients with dyspnea used by Hur Park (2012) included only contents to train theoretical education as the nursing process. In case of other research dealing with simulation case for patients with asthma in emergency units (Ko et al, 2010), the contents of scenario was formulated into five categories as follows: problem recognition, focused assessment, nursing diagnosis, intervention and problem resolution. However, there was a limitation about testing clinical performance ability. We suggest that three domains and contents of a scenario developed in this study are more suitable to improve students’ clinical performance. Lindsay(2010) suggest that measuring the performance of nursing care directly is more effective than using psychological variables as testing the effect of simulation learning. The evaluation checklist used in this study was developed to examine students’ critical thinking as well as their knowledge and skills in proper nursing care and validated by expert panels. The evaluation domain, which fully implements high-fidelity simulations, offers information to nursing educators about students learning outcomes. The use of simulations to evaluate clinical ability provides a more direct correlation to actual clinical settings than other commonly used forms of evaluation. The evaluation indicated that the focus was on performance rather than learning. The studys evaluation checklist would also be a useful and established guide for nursing educators evaluating student performance through simulations. This checklist describes the overall evaluation process and clarifies the evaluations target subject and procedure. This encourages students to repeat checkpoint reviews, leading to the correction of earlier mistakes. The effect of reviewing past checkpoints cr eates an integrative, rather than a static learning experience (Reed, 2010). To test evaluation validity, the consensus between evaluators was identified and showed almost similar evaluation results with no statistical significant difference. In the domain of patient safety, students showed the highest mean score in the item ‘identify patient by name care and asking, while the lowest item was ‘introducing self to the patient his/her parent(s)’. This result implies that addressing to introduce oneself to patient before caring patients as a part of simulation education is necessary. The research (Kim et al., 2013) which was developed simulation-based fever management module and evaluated student performance showed that ‘introducing self to the patient his/her parent(s)’ was identified as the lower mean score among other evaluation items. These similar results suggest that noticing themselves to the patient is so important to protect patient’s safety. In the domain of critical thinking and communication, the strong practice areas that student was well done were ‘identify vital signs’ in assessment, ‘ineffective breathing pattern related to airway obstruction’ in problem identification, and ‘notify doctor receive treatment order if needed’ in interventions and evaluations. However the weak practice areas which education and practice will be needed were ‘auscultate respiratory sounds’ in assessment, ‘ineffective airway clearance related to excessive secretion’ in problem identification, ‘educate coping behaviors when symptoms are aggravated’ in interventions and evaluations. It is required that students needs high level practice of assessment and performance skill with critical thing. Jeffries (2005) suggests that simulation education through direct participation and prompt feedback is effective learning method to reinforce clinical performance ability. In this study, theoretical class and orientation about simulation situation was given before simulation practice to find more effective nursing intervention. As a next step, students could enhance the strong point and make up week areas in the process applying nursing care with direct participation. Based on this result, we suggest that integrated simulation approach after learning of theoretical knowledge and nursing skill training could be effective education method to improve clinical performance ability and critical thinking of nursing students. The study of Kim et al (2007) supports these aspects that simulation education is more effective than lecture focused on knowledge and simple skill practice i n acquisition clinical performance skill of nursing students. CONCLUSION This study could provide a clinical performance or starting point for educators who desire to introduce simulation as teaching-learning strategy with high-fidelity simulation experiences for caring patients with asthma. The results provide evidence to support the integration of simulation as an effective teaching strategy that helps to improve nursing students` safety, problem solving, and communication in applying clinical skills using evaluation checklist. Annotated Bibliography: Portrayal of Women in the Media Annotated Bibliography: Portrayal of Women in the Media Literature Review The last 20 years has been a steady increase in the number of women professionals, although most common in the media business, politics and the economy continues to rely on men as experts in. Mostly Women portrayal news stories about accidents, natural disasters, or domestic violence instead of their professional capabilities or proficiency. Women in politics are similarly sidelined. Canadian journalist Jenn Goddu analyzed newspaper and magazine 15 years on the treatment of three women’s lobby groups. She found that journalists likely more focus on the domestic issues of the politically participated woman’s life (such as their fashion, routine life and way of living and dealing) rather than her point on the issues. Pdf _______________________________________________-04 http://www.mediaawareness.ca/english/issues/stereotyping/index.cfm Arpita Sharma, studied the Portrayal of Women in Mass Media in India. He stated that Indian sate have a free and responsible press. He investigated the issue women were sold in Eluru of Andhra Pradesh that issue news published in 1998. On such kinds of incidents he found two major aspects. One is women still only sold and purchased and unwanted away if you cursed suffer discrimination and degrading of women in various parts of the country may be a reflection of goods is considered one of the eateries. Second, but only a few sensational newspapers flashed on issues, emphasizes the role of the media in public construction. Usually, it is determined the place in the newspaper. He added that in India a few newspapers are running women’s page that represents the beauty tips, recipes and fashion. He also studied the womens magazines seek constantly to lead the feminine energies in narrow channels and define their concerns, concerns and aspirations within imposed arbitrarily framework of womens work. Apart from the looks and dresses stress it comes to the development of the mental faculties and the behavior in a way that they can fit into womens male dominated social structure. He studied the structure of the stories in magazines and described that women are described with the ambition of life get a straight man and his retention at all costs. The media advocacy group studied, the womens and mens news and current affair programs (1994) they stated that women have traditionally been associated with areas limited relationship programs. Even those women call their exterior prettified setting; can be seen to give their views on topics related to home and family. In conclusion words, Sharma says that Media in India not to discuss serious issues related to women and womens roles in society is equal to its own rights and makes a sufficient effort to ready to play. To change this situation, the benefits and disadvantages of the bride and the media constantly monitor is required. Arpita, Portrayal of Women in Mass Media The news media is changing to reflect their increasing womens representation in political status as elected representatives and community participation and and New Zealand national policy is clear. But it does not mean that the old adage applies better. Every day on television, radio broadcasts and print media increased visibility of women, in politics, structural, systematic gendering. This time, however, Women themselves with tolerance, gendering of tolerance and the representation of women in politics sexist media feeds. The media does not reflect the truth in politics or outdated, the ladies sexist images and words and concepts are mired in the private sphere about womens place (van Acker, 1999). New Zealand while on top of the world in terms of womens political resources are represented as instances of the trivialisation and condemnation, and continue to occur, in some cases, trivial media portrayals of women employed by the public relations strategies for political gain. I would suggest. Neglect, in its original form, dotted with high-profile women in the contemporary political scene, but the evidence is less relevant to the concept of womens perspectives, is still in some places is omitted. Journalism educators in the 21st century in terms of visibility/invisibility of gender theory, news and media, you must reboot for the quality of less represented. Susan Fountaine, Judy McGregor, Reconstructing gender for the 21st century: News media framing of political women in New Zealand With more than 50 State Capitol Hill each year representing the women, many women politicians have noted that the same treatment is not allowed, such as media men. In a study of women politicians on the news focuses on character traits and its policy more arguments less than male colleagues for that. 03. News coverage of female politicians focuses on personality, males on the issues Date: July 3, 2013, Source: SAGE Publications Dunaway et. al studied the Traits versus Issues: How Female Candidates Shape Coverage of Senate and Gubernatorial Races, in the State Elections of 2006 and 2008 elections, approximately 10,000 newspaper articles covering the data collected across the USA. The study authors Dunaway et. al, the focus in terms of the [political] stated that the net change between the races. The previous literature and their own expectations, in General, women candidates are racing against male races more likely the property feature stories. They found that Only 6% of the time and the character traits to choose coverage problems% 34.5 time, male-female issues from time to time the races, properties,% 10.8% focused on articles and only male selections, 33.0 character properties is focused on the issues from time to time,% 9.4% 32.1 found stories stories. The researchers concluded that, personal characteristics and properties of the candidates with a more focused news races women candidates and finding the Governor campaigns especially stark. J. Dunaway, R. G. Lawrence, M. Rose, C. R. Weber.Traits versus Issues: How Female Candidates Shape Coverage of Senate and Gubernatorial Races. Political Research Quarterly, 2013; DOI:10.1177/1065912913491464 In nature, this paper adopted the content analysis method. This did it begins with the small Big Naira Kobo, entrepreneurship is a leading national newspaper in Nigeria, a property of the column to explore womens participating in the media frame Because he was selected to work in the newspaper business desk signature page column. Analysis, paper print media framing, enhancing their socio-economic empowerment for Women Entrepreneurship is important for the world as a tool that can serve as the finish. Therefore, the Mission of becoming a real instrument of social change punch newspaper to fulfill this while maintaining his begins with the small Big Naira Kobo column property of the positive image you will have to increase the numerical quota framework womens characterization, frame. To the extent that these are three of the four women featured in the successful entrepreneur, the punch is acting as a complementary agency of women empowerment, Women womens ability to use their own aspects of the control is defined while they participate in the way of effective group work for social change. Samuel Okere, Justina Sam-Okere, Print Media Framing of Women in Entrepreneurship: Prospects for Women Empowerment IOSR Journal Of Humanities And Social Science (IOSR-JHSS) Volume 9, Issue 6 (Mar. Apr. 2013), PP 31-38 e-ISSN: 2279-0837, p-ISSN: 2279-0845. The depiction of women in the Indian media, its just a bad time is rude. Newspapers to give news about rape, crime, politics, scandals, sports and Economy, serious discussions and debates on womens issues in General is completely missing. Local media reported the woman Gets a share of only pages where the colorful portrayal of a lot of players in the TV serial or movie stars, as well as some of the warm welcome, and pin-up about the grapevine. The British press, hot babes snaps and party-Mania lives on the provision of very erotic Photo Gallery star hotels. Even sports stars are a way of depicting their physical attraction photos. The woman in the Indian media, be it Movies, TV series, news, media, Visual advertising, or modernized traditional media, social science research and studies of people indeed for a space is a big concern. Some studies have found women (status and equality of opportunity) the inevitable social issues related to the sensational stories of crime stories in the newspapers about women with less than nine percent between 52 to 63 percent. (Nitin Jugran Bahuguna) Dr. Sanjeev K. Sharma Depiction of Women in Indian Media- A Case of Introspection for Media Planners. Published in Samaj Vigyan Shodh Patrika, Amroha, Vol. I, No.1, April-Sep.2005, pp.32-36 Grant (2013) argued that analysts tend to think in terms of two broad categories: visibility, reporting and quality. How much a person shows the visibility or discussed, and how important is placed in a newspaper or news broadcast coverage. Women election participants from time to time get a lot of news coverage due to their novelty value because they associate with powerful man, as in the case of Chow, who married with former NDP leader Jack Layton is mentioned in every newspaper stories according to Grant analyses of coverage of the 2006 Canadian federal election. Such kind of women coverage portrayal women as different because of their sex, likely norm of as the men view however, it is not clear that it would be a direct electoral drawback for women. In fact, depending on the quality of the coverage more coverage may be useful for candidates. Grant also found in his study that important issue ofhowmen and women news story are covered differently. He stated that coverage of female candidates usually fall under the four categories; sex object, mother, pet, and iron maiden, each of which is equal to the representation of women in politics more generally, as well as for the danger of gender equality. However, Iron Maiden is another popular and at the same time, the male toughness while unfeminine implicitly criticized the women candidates is my discovery book news, intruder behavior with exaggerated. This news depiction of women politicians, aggressive behavior is actually harmful to the voter may be to find the book for the evaluation. He concluded that when a woman goes on the distasteful, voters’ evolutes her news stories more negatively, and a result that was not produced for her male comparators in this portion of the study. The general attitude and reporting directly link between news media under the cross-hairs of women assessing the political. Grant. G, Elizabeth News Media Coverage of Elections Contributes to Women’s Political Under-Representation 2013 http://womensuffrage.org/?p=22202 The study focused on womens issues related to the Newspapers by the welcome. The two daily newspapers in Hindi, Amar Ujala Jagran Danik is taken to work and . Both papers published and in Dehradun (capital of Uttarakhand state) circulation of Uttarakhand. Researcher analyized the newspapers about equality womens issues such as Health, education, sexual harassment, violence against women, police brutality and crime-related issues. All kinds of printed material on these issues articles, news, analysis, opinions, Editor, the letter was taken for analysis as a separate column, and etc. the year 2006 was selected to examine the contents of the newspaper. Newspapers are less indicates that the percentage of womens issues. Usually, the newspaper is a good place for an eye-catching image of women in the news; property, or ads. Womens issues in terms of sexual harassment such as more coverage to violence, crime and police brutality than the equality health, education, health coverage. The newspapers give a high rate of sexual abuse against women, developmental problems and other issues less coverage than this issue. The analysis also indicates that the given space vs. equality, health, womens education, as well as other topics to Newspapers by negligible. The newspaper society in a changing world does not provide a balanced picture of womens diverse lives and contributions to the data. He concluded that participation, representation and advancement of women in the media and its impact on access and use, and as a tool for empowerment of women. Dr Vandana Nautiyal Mr Jitendra Dabral WOMEN ISSUES IN NEWSPAPERS OF UTTARAKHAND Global Media Journal – Indian Edition/ISSN 2249-5835 , Summer Issue / June 2012 Vol. 3/No.1 Women in the absence of mass circulation Urdu language newspaper in a way that is evident in the senior ranks, in addition to smaller circulation in shaping social attitudes which the province plays a very important role in the regional press. Independent press, but applications of self-censorship and ethics, the outlook varies according to demand and audience made the newspapers. For example, while some shun the violence and disregard for others are projecting to highlight the needs of the people. The main concern in a way that the projection of women. Even while direct damage, this time the female victim, rape, wife-beating and humiliation of names through print, photo or both, always hinted at this without the permission of their privacy by. Objections to grow poor especially disadvantaged and often â€Å"made outcast. References Butt Mourion (1996) studied the portrayal of women in general press, is practically non-existent with the exception of magazine sections and limited news. The Womens lack of realism in private press and exhibits extreme offers the sad situations with fantasizing or is over-whelming portrayal. In addition, the scope of women in rural production, womens education, health, etc. is your own level of performance compared to the low level. The woman seems to be unaware of the needs of communities, and the private press skill does not address the various layers in a positive direction, whereby, in a variety of trades and social assistance programs is displayed, and a comprehensive and realistic way to portray positive women taught in different areas of our society contributes to this by the media projected us and women real projection would be a turning point for the progress and development of Women in the country. Butt, A. G. Mourion (1996). Portrayal of Women in the Communication Media, Lahore: Pakistan Women’s Institute. Gibbons (2006), in her latest study of women in journalism, found that women continue to be the breaking and making news away from the second sex. Radio, television and newspaper content on the same day, a full day after 76 countries that ignore the issues and resources for underrepresented and sometimes downright notice, regardless of the medium also commented. Women outnumber men as newsmakers in single big news. The effect of gender-based violence, intense women even stories like inserts; the judge is the voice of a man. This report, women second class status, grossly, and in general the judge reveals. Gibbons, S. (2006) â€Å"Womens Lowly News Status Is a Global Insult† Women News, Run Date: 02/22/06, http://www.womensenews.org/article.cfm?aid=2646, Retrieved on 19th July, 2006 Tiongson (1999), presented an outline of Isis International-Manila, Violence against Women in Media, a media pack, March 1998. She said that the depiction of women in the media that the victims, nurturing, selfless, obedient, and dependent, his mother and his wife, being heterosexual, sex-object, whore, mistress in Asia – the characteristic was consistent, she said and also contributing to the development process, many women workers, farmers and professionals. To make matters worse, some members of the media tend to the efforts of womens organizations or alleviate the cartoon. News womens visibility is often sensational stories, rape, sexual harassment, domestic violence and other violence-related. She further assumed that Asian media stereotypes, inaccurate and Biased media portrayal of women persistent content and pictures of stereotypical and traditional roles of women, thus perpetuating patriarchal and sexist gender identities, and to strengthen the relationships between men and women. Constant negative portrayal of women and freedom of expression in print, broadcast and Film screening has become a license for. This is an insult to womens portrayal of the nature of, in fact, its hard to pinpoint in the last few years has been more subtle and insidious.