Nurses and Child Abuse

Introduction

Child abuse and maltreatment is an issue that has continuously dug its roots into the contemporary society. As much as they may be viewed casually, these practices have long-lasting effects on the children, which may haunt them to their adulthood and completely change their lives in a way that was never to be. Nurses have a major role to play in the identification and reporting of cases of abuse against children since they are the closest individuals who interact with families.

It is important for nurses to identify any traces of abuse at earlier stages for appropriate interventions to set in order to prevent the development of adverse consequences of abuse within the involved children. Evidence-based practice stands out to be an effective way through which prevention can be applied as an intervention in potential cases of child abuse. However, there is need for further research on the application of prevention as an intervention and the use of evidence based practice in such cases.

Literature Review

During my break, I was sitting in a corner when I observed in the periphery of my vision, a father shove and corner his son into the corner of a hallway. I happened to be in the opposite side of the hallway, but I was obscured from the father’s vision. I observed as he grabbed the child and sat him down in a very physical manner. The man then proceeded to talk the child down, at times raising his voice. In my estimation, it was as if he assumed that there was no one in the hallway. Form the physique of the child; he looked to be about 8 years old. They were communicating in a different language, and therefore, I could not make out what they were saying. I did not detect any harm to the child. It seemed to me that perhaps the child had attempted to run away into the streets, and this had caused the parent to become overly anxious, hence their reaction.

The above incident characterizes a key nursing issue. It deals with the ethical conduct of nurses in dealing with issues such as the abuse of the child and the disclosure of such occurrences. Children are particularly made vulnerable by their overdependence on adult parties for the provision of amenities that lead to the satisfaction of their needs (Kearney, 2007).

In many, if not all instances, these needs are usually met by the child’s parent/guardian. However, research indicates that parent’s contribute the greatest deal to domestic violence and sexual assault (Ben Natan, Faour, Naamhah, Grinberg, & Klein‐Kremer, 2012). Child abuse contributes to long-term physical, psychological and emotional effects to the child. When exposed to maltreatment, children stand in a position of developing biological, social, cognitive, and emotional impairments.

Such children also develop psychiatric disorder in their adulthood. Studies have shown that children who are exposed to experiences of abuse are likely to develop deviant behavior including the use of illicit drugs and risky sexual behavior. They are also prone to healthy problems such as development of chronic diseases such as cancer. These behavioral consequences are due to changes in the brain structure band functioning of the affected children and the interference of the stress system (Gonzalez & MacMillan, 2008).

The role of nurses in identifying such children who are abused and reporting to the authorities has been highly emphasized by various researchers. Adams (2005) maintains that nurses have a role to play not only in the identification of cases where children are being abused, but also the identification of potential cases of abused, to allow for an intervention that would protect them against such abuse. The author maintains that nurses are important in linking the families that have been identified as being at risk and the various services and resources that are required for prevention of an occurrence of child abuse (Adams, 2005). For such a prevention to be effective, both its ethical and moral nature must be adequately addressed. The nurse should adopt an approach that is aimed at changing the society’s view of children. Adam (2005) maintains that the guiding principle for the interventions should be to achieve a societal environment where the children are treated in the same way as adults.

It is important for nurses to apply proper identification techniques in order for interventions to be introduced at the correct time and to avoid cases where the child develops adverse effects of maltreatment and abuse. Nurses are highly trained to identify cases of mistreatment and neglect among children through an analysis of their behavior. After identification of such cases, nurses should use the correct reporting procedures as outlined by child abuse legislation, and forward these cases to Child Protection Service (CPS) agencies for proper interventions to be carried out (Davidov, Nadorff, Jack, & Coben, 2012).

Studies show that as much as nurses have the responsibility to identify and report cases of abuse among children, at times they are faced with challenges especially in cases where reporting the incidence is not the best solution for helping the child. In such cases, the nurses remain in a dilemma on whether to stick to their obligations or to consider the child’s safety.

Analysis of Literature

It is important to note that various studies have been carried out on the need for nurses to intervene by reporting cases of child abuse in order to prevent the occurrence of adverse effects. However, fewer studies have been conducted on the effects of such abuse on the children, with most of the studies directed towards the psychological impact of abuse. According to the literature review, the most significant responsibility that nurses have is to protect children from abuse through early identification of children who are at risk and reporting such cases to the correct authorities for proper interventions to be initiated.

In view of the literature review, it is also evident that as much as there are many cases of child abuse in the society identified by nurses, only a few of these cases are reported to the authorities. This is due to the fact that the nurses lack the confidence to report such cases, as they believe that they could worsen the situations of the children involved. However, through embracing evidence-based practice, nurses can be able to gather enough evidence that would provide strong grounds on which to lay their case.

In evidence-based practice, nurses can employ various tools of analysis such as systematic reviews to assess the evidence of abuse on children. In this view, they can be able to use the evidence in identifying the interplay of the determinants. Through applying evidence-based practice, nurses can be able to find enough evidence that would help both in preventing the occurrence of abuse and offering therapy to children who have already succumbed to abuse.

The nurses can be able to incorporate obtained evidence in the child protection practices that they engage in during intervention. It is important for the nurses to ensure that they critically analyze the evidence collected in order to establish both the strengths and the weaknesses of recorded literature, and to identify any gaps in the evidence. According to Lisa (2008), evidence-based practice also has a disadvantage in the sense that the information gathered in form of evidence may be weak and thus form a weak basis onto which to lay one’s case and intervention strategies (Coles, 2008). Thus it is important to consider both the informal knowledge and formal evidence in developing any intervention measures.

Best Practice

Nurses have a duty to ensure the safety of their clients. Though they are obligated by law and by their ethical code of conduct to ensue the confidentiality of reports related to the patient, they also have a duty to report incidences of risk to the patient. In the case of children, the nurses have a duty to report any incidence of maltreatment, abuse or harassment to child protection service agencies. Nurses undergo training that facilitates the easy and proper identification of mistreatment, or neglect (Coles, 2008). They should make use of this training to assess a child’s situation and behavior and determine whether there is indeed a case of improper care for the child.

If such a case is perceived to exist, the nurse should take action to alleviate the likelihood of occurrence of actions that have serious outcomes on the child’s life. It may not be possible to entirely eliminate the threat to the child’s life, as inquiries into fatal child incidences have revealed. Nonetheless, what matters is that the nurse should act professionally or at least in good faith. Professionalism will be portrayed in the assessment of the circumstances facing the child, and the procedure they follow in dealing with this situation.

Education and Training

As has been mentioned, there are guidelines addressing how the nurse should deal with the case of child abuse or neglect. Moreover, it has also been pointed out that in the course of their education, nurses receive training which is aimed at ensuring that they can successfully and accurately identify such cases of child mistreatment. There are various interventions that nurses can undertake. These include early childhood home visitation, parent education program, child sexual abuse prevention programs and abusive head trauma (Davidov et al., 2012). Undertaking in this intervention requires that nurses are professional. Moreover, it is imperative that they employ evidence-based practices. Such practices involve the use of evaluative tools to analyze the evidence on abuse. Secondly, the nurse should evaluate the likelihood of the existence of a causal factors playing out. Before embarking on treatment, the nurse ensures that the preventive and therapeutic measures are grounded in sound evidence.

The use of the above tools as well as the evidence based practice model is important for the nurse in providing a sound framework for the execution of the nurse’s duties. This is why nursing training focuses on these areas. A sound approach is necessitated by the sensitivity of children. An inaccurate evaluation will mean that the instance of child abuse may not be detected.

On the other hand, the lack of evidence may lead to the dismissal of the case, and this may lead to a backlash against the child (Ben Natan et al., 2012). This will exacerbate the risk facing the child, thereby endangering them. In this case, poor practice on the part of the nurse will have led to a detriment on the situation facing the child. This emphasizes the importance of evidence based practice and the use of evaluative tools in promoting child safety and facilitating effective disclosure of risks facing children

Options for Future Research

Nurses can engage in future research to provide more knowledge on prevention as an intervention, since it is a vital part of protecting children from abuse. Currently, there is no clear definition of prevention as an intervention in the protection of children against abuse. The existing basis for evidence-based practice is counteracted inadequate theory and research (Coles, 2008). Thus, nurses can engage in researches that would enable them to come up with both quantitative and qualitative evidence, and theories that can be effective in successfully applying evidence-based practice in prevention.

In most cases, as a result of the nature of abuse, tacit knowledge is more likely to be applied in prevention, when such knowledge cannot be shared formally. Thus, it is important for further research to be conducted to build on more reliable formal knowledge that can be effectively shared. It is important for nurses to carry out further research on the causes of child abuse in order to effectively act preventatively.

Conclusion

Child abuse and maltreatment is an issue that has continuously dug its roots into the contemporary society. The consequences are grave for a child’s physical and psychological wellness. The pain haunts them to their adulthood and completely influences their lives in a way that was never to be. There are laws and regulations as to how these cases can be handled, and different stakeholders have a role to play to stop, minimize or deal with such situations when they have happened. Medical professionals, and especially nurses, have a role to investigate and report child abuses cases when there is suspicion that it could be happening.

The key to dealing with child abuse comprehensively is identifying them, punishing the culprits and helping the victims. It is important for nurses to identify any traces of abuse at earlier stages for appropriate interventions to set in order to prevent the development of adverse consequences of abuse within the involved children. One of the most effective way to prevent and deal with child abuse cases is evidence-based practice. However, for this to happen, nurses and other stakeholders such as community workers and parents need appropriate education and awareness on how to identify abuse, how to avoid environments that support the vice, and how to react when it has happened. In addition, there is need for further research on the use of evidence based practice and prevention as methods of intervention.

References

Adams, B. L. (2005). Assessment of child abuse risk factors by advanced practice nurses. Pediatric Nursing, 31(6), 498-502.

Ben Natan, M., Faour, C., Naamhah, S., Grinberg, K., & Klein‐Kremer, A. (2012). Factors affecting medical and nursing staff reporting of child abuse. " International nursing review, 59(3), 331-337.

Coles, L. (2008). Prevention of physical child abuse: concept, evidence and practice. Community Practitioner, 81(6), 18-22.

Davidov, D. M., Nadorff, M. R., Jack, S. M., & Coben, J. H. (2012). Nurse home visitors’ perspectives of mandatory reporting of children’s exposure to intimate partner violence to child protection agencies. Public Health Nursing, 412–423.

Gonzalez, A., & MacMillan, H. (2008). Preventing child maltreatment: An evidence-based update. Journal of Postgraduate Medicine, 54(4), 280-286.

Kearney, K. (2007). The nurse's duty to report child abuse versus the attorney's duty of confidentiality: The nurse attorney's dilemma. Journal of Nursing Law.