Violence against children and adolescents by nursing staff: prevalence rates and implications for practice

A critical perspective on institutional violence against hospitalized children: Testimonies by health professionals and family members

The purpose of this study is to understand institutional violence (IV) in the relationships between health professionals, hospitalized children, and family members. This is a qualitative study developed at the pediatric inpatient unit of a university hospital in the city of Salvador, Bahia, Brazil. The research participants consisted of 39 health professionals who specialized in pediatrics and 10 family members of hospitalized children. Semi-structured interviews were the method used for data collection. Using discourse analysis as a basis and taking a Foucauldian perspective, the researchers observed that the expressions of IV could be traced to abusive power relations within the system. We found four discursive forms within the data set: communication problems as IV, violence through inattention and neglect, violence as an action and consequent materialization on the body, and psychological violence as a submission mechanism. Based on these findings, we argue that professionals, managers, the scientific community, and users might be able to better guarantee the safety of children by recognizing IV and effectively intervening in it.

Health-related quality of life after child maltreatment in institutions: Results from a representative population-based sample in Germany

BACKGROUND

Child maltreatment (CM) is a major public health problem associated with enormous consequences, including impaired health-related quality of life (HRQOL). While the consequences of CM that occurs in the family context have been studied numerous times, studies on the consequences of institutional CM are lacking. This is of particular importance because cases of CM in churches, sport clubs and school, educational and medical settings have become increasingly apparent in Germany.

OBJECTIVE

Thus, the objective of this study was to assess the association of CM in various institutions with HRQOL in adulthood.

PARTICIPANTS AND SETTING

In a cross-sectional observational approach, a representative sample of the German population (N = 2516) was identified via a random-route.

METHODS

Socioeconomic information, HRQOL and CM experiences in school, medical and educational institutions were obtained and statistically evaluated.

RESULTS

Of the 2516 participants, 834 (33.14 %) reported CM in institutions and 1194 (47.46 %) reported impaired HRQOL. Participants who reported CM in institutions were more likely to have HRQOL impairments than participants who had been in the respective institution in childhood but had not reported having experienced CM there. In the case of CM in medical institutions, HRQOL impairments increased 2.2-3.9-fold. If CM in school was reported, HRQOL impairments increased 1.6-2.0-fold. If CM in educational institutions was reported, HRQOL impairments increased 2.1-2.7-fold.

CONCLUSIONS

CM in institutions is associated with an increased likelihood of HRQOL impairments in Germany. Institutions need to be aware of the risk of CM and safeguarding measures should be implemented.

Perceiving violence against healthcare workers in a child and adolescent emergency psychiatric ward in Hungary: a qualitative pilot study

Aim

Psychiatry is a challenging setting that requires extraordinary effort from the staff. Healthcare workers in the field of psychiatry face substantial levels of violence, making the identification of abuse risk factors a social concern. Both the conduct of the children and their relatives can pose potential harm. Our study delved into the criminological and psychiatric factors underlying violence against healthcare workers.

Methodology

We used qualitative, semi-structured, self-developed, online questionnaire involving 21 respondents. The participants were representing the staff composition of our department. The data set was coded in two phases using a multi-stage content analysis method. The results were compared with Hungarian and international literature.

Findings

Among the participants, 52% reported no instances of physical abuse. The most prevalent form of perceived non-contact abuse was threats, accounting for 38% of reported cases. The identified risk factors for abuse included the child's psychiatric disorder, communication issues, parental behavior, and low socio-economic status. Psychological trauma was identified as the most severe consequence. The respondents' opinion indicated that the most common cause of violence (52%) was attributed to the child's mental disorder. Workers primarily deal with abuse through negative emotions, with 76% of them reporting feelings of victimization. Additionally, 43% believed that abuse cannot be avoided, while 19% emphasized the significance of worker competence.

Value

Our research can help to identify risk factors in child psychiatry wards and provide guidance for developing effective responses to violence against healthcare workers in Hungary, especially at our ward.

Impact of housing conditions on changes in youth's mental health following the initial national COVID-19 lockdown: a cohort study

We aimed to investigate if declines in youth’s mental health during lockdown were dependent on housing condition among 7445 youth (median age ~ 20 years) from the Danish National Birth Cohort (DNBC), with data collected at 18 years of age and again three weeks into the first national lockdown (April 2020). We examined associations between housing conditions (access to outdoor spaces, urbanicity, household density, and household composition) and changes in mental health (mental well-being, Quality of Life (QoL) and loneliness). We report results from multivariate linear and logistic regression models. Youth without access to outdoor spaces experienced greater declines in mental well-being (vs. garden; mean difference: − 0·75 (95% CI − 1·14, − 0·36)), and correspondingly greater odds of onset of low mental well-being (vs. garden; OR: 1·72 (95% CI 1·20, 2·48)). Youth in higher density households vs. below median or living alone vs. with parents only also had greater odds of onset of low mental well-being (OR: 1·26 (95% CI 1·08, 1·46) and OR: 1·62 (95% CI 1·17, 2·23), respectively). Living in denser households (vs. below median; OR: 1·18 (95% CI 1·06, 1·33), as well as living alone (vs. with parents; OR: 1·38 (95% CI 1·04, 1·82) was associated with onset of low QoL. Living alone more than doubled odds of onset of loneliness compared to living with parents, OR: 2·12 (95% CI 1·59, 2·82). Youth living alone, in denser households, and without direct access to outdoor spaces may be especially vulnerable to mental health declines.

[Child health in the COVID-19 pandemic: results from school entry data and a parent survey in the Hanover region]

Einleitung

Die COVID-19-Pandemie und die damit verbundenen Kontaktbeschränkungen können für Kinder und Jugendliche besonders belastend sein. Die in Deutschland regulär durchgeführten Schuleingangsuntersuchungen liefern Daten zur Entwicklung und Gesundheit von Vorschulkindern und können Hinweise auf die Auswirkungen der Pandemie geben.

Methodik

Anhand der Schuleingangsdaten der Region Hannover wird überprüft, ob nach dem ersten Lockdown 2020 häufiger Entwicklungsauffälligkeiten und Gesundheitsbeeinträchtigungen auftraten als vor der Pandemie. Die Prävalenzen zu den Schuleingangsergebnissen der Einschulungsjahrgänge 2017/2018 bis 2020/2021 werden verglichen. Die Auswertung einer Elternbefragung gibt zudem Aufschlüsse über den Alltag und das Wohlergehen der Kinder und deren Familien während der Pandemie.

Ergebnisse

Nach dem ersten Lockdown zeigt sich, dass Auffälligkeiten in der Sprachkompetenz, der Sprachförderbedarf sowie der Anteil der Kinder, die nur eingeschränkt oder gar kein Deutsch sprechen, deutlicher zugenommen haben als in den Jahren davor. Ferner konnte eine Zunahme von Übergewicht und feinmotorischen Auffälligkeiten sowie ein Anstieg des Medienkonsums festgestellt werden. Die Befragung zeigte, dass der Anteil der Kinder, die häufiger traurig sind, im weiteren Verlauf der Pandemie auf 32,1 % und der Anteil der Kinder, die häufiger Wutanfälle haben, auf 24,9 % angestiegen sind. Kinder haben zunehmend Ein- und Durchschlafprobleme und klagen über Bauch- und Kopfschmerzen, Übelkeit oder Appetitlosigkeit.

Diskussion

Diese Ergebnisse decken sich mit anderen aktuellen Studien und liefern Hinweise auf mögliche Auswirkungen der COVID-19-Pandemie auf die Kindergesundheit. Um hierzu gesicherte Aussagen zu machen, sind jedoch weitere Auswertungen erforderlich.

Zusatzmaterial online

Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-021-03446-2) enthalten.

Häufigkeiten von Übergriffen auf Kinder und Jugendliche durch Angehörige der Heil- und Pflegeberufe

Zusammenfassung. Theoretischer Hintergrund: Kindesmisshandlung, -missbrauch und Vernachlässigung stellen ein gesamtgesellschaftliches Entwicklungsrisiko für Kinder in Deutschland dar. Zweithäufigster Kontext des Geschehens nach dem familiären Umfeld sind Institutionen. Fragestellung: Der vorliegende Artikel gibt eine Übersicht zu Häufigkeiten von Übergriffen durch Angehörige der Heil- und Pflegeberufe mit Schwerpunkt auf dem kinder- und jugendpsychiatrischen/-psychotherapeutischen Bereich. Methode: Mittels Literaturrecherche wird der Forschungsstand zum Thema dargestellt. Ergebnisse: Neben Auswertungen zu Zwangsmaßnahmen, welche von Betroffenen häufig als viktimisierend erlebt werden, existieren für Deutschland zwei repräsentative retrospektive Befragungen zum medizinischen Bereich. Hier ergaben sich Prävalenzen zwischen einem Fünftel und einem Drittel der Befragten, die mindestens eine Form von Gewalt oder Vernachlässigung bejahten. Diskussion und Schlussfolgerung: Neben alarmierenden Zahlen zeigt sich der große Bedarf an weiterer Forschung zum Thema.

[Protection Against Violence and Abuse in Medical Institutions - Reasons, Prevalence and Implications for Practice]

Protection Against Violence and Abuse in Medical Institutions - Reasons, Prevalence and Implications for Practice Reported cases of (sexual) abuse in institutions as well as the results of surveys show that violence against children and adolescents, but also against adults, occurs also in medical institutions. There are still few studies on the frequency of these cases. However, the cases that have come to public attention show that medical institutions bear systemic risk factors for such assaults. On the other hand, medical institutions also play an important role in child protection, since many children and adolescents affected by maltreatment including sexual abuse come into contact with the medical system. It is necessary that medical institutions deal with this problem and develop respective institutional protection concepts. A protection concept is a system of measures that ensure better protection against assaults within an organisation. Important steps are analysis of risk factors, structural changes, the creation of plan of procedures and the development of an institutional attitude that assaults are not tolerated. Although the development of protection concepts takes time and resources, it has many advantages for institutions, such as an increased sense of security for professionals, because they know how to proceed in such situation. Now that the obligation to draw up protection concepts is anchored in the quality management guideline of the Federal Joint Committee (G-BA), all hospitals and practices must set out to develop appropriate concepts.