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Zusman N, Koton S, Tabak N, Kienski Woloski Wruble AC. The mediating role of nurses' attitude towards reporting child abuse and neglect. J Pediatr Nurs 2024; 78:106-111. [PMID: 38908341 DOI: 10.1016/j.pedn.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/06/2024] [Accepted: 06/10/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Attitudes towards reporting child abuse and neglect play a significant role in determining the tendency to report abuse and neglect. In addition, Cognitive Response Theory (Shen, 2020) suggests that individuals actively process messages by producing pro and/or counter arguments referred to as "Gain - loss thoughts". However, literature positioning the variable, attitudes towards reporting, as a mediator, as well as its importance, are limited. The purpose of the study was to investigate the mediating effect of pediatric nurses' attitudes between "gain-loss thoughts" and the tendency to report child abuse and neglect. DESIGN AND METHODS A cross-sectional study examined 124 pediatric nurses working in central Israel's hospital departments concerning nurses' tendency to report (tendency to report = TTR), attitudes towards reporting, and "gain-loss thoughts" (positive and negative consequences for the child). RESULTS Most of the nurses had professional experience of 11 years or more (n = 75; 62.5%). According to the findings, nurses' attitudes towards reporting mediate the effect of gain-loss on the TTR child abuse and neglect. CONCLUSIONS Findings from this study contributed to our understanding of the importance of pediatric nurses' attitudes in determining the TTR abuse and neglect. Only nurses' positive attitudes towards reporting child abuse had a mediating effect on TTR. PRACTICE IMPLICATIONS Understanding the importance of attitudes and gain-loss thoughts can serve as a strategy for training programs and in the assimilation of reporting obligations by health professionals in general and nurses in particular.
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Affiliation(s)
- Nurit Zusman
- Head of Henrietta Szold School of Nursing of Hadassah and The Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Silvia Koton
- Head of the Herczeg Institute on Aging, Tel Aviv University; Head of PhD Program, Department of Nursing, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv 6997801, Israel
| | - Nili Tabak
- Nursing Department, Tel Aviv University, Israel
| | - Anna C Kienski Woloski Wruble
- Senior Lecturer- Research HUJI, Henrietta Szold Hadassah Hebrew University, School of Nursing in the Faculty of Medicine, Jerusalem, Israel
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Midtsund AD, Henriksen L, Lukasse M, Valla L. Detecting and preventing child maltreatment in primary care and PHNs' role-a cross-sectional study. BMC PRIMARY CARE 2024; 25:218. [PMID: 38879472 PMCID: PMC11179210 DOI: 10.1186/s12875-024-02445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Child maltreatment is a global problem that puts children at risk of mental illness, substance abuse, and premature death. Interdisciplinary collaboration is important in preventing and detecting child maltreatment. In Norway, children undergo universal preventive health assessments and receive complimentary follow-up care from specialized public health nurses in child and family health clinics. These nurses conduct regular check-ups and home visits to monitor children for signs of maltreatment. OBJECTIVE The objective of this study is to describe how public health nurses at child and family health clinics follow the National Clinical Guidelines to prevent and detect child maltreatment, with a particular focus on clinical procedures and interdisciplinary collaboration. Furthermore, we aim to determine factors that are associated with identification of child maltreatment. DESIGN A cross-sectional online survey was conducted among public health nurses working in primary care between October 24th and December 31st, 2022. Public health nurses who worked with children aged 0-5 years and had consultations with families were eligible to participate, resulting in 554 responses. The study employed descriptive analysis, including frequency, percentage and mean, as well as a two-step logistic regression analysis. The study was approved by the relevant authority, and informed consent was obtained through questionnaire completion. RESULTS The public health nurses in this study displayed strong adherence to the guidelines and utilized various comprehensive assessment procedures to monitor child well-being, growth, and development. However, there was limited and infrequent collaboration with other professionals, such as child protection services, general practitioners, and hospitals. Most public health nurses reported occasional suspicion of child maltreatment, with age and years of experience in child and family clinics influencing these suspicions. Older public health nurses were more likely to suspect physical violence, while those with less than two years of experience reported less experience in suspecting maltreatment. Additional education increased the probability of suspecting sexual violence. CONCLUSIONS This study provides insights into the practices of public health nurses in Norway regarding the detection and prevention of child maltreatment in child and family clinics. While adherence to guidelines is strong, suspicion of maltreatment is relatively rare. Collaboration across agencies is crucial in addressing child maltreatment. Age and experience may influence the detection of maltreatment. Improved collaboration, targeted guidelines, and ongoing professional development are needed to enhance child protection.
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Affiliation(s)
- Astrid Durdei Midtsund
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
- Oslo Municipality, Grünerløkka Child and Family Health Clinic, Oslo, Norway.
| | - Lena Henriksen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Division of General Gynaecology and Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Mirjam Lukasse
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Department of Nursing and Social Sciences, Institute of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Lisbeth Valla
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
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Soh HT, Bhurawala H, Poulton A, Liu A, Cush K, Griffiths G, Gandham S. Barriers to identification and reporting of child abuse and neglect experienced by medical officers and nursing staff in emergency departments of the Nepean Blue Mountains Local Health District. Emerg Med Australas 2023; 35:921-926. [PMID: 37400275 DOI: 10.1111/1742-6723.14256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE This structured survey sought to identify barriers to recognising and reporting potential child abuse by medical officers and nursing staff in the EDs of three Western Sydney hospitals. These include a large metropolitan teaching hospital, a small metropolitan hospital and a rural hospital. METHODS A mixed approach of qualitative and quantitative study methodology was used to survey potential participants. The electronic survey was distributed to participants to assess knowledge and experiences with identifying child abuse presenting to the ED over a 6-month period. A descriptive analysis of the data was performed. RESULTS A total of 121 responses were received from 340 potential participants, giving a participation rate of 35%. The majority of the respondents were senior medical officers (38/110, 34%) or registered nurses (35/110, 32%). The study participants perceived the lack of time as the most significant barrier to reporting child abuse (85/101, 84%). This was followed by a lack of education (35/101, 34%), resources (33/101, 32%) and support (30/101, 29%). CONCLUSION The combination of hospital, departmental and individual staff issues such as time limitations, lack of resources, education and support are potential barriers to reporting suspected child abuse. We recommend tailored teaching sessions, improved reporting procedures and increased support from senior staff to overcome these barriers.
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Affiliation(s)
- Huei Ti Soh
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
| | - Habib Bhurawala
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Poulton
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Liu
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kate Cush
- Emergency Department, Nepean Hospital, Sydney, New South Wales, Australia
| | - Glenys Griffiths
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
| | - Sowmya Gandham
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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Berchtold MB, Wüthrich C, Garcia D, Berger S, Löllgen RM. Nurses' and physicians' reported difficulties and enablers to recognising and reporting child abuse in Swiss paediatric emergency and paediatric surgery departments - an observational study. Swiss Med Wkly 2023; 153:40017. [PMID: 37410935 DOI: 10.57187/smw.2023.40017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Under-detection and under-reporting of child abuse remains a considerable challenge in paediatric care, with a high number of cases missed each year in Switzerland and abroad. Published data regarding the obstacles and facilitators of detecting and reporting child maltreatment among paediatric nursing and medical staff in the paediatric emergency department (PED) are scarce. Despite the existence of international guidelines, the measures taken to counteract the incomplete detection of harm done to children in paediatric care are insufficient. AIM We sought to examine up-to-date obstacles and enablers for detecting and reporting child abuse among nursing and medical staff in PED and paediatric surgery departments in Switzerland. METHODS We surveyed 421 nurses and physicians working in PEDs and on paediatric surgical wards in six large Swiss paediatric hospitals using an online questionnaire between February 1, 2017, and August 31, 2017. RESULTS The survey was returned by 261/421 (62.0%) respondents (complete n = 200, 76.6%; incomplete n = 61, 23.3%) with a preponderance of nurses (n = 150/261; 57.5%), 106/261 (40.6%) physicians, and 1/261 (0.4%) psychologists (n = 4/261; 1.5% missing profession). The stated obstacles to reporting child abuse were uncertainty about the diagnosis (n = 58/80; 72.5%), feeling unaccountable for notification (n = 28/80; 35%), uncertainty of whether reporting has any consequences (n = 5/80; 6.25%), lack of time (n = 4/80; 5%), forgetting to report (n = 2/80; 2.5%), and parental protection (n = 2/80; 2.5%) (unspecific answer, n = 4/80; 5%, multiple answers were possible, therefore items don not sum up to 100%). Even though most (n = 249/261 95.4%) respondents had previously been confronted with child abuse at/outside work, only 185/245 (75.5%) reported cases; significantly fewer nursing (n = 100/143, 69.9%) than medical staff (n = 83/99, 83.8%) (p = 0.013). Furthermore, significantly more nursing (n = 27/33; 81.8%) than medical staff (n = 6/33; 18.2%) (p = 0.005) reported a discrepancy between the number of suspected and reported cases (total 33/245 (13.5%). An overwhelming amount of participants were strongly interested in mandatory child abuse training (n= 226/242, 93.4%) and in the availability of standardised patient questionnaires and documentation forms (n = 185/243, 76.1%). CONCLUSION In line with previous studies, insufficient knowledge about and lack of confidence in detecting the signs and symptoms of child abuse were the principal obstacles to reporting maltreatment. To finally address this unacceptable gap in child abuse detection, we recommend the implementation of mandatory child protection education in all countries where no such education has been implemented in addition to the introduction of cognitive aid tools and validated screening tools to increase child abuse detection rates and ultimately prevent further harm to children.
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Affiliation(s)
| | - Christian Wüthrich
- Department of Paediatric Psychiatry, Inselspital, University Hospital, University of Bern, Switzerland
- Praxis für Kinder- und Jugendpsychiatrie, Bern, Switzerland
| | - Daniel Garcia
- Pediatric Emergency Department, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Switzerland
- Kinderpraxis Neuhegi, Winterthur, Switzerland
| | - Steffen Berger
- Department of Paediatric Surgery, Inselspital, University Hospital, University of Bern, Switzerland
| | - Ruth Mari Löllgen
- Pediatric Emergency Department, Department of Paediatrics, Inselspital, University Hospital, University of Bern, Switzerland
- Pediatric Emergency Department, Astrid Lindgrens Children´s Hospital, Karolinska University Hospital Solna, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Eaves T, Roney L, Neitlich J, Knapik K, Lapointe K. A-TEAM: An Interprofessional Approach to Mandated Reporting in the Hospital Setting. J Pediatr Health Care 2023; 37:e1-e5. [PMID: 36682970 DOI: 10.1016/j.pedhc.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/21/2023]
Abstract
Reporting suspected child maltreatment in pediatric settings presents unique challenges. Variation in mandated reporter training may lead to discomfort and emotional dysregulation. Failure to collaborate inter-professionally potentially results in suboptimal care for vulnerable children and families. A-TEAM promotes awareness, transparency, empathy, a nonjudgmental strategy, and management by an interprofessional team when referring patients for child protective services evaluation. A faculty trained in pediatric trauma nursing led the development of A-TEAM. Integrating nursing and social work expertise protects the integrity of family-centered patient care. The A-TEAM approach may be a valuable contribution to the continuing education of pediatric health care professionals.
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Affiliation(s)
- Tanika Eaves
- Tanika Eaves, Assistant Professor of Social Work, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Linda Roney, Associate Professor of Nursing, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Joshua Neitlich, Director of Field Education, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Katherine Knapik, Labor and Delivery Nurse, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Kayla Lapointe, MSW Candidate, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT..
| | - Linda Roney
- Tanika Eaves, Assistant Professor of Social Work, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Linda Roney, Associate Professor of Nursing, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Joshua Neitlich, Director of Field Education, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Katherine Knapik, Labor and Delivery Nurse, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Kayla Lapointe, MSW Candidate, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT
| | - Joshua Neitlich
- Tanika Eaves, Assistant Professor of Social Work, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Linda Roney, Associate Professor of Nursing, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Joshua Neitlich, Director of Field Education, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Katherine Knapik, Labor and Delivery Nurse, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Kayla Lapointe, MSW Candidate, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT
| | - Katherine Knapik
- Tanika Eaves, Assistant Professor of Social Work, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Linda Roney, Associate Professor of Nursing, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Joshua Neitlich, Director of Field Education, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Katherine Knapik, Labor and Delivery Nurse, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Kayla Lapointe, MSW Candidate, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT
| | - Kayla Lapointe
- Tanika Eaves, Assistant Professor of Social Work, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Linda Roney, Associate Professor of Nursing, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Joshua Neitlich, Director of Field Education, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Katherine Knapik, Labor and Delivery Nurse, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT.; Kayla Lapointe, MSW Candidate, Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT
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Kuruppu J, Humphreys C, McKibbin G, Hegarty K. Tensions in the therapeutic relationship: emotional labour in the response to child abuse and neglect in primary healthcare. BMC PRIMARY CARE 2022; 23:48. [PMID: 35300610 PMCID: PMC8932236 DOI: 10.1186/s12875-022-01661-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022]
Abstract
Background Child abuse and neglect (child abuse) is a prevalent public health issue linked to survivors experiencing a higher risk of health issues such as obesity, heart disease and major depression. Given the significant impact of child abuse on health, general practitioners (GPs) and primary care nurses (nurses) are well-placed to respond to child abuse. However, research shows that responding to child abuse is difficult for health practitioners, especially the act of reporting child abuse. The present study aimed to understand how GPs and nurses experience the response to child abuse in primary healthcare. Methods This study employed qualitative methods. Twenty-six in-depth individual and group interviews were conducted with 30 GPs and nurses. The interviews were audio recorded with consent, transcribed verbatim and thematically analysed. Results The participants were mostly metropolitan-based female GPs. Participants were sampled from two settings: private general practice and community health; and Doctors in Secondary Schools, a program that places GPs and nurses in high schools. Thematic analysis generated four themes: blowing trust out of the water; riding the reaction wave; opening a hornet’s nest; and battling emotions. Participants felt that, in considering child abuse, they were betraying the trust of the therapeutic relationship and thus, had to manage their patients’ reactions to preserve the therapeutic relationship. They used strategies that created shifts in perception in both themselves and their patients to help maintain the therapeutic relationship. Participants often felt that they had to compromise their professional code of ethics to fulfil their mandatory reporting obligations. Thus, they experienced internal emotional battles when responding which led to some experiencing burnout or vicarious trauma and others resilience. This complex interplay of relationship and emotional management was placed in the context of emotional labour theory. We contend that our participants undertook emotional labour across three levels: internal, organisational and systemic. Conclusions We conclude that the emotional labour exerted in the response to child abuse can be diminished by: developing strategies for therapeutic relationship management; undertaking an internal, organisational and systemic values assessment; and facilitating communication between health professionals and the child protection system.
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Rolovic JS, Bokonjic D, Masic S, Stevanovic N. Pediatricians' Attitudes Toward Child Sexual Abuse in the Republic of Srpska. JOURNAL OF CHILD SEXUAL ABUSE 2022; 31:707-725. [PMID: 36004396 DOI: 10.1080/10538712.2022.2112641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/30/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
Child sexual abuse (CSA) affects all cultures and sociodemographic sections. As health professionals, pediatricians are often the first line of defense when it comes to CSA identification and reporting. Our previous study examined encounters, competence, beliefs, and reporting regarding CSA among pediatricians in countries of the former Yugoslavia, Serbia, and Montenegro. Following up on this work, we expanded our research to another neighboring country, the Republic of Srpska (RS). Sixty pediatricians were surveyed in 2020, comprising 30% of all practicing pediatricians in the Republic of Srpska. Compared to their colleagues from Serbia and Montenegro, RS pediatricians revealed an increased perception that children are often abused by someone they do know well, were more confident in their abilities to detect CSA, reported a higher number of CSA cases, and were more interested in further trainings on the subject of CSA. Despite this, the level of underreporting remained high (40%). To our knowledge, this is the first study to both assess and compare CSA-related attitudes in this part of the world. Key differences between RS, other two neighboring countries as well as from other countries worldwide are likely to stem from the level of pediatricians' training and education, as well as from the socio-cultural and legislation context. Although encouraging, our data indicate a need for further research in the countries of the former Yugoslavia.
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Affiliation(s)
| | - Dejan Bokonjic
- University of East Sarajevo, Republic of Srpska, Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
| | - Srdjan Masic
- University of East Sarajevo, Republic of Srpska, Bosnia and Herzegovina, Banja Luka, Bosnia and Herzegovina
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