Identification, Assessment Reporting and Recovery Of Childhood Physical Abuse
Running Head: Childhood Physical Abuse
Nursing
Introduction
The physical abuse of children is a serious problem in the United States not only for the children themselves, but, for the nurses, social workers, and educators who must have the knowledge, and skill to identify, assess, and report the physical abuse of children as well as the strength to help them deal with the consequences of the abuse in order to recover and move on with their lives. As a profession nurses must do what they can to prevent these children from being permanently damaged by adults with a twisted sense of normality and caring.
I. Definition
According to Child Welfare.Gov (2008), the Federal Child Abuse Prevention and Treatment Act (CAPTA) defines child abuse as “any recent act or failure on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or any act or failure to act which presents an imminent risk of serious harm” (Child Welfare Information Gateway, 2008). Physical abuse of a child can be operationally defined in terms of this paper as any act of deliberate physical harm towards a child including, hitting, biting, kicking, pinching, punching, slapping, whipping, spanking in excess, poisoning or making the child physically ill in some way, and throwing items at the child. Each of these acts can cause serious physical injury to a child.
II. Prevalence
According the United States Department of Health and Human Services (2006), surveys in 2006 indicate that an somewhere around 905,000 children in the United Stated suffered from some form of child abuse which figures out to roughly 12 per 1,000 children in the United States. Seventy five percent of these children had been involved in incidents of child abuse or neglect prior to the survey and 16% of these children experienced physical abuse. More girls were abused than boys (m=48.2%, f=51.5%). The children that were the most likely to experience abuse at the hands of a parent or caretaker were the youngest (birth to 4 years) with 38.6% of all reports of abuse being for children in this age group. Finally, African American and Native American children were the most likely to be abused with 19.8 per 1,000 African American children being abused, and 15.4 per 1,000 Native American Children being abused. Finally, 83% of all child abuse victims in 2006 were abused by a parent. Finally, MacGuiness, and Schneider (2007) state that, a recent survey on the National Incidence of Child Abuse and Neglect found that children from low SES families were 22% more likely to be abused than children of the middle or upper classes.
III. Identifying Child Abuse
When it comes to identifying the physical abuse of children, nurses are often on the frontlines. Whether they serve the profession working in a hospital emergency room, or in a school health office, nurses are the first to see the indications that a child may be being abused. There are several signs that will tell a nursing professional that a child may be being abused. First, a child may have burns, bruises, scratches, broken bones, black eyes, or welts that they cannot explain- these may be fading or partially healed. The child may be frightened of their parents or caregiver and will throw a tantrum when they are returned to the parents care. They also are reluctant, hesitant and fearful around adults. The final indicator is that the child may be honest and tell the nurse that they have been injured, and who by (Child Welfare Information Gateway, 2008).
There are also certain indicators in the behavior of a parent that they are abusing or neglecting their child. They will make excuses to explain away abnormal or unusual injuries on their child (“she shut her head in a door”). They may appear to be cold, or uncaring towards the child. They may describe the child in a negative manner such as calling the child a “brat” or a “Demon Child”. They may use harsh and often physical disciplinary methods with the child such as spanking, paddling, or belting. The parent may have been abused as a child themselves and may not recognize that what they are doing is wrong. Finally, the abuse may be concurrent with other types of abuse such as emotional abuse, or neglect of the child hence, the uncaring attitudes and name calling behaviors (Child Welfare Information Gateway, 2008).
IV. Assessment of Physical Abuse
When assessing current physical abuse of children the obvious way in which this is done is by asking questions of the child and the parents, as well as physically examining the child and then using ones good judgment to determine whether or not abuse has occurred. According to Taylor, Baldwin and Spencer (2008), one of the main difficulties has been in the assessment of past abuse. Many assessment measures used to determine past abuse have serious reliability and validity issues that may create difficulties in assessing child abuse accurately These measures also frequently have ethical and methodological issues that cause nurses to rely much more frequently on examination, observation and common sense. Ethical and methodological issues include the question of how one addresses prior abuse without causing further damage to the child, and what types of questions or observations must be focused upon in order to determine past physical abuse.
One of the most common measures of past abuse is the Child Abuse Potential Inventory (CAPI) which assesses past and present abuse by asking the person to fill out 160 Likert Scale questions including a scale that the developers created to assess physical abuse. The main issue with these types of measures state Taylor, Baldwin and Spencer (2008) is that with self-report measures is that they are notoriously inaccurate and that patients still have the ability to lie to the nurse assessing the level of abuse.
V. Reporting
Reporting is a serious issue for nurses in regards to physical abuse of children. In 48:50 states nurses as well as all other medical professionals and educators are considered to be mandatory reporters. This means that under the law they are required to reports any signs of physical, emotional, or sexual abuse, and physical or emotional neglect of children. In 18:50 states any person that is aware that a child may be abused is required to report this to state or local child welfare officials.
In some cases mandatory reporting of child abuse is limited by privileged communications such as, the doctor - patient privilege, or the attorney client privilege, although even these privileged communications are revoked in many cases, if a client/patient has indicated that they have harmed. or are intending to harm another. These mandatory reports can be made anonymously although in the case of medical professionals this does not happen as they are often required to act as witnesses if a child abuse case goes to court. It should be stated that a nurse should think carefully before reporting potential abuse because, while there is a powerful chance that a child is being abused they may also not be being abused. Finally, it should be stated that if a nurse has any doubts at all they should report potential physical abuse of a child because; failure to report could have dire consequences both for the nurse and the child.
VI. Recovery from Physical Abuse
According to MacGuiness and Schneider (2007), physical abuse can have serious consequences for a child. They may develop mental illnesses such as, eating disorders, or depression. They may also develop issues with oppositional behavior, promiscuity, and other behavioral problems. They argue that getting the children out of abusive homes and into homes where they will be cared for are vital in order to ensure their recovery. Bauman (2007) claims that there are three major paths that nurse can guide patients who have been abused as children on in order to recover. First, is the psychiatric/mental health model in which a person uses traditional psychological counseling and anti anxiety/depression medication to recover from abuse. Second, is the Spirituality method that includes participating in spiritual and religious activities and receiving pastoral counseling from church leader on how to deal with the abuse. The final method is that of Human Becoming Therapy in which the person focuses on learning their place in the universe, and dealing with quality of life issues such as learning what “ normal” is like. Each method has its strong and weak points and should be carefully considered before determining which one should be used to help a child recover from physical abuse.
Conclusion
In conclusion, it can be stated that nurses play a powerful role in preventing, identifying, assessing, reporting and helping children to recover from physical abuse. Their ability to identify the signs of abuse or potential abuse, and to assess the level of the abuse are strong determinants in whether legal steps are taken to prevent further harm to the child. They also play a role in educating parents about what types of behaviors constitute abuse in comparison to what types of behaviors are considered disciplinary from a legal and medical standpoint, and in insuring that a child has good quality of life, and a short recovery time after an incidence of physical abuse.
References
Baumann, S. (2007). Recovering from Abuse: A Comparison of Three Paths. Nursing Science Quarterly, v20 , 342-350.
Child Welfare Information Gateway. (2008, May 1). Identifying Child Abuse and Neglect.
MacGuiness, Teresa, and Schneider, Kristen. (2007). Poverty, Child Maltreatment and Foster Care. Journal of American Psychiatric Nursing v13, n 5 , 296-305.
Taylor, Julie, Baldwin, Norma, and Spencer, Nick. (2008). Predicting child abuse and neglect: Ethical, theoretical and methodological challenges. Journal of Clinical Nursing, v17 , 1193-1200.
United States Department of Health and Human Services: Administration for Families and Children. (2006). Child Maltreatment 2006.