Identification of child maltreatment while caring for them in a university hospital

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Abstract

The purpose of the study was to look at how nurses and physicians of a university hospital rated their ability to identify child maltreatment while caring for those children. In this study, child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child under the age of 18 by parents or caregivers. The total population of staff caring for children (N=513) in a university hospital were surveyed. Data were collected with a questionnaire developed for this study with reference to the literature. Altogether 317 questionnaires were returned, which yielded a response rate of 62%. The data were analysed using statistical methods and quantitative content analysis. Forty per cent of the respondents estimated that they had never cared for a maltreated child. Two-thirds of the respondents believed that they would be able to identify a child maltreatment case. The most distinct signs by which maltreatment could be identified were fractures, multiple bruises and the fact that the child had frequent injuries. The child's or parent's behaviour often aroused suspicion of maltreatment. Seventy-one per cent of the respondents rated the identification of maltreatment as rather difficult or difficult. Awkwardness of the phenomenon, the staff's pressure of work and relative unfamiliarity with the phenomenon were assessed as things that make the identification difficult. The fact that no jointly agreed guidelines were available for handling the matter was seen as a particular weakness. The respondents had fairly much theoretical knowledge about child maltreatment. However, child maltreatment is a multi-dimensional phenomenon that calls forth emotions. The development and improvement of practical nursing and medical care and of staff collaboration require that education be provided to different occupational groups and parties caring for children and that jointly agreed hospital-specific and regional models for operation be developed.

Section snippets

Types of maltreatment

Caffey (1946) was the first to launch scientific discussion about child abuse having an influence on medical and nursing practice after having observed in children's X-rays of fractures which were not explained by the accidents described by parents. Kempe et al. (1962) continued to clarify the phenomenon with their article “The battered child syndrome”. The issue, which had been suspected but not much discussed, was thus brought to public notice. On the other hand, children had been sacrificed

Purpose of the study

The purpose of this study was to ascertain and describe how the nursing and medical staff admitting and treating children in a university hospital rate their ability to identify child maltreatment. An additional purpose was to explore which factors make the identification easy or difficult, and what nurses’ and physicians’ actions are while suspecting child maltreatment. The aim is to acquire knowledge for developing the identification of child maltreatment and care of maltreated children and

Materials and methods

The study sample comprised the entire nursing staff (nurses, paediatric nurses, practical nurses and paramedics), medical and other staff (therapists and psychologists) (N=513) caring for children in a university hospital. The subjects worked in the paediatric clinic, surgical clinic, child psychiatry clinic and women's clinic. The total number of the participants was 317, which yielded a response rate of 62%. It was not possible to perform a drop-out rate analysis, because there was no

Demographic data

Ninety-one per cent of the respondents were women. More than half the respondents were registered nurses. One in ten respondent was a physician (Table 1). Nearly half of the respondents worked on paediatric wards or in a paediatric outpatient department. One in ten worked in an emergency unit, 6% worked on a paediatric surgical ward, a little less than one-tenth on child psychiatric wards or outpatient department and about one quarter in maternity care (Table 2).

The sample was evenly

Reliability of the study and ethical considerations

The questionnaire was developed for this study with reference to the literature concerning child maltreatment (Tzeng et al., 1991; Ney et al., 1994; Berliner and Elliott; 1996, Hart et al., 1996; Kolko, 1996). The questionnaire was pilot tested and on the basis of pilot testing some questions were adjusted and reworded. The questionnaire asked no names and the questionnaires were not numbered, so the respondents’ anonymity is assured. The respondents mailed the questionnaires in prepaid

References (39)

  • M. Brethier et al.

    Failure to prevent physical child abuse despite detection of risk factors at birth and social work follow-up

    Child Abuse and Neglect

    (1993)
  • J. Briere

    Child Abuse TraumaTheory and Treatment of the Lasting Effects

    (1992)
  • J. Caffey

    Multiple fractures in long bones of infants suffering from chronic subdural hematoma

    American Journal of Roentgenology

    (1946)
  • Child Protection Act, 1984. Suomen säädöskokoelma 683/1983, Helsinki, Ministry of Justice (in...
  • B. Corby

    Child AbuseTowards a Knowledge Base

    (1993)
  • F. Dickson et al.

    The role of public health nurses in responding to abused women

    Public Health Nursing

    (1996)
  • H. Dubowitz et al.

    A conceptual definition of child neglect

    Criminal Justice and Behavior

    (1993)
  • A. Elliott et al.

    Maternal sexual abuse of male childrenwhen to suspect and how to undercover it

    Postgraduate Medicine

    (1993)
  • M. Ericson et al.

    Child neglect

  • Cited by (0)

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