Child Abuse and Neglect As Nursing Challenges

Child Abuse Dealing In Health Care

What Is Child Abuse and Neglect,Child Abuse And Maltreatment,Emotional Abuse And Neglect ,Child Abuse And Neglect ,Gender Specific Literature,Child And Caregiver,Child Maltreatment,Conclusion.

What Is Child Abuse and Neglect

    Child abuse and neglect, often referred to by the broader term "child maltreatment," are recognized as major social and mental health problems throughout the world (Bonner, Logue, Kaufman, & Niec , 2001).

     In the United States, child maltreatment has been identified as a national emergency and one of our nation's "most compelling problems" (US Department of Health and Human Services, 1998). 

    All forms of child maltreatment pose major threats to the integrity of families and society at large and are known to be associated with a variety of mental health concerns as well as criminal activity ( Gelles & Cornell, 1990; Hobbs, Hanks, & Wynne, 1999 ).

Child Abuse And Maltreatment

    Child maltreatment can be differentiated into terms of acts of commission (ie, physical abuse, sexual abuse, and/or psychological maltreatment) and caregiver omission (ie, abandonment, neglect) (Cowen, 1999). "Child abuse" is legally defined as "Any form of cruelty to a child's physical, moral or mental well-being" (Nolan & Nolan-Haley, 1990, p. 239). 

    Examples of child abuse include overt physical abuse such as hitting. grabbing, burning, and shaking as well as emotional abuse that may be more subtle and difficult to detect. While reports of physical abuse still dominate the literature, there has been increasing interest in other acts of commission, particularly sexual abuse. 

    owever, to focus on sexual abuse alone, as is the recent trend, may be limiting as other important experiences commonly co-occur with sexual abuse that need identification and intervention (Dong, Anda, Dube, Giles, & Felitti , 2003).

Emotional Abuse And Neglect 

     Child emotional abuse and neglect are very common but have traditionally been, and continue to be, understudied, perhaps be-cause professionals have difficulty recognizing and defining these terms. 

    Generally speaking, child emotional abuse and neglect refer to a caregiver-child relationship that is characterized by patterns of harmful but non-physical interactions with the child. Unlike other types of abuse that are performed in secret, this emotional maltreatment is often publicly demonstrated (Glaser, 2002). 

    Children who frequently witness family violence and abuse are also described as psychologically maltreated (Dong et al., 2003). "Neglect has been defined as the "chronic failure of a parent or caretaker to provide children under 18 with basic needs such as food, clothing, shelter, medical care, educational opportunity, protection, and supervision" (Bonner et al., 2001, p. 1016). 

    Currently efforts are underway to further define the concepts of emotional abuse and neglect (Glaser, 2002) so that important research questions related to the prevalence, risk factors, and long-term effects of this type of maltreatment can be answered .

 Child Abuse And Neglect 

    Different forms of child abuse and neglect frequently coexist. For example, Clauseen and Crittenden (1991) found that 90% of children who had been physically abused and neglected had also been psychologically maltreated. 

    Another important factor worthy of further investigation is the finding that psychological maltreatment was more strongly predictive of impairment in child development than the severity of physical abuse (Glaser, 2002). 

    Researchers are faced with the challenge of clearly defining each type of maltreatment so it can be studied separately, while also evaluating the potential influence of one type of maltreatment on another. 

    For example, in longitudinal studies of physical abuse, mechanisms are needed to determine, if possible, sequelae of physical abuse versus coexisting emotional abuse and neglect. 

    Other related questions include whether co-existence of two or more types of maltreatment more adversely affect child prognosis than a single type of maltreatment, and whether current treatment modalities should be modified to address maltreatment coexistence.

Gender Specific Literature

     Male victims and perpetrators are also under represented in the literature, perhaps because females are traditionally more likely to volunteer for research studies or because male child abuse victims are less likely to report. 

    Gender differences are found in many areas of psychology and child-related research. For example, literature suggests that females are more likely to be victims of child sexual abuse, whereas males are more likely to suffer more physical abuse ( Behl , Conyngham , & May, 2003). 

    The first step in addressing this concern and other gender issues is to obtain accurate gender-specific prevalence data. Then efforts can be directed toward determining if child and/or perpetrator gender constitute risk factors and how those findings might be incorporated into prevention programs and intervention development.

Child And Caregiver

     The relationship between the caregiver and child is "nested" within the family that is, in turn, significantly influenced by each family member's personal belief system and history as well as the social environment and culture. 

    Yet, to date, the effect and interaction of these personal, social, and cultural influences have not been adequately studied. Ferrari (2002) provided a useful model for studying the predictive effect of cultural factors on parenting behaviors and definitions of mal-treatment in three ethnic groups. 

    Noting how the commonly used term "ethnicity" is complex and vague, the author defined three concepts associated with ethnicity ( maschismo , familism, valuing children) and defined them for study. 

    Measuring these components, the author also examined the possibility of intergenerational transmission of abuse among cultures. This is another area warranting continued research.

Child Maltreatment

    Child maltreatment is clearly a specific and challenging area of inquiry that is in need of further research to develop and empirically validate effective diagnostic, treatment, and prevention programs for all forms of child maltreatment. 

    Since the publication of Kempe, Silverman, Steele Droegenmuller , and Silver's seminal article over 4 decades. ago (1962), there have been promising trends in the development of relevant multidisciplinary theoretical models and increased focus for child maltreatment research. However, several important knowledge gaps remain. 

    These include the need for 

(a) more specificity and differentiation regarding the type of maltreatment that is studied and reported

(b) more adequate conceptualization and research in the understudied areas of child emotional abuse and neglect

(c) examination of the coexistence and interaction of different forms of maltreatment

(d) more information regarding both male victims and perpetrators

(e) examination of cultural influences upon child-rearing practices and definitions of maltreatment.

Conclusion

     In addition to focusing on the previously discussed knowledge gaps, future research must also address important methodological issues. 

    These include developing and using more standardized measures for identifying and differentiating forms of child maltreatment, measuring outcomes through recidivism data, conducting longitudinal studies to evaluate the children's health.

    Academic performance, and psychological adjustment, and developing culturally sensitive diagnostic and evaluative measures to ensure accurate representation and assessment of ethnically diverse children and families. 

Nurses are educationally, clinically, and ethically well positioned to lead the way in advancing this important area of science.