Physical Child Abuse - Essay Example

? A Case Presentation on Physical Child Abuse and Related Nursing Management First Last Touro Nevada School Of Nursing Children, as part of the vulnerable group, are repeatedly subjected to physical cruelty, resulting to a variety of physiopsychologic damages that are oftentimes irreversible. Surprisingly, the act of physical abuse to helpless young children is allegedly traced to incriminating circumstances surrounding the socioeconomic and personal coping capabilities of most parents. In the case study, the paper aims at exploring the various nursing mechanisms employed in detecting and managing cases of physical abuse in children. More importantly, the involvement of parents in their children’s healing process and reduction of violent risks are also examined closely. Through qualitative evaluation, outcomes of case study includes realization that both parties, the violated children and abusive parents, need to be critically assessed and, educated and treated, for risks of future physical abused to be eliminated. Moreover, the role of nurses in the whole process of care is vital in bridging gaps between perpetrators and victims of violence. In conclusion, children are not the only groups that need to be subjected to intense nursing assessment and management; the perpetrators (parents) are also included in the overall plan of nursing care in order to improve the rampant status of physical abuse in children. Table of Contents Introduction………………………………………………………………………………………4 Basic Assessment Measures in Physical Abuse…………………………………………….4 Nursing Problem Identification and Management…………………………………………...7 Conclusion……………………………………………………………………………………….9 References……………………………………………………………………………………..10 A Case Presentation on Physical Child Abuse and Related Nursing Management Introduction A case of R.K.A., 6 year-year-old male child, Protestant, from Clark County, Nevada, suspected of physical abuse, as initial physical complaint presents multiple bruises in various healing phases and an extremely withdrawn behavior. Child abuse is a collective term frequently seen in community households. This is generally a form of maltreatment in vulnerable groups, such as young children and elderly individuals. As explained by Giardino and Giardino (2010), specific in most abuse is the “presence of an injury...(contracted) at the hands of his or her caregiver” (p. 1). In an abusive family, the parents are pointed out as culprits in the scene (Humphreys & Campbell, 2010). Hence, it is safe to say that during child abuse, their supposed protectors are the ones inflicting both physical and physiologic damage. In the advent of clinical and mental interventions, American Psychiatric Society (2004) emphasized that clinical priority in this is mainly centered on the victims. Yet, as this is also a family dispute, the involvement of the perpetrators in the holistic therapy is deemed important in the clinical setting. For this reason, the case presentation will focus on a thorough assessment in identifying the presence of abuse, as well as related nursing interventions targeting resolutions in the conditions surrounding child victims and their perpetrators. Basic Assessment Measures in Physical Abuse Child abuse is a difficult case to prove. The first step towards the process of keeping victims safe is “detection and identification,” a recognition that such incidents can happen in the community (Videbeck, 2010, p. 187). Hence, nurses involved in direct care of clients need to maintain an open mind and critical attitude in order to aptly identify risk factors increasing the likelihood of children suffering from physical abuse. In the nursing process of uncovering the truth, White (2004) suggests inclusion of both subjective and objective data collection as prioritized actions; with the former as verbalized by both the parents and the child, while the latter is based on nurses’ clinical judgment. In the subjective category, history of family patterns and the child’s development and behavior are important indicators for tracing possibilities of physical violations. Nurses, then, need to initially determine circumstances involving the conception of children, from prenatal and afterbirth care provisions to the age and health status of parents; tactful inquiries must be performed in order to assess signs of neglectful disinterest in caring for the child (Bowden & Greenberg, 2007). Taylor and Mulller (1999, p. 192) narrowed the predisposing factor for such abuse on two significant dimensions: “materialistic aspects of the environment and the interpersonal behaviour of parents.” Nurses have to evaluate the existence of environmental stressors, such as poor economic status and occupational pressures, that predispose to shortened patience and violence; while it is important to determine whether parents are able to mentally and emotionally cope up with raising and supporting their children. In terms of childhood history, research shows that there is increased child vulnerability to physical abuse in the presence of “prematurity, poor bonding with caregiver, medical fragility...and (various psychophysiologic) abnormalities” (Giardino and Giardino, 2010, p. 1). Excessive child expectations can also mar the parenteral perceptions of parents, directing parents’ frustrations of failure towards physically punishing children for such shortcomings. Therefore, these factors in history assessment of family and child background are essential inquiry points in the process of holistic nursing care. In regard to objective data gathering, critical actions include recognizing certain physical and behavioral alterations common in most victims of physical abuse. In the case sample discussed above, multiple bruises and extremely withdrawn affect are a portion of symptoms suffered by abused children. With physical harm, Hatfield (2007, p. 134) identified the difference between damages due to excessively active children and physical abuse, as injuries on the former are visible on bony prominences (“knees, elbow, shins, and forehead”), while the latter are areas of tissue projections, including wounds on “abdomen, buttocks, genitalia, thighs and mouth.” Other common manifestations include traces of object markings the child’s skin, from belt buckles to long rods, and even welts from manhandling. All of these are in different episodes of healing phase, while in worst case scenarios, children present with burned body parts, from scalding water to cigarette blisters (White, 2004). On the emotional side, Rocha, Prado, and Carraro (n.d.) introduced therapeutic play as effective means in distinguishing altered behaviour patterns. As fear of bodily harm is greatest at home, children are living in constant negative feelings, bringing adverse psychological reactions that manifest in overt behaviors. They are, as expounded by Funnell, Koutoukidis and Lawrence (2008), either extremely distressed with simple problems, or maintain delayed language and motor development; either way, coping mechanisms are functionally hampered. Psychological disturbance reaches to the point where children adjust by maintaining a low-profile--being figuratively invisible in their own homes. Unfortunately, these children tend to assume dissociative personalities, where they pretend to be someone more independent and stronger in order to deflect the severity of their current situations (Uys & Middleton, 1997). Hence, physical injuries, coupled with several isolating behaviors may pinpoint to the direction of physical abuse--these must be detected earlier for appropriate interventions to be enacted. Nursing Problem Identification and Management As thorough historical and physical assessments are accomplished, a series of valid and clinical interventions are the next sound step in the process. Legally speaking, nurses have the liability to report suspicious incidents of abuse in order to provide early safety measures to victimized children (Thomas, Bernardo, & Herman, 2003). Clinical practitioners, then, have the primary responsibility to secure the status of children in clinical institutions. In the advent of actual nursing care interventions, Munden and Breuninger (2002) advocated therapeutic options that commonly range from “treating the physical injuries, psychological dysfunction, and safety of the abused (children)” (p. 60). As prescribed, actual physiologic infirmities must be addressed first before proceeding to existing mental status and environmental risk factors. In specific terms, several related interventions are established to address the three prioritized nursing diagnosis: from physical, to psychosocial and environmental dimensions. As indicated in Figure 1 (please see Appendix A), these diagnoses are accompanied by interventions targeting the exact experiences of the client in question. As observed, the first problem relates to the physical aspect of the problem, focusing on the skin integrity of physically abused children. As nurses secure the living condition of physically violated clients, addressing the physical pain and discomfort must also be a priority. In some cases, infectious complications may occur with external breaks in skin integrity; hence, it is important to maintain a wound area that is properly cleansed and covered. Moreover, the bruises sustained in physical violence can be improved through alternate warm and cold compresses, enhancing circulation for better blood flow in localized areas (Doenges, 2004, p. 465). These are primary nursing management actions concerning the case of children in such abuse. On the side of psychological damage, mental effects can be personally and socially debilitating. Fear and anxiety are frequently the emotional result of traumatic events. In remedy, nurses need to evaluate the extent of psychological damage generated by parental abuse, all the while, constructing trusting relationships with their young clients. As indicated in Erickson’s “psychosocial development of industry versus inferiority,” children aged 6 to 12 years tend to expand their horizons, with intentions of performing tasks to completion (Weber & Kelley, 2009, p. 714). In line with this theory, nursing interventions should focus on activities fit for this age group. As presented in nursing care plan diagram (please see Figure 1 in Appendix A), nurses must initiate simple yet achievable task, as in dressing on their own or taking a bath with minimum supervision, to promote the industrial train in school-aged children. As added by Uys and Middleton (1997, p. 695), these children need to be immediately oriented back to their normal routinely activities prior to physical abuse, such as going “back to quickly...normal bedtimes, etc.” By doing so, children are less reminded by thoughts of physical violence as they are kept occupied for longer periods. In addition, Figure 2 (please see Appendix B) imparts information regarding related medication regimen indicated in worst cases of psychological disturbance. By this, proper pyschotherapeutic approach, both in personal management and pharmacological administration must go hand-in-hand in helping young children mentally and emotionally cope with being physically violated. Lastly, the role of parents in the violent act must also be taken into perspective. Videbeck (2010) proposes that if there is positive chance that parents (perpetrators) and child (victim) can be reunited, family therapy is commonly indicated. Hence, the role of education is of high priority. Parents, as exhibited in Figure 1 (please see Appendix A), need to informed on several significant topics--from management of developmental age and tasks to converting violent tendencies to more positive acts. As most parents displace their stressful situations towards their children, nurses must collaboratively teach parents on stress-reducing techniques, such as engaging in routine exercises, in relieving tensions. On the aspect of financial shortcomings, such problem cannot be altered by nurses, but they can help improve moods through indicated stress-releasing tactics. In patient education, parents are encouraged on the constructive values of familial support and trust in their offsprings, as well as improving communication patterns between the two parties to avoid conflicts and eventual violence (Fennell & Fishel, 1998). More or less, these strategies in parent education benefit not only their personal disposition, in the process, risk of child violence is profoundly prevented. Conclusion All in all, detecting the results of violence can be difficult for nurses, but as part of their responsibilities, nurses need to be keen in identifying even the smallest hints of physical attack. A variety of historical and physical assessment parameters are initiated to ensure the absence of physical violence. In subsequent nursing management, physiologic interventions are attempted first, before dealing with the psychological and educational treatment in the abuse. While nursing care focuses essentially on victimized clients, conserving the important roles of the parents in the healing of children’s trauma is still a critical action in care. Thereby, the two parties need to be assessed and holistically managed, albeit for more successful nursing health provisions. References American Psychiatric Society. (2004). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). Arlington, VA: American Psychiatric Publishing. Bowden, V.R., & Greenberg, C.S. (2007). Pediatric nursing procedures. (2nd ed.). Philadelphia: Lippincott Williams and Wilkins. Doenges, M. E., Moorhouse, M. F., & Geissler-Murr, A. (2004). Nurses’ pocket guide: Diagnoses, interventions, and rationale. (9th ed.). Thailand: Book Promotion and Service. Fennell, D.C., & Fishel, A.F. (1998). Parent education: An Evaluation of step on abusive parent’s perceptions and abuse potential. Journal of Child and Adolescent Psychiatric Nursing, 11 (3), 107-122. Funnell, R., Koutoukidis, G., & Lawrence, K. (2008). Tabbner’s nursing care: Theory and practice. (5th ed.). Chatswood, NSW: Elsevier Australia. Giardino, A. P., & Giardino, E.R. (2010). Child abuse and neglect, physical abuse. Medscape. Retrieved from http://emedicine.medscape.com/article/ 915664-overview Hatfield, N.T. (2007). Broadribb’s introductory pediatric nursing. (7th ed.). Philadelphia, PA: Wolters Kluwer Health. Humphreys, J., & Campbell, J.C. (2010). Family violence and nursing practice. (2nd ed.). United States of America: Springer Publishing Company. Munden, J., & Breuninger, C.C. (Eds.). (2002). Disease management for Nurse practitioners. Danvers, MA: Springerhouse Corporation. Rocha, P.K., Prado, M.L., & Carraro, T.M. (n.d.). Nursing care model for children victims of violence. Australian Journal of Advance Nursing, 25 (3), 80-85. Taylor, J., & Mulller, D.J. (1999). Nursing children: Psychology, research and practice. United Kingdom: Harper and Row. Thomas, D.O., Bernardo, L.M., & Herman, B. (2003). Core curriculum for pediatric emergency nursing. Sudbury, MA: Jones and Barlett Publishers. Uys, L.R., & Middleton, L. (1997). Mental health nursing: A South-African perspective. Cape Town, South Africa: Juta and Corporation. Videbeck, S.L. (2010). Psychiatric -Mental health nursing. Philadelphia: Lippincott Williams and Wilkins. Weber, J.R., & Kelley, J. (2009). Health assessment in nursing. (4th ed.). Philadelphia: Lippincott Williams and Wilkins. White, L. (2004). Foundations of nursing. (2nd ed.). USA: Cengage Learning. Zoloft Clinical Pharmacology. (2011). RxList. Retrieved from http://www.rxlist.com/zoloft-drug.htm Zoloft Oral. (2011). WebMD Professional. Retrieved from http://www.medscape.com/druginfo/dosage?cid=med&drugid=35&drugname=Zoloft+Oral&monotype=default Appendix A Nursing Diagnosis Outcome Nursing Interventions Evaluation Date Derived from assessment, NANDA- approved Measurable, specific, realistic, achievable & desired by patient & are attainable, indicate time frame Prescriptions for behavior, treatments, activities or actions that assist the patient in achieving expected outcomes. Include date, action verb, how, time/frequency, where, amount Ongoing process, focus on patients progress or lack of, may reassess 7 Jan. 2010 Impaired skin integrity related to presence of mechanical factors (trauma), secondary to intentional physical injury, as manifested by multiple bruises and lacerations on upper and lower extremities. After a 3 days of effective nursing management, the client will manifest timely healing of wound, in the absence of any complicated conditions. --Constantly monitor and properly document integumentary status of extremities, from color, texture and temperature, including any abnormalities indicating infectious complications. --Handle injuries through daily cleansing of wound and providing alternate warm and cold compresses on bruised areas for comfort and prevention of complications. --Provide adequate nutritional sustenance through increased protein intake appropriate for developmental age, for faster wound healing. (Doenges, 2004, p. 465) 7 Jan. 2010 Fear (Learned Response) related to traumatic conditioning in severe physical punishment. After 6 weeks of nursing management, the client will be able to demonstrate progress in adopting appropriate coping skill and manifest lessened degree of isolating behavior and affect. --Initially determine client perception on physical abuse and the degree of emotional disturbance with traumatic experience through play therapy in order to form situational-appropriate interventions. --Establish a trusting relationship with therapeutic communication techniques, such as active listening, and constantly communicate according to the developmental age of child; a strategy in reaching out beyond the feeling of fear and apprehension. --Encourage and enhance client control by helping them engage in simple but valuable tasks, such as performing activities of daily care independently and at their own pace, as”healthy outlet for energy and promotes relaxation.” (Doenges, 2004, p. 239) 7 Jan. 2010 Impaired parenting related to stressful financial role strain and dysfunctional parenting strategies. After 2 weeks of effective nursing interventions, the parents will be able to verbalize understanding on situational crises and demonstrate coping appropriate mechanisms in the absence of physical violence. --Periodically take note of factors that alter appropriate parenting behaviors during contact with parents, from financial status, cultural background, and personal values towards family and parenting before planning for attitude improvements. (Doenges, 2004, p. 383) --Educate parents on constructive parenting skill, including suitable pointers on “normal growth and development, well-child care and nurturing” for knowledge on how to properly care for children. (White, 2004, p. 1635) --Collaboratively work with parents in establishing alternative outlets for anger and frustrations, such as performing self-time outs or engaging in exercise routines in exhausting excess energy and avoiding violent conflicts with children. (Doenges, 2004, p. 384) Figure 1. Three Prioritized Nursing Diagnosis and Interventions in Physically Abused Children (Doenges, 2004; White, 2004) Appendix B Name of drug, Generic/ brand, Route, dose and frequency Classification Actions Side effects Reasons for the administration of this drug to client Any nursing considerations about the administering of this drug to THIS particular client Sertraline (Zoloft) blocks the reuptake of the CNS neurotransmitter serotonin in human platelet t abdominal pain and discomfort, abnormal sexual function, Anorexia, diarrhea, dizziness, drowsiness, erectile dyfunction, general weakness, hyperhidrosis, insomnia, libido changes, weight loss, xerostomia --for stabilized mood and affect of patients suffering from post-traumatic disorder and possibly social phobia in pediatic cases, the drug should be taken in extreme precaution for it potentially increase suicidal ideation and attempts in clients Figure 2. Prescribed Medication for Children in Emotionally-Distressed States (Zoloft Clinical Pharmacology, 2011; Zoloft Oral, 2011) Read More