Child Abuse As It Is - Essay Example

Child Abuse  Ginger Cotton R.N.  Duquesne Karen Halpern MSFN, RN  GPNG 500 Introduction to Forensic Nursing  November 16, Introduction  Child abuse and maltreatment are very common across North America. In 2003, child welfare agencies received more than three million reports of child abuse (Dorsey and Mustillo, 2008). In any situation of child abuse, everything depends upon an assessment, which is performed for the sake of prevention. This includes prevention of further abuse to the child as well as the abuse of other children at risk. As forensic health care specialists are ones who are most directly in contact with patients, forensic nurses are exposed to cases such as assault, homicide/murder, child or even elder abuse. It is due to this clinical background training in systematic investigation techniques, and evidence in collecting of data (, e.g. bruises, lacerations) that allows the forensic nurse to be part of child abuse prevention/investigation team.  Child abuse can be defined as physical abuse/neglect, sexual abuse, or emotional abuse/ neglect. While child abuse has been known to involve the physical, psychological, social, emotional, and sexual maltreatment of children, the survival, safety, self-esteem, growth and development of the child is threatened (Hick, 2006, p. 127). The extent of child abuse is depressingly wide. It crosses all economic, cultural, religious, and geographical boundaries. Physical abuse of children covers such things as deliberate violence that causes any kind of injury or even death to a child. As Richard J. Gelles (1982) states in his article “Child Abuse and Family Violence”, physical acts of child abuse include punching, biting, kicking, beating, and threatening to use or using a weapon against a child (28). Signs of this type of abuse can be found on the body in the form of bruises, scars, broken bones, burn marks, or deformities. However, such injuries may not be present even though abuse has occurred. As stated by Gelles (1982), many children have been pushed downstairs or punched and kicked by their parents without receiving a concussion or broken bones (28). Physical neglect involves the negligence of a guardian to provide the necessary food, clothing, shelter, or medical attention necessary to the physical well-being of a child. Sexual abuse, which sometimes occurs along with physical abuse, involves an adults use of a child for sexual gratification. Very often, it is a family member that perpetrates the abuse, but sometimes strangers are involved. Alvin A Rosenfeld offers the following precise definition:  The phrase, sexual abuse of children refers to a disparate array of situations that share one characteristic: someone considered too young to give informed consent has been involved in a sexual act. For that reason, in all sexual abuse cases, the child is the aggrieved party, and the adult, from whom we expect self-control, is held legally culpable (Rosenfeld, 1982, p. 66).  Sexual abuse of children can have profound effects. The abuse most often comes to the attention of outsiders when children see a doctor for a medical complaint that is somehow related to the abuse. Parents may complain that their child has developed an antisocial personality, has difficulty in his or her relationships with other children, is anorexic, asthmatic, or bulimic. Many other possibilities exist, of course, as well.  A challenge for medical practitioners is to determine whether these problems, if they do exist, are spontaneously generated, or if they can be traced to some underlying sexual abuse. This can be a very difficult determination to make. One thing practitioners can investigate is abrupt changes in a child’s behavior. This may well be a sign of molestation, with the changes representing troubling emotions that the child cannot resolve. A change from garrulity to shyness, from openness and affection to secretiveness and coldness, are just such changes that could well be tip-offs of sexual abuse. Rosenfeld (1982) also cites acting-out behavior as a likely indicator of sexual abuse. As he explains, children and adults occasionally act because they cannot tolerate the intense pain, anger, or sadness they feel. Sometimes desperation may never be expressed, but the person will begin frantic activity to hide from these feelings (Rosenfeld, 1982, p. 72). Sexuality is a common mode of acting out, and can include such things as childhood promiscuity, teenage pregnancy, running away from home, drug abuse, and suicide attempts. It may also manifest in an extreme aversion to sexuality, a fear of what the sexual act has meant in the past. The four categories of medical problems relating directly to sexual abuse in children are pregnancy, venereal disease, physical trauma, and psychological trauma. These may occur separately or together, with the last of these, psychological trauma, the most frequent and indeed the most lasting. Psychosis in victims of sexual abuse is very common. However, psychosis and suicidal impulses are also very common in those perpetrating the abuse.  In his concluding remarks, Rosenfeld (1982) notes the reluctance of some medical practitioners to become involved in cases of sexual abuse, since it is often very hard to prove that the abuse has occurred, and gathering evidence can cause great disturbance for all involved. The procedure can be extraordinarily draining emotionally. However, he insists that investigations must take place, and advises that more primary care physicians become alert to the possibility of molestation, and use thoughtful, empathic techniques to intervene (86). He suggests that medical schools train medical students more fully in this area, and that the students become more sensitive to the social and emotional aspects of illness and medical care, as well as become empathic and skilled in interviewing techniques and in psychiatric approaches (86). This would go a long way in assisting the discovery of sexual abuse, and in making its resolution less painful than it has been.  Emotional abuse is the attack upon a childs self-esteem by an adult. This may take the form of extensive verbal abuse (yelling at a child, taunting them with humiliating facts, or outright threats). This leaves the child without a feeling of self-worth, and often results in the child harboring intense feelings of anger and resentment, which might well explode later on in life into criminal activity, to name just one manifestation. Children who are abused emotionally are also at great risk of becoming abusers in turn when they reach the age to have children themselves. Emotional neglect can be said to take place when a guardian is negligent in meeting a basic standard in delivering affection to a child under his or her care.  The causes of child abuse are complex. Most of us find the idea of abusing a child unthinkable, and react with considerable revulsion when thinking of the subject. Child abusers, however, tend to be very much like the rest of the population except that they lack some of the basic psychological necessities for coping with children. These are, namely, patience in dealing with children, and the maturity necessary to assume an adult role. Often, child abusers were victims of child abuse themselves, and so repeat a vicious cycle.  Richard J. Gelles identifies four main factors that are relevant in determining the causes of child abuse. They are the cycle of violence, socioeconomic status, stress, and social isolation.  The cycle of violence refers to the fact, as mentioned above, that child abusers were often victimized themselves when young. In the case of men, the abuse they perpetrate often includes spousal abuse. As Gelles (1982) has it, violence begets violence and data shows that the higher the frequency of violence, the greater the chance that the victim will grow up to be a violent partner or parent (30). This obviously suggests that child abuse is a learned behavior, one that is, tragically, passed on from victim to victim in a sickening cycle.  Studies have shown that those people of low socioeconomic status are more likely to become child abusers than those of high socioeconomic status. As Gelles (1982) cautions, however, this conclusion does not mean that domestic violence is confined to lower-class households. Investigators reporting the differential distribution of violence are frequently careful to point out that child and spouse abuse can be found in families across the spectrum of socioeconomic status (30). Economic concerns are not; therefore, all we have to look for when considering which families are at risk of abusing their children. Other factors must come into play, and careful attention must be given to them.  The role stress plays in child abuse is a large one. Adults pushed over the edge by complicating factors in their own lives often account for harm done to children. As Gelles (1982) points out, a third consistent finding of most domestic violence research is that rates of family violence are directly related to social stress in families. In addition to reporting that violence is related to general measures of stress, investigators report associations between various forms of family violence and specific stressful situations and conditions, such as 1) unemployment or part-time employment of males; 2) financial problems; 3) pregnancy, in the case of wife abuse; 4) single-parent families, in the case of child abuse (30-31).  When alcohol and drug use, which are very common among abusive parents, are added to the pie, additional stress and an incrementally high risk are added as well. It should also be added that certain characteristics of children could be contributing factors in the production of stress. Mentally retarded children, for obvious reasons, can provoke stress because they demand extra attention and can be especially frustrating in certain circumstances. Those children who possess physical disabilities can also be placed in this category. The stress for parents rises, and so does the risk of serious abuse.  What all this indicates is that stress-management in families might go a long way in preventing abuse from occurring. When situations arise that, suggest the likelihood of abuse in a family is high for instance, recent unemployment of the male, or pregnancy for the female, all parties involved might want to take time out and pay special attention to the situation at hand. In this way, volatile situations might well be defused before they get out of control.  Social isolation is another major factor predisposing people to commit acts of abuse. If people are isolated from society, they have a tendency to drift free of the societal restraints that are placed upon them. They become more likely to lose self-control and indulge in actions that were the censuring eye of the community more obviously placed on them, would not occur. Like Kurtz in the heart of the African darkness, adults beyond the police officer’s gaze tend to drift in personal expressions of morality that may well be offensive and at odds with the more general community standards. This should make us aware that we must keep our police officers eye on those who are isolated. Encouraging involvement with the community will also encourage more responsible attitudes towards the care of children. Societys constraints are more binding when society is actively involved in a familys care. This should, then, be a primary consideration of every community, the promotion of involvement among all its members. Thankfully, efforts to protect children have increased in the last few decades. This has coincided with an increase in awareness among the general public of the extent of the child abuse problem our nation faces. As freakish and repulsive as the most serious forms of child abuse no doubt are, we must, as a society, take responsibility for the causes that lead to this abuse and take steps to encourage its eradication to the greatest extent possible.  A case of physical abuse by a mother and her boyfriend which resulted in a young girls death, provides information regarding how important it is to perform a through risk assessment, and what steps should have been followed that would have prevented a childs death. According to Dorsey and Mustillo (2008), there are three reasons that problems arise with identification and assessment of child abuse. Often there is no consistency between what various healthcare workers choose as approaches. As well, some healthcare workers who do not implement models of assessment properly and, third, other healthcare workers ignore the models entirely.  Assessment of child abuse begins not with confirmation that abuse is taking place but with risk assessment. Assessment of risk to the child is the crucial aspect of all child welfare practice (Hick, 2006). If a risk assessment can be done effectively, then the child will be safe and the family can remain intact (Dorsey and Mustillo, 2008). Risk assessments are concerned with the possibility of a child being abused with the goal of preventing abuse. The investigation of child abuse is based on data collected through interviews, assessment, service reports from various professionals, and records. The healthcare worker in the case of utilized for this paper had every right to enter the dwelling. Under every provincial law, child protection workers/healthcare team members are entitled to enter any residence to remove children who are in need of protection (Hick, 2006). There are established investigative guidelines for child abuse cases and certain guidelines were not observed in the case reported by Lambert (2008), which is why a review of the child welfare system was demanded. For example, it is logical to actually see the child who may be abused. The alleged abuser, along with any children in danger of potential abuse, need to be interviewed by the police. Another lack in the case was coordination where all professionals involved would share information (Hick, 2006). If that were done, the patterns of reopening and closing files would have been observed.  When there is a possibility of abuse, suspicions and presumptions are misleading and useless. The only certain way to prove that a child is being physically abused is through a medical examination where physical marks can be documented. A number of healthcare workers clearly suspected abuse. However, workers are far more accurate in assessment of low risk than of high risk (Dorsey and Mustillo, 2008). What was missing in the case of the girl was verification. One means of gathering information would have been to turn to neighbors and all others in the community because of the type of social context for child abuse in rural areas (Hancock, 1997). The ongoing pattern was suspected abuse, no problem, and back to suspected abuse. According to Hick (2006), the healthcare worker needs to record the process of verification and why the decision was made. Otherwise, there is simply no child protection concern. Healthcare workers tend to focus on such parental risk factors as mental illness and a high degree of family stress in cases of possible physical abuse. The problem with such risk factors is that they are stereotypical and healthcare workers emphasize them because of research and reading other reports of abuse (Dorsey and Mustillo). Even though a protection concern may be verified, the child can continue living in the home as was the situation with this child. For the childs safety in that scenario, there must be a set course of visits and there should be restricted access by any family member who warrants it (Hick, 2006). The most common mistake made by healthcare workers in child abuse cases, according to Dorsey and Mustillo, is to classify a situation as low risk and then later discover there is a major case of abuse. Proper identification of risk factors and level of risk is essential in order to determine interventions. There are basically two options in terms of interventions. The child may remain in the home but be in need of protection, or the child will be removed from their home (Hick, 2006).  Values might help to clarify the indecisiveness in the situation and to resolve the oscillating patterns of suspicion. First of all, values are more likely to be a source of interference since the healthcare worker often denies the possibility and thinks that abuse cannot be occurring in this situation. Physical abuse may be absolutely foreign to the healthcare workers experience and way of thought. Values apparently were at work in the case where healthcare workers briefly considered that the child was being abused and opted for an attitude of what cannot be happening. Our own psychosocial development determines how we perceive reality and this can sometimes cause us to respond in a way that is not appropriate for a clients needs (Hancock, 1997). It is especially important in situations of potential child abuse that the healthcare worker should have self-awareness. Just as the influence of our childhood experiences can cause us to deny physical abuse, the opposite situation can occur. The healthcare worker who comes from a dysfunctional family may never have been capable of dealing with the experience and pain. Encountering a situation of physical abuse of a child can be a direct cause of trauma for the healthcare worker who was disciplined in unfair ways (Hancock, 1997). Another factor, which the healthcare worker brings to the situation, is their own needs and these can be beneficial or detrimental for that healthcare worker as they work with clients. Some of our needs are contradictory such as the need for control and power as opposed to the need to be nurturing (Hancock, 1997). Some of the needs can be constructive for the client while others do not help the situation. Probably the most common trap for the healthcare worker is the desire to offer instant solutions to other peoples problems and especially to change others so that they will conform to our own values.  I can evaluate my work by several criteria. The first is whether I used a model or approach as a guide. Another criterion concerns whether I have taken all aspects of the situation into account. This means questioning whether I have focused on the contributing factors and whether I am certain that the situation is low or high risk. My assessment report details the abuse and its precipitating factors, family functioning, and risk of continued abuse. I have recorded the process of verification and then followed the appropriate investigative process to arrive at the best outcome (Hick, 2006). My plan includes risk factors, strategies, along with care expectations and coordination of care.  The case of child physical abuse as reported by Lambert (2008) is complex because vital information is missing from the article related to the healthcare workers actions and motives. The pivotal point is that they failed in risk assessment as well as in identifying the category of risk. To prevent such errors there are models and guidelines that the healthcare worker needs to follow. When a protection verification decision is made, for example, there are clear procedures to be followed. The healthcare worker can never presume and must use critical judgment when making use of risk factors. The wrong decision by a healthcare worker will end precisely where the newspaper article begins, telling a story of an abused child who slips through the cracks and looses their life due to abuse.  Forensic nursing, as the name implies, deals with the investigation of judicial cases and the collection of evidence as part of a court of law within the context of the nursing environment. Subspecialties within the field of forensic nursing encompass both forensic and nursing specialty field including, but not limited to gynecology, law, sexual assault investigation, gerontology and psychiatry (Hoyt & Warner, 2005). Collaboration with the appropriate authorities by effectively documenting the events, providing for immediate and long-term psychological and physical needs of the patient, are some of tasks for which the forensic nurse is adequately equipped (Pyrek, 2006). Assessment of physical abuse can be extremely complex especially in terms of identifying instances of child abuse.  References Cameron, J.M. (1975). Atlas of the Battered Child Syndrome. London: Churchill Livingstone.  Dorsey, S. and Mustillo, S. (2008). Caseworker assessments of risk for recurrent maltreatment. Child Abuse & Neglect, 32, 377-391.  Garbarino, James. (1982). Healing the Wounds of Social Isolation. Child Abuse. Boston: Little Brown, and Company.  Gelles, Richard J. (1982). Child Abuse and Family Violence. Child Abuse. Boston: Little, Brown, and Company.  Hancock, M.R. (1997). Principles of social work practice. London: Haworth Press.  Hick, S. (2006). Social work in Canada, 2nd edition. Toronto: Thompson Educational Publishing.  Lambert, S. (2008). Girl, 5, endured months of abuse, Winnipeg jury told. The Canadian Press, November 5.  Newberger, Eli H. (1982). Child Abuse. Boston: Little, Brown, and Company.  Rosenfeld, Alvin A. (1982). Sexual Abuse of Children: Personal and Professional Responses. Child Abuse. Boston: Little, Brown, and Company. Read More