What Are the Barriers and Facilitators Experienced by Registered Nurses in Relation to Mandatory Reporting of Child Abuse and Neglect - Literature review Example

What are the barriers and facilitators experienced by registered nurses in relation to mandatory reporting of child abuse and neglect? Introduction Child physical abuse and child neglect is currently a global public health issue that occurs within all socio-economic levels, educational levels and also within all family situations. According to Lazenbatt & Freeman (2005) children who survive physical abuse might end up suffering many years of incapacity due to childhood injury. Moreover, such individuals during their adulthood might experience increase psychiatric diseases, depression, low self-esteem and poor quality of life. Due to the numerous detrimental effects of child abuse and neglect has on the victims, it is important to ensure all such cases are reported for the children to get the required care and also for the families where child abuse takes place to given the required care and support in order to rectify the situation and ascertain long-term wellbeing of the children (Natan et al, 2012). As a result, various countries have set up legislative provisions that obligate registered nurses to report cases of child abuse and neglect, suspected of physical, sexual or psychological and emotional abuse that has occurred or has a likelihood of taking place (Ainsworth, 2002). The significance of the mandatory reporting of child abuse and neglect by registered nurses is that it ensures the child abuse and neglect cases are identified and hence early intervention addressing the cases is instituted. Additionally, the reporting also ensures that such the child abuse and neglect cases are disclosed. A study conducted by Mathews et al (2008) found out that mandatory reporting by registered nurses is the main way through which of child abuse and neglect cases are uncovered. For instance, mandatory reporting by registered nurses has been responsible in uncovering 67% in USA, 75% in Canada and 58% in Australia of child abuse and neglect events (Mathews & Kenny, 2008). Disclosure of child abuse and neglect case ensures that there is child protection, and also child and families are provided with support and intervention services; this can enhance health, development as well as wellbeing with long-lasting benefits which include saving downstream expenditure to children and society (Mathews & Kenny, 2008). However, in spite of laws obligating mandatory reporting of child abuse and neglect cases, there are several factors that influence the reporting practice under mandatory reporting legislations by registered nurses where some factors facilitate while others hinder the reporting practices (Yehuda et al, 2010). Moreover, studies indicate that there is minimal evidence regarding nurses’ conformity to the mandatory reporting. Factors that influence their reporting include: nurses’ knowledge regarding particular aspects reporting child abuse and neglect cases, their attitudes towards reporting, their skills and training in indentifying and perceiving and reporting child abuse and neglect as well as the confidence of the nurse in sensing and reporting child abuse and neglect, among other factors (Feng & Levine, 2005). Furthermore, nurses lack the clear picture of what reporting entails or aspects allied to successful reporting practices. There are various factors that influence mandatory reporting of child abuse and neglect cases. These factors either hinder or facilitate the reporting practices and thus it is important to identify the factors to ensure barriers are addressed while facilitators are upheld to enable satisfactory compliance with mandatory reporting by nurse. Critique of the Literature According to Yehuda et al (2010) one of the main barriers that registered nurses experience in relation to mandatory reporting of child abuse and neglect include inadequate awareness regarding child protection issues. This is because of insufficient training as well as lack of skills and professional education on domestic violence during their education and training. A study conducted by Dunne et al (2010) supports this where the study found out that nurses who had completed training on child protection were more likely to report child abuse and neglect cases. This therefore confirms that lack of training in issues allied to children protection is one of the main barriers that registered nurses face in regard to reporting child abuse and neglect (Mathews & Kenny, 2008). Yehuda et al (2010) found out that the most common skills that nurses lack include; skills allied to testifying in court, talking to child in order to evaluate if the child has been maltreated, in addition to tackling their parents’ reactions during evaluation. Accordingly, this implies that basically nurses lack skills such as how to talk to children and their parents as well, how to prepare for testifying in courts and the cues of identifying signs of children abuse and neglect (Lazenbatt & Freeman, 2006). This shows that not only do nurse lack required training in regard to reporting child abuse and neglect case, but also the training content and methods used in training nurses regarding child abuse and neglect might be unsatisfactory (Feng & Levine, 2005). A study conducted by Louwers et al (2012) found out that even though healthcare practitioners are motivated to detect and identify incidents of child abuse and neglect, normally they do not have adequate time for developing policy and procedures, lack enough time to register suspected child abuse and also lack adequate time to arrange for education and training on child abuse and neglect. The lack of time by the nurses to address issues regarding child abuse and neglect are mostly attributed to the high workload nurses normally have. Normally, hospitals have high flow of patients with diverse ailments and this might make it difficult for nurses to find time to interview children they suspect may be experiencing child abuse and neglect and they may lack time to discuss suspected abuse with the parents (Louwers et al, 2012). As the evidence indicates, lack of time is a major barrier that nurse experience in relation to mandatory reporting of child abuse and neglect. This is because in many healthcare setting nurses have a heavy workload such that they hardly find time to tackle other matters apart from delivering nursing care. The heavy workload might not only prevent nurses from assigning time to probe suspected child abuse cases and report but they might also forget to report the cases due to heavy workload because they mostly give priority to providing nursing care. Nurses consider nursing care to be their prime responsibility and thus they opt to leave investigation of child abuse to other professionals such as Child Abuse Center (Louwers et al, 2012). Moreover, training and skills are essential when it comes to identifying and reporting child abuse and neglect. Likewise, heavy workload prevents nurses from enrolling in training programs that can equip them with the required knowledge and skills to identify and report child abuse and neglect cases (Louwers et al, 2012). Findings of Natan et al (2012) found out that attitudes of the nurses towards mandatory reporting are major reason why nurses do not report child abuse and neglect events. Such attitudes include their concern regarding legal charges whereby they fear legal charges that accompany reporting (Natan et al, 2012). Basically, the fear of legal charges by nurses when it comes to reporting arises because nurses fear that misjudgment may result to legal charges. Misjudgment might occur where nurses may be accused of having given false information regarding abuse where those associated with having done the abuse might claim that the abuse never took place and this might leave such nurses in legal tussles. In addition, the attitude of the nurses towards their professional responsibility also influences mandatory reporting by nurses (Feng & Levine, 2004). Professional-allied attitudes such as remaining anonymous, avoiding to be involved in legal suits and views that reporting can end up harming the child for instance a nurse may think that when the child is separated from his/her family to prevent abuse the child may end up experiencing emotional and psychological problems (Mathews et al,2008). Feng & Levine (2004) found out that at times attitudes of nurses support punishment of the abusive parents. In this case, nurses fail to report child abuse incidents because they believe that parents were right in inflicting maybe physical abuse on a child to punish the child for a wrong doing. Supportive Boards in hospitals facilitate reporting of child abuse cases by the nurses (Louwers et al, 2012). This is because the supportive board is likely to provide all the required support to nurses for them to report child abuse and neglect incidents. For instance, a supportive board is likely to propose financing of nurses’ training on child abuse and neglect and also has a likelihood of facilitating establishment of protocols, policies as well as supportive network that is likely to promote and motivate nurses to report child abuse incidents. Presence of policies regarding child abuse and neglect protocols also facilitates reporting. This is because nurses feel obligated to report abuse issues and they are also aware that failure to follow the institution’s policies and procedure might land them in problems (Louwers et al, 2012). Louwers et al (2012) further explains that presence of a child abuse team and child abuse attendants in the hospital facilitates reporting by nurses. This is because their presence ensures there is collaboration between them and nurses. The significance of child abuse team and child abuse attendants in hospitals assists in facilitating reporting in that they help not only in offering their valuable knowledge by also help in reducing workload of the nurses which is a major impediment in reporting. Normally, issues allied to child abuse require a lot of time and efforts and thus presence of child abuse team and child abuse attendants can assist nurses in easing this burden and hence facilitating reporting (Louwers et al, 2012). According to Yehuda et al (2010) professional development by nurses is an important facilitator when it comes to reporting of child abuse and neglect by nurses. Adequate training for nurses on child abuse and neglect ensures that nurses are able to successfully screen and detect early child abuse. This is because adequate training covers all important aspects involved in child abuse such as interviewing techniques/communication skills, and training on how to relate injuries with the history and developmental phase of the child (Yehuda et al, 2010). Findings Studies show that a big percentage of healthcare providers such as nurses have inadequate training regarding child abuse and neglect issues. As a result, most of the nurses are confused about their specific role in regard to child protection process, are not sure of what they are supposed to do and report when they encounter suspected incidents of child abuse and neglect and are also in particular unsure of the consequences (positive or negative) they might face after reporting maltreatment cases (Yehuda et al, 2010). The findings thus indicate that nurses lack the required skills and knowledge on how handle suspected incidents of child abuse and neglect. From the study findings, nurses lack the required skills for testifying in courts regarding the child abuse and neglect cases, they do not have the skills to talk with the children with the aim of examining suspected mistreatment and also they do not have the required skills to handle the reactions of their parents during examination (Yehuda et al, 2010). Additionally, studies indicate that nurses do not have the ability and skills of identifying signs of abuse in children. A study conducted by Lister & Crisp (2003) found out that nurses ware not adequately aware of what child protection involves or the contributions that nurses are supposed to make in regard to child abuse. Nurses have inadequate capability to respond to the child abuse cases that they encounter as well as carry out extensive work that is involved in reporting child abuse and neglect cases. All these are due to inadequate training for nurses regarding issues pertaining child abuse and neglect (Yehuda et al, 2010). This therefore indicates that lack of training is a major barrier to mandatory reporting of child abuse and neglect cases. Additionally, findings of the reviewed literature (Feng & Levin, 2004) indicated that the attitudes of nurses influence the mandatory report of child abuse and neglect cases. The attitudes may be barriers or facilitators to reporting depending on the negativity or positivity of the attitudes towards child abuse and neglect. For instance, pediatric nurses hold a positive attitude towards reporting and are more pressurized to report child abuse and neglect cases. This is because pediatric nurses are socially compelled to report child abuse cases (Mathews et al, 2008). Findings also indicate that general attitude of the nurses affects their reporting in that when nurses have an attitude that tolerates physical discipline of children by the parents they are less likely to report child abuse and neglect incidents. According to Feng & Levin (2004), cultural acceptance of parental obligations hinders reporting. The perception of nurses on acceptability of physical discipline directly impacts reporting. The higher the acceptance of physical discipline, the less likelihood of such a nurse reporting child abuse and neglect cases (Feng & Levin, 2004). Likewise, findings indicated that if nurses have an attitude that emphasizes of rights of children they have a higher likelihood of reporting child abuse incidents. In addition, the reviewed literature indicates that nurses tend to report supposed child abuse differently basing of the kind of abuse. For instance, nurses have a higher likelihood of reporting sexual abuse when compared to other types of abuse while nurses tend to report emotional and psychological abuse less when compared to other kinds of abuse (Mathews et al,2008). This therefore indicates that the attitude of nurses towards different kinds of abuse influences their reporting. Findings also indicate that board members can ensure that nurses in hospitals are given the necessary support to facilitate their reporting. Training and educating nurses on issues allied to child abuse and neglect facilitates nurses to effectively screen child abuse and neglect cases because with the required training and skills nurses are able identify child abuse and enhance communication skills which is important in interviewing suspected cases of child abuse and neglect (Yehuda et al, 2010). More importantly, findings show that having attendants specifically for child abuse in hospitals, hospital management supporting screening policy as well as implementation of a standard protocol and authenticated screening tool; facilitate reporting of child abuse and neglect incidents by nurses (Yehuda et al, 2010). Recommendations Healthcare providers including nurses should enroll in training and educational programs on child abuse, evaluation techniques, legal mandates, as well as professional duties. Nurses should receive adequate training in child abuse and neglect issues. According to the reviewed studies, most nurses lack the required skills and knowledge on how to handle child abuse and neglect issues (Louwers et al, 2012). Therefore, it is necessary for healthcare institutions to establish training programs for detecting child abuse as well as reporting of child abuse cases. The significance of these programs is that education is the foundation of appropriate detection of child abuse. Nurse should be training on successful interviewing technique, communication skills, how to report child abuse case, how to testify in court regarding child abuse cases and such (Yehuda et al,2010). More importantly, nurses need the training to make should they are knowledgeable on the signs of abuse and neglect and they posses rudimentary knowledge in reporting procedures. The training programs should stress on hands-on experience as well as active simulations devised to offer realistic experiences under controlled situations to enable numerous opportunities for feedback and self-reflection regarding training (Dunne, 2010). Hospitals should implement a screening procedure which should consist of a screening instrument and a suitable procedure that can be used in all children whenever child abuse is suspected (Louwers et al, 2012). The screening procedure can help in facilitating mandatory reporting by ensuring that all healthcare providers in hospitals follow all the required screening protocols that even cover child abuse and reporting. As a result, all screened child abuse and neglect incidences will be captured and screened as per the protocols (Lazenbatt & Freeman, 2006). Hospitals should implement policies for reporting child abuse and neglect issues. Such hospitals will ensure that all nurses follow the require hospital policy and report all child abuse cases. Additionally, nurses should be enlightened on the policy to ensure they satisfactorily understand the policy as this will enable them to follow the policy to the letter. Healthcare institutions should have committed child abuse attendants. This is because even heavy workload is one of the main factors that hinder reporting of child abuse and neglect cases and since psychosocial research and referral to child care involves significant time and efforts and hence specified child abuse attendant can take the burden of reporting child abuse cases from the busy nurses. In addition, child abuse attendants can ascertain quality control, swiftness of treatment or referrals, and appropriate follow-up of patients. Child abuse attendants can also promote the signaling and recognition of actual and suspected child abuse (Louwers et al, 2012). Bibliography Ainsworth, F 2002, Mandatory reporting of child abuse and neglect: does it really make a difference? Child and Family Social Work, vol. 7, pp 57–63. Dunne M , Fraser JA, Mathews B ,Walsh K & Chen, L, 2010, ‘Factors influencing child abuse and neglect recognition and reporting by nurses: A multivariate analysis’, International Journal of Nursing Studies, vol. 47, no. 2, pp. 146-153. Feng, JY & Levine, M 2005, ‘Factors associated with nurses’ intention to report child abuse: A national survey of Taiwanese nurses’, Child Abuse & Neglect, vol. 29, no. 7, pp. 783-795. Lazenbatt, A & Freeman, R 2006, ‘Recognizing and reporting child physical abuse: a survey of primary healthcare professionals’, Journal of Advanced Nursing, vol. 56, no. 3, pp. 227-236. 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