1. Child, Partner, and Elder Abuse Chapter 18

2. Concept of Abuse All forms of interpersonal abuse can be devastating Emotional abuse – Kills the spirit and the ability to succeed later in life, feel deeply, or make emotional contact with others Physical abuse – Potential for long-term physical damage and in some cases death Sexual abuse – Consequences of sexual abuse my never be resolved if treatment is unavailable – Causes behavioral and emotional difficulties throughout life

3. Child Abuse: Prevalence and Types Prevalence – Actual rates grossly underreported; parents appear to account for 78.9% of child abuse – Children younger than 4 are at greatest risk of severe injury or death Types – Physical – Emotional – Sexual – Neglect

4. Nursing Process: Assessment Guidelines for Child Abuse Some signs of abuse in child – Child is excessively fearful of parent/caregiver – May appear disheveled and neglected – Have history of absenteeism Characteristics of abusive parents – History of violence, neglect, or abuse as child – Low self-esteem, feelings of worthlessness – Depression, poor coping skills – Social isolation – Involved in crisis situation – Rigid, unrealistic expectations of child’s behavior – Poor impulse control

5. Interview Guidelines for Assessment of Child Conduct interview in private Sit next to child Tell child that interview is confidential Use language child understands Ask child to clarify words you do not understand Tell child if any action is required

6. Interview Guidelines for Assessment of Parent/Caregiver Conduct interview in private Be direct, honest, and professional Be understanding Be attentive Inform person if you must make referral to Child Protective Services and explain the process

7. Nursing Process: Diagnosis and Outcomes Identification Common nursing diagnoses – Risk for injury, Disabled family coping, Post-trauma syndrome, Anxiety, Fear, Impaired parenting, Acute pain, Delayed growth and development, Imbalanced nutrition: less than body requirements Outcomes identification – Immediate concern: ensure safety and well-being of child – General outcome: physical abuse, sexual abuse, or neglect has ceased

8. Nursing Process: Planning and Implementation Planning – When child abuse is suspected, nurse is legally responsible for reporting to appropriate child protective agency Implementation – Adopt nonthreatening, nonjudgmental relationship with parents – Understand that children do not want to betray their parents – Be aware of agency’s and state’s policy in reporting child abuse – Ensure that proper procedures are followed – Keep accurate and detailed records – Use of dolls might help child tell how “accident” occurred

9. Case Study: Physical Neglect of a Child Amy, age 5, started kindergarten this year. Her teacher noticed that she seems to spend a lot of time alone, standing on the sidelines during recess watching the other children play, but not entering into the interaction. She comes to school somewhat unkempt and with a noticeable body odor about her. She participates in the free school lunch program, and often gulps her food, appearing ravenous when the food is presented. As the weather turns cold, the teacher notices that Amy is coming to school without a coat. When questioned, she states, “I don’t have a coat.” The teacher reports Amy’s case to the DHS and a home health nurse is sent to Amy’s home to investigate. At Amy’s home the nurse finds a teenager who identifies herself as Amy’s sister, Carol. She is caring for three other children: an 8-year-old boy and a 3-year-old girl, whom she identifies as her siblings, and a 6-month-old girl, whom she identifies as her own child. There is no adult in the home. Carol tells the nurse that she is 16 years old and has full charge of these children most of the time. Carol’s mother lives with her boyfriend most of the time, but comes to the house occasionally to bring a few groceries. Carol tells the nurse that she is worried because the electric company has threatened to turn off the electricity for lack of payment, and because there has been no food in the house for 2 days. She says she has talked to her mother several times, but her mother just responds that she doesn’t have any money right now, and they must do the best that they can. DHS places all the children in foster care and tells the mother that she must undergo therapy in order to justify return of the children to her care. Devise a plan of care that the home health nurse might use to assist the mother in this effort.