The role of Community Nurse
Introduction
Domestic violence on children or child abuse is defined by the Child Abuse Prevention and Treatment Act as “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm” (Child Abuse Prevention, 2009).
In most of the cases, it is not a onetime incident, but a pattern of abuse that is used to make a control over a child or humiliate the child or maintain power over him/her. In cases where the violence is physical or sexual, or if there is a threat of causing physical or sexual violence to the child, domestic violence is considered a criminal offence (Baker, 2002).
Studies based on administrative data or reporting by healthcare professionals in the US and Canada show a national incidence rate of 1.6–3% (DCSF, 2009 & Euser, 2010). A study by Woodman et al. concluded that child physical abuse occurs in about 1 in 11 children in the UK each year (Woodman, 2008). Community-based studies where parents or children have reported show more than tenfold rate than studies based on reporting by professionals, yet many cases still go under reported (Fallon, 2010). Another research suggests that domestic violence against children has been going on for centuries now and fairly common in many parts of the world, but it is more frequent in the US (Ronan, 2004). Only after American pediatrician Henry Kempe’s introduction of ‘battered child syndrome’, violence or abuse or maltreatment of children has become widely known. That a child has faced domestic violence can be known by two key factors, either the harmful behavior towards the child is evident or there is damage due to such an act (Messman, 2004).
Battered child syndrome is described typically in a child younger than 3 years old who suffers from serious physical abuse. Such children usually suffer fractures in one or many parts of their body. They may have subdural hematomas and multiple soft tissue injuries. In such cases, parents usually provide inconsistent explanations for the injuries, which should prompt one that the injuries are not traumatic or accidental, but intentional (Walker, In Press).
A kind of domestic violence - sexual abuse of a child is a serious public health issue. Walker et al’s study showed a strong association between psychological disorders and a sexual abuse history in the childhood. According to the findings of the study, sexual abuse in early life adversely impacted the emotional development of the victim child. Sexual abuse victims are generally in the age group of five to ten years (Walker, In Press). In a study by Zambon et al, most cases of sexual abuse were reported in the home environment by a person known to the victim, with one third of the cases being incestuous. Among all the cases reported in this study, almost half of the cases were already chronic at the time they were first noticed (Zambon, 2012).
This topic interests me because it is related to the wellbeing of a child. Children are tomorrow’s budding citizens and they need to be protected when they are young, so that they grow up into mature and healthy individuals. As we learnt above, child abuse is a common phenomenon, but go many cases go unnoticed and unreported. If such cruel cases against children go unreported, children may not grow up as healthy individuals and not form a healthy community, which is not a good sign for the development of a nation.
Effects of domestic violence
Experience of domestic violence during tender years of life can significantly interfere with future development of child with varying damage to the child’s mind and body. In addition to this, unfavorable social conditions like poverty, unemployment, poor housing conditions, dysfunctional families or separated parents, children neglected in childhood, drug user parents, or parents suffering from psychiatric disorders, all can be reasons for domestic violence (Zambon, 2012). Usually cases of violence are not notified and go hidden; therefore, the quantification of correct cases of domestic violence is a major issue in the US and so also other parts of the world (Zambon, 2012).
Studies have shown that children, who grow up in an environment, where they have faced domestic violence, generally are (Baker, 2002)
- Are violent themselves
- There is evidence to suggest a link between exposure to domestic violence and “bulimia nervosa” or ‘emotional eating”.
- There is an increased emotional and behavioral problem like depression, suicidal tendencies, and psychosomatic illness
- Children learn to imitate parents (acting violently)
- Children are cruel to animals
- They are not sensitized to violence
- They may have habits of bedwetting or constant worry of danger
- Love and affection for parents may be coupled with fear, disappointment, and resentment
- They have a decreased sense of safety, normalcy, and ability to cope with stress
- Children continue to have health problems in adolescence that extend to alcoholism, depression, obesity, drug abuse, and chronic adult diseases
Effects of domestic violence on children at schoolwork
Children who are exposed to domestic violence may have difficulties coping at school work. There may be behavioral problems, such as aggressiveness, lack of discipline, depression, and decreased self-esteem (Carter, 1999). Child may not be able to cope with school studies, his learning ability and concentration will be severely impacted. The child may also have problems in getting along with the rest of his class and exhibit a difficulty in connecting with others in the school (Carter, 1999). They may perform poorly in the school and may score significantly lower on assessments of motor and cognitive skills or verbal skills as compared to general student population. Due to these things, there are chances either the student remains absent from the school or there are chances of suspension from the school (Carter, 1999).
A nurse can play an important role in the referral of such children and supporting them. A nurse who is appointed in a school called as a “school nurse” always has a special role to play in helping students exposed to domestic violence. She is also responsible for providing general medical support. The first thing a school nurse needs to do is to recognize the case of abuse, note down any injuries that may have occurred as a result of domestic violence, which will help in case of legal action being taken against the abusive parent/ caretaker. The school nurse can also actively participate in school wide prevention programs, if schools are undertaking such type of activities as a part of approaching the issue of domestic violence against child students (National Law Enforcement Museum, 2011).
What role a community nurse can play?
The profession of nursing has its own challenges, but the bigger challenge is the area of child abuse. Clinical expertise needs to be enhanced first to gain knowledge. A nurse can really make a tremendous difference in a child’s life by offering support (Lazoritz, 2010).
One objective of a community health nurse is to provide emotional/ psychological support to the young mind, which has faced abuse, and help them grow as mature individuals. At the same time, the nurse needs to attend to the overall health and wellbeing of the child, incorporating resources, when indicated, into the treatment program for the child. She needs to well qualified and literate and should be familiar with the state’s child abuse law so that she knows reporting of a child abuse case. It is mandatory for a nurse to report a case of child abuse. Each state has its own legal definition of child abuse and has a child abuse hotline to report suspected case of abuse. www.childwelfare.gov is a website which the nurse can visit for each state website and their contacts (National Law Enforcement Museum, 2011).
As community nurse, my role would be to try to prevent child abuse and develop strategies that promote safe environment for children. I would need to work in a community and along with the community to identify issues that children face, develop strategies, and take action to treat the child immediately offering medical and psychological support. I will also have to take active part in mobilizing individuals to take actions on determinants of health and provide information to individuals and community and counsel them regarding healthy choices. Importantly, I will have to educate parents on understanding of early childhood development.
I need to gather knowledge and read wide literature on laws for abuse against children, so that I can help report the cases to concerned authorities.
I would recommend a community nurse to first educate herself with laws for domestic violence, learn to recognize a case of abuse, report it, and treat it medically as well as psychologically. A very significant part of the whole process is reporting, so that a legal action can be taken against the culprits who abused the child.
References:
- Child Abuse Prevention and Treatment Act as Amended by the Keeping Children and Families Safe Act of 2003. (2009) Administration for Children and Families. U.S. Department of Health and Human Services.
- Baker, L., Jaffe, P., Carter, S. & Ashbourne, L. (2002). Children Exposed to Domestic Violence: A Teacher’s Handbook to Increase Understanding and Improve Community Responses. London, ON: Centre for Children & Families in the Justice System
- Euser EM, Ijzendoorn MH, Prinzie P, Bakermans-Kranenburg MJ. (2010) Prevalence of child maltreatment in The Netherlands. Child Maltreat, 15, 5–17.
- Woodman J, Pitt M, Wentz R, Taylor B, Hodes D, Gilbert RE. (2008) Performance of screening tests for child physical abuse in accident and emergency departments. Health Technol Assess 12(33):iii, xi–xiii, 1–95.
- Fallon B, Trocme N, Fluke J, MacLaurin B, Tonmyr L, Yuan YY. Methodological challenges in measuring child maltreatment. Child Abuse Negl. 2010;34:70–79.
- Ronan GF, Dreer LE, Dollard KM, Ronan DW: Violent couples: coping and communication skills. J Fam Violence 2004, 19:131-137.
- Messman-Moore T, Brown AL. Child maltreatment and perceived family environment as risk for adult rape: is child abuse the most salient experiences? Child Abuse Negl. 2004;28:1019-34.
- Walker, P., In Press: Proceedings of the Xth European Meeting of the Paleopathology Association. Retrieved from: http://www.anth.ucsb.edu/faculty/Walker/Published/publications/PLW%20Battered%20Child%20Syndrome.pdf
- Zambon M. P., Jacintho A, De Medeiros, M, Guglielminetti, R, Marmo, D. (2012) Domestic violence against children and adolescents: a challenge. Elsevier Editora Ltda.
- Carter, L. S., Weithorn, L. A., & Behrman, R. E. (1999). Domestic violence and children: Analysis and recommendations. The future of children: Domestic violence and children, 9(3) Winter, 1–20. Retrieved from: http://futureofchildren.org/futureofchildren/publications/docs/09_03_Analysis.pdf
- National Law Enforcement Museum. (2011). Supporting children exposed to domestic violence: A facilitator’s guide to creating a coordinated response in elementary schools. Washington, DC.
- Lazoritz S, Rossiter K, Whiteakar D. What every nurse needs to know about the clinical aspects of child abuse. American Nurse Today. 2010. 5 (7). Retreived from: http://www.americannursetoday.com/article.aspx?id=6902&fid=6846
- Bowden, Vicky R., Cindy Smith Greenberg. Pediatric Nursing Procedures. 2nd ed. Philadelphia: Lippincott Williams & Wilkins, 2009.]
