Inquiring about childhood sexual abuse as part of the nursing history: Opinions of abused and nonabused nurses
This article explores the opinions of nurses who were sexually abused as children and those who were not, concerning routine inquiry about a history of sexual abuse. Approximately 60% of the participants indicated that routine inquiry should be conducted in pediatric and psychiatric settings. Reasons put forward for not inquiring included concerns about being intrusive, feeling unqualified to deal with content if abuse had occurred, and fear of increasing the distress of clients. Participants believed nurses needed education in this area if they were to be effective. Reasons why this topic involving sexuality and violence may be difficult for nurses are considered.
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Methods to Assess Adverse Childhood Experiences of Children and Families: Toward Approaches to Promote Child Well-being in Policy and Practice
2017, Academic PediatricsAdvances in human development sciences point to tremendous possibilities to promote healthy child development and well-being across life by proactively supporting safe, stable and nurturing family relationships (SSNRs), teaching resilience, and intervening early to promote healing the trauma and stress associated with disruptions in SSNRs. Assessing potential disruptions in SSNRs, such as adverse childhood experiences (ACEs), can contribute to assessing risk for trauma and chronic and toxic stress. Asking about ACEs can help with efforts to prevent and attenuate negative impacts on child development and both child and family well-being. Many methods to assess ACEs exist but have not been compared. The National Survey of Children's Health (NSCH) now measures ACEs for children, but requires further assessment and validation.
We identified and compared methods to assess ACEs among children and families, evaluated the acceptability and validity of the new NSCH-ACEs measure, and identified implications for assessing ACEs in research and practice.
Of 14 ACEs assessment methods identified, 5 have been used in clinical settings (vs public health assessment or research) and all but 1 require self or parent report (3 allow child report). Across methods, 6 to 20 constructs are assessed, 4 of which are common to all: parental incarceration, domestic violence, household mental illness/suicide, household alcohol or substance abuse. Common additional content includes assessing exposure to neighborhood violence, bullying, discrimination, or parental death. All methods use a numeric, cumulative risk scoring methodology. The NSCH-ACEs measure was acceptable to respondents as evidenced by few missing values and no reduction in response rate attributable to asking about children's ACEs. The 9 ACEs assessed in the NSCH co-occur, with most children with 1 ACE having additional ACEs. This measure showed efficiency and confirmatory factor analysis as well as latent class analysis supported a cumulative risk scoring method. Formative as well as reflective measurement models further support cumulative risk scoring and provide evidence of predictive validity of the NSCH-ACEs. Common effects of ACEs across household income groups confirm information distinct from economic status is provided and suggest use of population-wide versus high-risk approaches to assessing ACEs.
Although important variations exist, available ACEs measurement methods are similar and show consistent associations with poorer health outcomes in absence of protective factors and resilience. All methods reviewed appear to coincide with broader goals to facilitate health education, promote health and, where needed, to mitigate the trauma, chronic stress, and behavioral and emotional sequelae that can arise with exposure to ACEs. Assessing ACEs appears acceptable to individuals and families when conducted in population-based and clinical research contexts. Although research to date and neurobiological findings compel early identification and health education about ACEs in clinical settings, further research to guide use in pediatric practice is required, especially as it relates to distinguishing ACEs assessment from identifying current family psychosocial risks and child abuse. The reflective as well as formative psychometric analyses conducted in this study confirm use of cumulative risk scoring for the NSCH-ACEs measure. Even if children have not been exposed to ACEs, assessing ACEs has value as an educational tool for engaging and educating families and children about the importance of SSNRs and how to recognize and manage stress and learn resilience.
Factors associated with nurses' intention to report child abuse: A national survey of Taiwanese nurses
2005, Child Abuse and NeglectThe objectives were to determine the experiences of Taiwanese nurses with a new child abuse reporting law and to assess attitudinal correlates of nurses’ intention to report.
A stratified quota sampling technique was used to select registered nurses working in pediatric, psychiatric and emergency care units in Taiwan. A total of 1400 (return rate 88%) questionnaires from 1617 nurses were used. The questionnaire includes demographic information, attitudes toward and knowledge of child abuse and reporting laws, and eight vignettes of child abuse.
Most nurses (86%) said they had never reported a child abuse case; 21% said they had failed to report a suspected case of child abuse. Most (80%) had never had any child abuse education. About 75% felt their nursing education and in-service training was inadequate or absent. Most had an inadequate knowledge of the reporting law (mean score: 60% correct). Nurses only answered 17–43% of the law-related questions correctly. The majority accepted the professional responsibility to report. There were some differences among pediatric, psychiatric and emergency care nurses. In general, these Taiwanese nurses had negative attitudes toward corporal punishment and toward parents who abuse their children. The study also identified a variety of attitudes related to intention to report relevant to the Theory of Planned Behavior.
Nurses accept responsibility for reporting but they believe their professional preparation for reporting is inadequate. There is a strong need for in-service and pre-service education about child abuse among nurses in Taiwan.
Connaître les expériences d’infirmières taiwanaises suite à la création d’une nouvelle loi sur le signalement obligatoire, et évaluer leurs attitudes par rapport à leur intention de signaler.
Un échantillon stratifié a servi à identifier des infirmières affectées aux services pédiatrique, psychiatrique et de l’urgence à Taiwan. Au total, on a retenu 1400 questionnaires (88% de l’échantillon de 1617). Le questionnaire portait sur des données démographiques, des attitudes et des connaissances de la problématique de l’enfance maltraitée et des lois du signalement obligatoire, et contenait huit historiettes décrivant des situations de mauvais traitements.
La plupart des infirmières (86%) avouent n’avoir jamais signalé un cas de mauvais traitements; 21% avouent avoir manqué à la tâche de signaler un cas suspect. La majorité (80%) n’ont jamais reçu de formation sur la problématique. Environ 75% sont d’avis que le programme d’étude et la formation reçue après la graduation sont inadéquats ou inexistants. La plupart connaissent mal la nouvelle loi sur le signalement (score moyen: 60% de bonnes réponses). Leurs réponses correctes concernant la nouvelle loi varient de 17% à 43%. La plupart acceptent leur devoir professionnel de signaler. On a noté quelques différences selon qu’elles travaillent dans les services de pédiatrie, de psychiatrie ou de l’urgence. En général, les infirmières taiwanaises ont des attitudes négatives vis-à-vis des punitions corporelles et envers les parents qui maltraitent leurs enfants. Dans le contexte de la théorie du comportement planifié, cette étude a aussi identifié une gamme d’attitudes relatives aux intentions de signaler.
Les infirmières acceptent leur devoir de signaler mais elle croient avoir été mal préparées à ce niveau. Il existe un besoin notable de fournir des programmes de formation tant pour les étudiantes que les infirmières graduées.
Spanish language abstract not available at time of publication.
Arriving at readiness to recover emotionally after sexual assault
2000, Archives of Psychiatric NursingThe purpose of this grounded theory study was to discover behaviors and processes that lead survivors of sexual assault to seek help with emotional recovery. The substantive theory Arriving at Readiness was developed from interviews with 11 women survivors of sexual assault. Eleven categories, each containing several strategies, form the theory. The core variable is arriving at readiness. The findings clarify why survivors often delay obtaining help with emotional recovery. The theory can be used as a tool to make it more likely survivors will be identified and receive help that is responsive to their needs.
Opening the doors to disclosure. Childhood sexual abuse survivors reflect on telling physical therapists about their trauma
1999, PhysiotherapyThe purpose of this paper is to inform physical therapists about the feelings and thoughts of childhood sexual abuse survivors regarding the disclosure of their history of abuse to health professionals. It is part of a larger project designed to develop guidelines for physical therapy practices that are sensitive to the needs of survivors. The data were obtained through semi-structured interviews with 27 female survivors of childhood sexual abuse who received physical therapy or who had considered seeking physical therapy upon referral.
After explaining the relevance of disclosure to physical therapy, the paper highlights recommendations that take into consideration the diversity of views expressed by the participants regarding being asked about their abusive past, and how much they are willing to share with physical therapists. We propose that physical therapists ask questions that open the door for differential levels of disclousre, allowing clients a choice between speaking about their history of abuse or limiting the disclosure to sensitivities that are relevant to physical therapy, such as touch, disrobing, and body positions. We also discuss appropriate responses to disclosure and emphasise the need for post-disclosure clarification of clients' expectations and physical therapists' ability to respond to these expectations.
The paper provides a detailed account of the data that formed the basis for our recommendations. The participants' thoughts and emotions regarding the disclosure of childhood sexual abuse are discussed under the following themes: (a) levels of disclosure and ways of asking about past abuse: (b) ways of relating and responding; (c) societal attitudes and personal readiness to disclose.
A survey of psychiatric nurses regarding working with clients who have a history of sexual abuse
1998, Journal of the American Psychiatric Nurses AssociationBackground: There is strong evidence that a history of sexual abuse can have serious psychologic sequelae.
Objective: The purpose of the study was to assess the comfort, attitudes, identified competencies, and educational needs of psychiatric nurses who work with these clients.
Study Design: Surveys were mailed to a random sample of 3542 nursing personnel in four Canadian provinces. Measures were used to assess comfort, sexual attitudes, competencies, and educational needs.
Results: A response rate of 48% (1701 responses) was achieved. Comfort and competency regarding working with clients varied according to educational preparation, gender of the nurse, and a personal history of abuse (p < .001). All participants identified a critical need for more knowledge in all areas related to providing care for these clients.
Conclusion: The surveys showed that significant numbers of nurses are working with clients who report a history of sexual abuse. However, most participants do not believe they have adequate knowledge or therapeutic skills to work with these clients. Information from this study should provide direction for content of sexual abuse education programs.
Nurses' views regarding false memory syndrome
1997, Archives of Psychiatric NursingKnowledge concerning the storage and retrieval of traumatic memories and so-called False Memory Syndrome has not been widely available in nursing journals. Information in the popular media, however, means that nurses are learning about aspects of the memory debate from such sources. This article reports on 1,701 nurses' views of False Memory Syndrome (FMS). As background, this report reviews briefly current issues and research on traumatic memory retrieval. The majority of participants believed that FMS, although rare, could occur. For these nurses, FMS was a consequence of incompetent and unethical therapists. They worried that attention to FMS would silence or revictimize survivors of abuse.
Supported by a grant from the Quality of Nursing Worklife Research Unit, University of Toronto.