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Psychiatric Nursing -A Case Study of a Patient with Child Abuse and Neglect

Psychiatric Nursing -A Case Study of a Patient with Child Abuse and Neglect

 Chapter One

Introduction

This is a comprehensive nursing case study carried out on Miss N.A., a 17 year old young girl.

She was admitted into the female ward through the emergency unit on 20th July, 2013. She came in with the complaints of irrational talk, poor sleep, wandering about aimlessly and also hears voices of unseen people saying “help”. She also said that people, including her mother, want to kill her. After physical examination and neurological assessment, the doctor who saw her made a diagnosis of child abuse and neglect.

Child abuse or neglect refers to any non-accidental behavior by parents, caregivers, other adults or older adolescents, that is outside the norms of conducts and entails a substantial risk of causing physical or emotional harm to a child or young person; such behavior may be intentional or unintentional and can include acts of omission (i.e. neglect) and commission (i.e. abuse) (Bromfield, 2005).

Centers for disease control and prevention (CDC, 2012) defines child abuse as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child.

According to World Health Organization (WHO), child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other exploitation which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power.

This case study will provide information as to how child abuse and neglect affect children and adolescent mental health and development and its management.

Significance of the Study

It will help nurses and other health professionals to be involved in the prevention of child abuse and neglect.

It will help in education and awareness creation of good parenting.

It will enlighten the public on various causes of child abuse and neglect as well as the preventing measures.

It will help in the formulation of policies through advocacy that will help curb the rate of child abuse and neglect.

It will help nurses and other professionals to know the implication of child abuse and neglect in psychiatry.

Objectives of the study

  1. To make an in-depth study into child abuse and neglect.
  2. To create awareness on the consequences of child abuse and neglect.
  3. To fully participate in the management of a client with abuse and neglect.
  4. To provide a basis for further study into the management of a client with child abuse and neglect.
  5. To add to the existing knowledge about causes, manifestations and management of child abuse and neglect.
  6. To fulfill part of the requirement for the award of registered psychiatric nurse certificate by the nursing and midwifery council of Nigeria.

Chapter Five

SUMMARY

Child abuse and neglect represent a problem of alarming proportions with tremendous psychological and economic costs to both the individual involved and to the society. Early identification and treatment is important to avoid or minimize the long term consequences of abuse through treatment, the abused child is helped to regain sense of self esteem and trust, an the family learns new ways of support and communication.

Miss N.A. was taught some behavior modifications as this will influence her relationship among individual, families, neighbours, community. A therapeutic environment was created to enhance and support safe, stable and nurturing relationship for her and the family members. The parents were taught parenting skill and were encouraged to show love and care which will help patient to a stable relationship.

Implication for Nursing Practice

Many approaches have been developed to attempt to prevent child abuse and neglect and are protective factors which are put in place for children and families, or to strengthen factors that are already in place. The implication of this study for nursing practice is basically on prevention which is geared towards three (3) approaches which includes: the nurse should be involved in primary or universal prevention activities which are directed at the general population. The goal is stopping the occurrence of maltreatment before it starts. This involves: creating awareness among community members, the public service providers and campaigns informing citizens how and where to report suspected child abuse and neglect.

  • The nurse should create public awareness through media to encourage and educate parents to use non-violent forms of discipline.
  • Nurses should organize parent education programs located in high schools for teen mothers.
  • Nurses also should organize substance abuse treatment programs for parents with young children.
  • Home visitation services by nurses to assess for child abuse in families with infant and young children.
  • Nurses assist parent in creating safe home environments and fostering healthy children through family support services.
  • Nurse at the local hospitals or community organization should offer prenatal care and parenting classes to new or expectant parents.
  • Goals are set to prevent maltreatment from reoccurring and reducing negative consequences associated with maltreatment. This is achieved through:
    • Intensive family preservation services with trained mental health counselors available to families.
    • Parents mentor programs with stable non-abusive families, acting as ‘role models’ and providing support to families in crisis.
    • Mental health services for children and families affected by maltreatment to improve family communications and functioning.

CONCLUSION

Child abuse and neglect may lead to a wide range of adverse consequences for children and adolescents. Many physically abusive parent and caregivers insist that their actions are simply forms of discipline-ways to make children learn to behave. But there is a big difference between using physical punishment to discipline and physical abuse. The point of disciplinary children is to teach them right from wrong, not to make them live in fear. Everyone has an important role and responsibility to prevent child abuse and neglect. Children need everyone to stand up for their safety when they are in danger of abuse and neglect or when families are in crisis or turmoil and need support from those close to them.

Recommendation

  • Professionals who work with children are required by law to report any suspicion of abuse and neglect, if you suspect that child abuse is occurring, first report it to the local child protective service agency or human services.
  • Observation and maintenance of good rapport by all members of the health team as a continued education approach which impact the overall quality of services given to client.
  • There should be proper screening and assessment by health personnel to identify the root causes of client’s presenting symptoms which may increase effective treatment.
  • Counselors or professionals must understand how client interpret their experiences, not all abuse meet legal or commonly held criteria for abuse.
  • Professional should receive specific training in screening and assessing of client with child abuse and neglect and should have an understanding of the types of psychiatric disorders and symptoms that are common with child abuse and neglect.
  • Educators should provide support for the abused child, parents and family by designing programs for affected persons.
  • Abused children with disabilities should be supported with services like speech, hearing and language therapy, behavioural management, special education and health care.

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