Evaluate the nurse’s role in relation to nursing care of the child and family when
there is a suspicion of child abuse. Discuss how this information will guide
evidence based Australian nursing practice.
The essay is aimed at critically evaluating the content of the artefacts in the
portfolio and the importance of using and evaluating evidence-based artefacts
when caring for children, adolescents and their families in relation to current
Australian nursing practice.
This should include the following;
� Demonstration of what learning was achieved through the content of the
artefacts selected for the portfolio relevant to the chosen essay topic.
� Evaluation of evidence and value of the information or message within the
chosen artefacts. The essay will demonstrate the ability to critically evaluate the
research contained in the artefact portfolio. This will be undertaken whilst
discussing the importance/value of the evidence-base for future nursing practice.
CRITICAL ARTEFACT EVALUATION
According to World Health organization, child abuse refers to all forms of ill-treatment
(physical and emotional) including, neglect, sexual harassment, and exploitation, and results to
potential harm to child’s development, dignity, and health. This broad definition identifies five
main subtypes including a) sexual abuse, b) negligent treatment, c) physical abuse, d)
exploitation, and e) emotional abuse (Biehal, 2014). Actions by the abuser or failing to act
especially by the caregiver or parents will also result in child abuse. Child abuse can take place
in different environments including the school, home, organizations, or the communities that the
children interact with (Fraser et al, 2010).
Child abuse data Australia Statistics
CRITICAL ARTEFACT EVALUATION2
Child abuse is a common social problem in Australia despite it been under-reported and
underrated. Reports and statistics for the year 2013-2014 confirmed a high number of child abuse
and neglect to about 40,844 children (Budiselik et al, 2010). The statistics indicate that for every
13 minutes, children suffer neglect or abuse in Australia. Emotional abuse accounts for most of
the cases involving child abuse that is about 40 % as per statistics in 2013-2014(Reeve&Gool,
2013). Physical abuse and sexual abuse accounts for 19% and 14 % of the cases respectively.
The statistics also indicate that there is a higher possibility of girl falling victims of child abuse
as compared to the boys. The comparison of the 37,700 cases in 2011-2012 and the 40,844 cases
in 2013-2014 indicates that there is some rise of the child abuse and neglect problems in
Australia (Budiselik et al, 2010). The figures reported by the Australian Institute of Health and
Welfare showing high cases of child abuse should prompt those responsible for addressing the
issue with utmost seriousness.
Types of Child abuse
In Australia, there is the high prevalence of emotional abuse as compared to other types.
Emotional abuse will refer to the social or psychological aspect of child abuse and includes, rude
or coarse attitude, denigration of the child’s personality, harsh criticism and inattention are major
ways that indicate the instance of emotional abuse (Budiselik et al, 2010).
Neglect occurs when the responsible people or parents fail to provide the required needs
and support to the children. Physical abuse will entail the causing of harm of injury to children
whereas Sexual abuse will entail the engagement of children in sexual acts or exposure to
inappropriate sexual behavior or material (Paavilainen&Flinck, 2013).
Sign and Symptoms (Recognize when Suspicion)
CRITICAL ARTEFACT EVALUATION3
Signs and symptoms of child abuse depend on the type of abuse the child is undergoing.
Physical signs and symptoms include unexplained injuries and bruises, untreated dental or
medical conditions. Sexual symptoms and signs include pregnancy; abuse of others sexually,
sexually transmitted infections and the inappropriate sexual behavior at the child’s age
Psychosocial disorders are most common signs and symptoms of child abuse and include social
withdrawal, loss of self-esteem and confidence, inappropriate emotional development and the
avoidance of certain situations (Allwood&Widom, 2013).
Neglect type of child abuse will lead to signs and symptoms such as, poor hygiene, poor
growth, emotional swings, and psychological problems, lack of basic needs; poor school
attendance and indifference in the child Recognition and suspicion of these types of signs and
symptoms of a child prompt the taking of necessary actions and interventions. Registered nurses
should use these signs and symptoms to identify child abuse incidences and to take the
appropriate actions (Allwood&Widom, 2013).
Other effects of child abuse include guilt, nightmares, self-blame and insomnia and are
common in child abuse victims. Subsequent ill health and high-risk health behaviors are among
the effects of child abuse (Camilleri et al, 2013).
Nursing process refers to a series of well-organized steps that are designed for nurses
aimed at delivering safe and quality care. The process involves five key steps namely
assessment, diagnosis, planning, implementation and evaluation.
During the assessment stage, the nurses need to identify the suspected child abuse cases
properly (Francis et al, 2012). Identification is the first step in the nursing process when handling
CRITICAL ARTEFACT EVALUATION4
child abuse cases. The nurse will receive a disclosure or observe indicators. If the concerns relate
to cases of child abuse, the nurse should assess and consult the issue (Oates, 2013).
Observations and concerns should be documented after the complete assessment.
Assessment and diagnosis of the child are vital before interventions of the issue. Examples of
assessment tools include use of Estimate of Risk of Adolescence Sexual Offence Recidivism
(ERASOR), Maltreatment and abuse chronology of exposure (MACE) scale used to assess child
abuse due to neglect, other relevant psychological assessment scales. Various assessments of
safety risk, family, and child functioning are vital when it comes to child protection strategies
(Budiselik et al, 2010). The risk assessment scale will be used by nurses to diagnose the severity
of case. The history of the child will be useful to the nurses during assessment of the child abuse
issues during his/her lifetime. Contributing factors to risk of child abuse and also the future risk
will be assessed by the nurses through dependence on the risk assessment scale.
Diagnosis of child abuse victims will rely on symptoms of trauma, depression and the
presence of unexplained injuries can be used to diagnose the case of child abuse (Babington,
2011). The nurses should thereafter refer the child urgently to those responsible for handling
neglect issues. Legal action should be sought before referring the children to the relevant
departments (Camilleri et al, 2013). Physical examinations of the child’s situation and
circumstances are also crucial at this stage. This helps in planning and implementing of
intervention strategies as described by evidence based nursing.
Nursing goal for Treatment
Nursing treatment goals will be guided by evidence based practice. The nursing goal is
to ensure improved physical state of children by treating those who might have experienced child
abuse. Prevention is a key goal that would help avoid challenges that could be encountered
CRITICAL ARTEFACT EVALUATION5
during addressing the cases during severity levels. Most studies indicate that the effective
treatment of child abuse is use of cognitive behavioral framework (Babington, 2011). However,
this framework depends on the victim’s extent of abuse and other attributes such as age, gender,
and ethnicity. In one randomized control study on 291 adults, it was identified that
psychodynamic therapy resulted into better outcome of victims than those who received CBT
alone. This indicates that the nurse must reflect on to the victim’s psychological status to select
the best type of treatment (Camilleri et al, 2013). This is in accordance to nursing treatment goals
of health restoration.
Evidence based research also identities Trauma-focused cognitive behavioral therapy
(TF-CBT) as a good treatment strategy. This therapy involves training sessions for both the
offender and the caregiver. The key components of this treatment is acronym as PRACTICE and
entail, Psycho-education, Parenting techniques that are effective, Relaxation, Affective
modulation, ability for cognitive coping and trauma narrative. Six randomized studies have
proved that the use of TF-CBT as best treatments within two years post treatment (Fraser et al,
One follow up study on sexual child abuse associated with PTSD symptoms indicated
that the use of TF- CBT therapy resulted to fewer PTSD symptoms as compared to use of Child
centered therapy (CCT). This involves implementing intervention strategies as supported by
scientific research (Babington, 2011). The study concluded that effective treatment goals as
evidenced by EBN entails the use of cognitive behavioral therapy (for both the victim and the
offender), specifically those that are trauma focused. Other treatment therapy such as multi-
systemic therapy (MST) and Dynamic therapy are effective as they operate with concrete
CRITICAL ARTEFACT EVALUATION6
frameworks and are also more interpersonal, but they effectiveness is lower than TF-CBT
Evidence based research also indicates that referral of the children to the relevant child
protection agencies is a necessary intervention. This multi-factorial approaches and collaboration
between the relevant stakeholders will facilitate effective coordination of intervention plans,
maximum provision of support, and the quality provision of the care required by the abused
children (Budiselik et al, 2010). It is the objective of nurses to monitor the children for as long as
possible to avoid recurrence of cases and for the provision of vital physical and psychological
Evidence based research indicates that management and intervention are also vital in this
process. The nurses can adopt the nurse-family partnership, which is an effective intervention
method. The nurses will have the program for teaching appropriate parenting skills and healthy
behaviors by those in the community (Fraser et al, 2010). The intervention will help the
development of the child abuse cases to severity levels. The nurse will compare the It will ensure
the follow up of assessed cases is effective to prevent issues related to abuse. The nurse can
support the child parent centers as an intervention measure. They will encourage the
individualized approach to cognitive and social development. The nurse should provide support
and ongoing treatment. Media based public awareness is a proper intervention where nurses will
create awareness on the effects and ills of child abuse to the community (Babington, 2010).
The intervention is taken as a measure for prevention of the child maltreatment by
encouraging responsibility among people. The nurses can also support the mutual aid groups that
seek to address the child abuse cases. Further assessment, to identify exposure to other child
abuse cases is vital for necessary interventions to be taken (Fraser et al, 2010). The nurses should
CRITICAL ARTEFACT EVALUATION7
respond to the child by providing moral support. In case of any physical injuries, first aid
treatment should be provided The nurse should consider issues relating to sharing of information
and consent to treatment. It will also involve having consultations with health workers or other
child abuse managers.
To carry out the effective evaluation, the close monitoring of intervention plans is
important. The outcomes of the interventions include reduction of risks of child maltreatment.
Overall performance at the family and school level is another outcome to be evaluated by the
nurses after implementation of the interventions. The improvement of the performance will
indicate success of the intervention plans. The outcome of the intervention plan will also be done
using the improvement of physical health, which is expected after implementation of efforts by
the nurse. The success of intervention plans by the nurses is determined by the effectiveness of
treatment administered as well as the child protection strategies (Oates, 2013). The child
protection reports will be evaluated to identify the major issues that need better intervention
methods. The family satisfaction in the achievement of the set goals will also be used to evaluate
outcomes. The outcomes will be based on the risk factor consideration of the prevalence of signs
and symptoms (Fraser et al, 2010). Improvements and the end of signs and symptoms assessed
through various diagnoses is a positive outcome indicating the success of the process of child
abuse management by the nurses (Fraser et al, 2010).
Concisely, the nurses have the role of ensuring the cases of child abuse in Australia are
properly addressed to reduce the prevalence. The identification, assessment, intervention, and
evaluation of the issues affecting the children will be vital during the performance of their roles
CRITICAL ARTEFACT EVALUATION8
in accordance with the Australian nursing practice (Oates, 2013). The early identification of
signs and symptoms will make the process for the nurses easier. Collaboration between all
people in the society will smoothen and ensure child abuse management is efficient.
Allwood, M. A., &Widom, C. S. (2013). Child abuse and neglect, developmental role
sattainment, and adult arrests. Journal of research in crime and delinquency,
Babington, B. (2011). National Framework for Protecting Australia’s Children: Perspectives on
progress and challenges. Family Matters, (89), 11-20.
Biehal, N. (2014). Maltreatment in Foster Care: A review of the evidence. Child Abuse Review,
23(1), 48-60. doi:10.1002/car.2249
CRITICAL ARTEFACT EVALUATION9
Budiselik, W., Crawford, F., & Squelch, J. (2010). Acting in the best interests of the child: a case
study on the consequences of competing child protection legislation in Western Australia.
Journal Of Social Welfare & Family Law, 32(4), 369-379.
Camilleri, P., Thomson, L., & McArthur, M. (2013). Needs or deeds? Child protection and youth
justice in the Australian Capital Territory. Journal Of Social Welfare & Family Law,
35(2), 193-206. doi:10.1080/09649069.2013.800285
Francis, K., Chapman, Y., Sellick, K., James, A., Miles, M., Jones, J., & Grant, J. (2012). The
decision-making processes adopted by rurally located mandated professionals when child
abuse or neglect is suspected. Contemporary Nurse: A Journal For The Australian
Nursing Profession, 41(1), 58-69.
Fraser, J. A., Mathews, B., Walsh, K., Chen, L., & Dunne, M. (2010). Factors influencing child
abuse and neglect recognition and reporting by nurses: A multivariate
analysis. International Journal of Nursing Studies , 146(153).
Oates, R. K. (2013). The spectrum of child abuse: Assessment, treatment and prevention.
Paavilainen, E., &Flinck, A. (2013). National Clinical Nursing Guideline for Identifying and
Intervening in Child Maltreatment within the Family in Finland. Child Abuse Review,
22(3), 209-220. doi:10.1002/car.2207
Reeve, R., &Gool, K. (2013). Modelling the Relationship between Child Abuse and Long-Term
Health Care Costs and Wellbeing: Results from an Australian Community-Based Survey.
Economic Record, 89(286), 300-318. doi:10.1111/1475-4932.12044