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The impact on the paediatric nurse’s role, working within the Children First; National Guidelines for the Protection and Welfare of Children (DoHC, 2010).

The impact on the paediatric nurse’s role, working within the Children First; National Guidelines for the Protection and Welfare of Children (DoHC, 2010).

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An essay for the 2011 Undergraduate Awards Competition by Aifric Rabbitt. Originally submitted for NUC05: The adolescent and their family/The healthy child at Trinity College, Dublin, with lecturer Carole King in the category of Life Sciences
An essay for the 2011 Undergraduate Awards Competition by Aifric Rabbitt. Originally submitted for NUC05: The adolescent and their family/The healthy child at Trinity College, Dublin, with lecturer Carole King in the category of Life Sciences

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Published by: Undergraduate Awards on Aug 29, 2012
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05/13/2014

 
Child abuse can be defined as an abusive act that causes emotional orphysical harm to a child. This includes the failure of a parent/carer toprovide sufficient care for their children or protect them from harm(Piltz & Wachtel, 2009). A child should grow up in a loving home thatencourages physical and emotional development (Coyne et al, 2010).Tragically, this is not always the case. According to the World HealthOrganization, aproximately 40 million children worldwide suffer someform of abuse (WHO, 2001). Consequently, child protection and welfareis a salient issue for paediatric nurses. The family is central to a child’scare and family-centered care is core to paediatric nursing (Bruce & Ritchie, 1997). However, the parent-nurse relationship, that is a “cornerstone of paediatric nursing care”, can come under threat as thenurse assumes a role within the child protection team (Espezal Canam, 2003).This essay will explore the impact on the paediatric nurse’s role,working within the Children First; National Guidelines for the Protectionand Welfare of Children (hereafter refered to as the ‘Children FirstGuidelines’) (DOHC, 2010). These guidelines aim to assist in thedetection and reporting of child abuse, while keeping the family centraland putting the child’s best interests first. This essay will discuss thenurse’s role in relation to accountability and responsibility to children,families and the child protection team. This will be completed under thefollowing headings; observation, documentation, reporting,communication, being objective, training and legal implications.
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Observation
Paediatric nurses work closely with children and their families,establishing a relationship. The impact of this on the nurse’s role withinchild protection is that he/she is in a pivotal position to assess, monitor,evaluate and detect abuse and protection issues. Paediatric nurses arefamiliar with normal stages of childhood development, and are in a keyposition to recognize and detect unusual and abnormal behaviours(Coyne et al, 2010). Firstly, the nurse must be open to the possibility of abuse. A child who is suffering from abuse may imply that he/she isbeing mistreated or could directly confide in a nurse that he/she is avictim of abuse. Disclosures should always be believed. However, it isimperative that the nurse is also objective and open to otherrationalizations for signs of abuse. For example, a child who presentswith unusual bruising may have a blood coagulation disorder.Consequently, the Children First Guidelines advise that an expert reviewmay be necessary to establish the presence of abuse (DOHC, 2010).Child abuse can be classified into neglect, physical abuse and sexualabuse.Neglect is “where a child suffers significant harm or impairment of development by being deprived of food, clothing, warmth, hygiene,intellectual stimulation, supervision and safety…[that] is likely to resultin the serious impairment of the child’s health or development” (DOHC,2006). Within the Children First Guidelines, neglect is described asbeing either deliberate or unintentional. Deliberate neglect is when theparent/carer intentionally withdraws the child’s basic needs such asfood. Unintentional neglect can occur as a result of parental inabilitydue to an intellectual disability, mental health issues or poor parentingskills (for signs and symptoms of neglect refer to Appendix 1) (DOHC,2010).
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Physical abuse is “any form of non-accidental injury or injury whichresults from willful or neglectful failure to protect a child” (DOHC,2006). Child abuse should be suspected if the child presents with aninjury that the parent/carer/child is unable to explain, such as unusuallesions. The nurse should also suspect child abuse if an explanation isprovided that does not correspond with the injuries that the child hassustained (for signs and symptoms of physical abuse refer to Appendix1) (Coyne et al, 2010).Sexual abuse can be defined as when a person uses a child as an objectof arousal or for sexual satisfaction (DOHC, 2006). Sexual abuseincludes molestation, masturbation in the presence of, or involving thechild, sexual intercourse whether oral, anal or vaginal, sexuallyexploiting a child, revealing sexual organs or deliberately performingsexual acts in the presence of a child (Coyne et al, 2010). The ChildrenFirst Guidelines advise that nurses should suspect sexual abuse if thechild appears to have an unsuitable comprehension of sexual acts fortheir age, if they have a sexually transmitted disease or if there isbleeding from the vagina or anus (for age specific signs of sexual abuserefer to Appendix 1) (DOHC, 2010).
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