Knowledge and awareness of nursing students about child abuse and neglect

Received: 26-Jun-2018 Accepted Date: Jul 19, 2018; Published: 27-Jul-2018

Citation: Ozbey H, Ozcelep GA, Gul U, et al. Knowledge and awareness of nursing students about child abuse and neglect running head: Child abuse and neglect. J Nurs Res Pract. 2018;2(3):21-25.

This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC) (http://creativecommons.org/licenses/by-nc/4.0/), which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes. For commercial reuse, contact reprints@pulsus.com

Abstract

Objective: This study aimed to investigate the nursing students’ knowledge and awareness levels regarding child neglect and abuse.

Methods: This descriptive study was conducted at Karadeniz Technical University, Faculty of Health Sciences, Department of Nursing between May and June 2018. The data were collected by the researcher using a questionnaire and the “Scale for the Identification of Symptoms and Risks of Child Neglect and Abuse”. For the evaluation of the data, in addition to descriptive statistical methods (mean, standard deviation), for the comparison of the quantitative data Mann Whitney U and for the multiple group evaluations Kruskal Wallis tests and Chi square were used. The significance level was accepted as p<0.05. Institutional and ethics committee permits were obtained for the research.

Results: It was determined that the mean scores of the students was 20.16 ± 1.32, the majority of the students were female (84.9%), they graduated from Anatolian High School (60.7%), 42.2% lived in the city and 82.5% had nuclear families. 29.4% of the students were educated about child neglect and abuse, and 63.0% of these students received the related education in a school-based course. The mean scores of the students regarding child neglect and abuse was 3.7 ± 0.3 and the level of their knowledge was found to be moderate. The mean scores of female students regarding child neglect and abuse was higher than male students (p<0.0001) and the knowledge level of those who were educated about this issue was higher than those who did not and the difference between the groups was significant (p<0.0001).

Conclusions: The study showed that the mean scale scores of the students regarding child neglect and abuse were moderate.

Keywords

Child neglect; Child abuse; Awareness; Nursing student

Introduction

Children are the group of people that are in need of protection the most due to their characteristics. For this reason, many national and international regulations have been made in order to ensure that children are protected at a high level. However, in spite of many arrangements, neglect and abuse cases are increasingly becoming an important health problem in the world and in our country [1].

The World Health Organization (WHO) defines a maltreatment towards a child as ‘’any physical and/or emotional maltreatment that may really or potentially lead to a negative impact on the child’s life, growth and development; all kinds of attitudes and behaviors including sexual abuse, negligence / negligent attitude, commercial or other exploits within the scope of kinship, responsibility, power or trust relationship with the child [2]. WHO has divided child neglect and abuse into four groups: physical, emotional, economic and psychological neglect and abuse. There are many factors in the etiology of child neglect and abuse. Parents’ low education level, mother’s young age, parents’ absence, parents with neglect, abuse stories, parents with psychiatric disturbances, low socio-economic level, substance dependence of parents, unwanted pregnancy and having a step mother or father are among these factors [3].

Considering the numerical dimensions of child neglect and abuse, it has been revealed that 31,000 children under the age of 15 years old per year have lost their lives due to abuse, and millions of children have been exposed to neglect and abuse. According to the ‘Child Abuse and Domestic Violence Research in Turkey’ report conducted with the support of UNICEF in 2010, of the children at the age of 7-18 in Turkey, 56% were physically abused, 49% were emotionally abused, 10% were sexually abused, 25% were neglected, 43% were physically neglected, 3% were sexually neglected, and 51% were emotionally neglected [4]. WHO reported that in 2014, 22.6%, 3.3% and 16.3% of the adults worldwide experienced physical abuse, emotional abuse and physical neglect respectively. According to the same report, 18% of the girls and 7.6% of the boys were reported to have been sexually abused [5].

Serious damages can be avoided when child neglect and abuse, a very important child health problem, is diagnosed early. As professional healthcare providers, nurses have very important roles in this context. They should undertake important roles such as early diagnosis and treatment of neglect and abuse, the identification of signs and symptoms, the identification of communities at risk, and raising the awareness of families and societies [3]. For this reason, the nurses must have extensive knowledge of identifying child neglect and abuse to be able to detect them. However, the national and international studies have demonstrated that nurses do not have knowledge about this issue. 60% of physicians and nurses working in a Finnish University Hospital study were found not to have knowledge about child neglect and abuse [6]. In a study conducted in our country, it was found that 43.4% of the physicians and 25% of the nurses were educated about child abuse and neglect, and their knowledge and awareness levels about it were moderate [7]. Another study conducted in our country reported that 59.1% of the health personnel did not receive any education in this field during their undergraduate education and 98.2% did not participate in any education after graduation [8]. In a study by Elarousy et al. Nursing students were found to be at a moderate level of knowledge of child abuse and neglect, and the level of knowledge after the course was increased [9]. In his research conducted with Young Ok Ha’s nursing students, the level of knowledge about child abuse and neglect of nursing students was moderate [10]. In the study conducted by Poreddi et al. It was stated that the level of knowledge about child abuse and neglect of nursing students is insufficient [11].

One of the principles included in the UNICEF Child Protection Strategy is the increase of the information and motivation capacities of the persons who are in contact with children, including nurses, in order to protect the children. For this reason, the nurses should be equipped with the knowledge, skills and attitudes necessary to manage the child abuse and neglect adequately and effectively. To be able to do this, nurses need to have adequate training during their training [9].

Nursing students who proceed step by step to their professions will encounter child neglect and abuse cases during their professional lives. For this reason, it is considered that nursing students should have knowledge about the identification of child neglect and abuse during their education. In this study, it was aimed to investigate the level of knowledge and awareness of nursing students about child neglect and abuse. For this purpose, it is thought that this study will shed light on more extensive research and contribute to literature.

Methods

Type of the research

This research was planned descriptively to determine the level of knowledge and awareness of the 1^st, 2^nd, 3^rd and 4^th grade nursing students studying at Karadeniz Technical University, Health Sciences Faculty Nursing Department about child neglect and abuse.

Location and time of the research

The research was carried out at Karadeniz Technical University Health Sciences Faculty, Nursing Department between May and June 2018.

The universe and sampling of the research

The universe of the research consisted of 750 nursing students. The sample of the research was calculated by using the Sampling from a Finite Population and it was aimed to reach a total of 254 students in the first stage [12]. However, considering that it would represent the universe better, the study was conducted with 377 nursing students in their 1^st, 2^nd, 3^rd, and 4^th grade who volunteered to participate in the study.

Data collection

The data were collected by the researcher using the ‘Introductory Information Form’ prepared in the light of the literature and the ‘Scale for the Identification of Symptoms and Risks of Child Abuse and Neglect’.

Introductory information form

This form consists of 17 questions based on the literature [1,13-15]. The questions include the participants’ socio-demographic characteristics, and their views on child abuse and neglect.

“The Scale for the Identification of Symptoms and Risks of Child Abuse and Neglect”

This scale is a Likert type scale consisting of 67 items with 6 subscales which was developed by Uysal in 1998 to identify the symptoms and risks of child abuse and neglect. To use the scale, the permission was received from Prof. Aynur Uysal TORAMAN. There are five options in each of the items in the scale as “really right”, “quite right”, “neutral”, “not quite right”, “not right”.

• Physical symptoms of child abuse (19 items)

• Behavioral symptoms of child abuse (15 items)

• The effects of neglect on the child (7 items)

• Characteristics of parents who are inclined to abuse and neglect (13 items)

• Characteristics of children who are inclined to abuse and neglect (5 items)

• Familial characteristics in child abuse and neglect (8 items)

The validity and reliability of the scale was performed in the study entitled as “Determination of Knowledge Levels of Nurses and Midwives in Identifying Symptoms and Risks of Child Abuse and Neglect” carried out by Uysal. Within the scope of internal consistency, Cronbach’s Alpha coefficient is 0.924 and coefficients of subscales range from 0.596 to 0.892. In this study, Cronbach’s Alpha coefficient of 67 items in the “Scale for the Identification of Symptoms and Risks of Child Abuse and Neglect” was calculated as 0.890. According to this value, we can say that the survey is highly valid and reliable.

Mean scores of the items were calculated. A mean score towards 5 shows that the answer is correct and a decrease from 3 indicates that the answer is wrong.

Evaluation of the data

The Kolmogorov Smirnov test was used to assess whether the data obtained from the study had normal distribution. In the evaluation of the data, in addition to descriptive statistical methods (mean, standard deviation), for the comparison of the quantitative data Mann Whitney U and for the multiple group evaluations Kruskal Wallis tests and Chi square were used. The results were evaluated at a significance level of p<0.05 and at a confidence level of 95%.

Ethical aspect of the research

Ethics committee approval was obtained by decision no. 317 on 07.05.2018 and institutional approval was received from the faculty of Health Sciences of Karadeniz Technical University on 29.03.2018. Verbal consent was also obtained from the nursing students to collect the data.

Results

The findings showed that the mean age of the students was 20.16 ± 1.32 and the majority of them were girls (84.9%), graduated from Anatolian High School (60.7%), lived in the city (42.2%) and had nuclear families (82.5%). Most of the students (73.0%) did not encounter a child neglect and abuse case. 34.9% of those who encountered such a case (27.0%) encountered emotional neglect and abuse and only 8.7% of them had performed an intervention. It was found that the majority of these students (99.7%) had intervened with a word of warning the families of the children about the issue. 91.3% of the students did not report it. 14.1% of these students stated that they did not report it because they had no knowledge about this subject (Table 1).

Table 1: The distribution of some descriptive characteristics of the students in the study

It was determined that 70.6% of the students did not receive education about child neglect and abuse and 63.0% of those who received education (29.0%) had a school-based course about it (Table 1). When the students were asked “which factors related to the family, the child and the environment lead to child neglect and abuse”, very few (15.4%) replied it as “physical and developmental difficulties in the child” among factors related to the child, “psychological problems in parents” (13.7%) among familial factors, and “the presence of crowded and unhealthy living conditions” (14.7%) among environmental factors. When the students were asked “what kind of situations in the clinic make you think that it is a child neglect and abuse case”, very few (9.6%) replied it as “the differences in the given stories”.

The results showed that the total mean score of the students about child neglect and abuse was 3,7 ± 0,3 and the level of knowledge was found to be moderate. The highest mean score of the subscales was obtained from the subscale of “The Effects of Neglect on the Child” (3,9 ± 0,5) and the lowest score mean was obtained from the subscale of “Characteristics of Children that are Inclined to Abuse and Neglect” (3,3 ± 0,5) (Table 2). When the average of the scores according to the class is examined, the average of the grades of the 1^st class is 3,7 ± 0,3, the average of the second class is 3,7 ± 0,3, the average of the 3^rd class is 3,6 ± 0,03, the average score of the 4^th was found to be 3.7 ± 0.4.

Table 2: The distribution of mean scores of subscales in the "Scale for Identification of Symptoms and Risks of Child Neglect and Abuse"

When the gender groups and the general knowledge score averages were compared, it was determined that the knowledge level of the female students was higher than that of the male students (p<0.0001) and the score averages of those who were educated about child neglect and abuse were higher (p<0.0001) (Table 3).

Table 3: The evaluation of the mean scale scores of the students’ knowledge on child neglect and abuse according to their demographic characteristics

A statistically significant difference was found both between the students receiving education about child neglect/abuse and class groups and between the status of intervening when they face child abuse and neglect and class groups (p<0.0001, p<0.0001, respectively)

Discussion

Nurses play an important role in the identification and treatment of the child neglect and abuse, one of the issues that need to be addressed using a multi-faceted approach because they are the health care personnel who first meet the children and their families in protective, therapeutic and rehabilitative fields and have a chance to observe them for long periods [16]. In order to prevent child neglect and abuse and to be able to identify it early, nursing students who will perform the nursing profession in the future should be informed about this issue during their training. It is important to determine the awareness levels of nursing students to plan such an education program [8]. In this study, it was aimed to investigate the level of knowledge and awareness of nursing students about child neglect and abuse.

Nursing students face with child neglect and abuse cases both during their education and during their own life. It is especially important that nursing students have knowledge about this issue in order to be able to identify neglected and abused children and to report them. It was determined that one- fourth of the nursing students in the study encountered child neglect and abuse cases (Table 1). Compared with our studies, national and international studies showed that nursing students encountered child neglect and abuse cases at a lower rate. Ok Ha and Poreddi et al. found that 7.5% and 13.3% of the nursing students encountered child neglect and abuse cases respectively [10,11]. 33.3% of the university students in Taş’s 2017 study, 18.8% of the nurses in Turker’s (2017) study and 30.1% of the nurses during their professional life in Kocaer’s study encountered such cases [1,14-18].

It was determined that 19.6% of the students who encountered child neglect and abuse cases in the study had performed an intervention and that nearly all of them did this in the form of warning their families. One-fourth of the students who stated that they were not involved in the intervention were found not to do it because they had no knowledge on the issue (Table 1). In parallel with our research, when the reason why the nurses did not report the cases was examined by Yilmaz and it was found that 70.6% of them did not report it because they did not have information about the subject [19]. The fact that health staff is not informed about the negligence and abuse of children causes the cases not to be identified. For this reason, it is very important for health personnel to be trained about child neglect and abuse during their education. However, it has been observed that the health staff is not trained adequately during their education [17,19-23]. This study demonstrated that one- third of the students who participated in this research had been trained about child neglect and abuse, and more than half of these students received the training at school (Table 1). Unlike our study, Elarousy et al. reported that the majority of nursing students did not receive education about child abuse and neglect from their schools but from the internet [9].

Similar to our study Kostak et al. found that 40.8% of nursing students were informed about child neglect and abuse during their education [20]. Kurt et al. stated that 68.1% of university students were informed about the issue during their education [24]. Kocaer did a study on physicians and nurses’ awareness levels of child neglect and abuse and found that one third of the nurses were trained about it during their education [18]. Golge et al. found that more than half of the nurses were informed about it during their education and that very few of them attended related trainings after graduation [21].

In the study, the nursing students’ mean score in the child neglect and abuse identification scale was found as 3.7 ± 0.3, and the level of their knowledge about the issue was found moderate (Table 2). In this case lately child abuse and neglect are thought to be due to the agenda in Turkey. Similarly, Elarousy et al. found that nursing students had a moderate level of knowledge of child abuse and neglect [9]. Unlike our study, Poreddi et al. pointed out that nursing students had a low level of knowledge of child neglect and abuse [11]. In Yilmaz’s study, the general knowledge scores of the graduate nurses were found to be over 3 and their knowledge levels were found high [19].

When the mean scores of children neglect, and abuse diagnosis subscale scores of nursing students were examined, it was determined that while the highest mean subscale score was the effects of neglect on the child (3.9 ± 0.5), the lowest mean subscale score was the characteristics of the children who are inclined to neglect and abuse (3.3 ± 0.5) (Table 2). Unlike our study, the highest mean subscale score in the study conducted by Taş (2017) was the characteristics of the children who are inclined to neglect, and abuse and the lowest mean subscale score was the sexual symptoms of child neglect and abuse [1].

According to the research, the knowledge level of female (4,71 ± 3,7) students was higher than male (4,57 ± 3,6) students (p<0.0001) (Table 3). This is thought to be due to the fact that female students pay more attention to child abuse and neglect. In parallel with our research, Ok Ha (2018) reported that the level of knowledge and awareness of female students was higher than that of male nursing students [10]. Unlike our research, In Turker’s (2017) study, the general knowledge point averages of nurses and midwives were evaluated according to gender, but no statistically significant difference was found [14].

It was observed that the education given on child neglect and abuse significantly increased the awareness of students [25]. The comparison between the status of receiving education on child neglect and abuse and the general knowledge score averages revealed that those who received training had higher knowledge levels (p<0.0001) (Table 3). Elarousy et al. found that knowledge and attitudes of nursing students who took related courses were significantly better [9]. In Turker’s study, unlike our research, no statistically significant difference was found between the general knowledge mean scores of the graduated nurses and their status of receiving training [14].

Conclusion

The study demonstrated that more than half of the students participating in the study encountered a case of child neglect and abuse. The majority of these students had not reported it because they did not have information about the issue. It was determined that the knowledge level of the students who participated in the research was moderate. The female nursing students were found to have higher knowledge levels. Those who received education on child neglect and abuse were found to have higher levels of knowledge. In line with these results, it can be suggested that nursing department education curriculum should have more lectures on child neglect and abuse, students should have opportunities to make applications aimed at raising their awareness about the issue, training programs should be organized to increase the knowledge level of the students and similar studies should be conducted with larger sample groups.

REFERENCES

1. Taş A. Investigation of the knowlegde levels of the Hacettepe University about neglect and abuse against children: Hacettepe University Institute of Social Sciences, Master Thesis, Ankara, Turkey. 2017.
2. WHO. Child Maltreatment (Child Abuse). 2015.
3. Uncu F. Health Care Workers Who Work in The Province of Elazig Levels of Awareness About Child Abuse and Neglect, And the Factors Affecting This Situation. Fırat University Health Sciences Institute, Master Thesis, Elazıg, Turkey. 2013.
4. Gokçay G, Beyazova U. Monitoring First Five-Year-Old Child Health: Nobel Medical Bookstore, Istanbul, Turkey. 2017:201-9.
5. WHO, Global Health Observatory (GHO). 2014.
6. Paavilainen E, Astedt-Kurki P, Paunonen-Ilmonen M, et al. Caring for maltreated children: A challenge for health care education. Jou Adv Nurs. 2002;37:551-7.
7. Kaptan D. The levels of information and awareness about child abuse and neglect of doctors and nurses working in pediatric clinics in the city center of Trabzon: Avrasya University Health Sciences Institute, Master Thesis, Trabzon, Turkey. 2017.
8. Akcan A, Demiralay S. Perceptions of department of nursing students on child neglect and abuse. J Educ Train Res. 2016;5:275-81.
9. Elarousy W, Helal H, de Villiers L. Child abuse and neglect: student nurses' knowledge and attitudes. J Am Sci. 2012;8.
10. Ok ha Y. Nursing students’ perceptions of child abuse and factors influencing those perceptions. Child Health Nurs Res. 2018;24:178-85.
11. Poreddi V, Pashapu DR, Kathyayani BV, et al. Nursing students’ knowledge of child abuse and neglect in India. Br J Nurs. 2016;25:264-8.
12. Yazıcıo glu Y, ve Erdo gan S. Spss Applied Scientific Research Methods, Ankara: Detay Publishing. 2004.
13. Yetiş O. Teachers’ attitudes towards reporting child abuse and neglect: Istanbul University Institute of Forensic Medicine, Master Thesis, Istanbul, Turkey. 2017.
14. Turker G. Levels of Awareness in family doctors, nurses and midwifes regarding child abuse and neglect: sample of burdur: Selçuk University Institute of Health Sciences, Master Thesis, Konya, Turkey. 2017.
15. Demircan B. The relationship among abuse and neglect with peer bullying and self concept perception between ages of 12-15 adolescence: Gazi University Educational Sciences Institute, Ankara, Turkey. 2017.
16. Kurklu A. Levels of teachers’ awareness about child exploitation and negligence: Afyon Kocatepe University Health Sciences Institute, Master Thesis, Afyon, Turkey. 2011.
17. Erzurumluo glu Z, Gozen D. The role of the nurse in child abuse and neglect: 1st International Child Protection Congress, Istanbul. 2014:127.
18. Kocaer U. Awareness levels of physicians and nurses about child abuse and neglect: Master Thesis, Marmara University Institute of Health Sciences, Istanbul, Turkey. 2006.
19. Yılmaz B. The investigation of nurse’s knowledge level and approach towards child abuse and neglect: Ankara University Health Sciences Institute, Master Thesis, Ankara, Turkey. 2015.
20. Akgun Kostak M, Vatansever C. Views and opinions of faculty of health sciences students about child abuse and neglect. J Health Sci Occ. 2015;2:1-11.
21. Golge ZB, Hamzao glu N, Turk. Assesment of Medical Staff Awareness About Child Abuse and Neglect. J Emerg Med. 2012;26:86-96.
22. Burç A, Guducu Tufekçi F. The Level of Diagnosis of the Symptoms and Risks of the Child Abuse and Neglect of the Nurses. Acıbadem University. J Health Sci. 2015;6:144-51.
23. Işık Metinyurt H, ve Yıldırım Sarı H. Awareness of health professionals about child abuse and neglect. Child and Civilization. 2016;1:101-21.
24. Kurt G, Donmez S, Eren O, et al. The university last year student students who are reading three different sections; perceptions of abuse, neglect and domestic Violence. Int J Soc Res. 2017;10:405-13.
25. Tınmaz Pehlivan G. Determination of awareness levels of nursing students on child abuse and neglect and evaluation of effectiveness of planned education given in this subject: Pamukkale University Health Sciences Institute, Master Thesis, Denizli, Turkey. 2017.