The Barriers to Recognizing and Reporting Child Physical Abuse by Emergency Physicians and Associated Factors.

BACKGROUND: Although the reporting rate of child abuse is increasing every year, the child abuse detection rate is 3.81% as of 2019 in Korea, which is significantly lower than that of developed countries for child rights. OBJECTIVE: We investigated the associated factors with barriers that emergency physicians face in recognizing and reporting cases of child abuse. METHODS: From May to July 2022, 240 emergency physicians working in the 15 emergency department were asked to participate in the survey via email. The questionnaire included the respondent's basic information, treatment experience for child abuse, reasons for reporting or not reporting, and opinions on measures to increase the reporting rate. We conducted a logistic regression analysis to discern the factors contributing to underreporting. RESULTS: Seventy-one individuals were included in the analysis, after excluding those who had never encountered suspected cases of child abuse. A multivariable logistic regression was performed with the above variables, and although it was not statistically significant, there was a tendency for workers to report well when working at a pediatric emergency department (odds ratio [95% confidence interval], 3.97 [0.98-16.09]). The primary reason for reporting suspected abuse was the pattern of damage suspected of abuse. The first reason for not reporting suspected abuse was because they were not sure it was child abuse. Respondents answered that to report better, a quick and appropriate response from the police and confidentiality of the reporter were needed. CONCLUSIONS: Physicians in pediatric emergency departments demonstrated a tendency for more proactive reporting suspected cases of child abuse.

Prevalence and determinants of physical violence against doctors in Bangladeshi tertiary care hospitals.

BACKGROUND: The increasing physical violence against doctors in the health sector has become an alarming global problem and a key concern for the health system in Bangladesh. This study aimed to determine the prevalence and associated factors of physical violence against doctors in Bangladeshi tertiary care hospitals. METHODS: A cross-sectional survey was performed among 406 doctors working in tertiary care hospitals. Data were collected using a self-administered questionnaire and the binary logistic regression model was employed for predicting physical violence against doctors. RESULTS: Of the participants, 50 (12.3%) doctors reported being exposed to physical violence in 12 months prior to the survey. According to logistic regression analysis, aged less than 30 years or younger, male and never-married doctors were prone to physical violence. Similarly, doctors from public hospitals and those worked in emergency departments were at higher risk of physical violence. More than 70% of victims reported that patients' relatives were the main perpetrators. Two-thirds of the victims referred to violence in the hospitals as a grave concern. CONCLUSIONS: Physical violence against doctors is relatively common in the emergency departments and public hospitals in Bangladesh. This study found that male and younger doctors were at high risk of exposing physical violence. To prevent hospital violence, authorities must develop human resources, bolster patient protocol and offer physician training.

A national educational campaign to raise awareness of child physical abuse among health care professionals.

Education is necessary to improve child physical abuse detection and management. A few studies have described national child abuse training programs, but none has measured changes in knowledge among participants. A collaboration of child abuse experts from the USA, an academic pediatric department, and a non-governmental organization in child protection aimed at (a) training hospital physicians in a train-the-trainer course for the detection and management of child physical abuse and (b) conducting workshops and measuring attendance and gain of knowledge of participants. A train-the-trainer and a national curriculum were created. A 78-item and a 20-item knowledge questionnaire were used pre and post the train-the-trainer course and all workshops, respectively. Nineteen physicians from all pediatric departments of the seven medical schools in Greece attended the course. Eight workshops in seven cities took place with a total attendance of 1220 health care professionals. Gain of knowledge was demonstrated for participants in the train-the-trainer course (p = 0.0015) and local workshops (p < 0.001).Conclusion: We successfully engaged physicians from all medical schools in Greece and conducted a train-the-trainer module and eight workshops in major cities that improved the participants' knowledge in child physical abuse. This approach may help address physician deficiencies in emerging areas of child abuse clinical practice. What is Known: • Education is necessary to improve child physical abuse detection and management. • Although national training programs have been described, none has measured participants' changes in knowledge. What is New: • A collaboration of child abuse experts, all medical schools in Greece, and a non-governmental organization resulted in a national educational campaign in child physical abuse and gains in knowledge for participants. • This approach may help address deficiencies in emerging areas of clinical practice.

Workplace violence towards workers in the emergency departments of Palestinian hospitals: a cross-sectional study.

BACKGROUND: Workplace violence (WPV) in hospital emergency departments (EDs) is a common problem. The objective of this study was to assess the characteristics (level and type), associated risk factors, causes, and consequences of WPV against workers in Palestinian EDs. METHODS: A cross-sectional study was conducted in 14 out of the available 39 EDs in Palestine: 8 from the West Bank and 6 from the Gaza Strip. Data were collected using a self-administered questionnaire between July-September 2013. Multivariate logistic regression models were used to examine risk factors associated with exposure to WPV. RESULTS: A total of 444 participants (response rate 74.5%): 161 (32.0%) nurses, 142 (32%) physicians, and 141 (31.7%) administrative personnel. The majority (76.1%) experienced a type of WPV in the past 12 months: 35.6% exposed to physical and 71.2% to non-physical assaults (69.8% verbal abuses, 48.4% threats, and 8.6% sexual harassments). Perpetrators of physical and non-physical violence were mainly patients' families/visitors (85.4% and 79.5%, respectively). Waiting time, lack of prevention measures, and unmet expectations of patients and their families are the main reasons for WPV. The multivariate regression analysis showed that younger personnel (OR = 2.29 CI 95% 1.309-4.036), clinicians (nurses and physicians) (OR = 1.65 CI 95% 0.979-2.797) comparing with administrative, and less experienced ED personnel (OR = 2.39 CI 95% 1.141-5.006) are significantly at higher risk of exposure to WPV (P < 0.05). Low level (40%) of violence reporting is evident, largely attributed to not enough actions being taken and fear of consequences. Violence has been shown to have considerable consequences for workers' well-being, patient care, and job retention. CONCLUSIONS: Violence against workers in Palestinian EDs is highly common. The effects of violence are considerable. Multiple factors cause violence; however, EDs' internal-system-related factors are the most amenable to change. Attention should be given to strengthening violence prevention policy and measures and improving incident-reporting system.

[Physical abuse of children in Denmark].

Physical abuse is experienced by approximately 20% of children in Denmark. Healthcare workers issue less than 20% of all reports suspecting physical child abuse to responsible authorities. Insufficient knowledge and other barriers may partly explain this low percentage. Recognition and adequate handling by referral to child protective teams and reporting to local authorities are of paramount importance to prevent mortality, physical and mental morbidity. With this review we hope to enlighten Danish healthcare workers and thereby ensure a qualified course of action for children, who have been subjected to physical abuse.

Exploration of Ghanaian radiographers' reporting of suspected physical abuse amongst children.

INTRODUCTION: The success of the child protection process is dependent on rapid actions by healthcare professionals who encounter a child in possible need of protection and make appropriate referrals to statutory agencies. Clear rules that promote inter-professional working among health professionals is necessary to enhance child protection. AIM: To explore the internal factors leading to bystander attitude towards reporting of suspected physical abuse amongst Ghanaian radiographers. METHODS: Twenty radiographers across Ghana who have encountered suspected child physical abuse during practice interviewed. Data was collected using qualitative methodology using semi-structured interviews. Participants were radiographers who were selected using purposive sampling. Data was thematically analysed and managed with NVivo version 10. Themes developed formed the basis of the discussion. RESULTS: Participants reported barriers such as training deficits, lack of knowledge in reporting regulations, and the absence of a framework or structures in place to guide suspected physical abuse (SPA) management. The results showed that the majority of participants were ignorant of the role of the social worker in identified cases of SPA. Additionally, there was no teamwork in the majority of the hospitals in the management of suspected physical abuse. CONCLUSIONS: Participants' behaviour towards child protection was congruent with the situation where an individual would assess the consequences of an action. Fear, lack of direction and collaboration characterised the management of suspected physical abuse. IMPLICATION FOR PRACTICE: The timely identification of child abuse is key to providing the necessary intervention for the child. However, the mere identification of abuse would be of no use to the child when no action was taken by radiographers handling the case as a result of impediments on their way.

Significados, concepções e experiências de enfermeiros da Estratégia Saúde da Família de Belo Horizonte frente ao abuso infantil: teorização sobre a não notificação / Meanings, conceptions, and experiences of nurses from the Family Health Strategy from Beautiful Horizon when faced with child abuse: theorization of non-reporting

O abuso infantil tem sido considerado um problema de saúde pública entre crianças e adolescentes sendo reconhecido, cada vez mais como uma questão social complexa e endêmica. Os profissionais da saúde desenvolvem um papel fundamental no combate ao abuso infantil, porém o padrão encontrado na atuação dos enfermeiros diante de casos de abuso infantil sugere a existência de dificuldades e barreiras, indicando uma alta prevalência de comportamento de não-notificação entre esses profissionais. Nesse contexto, este estudo objetivou compreender os significados, concepções e experiências de enfermeiros da Estratégia Saúde da Família (ESF) de Belo Horizonte frente ao abuso infantil, bem como, construir teorização sobre o comportamento de não notificação. Trata-se de um estudo qualitativo baseado no referencial metodológico da Teoria Fundamentada nos Dados (TFD) e teórico do Interacionismo Simbólico (IS). A seleção dos participantes (enfermeiros) se deu de forma intencional e paralelamente foi utilizada a técnica "snowball", na qual cada profissional entrevistado indicou outro para participar do estudo, possibilitando a definição da amostragem por referência. Foram realizadas 14 entrevistas intensivas com enfermeiros que atuam na ESF de nove Centros de Saúde de Belo Horizonte. A coleta e a categorização dos dados ocorreram simultaneamente segundo a TFD e a partir do processo de análise emergiram quatro categorias principais. A categoria "Concepção de abuso infantil", segundo os enfermeiros, é um assunto difícil de ser tratado, sendo associado à violação dos direitos da criança. A "Concepção sobre a notificação" dos enfermeiros da ESF evidenciou confusão teórica entre os termos notificação e denúncia, o que em parte, pode explicar o comportamento de não notificação. A categoria "Comunicação entre os profissionais e os órgãos de apoio" sugere que, a comunicação geralmente ocorre por meio de uma assistente social, sendo a atuação desta, para a maioria dos participantes, mais efetiva que a do conselho tutelar. "Barreiras e Facilitadores" incluem medo e alta demanda dos profissionais, o que pode dificultar a identificação e notificação do abuso. Treinamento, capacitação e reuniões da ESF foram identificados como possíveis fatores facilitadores para a notificação. Das conexões entre as categorias emergentes e suas relações construiu-se a "Teoria do comportamento de não notificação entre enfermeiros da Estratégia Saúde da Família". Entender as experiências, concepções e comportamentos dos enfermeiros frente ao abuso infantil, permitiu identificar ações que ainda precisam ser realizadas para que o propósito da notificação se cumpra, uma vez que estes profissionais desempenham um papel fundamental no cuidado das crianças e no combate ao abuso infantil.

Child abuse has been recognized as a complex and endemic social issue, and a public health problem among children and adolescents. Healthcare professionals play a pivotal role in addressing child abuse. However, the patterns observed in the actions of nurses when dealing with cases of child abuse suggest the existence of difficulties and barriers, suggesting a high prevalence of non-reporting behavior among these professionals. In this context, this study aimed at understanding the meanings, conceptions, and experiences of nurses from the Family Health Strategy (FHS) in Belo Horizonte regarding child abuse, as well as to construct a theory about non-reporting behavior. This is a qualitative study based on the methodological framework of Grounded Theory (GT) and the theoretical framework of Symbolic Interactionism (SI). The participants (nurses) were selected in an intentional manner, and the snowball technique was also used, which each interviewed professional indicated another to participate in the study, allowing for reference-based sampling. Fourteen intensive interviews were conducted with nurses working in the FHS of nine Health Centers in Belo Horizonte. Data collection and categorization occurred simultaneously according to GT, and four main categories emerged from the analysis process. The category "Conception of child abuse" suggests that nurses find it difficult to address this issue, as it is associated with the violation of children's rights. The category "Conception of reporting" revealed theoretical confusion among FHS nurses regarding the terms "reporting" and "denunciation," which may partly explain the non-reporting behavior. The category "Communication between professionals and support agencies" suggests that communication usually occurs through a social worker, and most participants perceived the social worker's actions as more effective than those of the child protective services. The category "Barriers and Facilitators" includes fear and high workload, which can jeopardize the identification and reporting of abuse. Training, and FHS meetings were identified as potential facilitators for reporting. By analyzing the connections between the emerging categories and their relationships, the "Theory of non-reporting behavior among nurses in the Family Health Strategy" was developed. Understanding nurses' experiences, conceptions, and behaviors regarding child abuse allowed for the identification of actions that still need to be taken to fulfill the purpose of reporting, as these professionals play a fundamental role in caring for children and combating child abuse.