The term child abuse is used to describe any neglect or mistreatment of infants or children including infliction of emotional pain, physical injury, or sexual exploitation. Neglect or abuse is most often inflicted by the child’s biological parents. Others who have been implicated include foster parents, babysitters, boyfriends, friends, and daycare workers. Nurses are legally and morally responsible to identify children who may be maltreated and to report findings to protect the child from further abuse.
Neglect is the most common form of abuse and may include deprivation of basic physical or emotional needs: food, clothing, shelter, healthcare, education, affection, love, and nurturing. Emotional abuse stems from rejection, isolation, and/or terrorizing the child.
Physical abuse may result in burns, bruises, fractures, lacerations, or poisoning. Infants may suffer from “shaken baby syndrome” with severe or fatal neurologic injuries caused
by violent shaking of the infant. Signs of shaken baby syndrome include retinal and subarachnoid hemorrhage. Signs of sexual abuse include bruising or bleeding of the anus or genitals, genital discharge, odor, severe itching or pain, and sexually transmitted diseases. A discrepancy between the nature of the child’s injuries and the reported cause of injury is a frequent clue that abuse has occurred.
The major nursing care planning goals for the child experiencing abuse includes ensuring adequate nutrition, safety of the abused child, relief from anxiety, improving parenting skills and building parental confidence.
Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for child abuse:
Risk for Trauma
May be related to
- Characteristics of child, caregivers, environment.
Possibly evidenced by
- Sexual assault of child
- Evidence of physical abuse of child
- History of abuse of abuser
- Social isolation of family
- Low self-esteem of caretaker
- Inadequate support systems
- Violence against other members of the family
- Child will not experience maltreatment or abuse by parents or other offenders.
|Assess the abuser for violent behavior or|
other abusive patterns, use of alcohol
or drugs, or other psychosocial problems.
|Provides information to determine warning signs of child abuse.|
|Assess behavior of parents toward the child, including responses to the child’s behavior, ability to comfort the child, feelings, and perceptions toward the child, expectations for the child,over-protective or concern for the child.||Reveals characteristics that may indicate risk for abuse.|
|Maintain factual and objective|
documentation of all observations, including child’s physical condition, child’s behavioral response to parents, health care workers, other visitors, parent’s response to child, and interviews
with family members.
|Provides information that may be used in legal action regarding abuse.|
|Communicate information and needs of the child to those on the abuse team (or to new caretakers if the child being placed with a foster parent or someone other than parents); provide written instruction for care and child’s needs.||Provides care plan for the child based on the court decision to caretakers working with the family based on the court decision for child’s care.|
|Instruct parents in identifying events that|
lead to child abuse and in methods to deal with behavior without harming the child.
|Prevents further abusive behavior directed at the child.|
|Inform parents of follow-up care and needs of the child, need to evaluate child’s progress.||Promotes emphasis on child’s care and prevention of recurrence of abuse.|
|Inform parents of child’s placement in|
a foster home, allow them to meet and speak to a new caretaker.
|Prepares parents for court order of alternate placement to ensure a safe environment.|
|Inform of Parents Anonymous and other child protective groups to contact for assistance.||Provides self-help group activities, information, and support based on the type of abuse and parental needs.|
|Initiate referral to a social worker,|
public health nurse, psychological counselor before discharge to home.
|Provides support to child and family, and monitors behaviors following discharge.|
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