Are Nursing Students Prepared to Recognize Violence Against Children? The Evaluation of an Italian Sample

Violence against children can be difficult to diagnose due to misleading histories and because of the absence of specific injuries. Missing or misdiagnosing violence could result in dangerous consequences for both children and families. In cases of misdiagnosis, children will not have the chance to accede to useful treatments. Moreover, in cases of misdiagnosis, erroneous interpretation of events can generate legal issues in civil, juvenile, family, divorce, and criminal courts. Since children account for nearly one-third of emergency department visits, medical and nursing staffs should be trained to understand the various forms that child abuse can take, and the warning signs seen. In Italy, the first health care professional who triages patients in emergency departments is usually a nurse. Moreover, nurses are usually in continuous contact with patients during hospitalization. For these reasons, they should have accurate and specific knowledge about identification and management of cases suspected for child abuse. A limited number of studies have been conducted about health workers’ abilities, especially for nurses, to recognize suspected child abuse cases.1-3 Health care professionals may miss sentinel injuries or incorrectly attribute them to accidental trauma. Studies and research about nursing students’ knowledge of violence against children thematic are extremely limited. The present analysis aims to: investigate nursing students’ objective knowledge about this topic and identify useful recommendations to increase future nurses’ awareness. The study population included 175 Italian nursing students, divided into two groups: Group-A—students who attended pediatric traineeship and/or pediatric exam, and Group-B—students who did not attend pediatric traineeship and/or pediatric exam. The 175 nursing students filled out a questionnaire consisting of 18 questions (1 general, 6 about sexual-abuse, 6 about child-maltreatment, and 5 about neglect). In addition, the students were asked to self-score their knowledge about this thematic with a score from 1 to 10 points. Objective knowledge and self-rated knowledge were analyzed separately. Quantitative and statistical analysis were carried out by Excel® formulas. In all, 70.1% demonstrated a low objective knowledge about child abuse thematic, answering less than half of the questions correctly. In this population, students’ objective knowledge about signs of non-accidental traumas, sexual abuse, and neglect appeared particularly deficient. For example, 70% incorrectly answered the following question: “Which of the following findings is more frequently associated with abusive head trauma?” (Correct answer: bilateral retinal hemorrhages). In addition, 84.57% demonstrated awareness of their lack in this field, self-scoring their knowledge from 1/10 point to 5/10 points. Both objective knowledge and self-rated knowledge were non-significant with regard to students who took the training/the pediatric exam (Group A) versus those who did not (Group B). For all questions, results of chi-square tests yielded no statistical differences between the two groups, demonstrating that the deficiencies were not related to students’ different levels of progression in school training and/or preparation. This analysis points out that nursing school education can be a weak point in future nurses’ knowledge on violence against children. Thus, educational programs should improve this thematic to assist future nurses in recognizing abusive suspected cases. This goal could be easily reached due to students’ high awareness of their lack of knowledge in this field, as was demonstrated in our sample. The first step for nursing schools should consist of revising the pre-existing training program by a group of experienced health care professionals. Then, it should be implemented to guarantee proper skills. Moreover, extensive review of the literature—comparing nursing schools from different geographical areas—suggests common issues independent of which accreditation system is implemented. Thus, independent of which corrective strategy will be planned, it could be useful to identify a common program for all nursing schools to standardize students’ knowledge. References: 1. Al-Ani A, Hashim R, Schiffner U, Splieth CH. Child physical abuse: Knowledge of dental students in Hamburg, Germany. Eur Arch Paediatr Dent. 2021 Dec;22(6):1057-1065. 2. Poreddi V, Pashapu DR, Kathyayani BV, Gandhi S, El-Arousy W, Math SB. Nursing students’ knowledge of child abuse and neglect in India. Br J Nurs. 2016 Mar 10-23;25(5):264-8. 3. Ali Khan HM, Mansoori N, Sohail MH, Humayun MA, Liaquat A, Mubeen SM. Child physical abuse: Awareness and practices of medical and dental doctors in Pakistan. J Pak Med Assoc. 2021 Jun;71(6):1704-1708.