You have been tasked with orienting new registered nurses in the emergency department in your hospital about how to manage child abuse and neglect cases. The orientation should cover child abuse and neglect definitions, prevention, detection, intervention and treatment, reporting, and interdisciplinary resources.

1. Running head: PROMOTING HEALTHY COMMUNITIES 1
Abuse and Neglect: Orientation Project
Tsai Lien Yang Shen
NSG/478 Promoting Healthy Communities
March 6, 2017
Diane Schlicke

2. ABUSE AND NEGLECT: ORIENTATION PROJECT 2
Abuse and Neglect
Childhood trauma is not something that anyone can just get over whenever they want. In
2010, over 1,560 children died as a result of abuse and neglect in the United States alone. What
is child maltreatment? It includes, but is not limited to, “the abuse or neglect of a child under the
age of 18 by a parent, caregiver, or another person in a custodial role (e.g., clergy, or teacher).
“Neglect” is the failure to meet a child's basic needs such as housing, food, clothing, education,
and access to medical care.” (Zimmerman, & Mercy, 2010, May). Virginia’s Judicial System
states that, “an abused or neglected child is one whose parent or custodian creates, inflicts,
allows, or threatens physical or mental injury (other than by accidental means)” (Virginia’s
Judicial System 2009). Similarly, the Federal Child Abuse Prevention and Treatment Act
(CAPTA) defines child abuse and neglect as “any recent act of coercive (emotional harm) or
threatening behavior (physical or sexual assault) which results in death toward those who are
younger than age 18 or who is not a liberated youth.” (Child Welfare Information Gateway,
2010)
(cacmercer.org)

3. ABUSE AND NEGLECT: ORIENTATION PROJECT 3
In modern times, the nurse’s role in primary healthcare is to have the knowledge and
confidence to take action to stop violence, abuse or neglect before it occurs. It is important that
they recognize the risk factors and various signs of child maltreatment and promote the healthy
maturation of the child as a physical, intellectual, and emotional being within the context of his
family and communities (primary level). The nurse provides the children and their parents with
basic health education and immunization. Nurses can assess children’s health conditions, while
helping the child achieve his/her optimal growth and prevent diseases and further complications.
After assessing the situation, the nurses provide proper treatment for the child according to the
disease(s) (secondary level). The nurse should give healthcare to sick children and their families
by assessing their needs, formulating a healthcare plan, executing the plan, evaluating children’s
conditions and providing heath education to children and their parents. Finally, the nurses can
directly deal with the children disabilities (tertiary level). The nurse should assist children to
return to their normal lifestyles after recovering from their illnesses and/or disabilities. A risk
factor is a characteristic that increases the chances of someone experiencing violence. As the
socio-ecological model illustrates, these risk factors can affect humans on an individual,
relationship, community, and even social government level. (Nies, & McEwen, 2015).
Risk factors: (https://vetoviolence.cdc.gov/violence-prevention-basics-social-ecological-model)

4. ABUSE AND NEGLECT: ORIENTATION PROJECT 4
Working in a different department (med/surge, pediatric or OB/GYN) has brought to
light many signs and systems of abuse. Many patients who are admitted for suicidal thoughts or
attempts have suffered from abuse or trauma. It would thus be important to understand the
relationship between abuse and suicide. This information could be used to educate the public
about the effects of abuse and suicide with the goal being to reduce the amount of suicide-related
incidents and to provide proper treatment to those with suicidal symptoms.
Sign and Systems
S/S of child abuse (Childhelp.org)
Address
Once you know the signs, you can help the children be safer - nurses are mandated to
report all abuse. Everyone must take action; “don’t wait for someone else to do it.” (Taylor, &
Bradbury-Jones, 2015).
Dial 2-1-1to help find answers, or call 911

5. ABUSE AND NEGLECT: ORIENTATION PROJECT 5
Virginia child abuse/neglect hotline: 1-800-552-7096
Prevent child abuse Virginia 800-CHILDREN (800-244-5373)
One could arrange an education program in the community (hospital, church, club, or
organization) to inform people about children’s healthcare needs. One can also open a
school/clinical group’s facility for local education programs for parents. The more we know
about abuse and neglect, the more we can do to stop it. One can volunteer in a child crisis shelter,
parenting support program, drug abuse prevention or treatment program, or a shelter for the
homeless focused on development and growth (parental resilience) of identified problems. One
can also develop new relationships with extended family, friends, co-workers, and other
members of the community who can provide emotional support and concrete help. This can
provide parents with more knowledge of how to raise their children and to manage expectations
for their behavior. In Virginia, “dial 211 to get connected and to get answers” - this will connect
you to health care, support, and response from statewide partners. This will improve a child’s
ability to interact positively with others and also to communicate his/her emotions well.
(Zimmerman, & Mercy, 2010, May).
“2-1-1 VIRGINIA STATEWIDE PARTNERS
▪ Northern Virginia Regional Commission ▪ Virginia Child Care Resource & Referral
Network
▪ Virginia Alliance of Information & Referral Systems ▪ Virginia Department of Health
▪ Virginia Board for People with Disabilities ▪ Virginia Commission on Youth
▪ Virginia Council on Social Welfare ▪ Virginia Department of Social Services

6. ABUSE AND NEGLECT: ORIENTATION PROJECT 6
▪ Virginia Cooperative Extension ▪ Virginia Department for the Aging
▪ Virginia Department of Mental Health, Mental Retardation and Substance Abuse Services
▪ Virginia Statewide Information & Referral” (Child Protective Service (CPS), 2016).
Summary
Stress strongly affects one's overall physical health. Long-term stress can bring
significant changes to a person's body and behavior, both threatened and actual, towards oneself,
others (family members, friends or co-workers), or against a group or community. This behavior
has a high likelihood of resulting in injury, death, psychological harm, or deprivation. Violence
affects us on the inside and the emotional or psychological scars can last a lifetime. (Nies, &
McEwen, 2015). Violence can also impact one’s general health. According to Pediatrician
Nadine Burke Harris, “ Adverse Childhood Experiences (ACEs) - those who’ve experienced
high levels of trauma are at triple the risk for heart disease and lung cancer, twelve times the risk
for suicide attempts” (TED Talks, 2015). Abuse can lead to many changes in a child’s behavior,
ranging from becoming isolated and withdrawn to becoming overly aggressive. Therefore,
everyone must identify victims of abuse and then uncover the root cause of the abuse. This
analysis should answer “what type of abuse was it?”, “where it happened?”, “why it happened?”,
and “who was affected?”

7. ABUSE AND NEGLECT: ORIENTATION PROJECT 7
(https://vetoviolence.cdc.gov)
http://www.newhopeforwomen.org/domestic-violence
The signs and symptoms of abuse vary with age, with females and elderly particularly
susceptible. The abuse and neglect that children bear, both physically and emotionally,
contribute to the leading causes of depression, suicide, and also unintentional injuries disability
among youth and adult. Sexual abuse contributes to unintended pregnancy and sexually
transmitted diseases, including HIV infection, while elderly abuse contributes to alcohol, tobacco
and drug use, unhealthy diets, and inadequate physical activity.
 Adult abuse hotline 1-888-832-3858

8. ABUSE AND NEGLECT: ORIENTATION PROJECT 8
 National Council on Aging 1-800-677-1116
 New Help for Women 1-800-799-7233
 Virginia Department for the Aging 1-800-552-3402
 Virginia Insurance Counseling and Assistance Program (VICAP) 1-800-552-3402
 Call 911 for all types of abuse.
Nurses appear in the primary prevention level as an educator and an assessor. Nurses
must be familiar with NICE guidance (Appleton, & Glaser, 2009), signs and symptoms of abuse,
and have “crucial conversations.” (Bradbury-Jones, 2015). Classes such as “Care Connection”
for children and websites such as: https://www.inova.org/inova-in-the-community/care-
connection-for-children/index.jsp help increase abuse awareness. Join a support program for new
parents to learn how to prevent child abuse. On the secondary prevention level, nurses act as an
advocator for the victim to help them develop a safety plan with their own team members, which
includes geriatricians, nurses, physiotherapists, and social & health workers. The nurses must
know the age-related variables while interpreting the results and regularly review the medication.
Next, on the tertiary prevention level, nurses must provide coordinated care for the victim. For
example, accept a woman’s decision (self-care) for action or lack of action (Zimmerman, &
Mercy, 2010, May) – Remain supportive of the family and pursue alternative methods to solve
the problem. Remember that abusive people have a worldview in which it is acceptable to use
power, control, and violence to get what one wants. Also, remember - your report helps protect
the victim!

9. ABUSE AND NEGLECT: ORIENTATION PROJECT 9
References
Zimmerman, F & Mercy, J (2010, May). A Better Start: Child Maltreatment Prevention as a
Public Health Priority. Zero to Three. 4-10.
Retrieved from: https://vetoviolence.cdc.gov/apps/phl/docs/A_Better_Start.pdf
Taylor, J., & Bradbury-Jones, C., (2015). Child maltreatment: Every nurse's business. Nursing
Standard, 29(29), 53-58.
Child Welfare Information Gateway (2010): Definitions of Child Abuse and Neglect in Federal
Law. Retrieved From: https://www.childwelfare.gov/topics/can/defining/federal/
Virginia’s Judicial System (2009). Lynchburg Juvenile and Domestic Relations District Court:
Child Abuse and Neglect.
Retrieved from:http://www.courts.state.va.us/courts/jdr/Lynchburg/abuse.html
Nies, M.A., & McEwen, M. (2015). Community/public health nursing: Promoting the health of
populations. St. Louis, MO: Elsevier.
Wright, L.M. & Leahey, M. (2000). Nurses and Families: A guide to family assessment and
intervention (3rd. ed.). Philadelphia: FA Davis

10. ABUSE AND NEGLECT: ORIENTATION PROJECT 10
Healthpeople.gov. (2017). 2020LHI Topics.
Retrieved from https://www.healthypeople.gov/2020/leading-health-indicators/2020-LHI-
Topics
Child Protective Service (CPS) (2016). Virginia Department of Social Services state
Retrieved from: http://www.dss.virginia.gov/abuse/index2.cgi
TEDTalks, (2015). Nadine Burke Harris—How childhood trauma affects health across a lifetime
(16:02) [Video file]. Films on Demand.
Appleton, J.V., & Glaser, D., (2009). Suspecting child maltreatment. Community Practitioner,
82(9), 34-35.
Bradbury-Jones, C., (2015). Talking about domestic abuse: Crucial conversations for health
visitors. Community Practitioner, 88(12), 40-43.
What is Child Abuse An Neglect? (2017). Mercer County Children's Advocacy Center.
Retrieved from http://www.cacmercer.org/?page_id=221
Module 4: Building Safe and Protective Environments for Children (2017). Open.edu.
http://www.open.edu/openlearncreate/mod/book/tool/print/index.php?id=68101&chapterid=252