Narrative language skills of maltreated children living in out-of-home care

Abstract

Purpose: Children’s narrative accounts of their experiences are central to the prosecution of perpetrators of alleged maltreatment. We describe the narrative language skills of children who were placed in out-of-home care (OOHC) following substantiated maltreatment. It was hypothesised that (i) children with such histories would display narrative language skills that fall significantly below published age-expected norms, (ii) narrative language skills and core language skills would be positively correlated and (iii) narrative language skills would be associated with measures of socio-economic disadvantage.

Method: Eighty-three children (40 males and 43 females) aged 5;3 to 12;10 (M?=?7.9, SD = 2.3) from English-speaking home backgrounds were assessed using the Test of Narrative Language and the Clinical Evaluation of Language Fundamentals (CELF-4) Core Language Score. The Raven’s Coloured Progressive Matrices, a measure of nonverbal intelligence, was employed as a covariate.

Result: Forty-two percent of children scored in the below-average range on the Narrative Language Index Ability Index. The same proportion scored at/above age-expected levels on the Narrative Comprehension subtest, and 19% scored at/above age-expected levels on Oral Narration. There was a significant correlation between CELF-4 Core Language Scores and the Narrative Language Index Ability Index. Female carers’ education was significantly positively associated with overall narrative language scores; however, household income and index of socio-economic disadvantage were not significantly associated with narrative language scores.

Conclusion: Children who are victims of substantiated maltreatment should be considered at-risk for compromised ability to provide a narrative account of their experiences. The heterogeneity and often scant oral narrative language skills of these children highlights the importance of police/human services training on best-practice forensic interviewing. Policy and practice implications for speech-language pathology early intervention to support the needs of at-risk children are also discussed.     

Barriers to preventive health care for young children

PURPOSE: To review the literature on barriers to availability, access, and utilization of preventive health care for young children three to five years of age and their families and to discuss the role of nurse practitioners (NPs) in future research, education, and practice in this area. DATA SOURCES: A comprehensive literature search was conducted of online material and CINAHL and Medline (CD-ROM 1990 to present). In addition, experts in this area were asked to recommend extra reading materials. Additional references in textbooks and articles were examined. CONCLUSIONS: The literature review supports that there are major barriers to be addressed in the areas of availability, access, and utilization of preventive health care services for young children and their families. Major concerns include mandatory system for preventative health care, lack of health insurance coverage, cultural issues, and parental effects. IMPLICATIONS FOR PRACTICE: Health professionals in the community will need to work together to reevaluate current preventive health care practices for young children. Alternative methods for approaching and providing preventive health care services may become increasingly important if these services for young children are to be provided at current or increased levels.     

Nurse practitioners and parent education: a partnership for health

PURPOSE: To present the findings from a pilot-test of an innovative curriculum for parent education classes that included information about well child care and the care of sick children presented to substance abusing women at a residential drug treatment facility. DATA SOURCES: Selected literature and the results of a comparison of pre- and post-tests from the 37 women who received the classes over a 6 week period. CONCLUSIONS: The Healthy Children, Happy Children parent education program was successful overall in increasing the knowledge of the mothers about common skin disorders, care of infants, toddlers, and preschoolers, and basic first aid. IMPLICATIONS FOR PRACTICE: Nurse practitioners (NPs) are well suited to teach parent education classes that contain information on growth and development, well child care and diagnosis and management of acute minor conditions. The Healthy Children, Happy Children curriculum can be adapted to a variety of settings and populations.     

Mothers' decision-making processes regarding health care for their children

This research study explored mothers' decision-making processes regarding health care for their children. Identifying how decisions are made by mothers about health care for their children will assist health care professionals to be appropriate advocates for mothers, to improve quality of life, and to contain costs of health care for children. A sample of 114 rural mothers (51 with one child, 63 with more than one child) completed questionnaires identifying demographics, social support, client and professional interaction elements, self-determinism, competence in problem-solving skills, and relationships to responses to health care scenarios. Qualitative data were also gathered by structured in-depth interviews of 7 subjects. ANOVA, correlations, and factor analysis were completed to analyze data. Most of the mothers' decisions were based on the perceived degree of seriousness, mother's degree of fear of the child's condition, attitude of the health care provider, previous experience with the situation, and social support for the mother. There were no significant differences in decision-making processes by first time mothers and by mothers with more than one child. Implications include teaching mothers assessment skills to identify serious versus nonserious situations and to utilize other social supports.     

Placing physical activity in mental health care: a leadership role for mental health nurses

The wide-ranging benefits of physical activity for consumers with mental illness are acknowledged within the mental health nursing field; however, this is not commonly translated to practice. The primary aim of this paper is to argue that mental health nurses are well positioned to, and should, provide leadership in promoting physical activity to improve the quality of care for people with mental illness. Topics addressed in this paper include the relationship between physical activity and both physical and mental health, the views and experiences of consumers with physical activity, the efficacy of physical activity interventions, the attitudes of nurses to physical activity as a component of care, barriers to a physical activity focus in care for mental illness, and the role of mental health nurses in promoting physical activity. There is a clear and important relationship between physical activity and mental health. Mental health nurses are well positioned to encourage and assist consumers to engage in physical activity, although they might lack the educational preparation to perform this role effectively.     

How public health nurses understand mothers of abused and neglected children: The perception of 'Shindosa' in mothers

Aim: The purpose of this paper is to describe the practical knowledge that public health nurses use in identifying and providing assistance to the mothers of child abuse victims. Methods and Results: A grounded theory qualitative research method was used to collect and analyse semistructured interviews of 22 public health nurses from health centers in Osaka, Japan. The data was systematically analysed by using a constant comparison process. The participants had an average age of 46.2 years with an average of 21.6 years of experience in their profession. The research examined the perspective of the public health nurses regarding the mothers of child abuse victims. The key factor ‘shindosa’, which is a sense of fatigue, defeat, or lack of energy, emerged from the data. In addition, public health nurses used a two‐step process of perception. First, public health nurses began providing assistance to mothers by noticing the presence of shindosa in thems. Nurses became concerned by the state of the mothers and the way they interacted with their children. They perceived that the mother might be experiencing shindosa. Second, through continuous involvement with the mothers, public health nurses came to ascertain the essence of shindosa in mothers. Thus, their initial vague impression of the presence of shindosa became the catalyst to providing assistance to the mothers, and as a result, they gradually understood the fundamental nature of shindosa. Conclusion: By focusing on mothers as well as children, public health nurses successfully achieved their goal to provide the appropriate and specific care to each mother with shindosa as a solution in the prevention of child abuse.     

社区卫生服务中心儿童保健团队的服务模式与效果

目的探讨社区卫生服务模式,提高社区儿童保健工作质量。方法在某社区卫生服务中心建立儿童保健模式,改造服务流程,合理分工,确定服务内容,实施团队式服务管理模式。结果 0~3岁儿童的系统管理率提高;社区居民满意度提高,差异均具有统计学意义(P0.01)。结论社区儿童保健服务管理模式可以提高儿童保健的服务质量。     

阅读疗法在围手术期患儿健康教育中的应用

目的探讨符合儿童认知发展水平的健康教育形式,提高儿科健康教育效果。方法利用阅读疗法作用机理,编写住院患儿阅读疗法读本。选择符合入选标准的住院患儿分为观察组（60例）和对照组（60例）。对照组手术前后给予常规口头宣教及疾病护理宣教手册;观察组在此基础上,于患儿住院后24h内将“住院患儿阅读疗法读本”发给陪护人员或有阅读能力的患儿本人,以供随时阅读,术前一天再次阅读并讨论相关问题。根据患儿的年龄,采取亲子阅读、交互式阅读、自我管理式阅读等不同阅读形式。对患儿和陪护人员进行住院患儿阅读读本认可度调查;向观察组和对照组患儿或陪护人员发放手术前后护理知识知晓率调查表,了解健康教育效果。结果91．67％的患儿认可住院患儿阅读读本的故事内容及图文并茂的形式;95．00％的患儿通过阅读了解住院期间要经历的过程;93．33％的患儿愿意向朋友推荐此读本;健康教育效果调查：观察组在疾病相关知识、治疗相关知识、饮食知识、手术注意事项等方面均优于对照组,两组差异均具有统计学意义（P〈0．05）。结论阅读疗法作为儿科健康教育的一种补充形式,符合儿童身心发展的自然规律和客观需求,体现了以家庭为中心的人文护理理念,较有效地实现了健康教育目标。     

健康教育在老年患者家庭护理中的应用

目的探讨健康教育在老年患者家庭护理中的实施效果。方法对65例老年患者家庭护理中实施健康教育,比较实施前后健康教育效果的差异,包括患者对疾病知识知晓程度、健康行为、治疗依从性、情绪管理等。结果实施后健康教育效果优于实施前,实施前后比较,χ2=28.770,P0.01,差异具有统计学意义。结论老年患者家庭护理中实施健康教育,有效改善患者对疾病知识知晓程度、健康行为,提高治疗依从性及自我管理能力,提高患者的生活质量。     

授权式教育在行PICC化疗患儿家属健康教育中的应用

目的探讨授权式教育在行PICC化疗患儿家属健康教育中应用的效果。方法选取确诊为恶性肿瘤患儿行PICC置管的家属35例,分别在置管前和置管后采用Zung焦虑自评量表（SAS）测定家属焦虑指数,应用自制健康教育评价表观察比较置管前后家属对置管相关知识的掌握情况。结果置管后患儿家属对授权式教育获得的PICC知识掌握情况优于置管前（P〈0．05）,焦虑情绪明显减轻,与置管前相比差异有显著意义（P〈0．05）。结论授权式教育让家庭参与健康照顾的各个方面,改变患儿家属行为方式和心理适应度,明显提升了患儿家属的自主性和参与性。     

社区护士健康教育认知状况调查分析

目的：了解社区护士对健康教育的认知状况及开展健康教育现状,找出目前社区护士开展健康教育工作存在的困难和薄弱环节。方法：使用问卷方式对北京市海淀区8所社区卫生服务中心100名社区护士进行调查。结果：被调查的100名护士中,95%认为健康教育是社区护理工作的一部分,开展健康教育是非常重要的。社区健康教育基本理论知识总分平均分为6～14（9.75±1.755）分。护士在健康教育过程中遇到的主要困难,依次为资金设备缺乏,知识和技能缺乏,场所缺乏,护理人员不足等。结论：社区护士的观念已经发生改变,但对开展健康教育仍然存在不同层次的认识误区,社区护士在健康教育中没有发挥应有的作用,应引起社区护理管理者的重视。     

Caring in nursing: a multivariate analysis

The dimensions underlying the perceptions of caring among nurses were investigated using the Edinburgh Caring Dimensions Inventory (CDI). Exploratory and confirmatory factor analysis techniques were used. While there was a general caring factor on which the majority of the items in the CDI loaded, there were two separable major dimensions to caring, namely 'psychosocial aspects' and 'professional and technical aspects'. In addition, two smaller dimensions were identified that were both related to self-giving, and it is postulated that these refer, respectively, to appropriate and inappropriate self-giving in nursing.     

Identification of child maltreatment while caring for them in a university hospital

The purpose of the study was to look at how nurses and physicians of a university hospital rated their ability to identify child maltreatment while caring for those children. In this study, child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child under the age of 18 by parents or caregivers. The total population of staff caring for children (N=513) in a university hospital were surveyed. Data were collected with a questionnaire developed for this study with reference to the literature. Altogether 317 questionnaires were returned, which yielded a response rate of 62%. The data were analysed using statistical methods and quantitative content analysis. Forty per cent of the respondents estimated that they had never cared for a maltreated child. Two-thirds of the respondents believed that they would be able to identify a child maltreatment case. The most distinct signs by which maltreatment could be identified were fractures, multiple bruises and the fact that the child had frequent injuries. The child's or parent's behaviour often aroused suspicion of maltreatment. Seventy-one per cent of the respondents rated the identification of maltreatment as rather difficult or difficult. Awkwardness of the phenomenon, the staff's pressure of work and relative unfamiliarity with the phenomenon were assessed as things that make the identification difficult. The fact that no jointly agreed guidelines were available for handling the matter was seen as a particular weakness. The respondents had fairly much theoretical knowledge about child maltreatment. However, child maltreatment is a multi-dimensional phenomenon that calls forth emotions. The development and improvement of practical nursing and medical care and of staff collaboration require that education be provided to different occupational groups and parties caring for children and that jointly agreed hospital-specific and regional models for operation be developed.     

图文式健康教育对学龄前期小儿预防接种的影响

目的:探讨图文式健康教育在3~4岁学龄前期小儿预防接种中对小儿及家长的影响。方法:将2013年5~8月78例将要进行预防接种的小儿随机分为对照组36例和观察组42例,对照组采用传统健康教育方法,观察组采用图文式健康教育方法,比较两种方法对小儿的影响及家长对两种教育方法的满意度。结果:观察组患儿预防接种时疼痛程度低于对照组(P0.05),家长满意度高于对照组(P0.05)。结论:免疫接种前应用图文式健康教育路径对小儿及家长进行健康教育,可有效降低小儿预防接种时对疼痛的反应程度,同时能提高家长的满意度,值得临床推广应用。