Child abuse as a stressor of pediatricians

Impacts on paediatricians testifying in cases of child maltreatment: protocol for a systematic review

INTRODUCTION

Paediatricians perform medical assessments for children in cases of suspected child maltreatment. Due to their role with statutory child protection agencies and police, paediatricians may be asked to testify in court about child protection and criminal justice matters. To the authors' knowledge, there has been no previous systematic review of the literature synthesising the evidence on the impacts on paediatricians testifying in cases of child maltreatment.

METHODS AND ANALYSIS

A search strategy comprising indexed and key terms will be applied to six electronic reference databases from inception to May 2023: Medline, EMBASE, PsycINFO, CINAHL, Criminal Justice Abstracts and Cochrane Library. Two reviewers will independently screen titles and abstracts and full-text articles against predefined eligibility criteria to identify studies of interest. Conflicts will be independently adjudicated by a third reviewer.

ETHICS AND DISSEMINATION

Since the systematic review methodology aims at synthesising information from available publications, this study does not require ethical approval. An article reporting the results of the systematic review will be submitted for publication in a scientific journal, presented at relevant conferences and used in subsequent stakeholder consultations.

The experience of paediatric residents participating in a child protection rotation: A qualitative study

BACKGROUND

Practitioners working in the field of child maltreatment are at risk for vicarious traumatization. For Canadian paediatric residents, exposure to child abuse during training is limited.

OBJECTIVE

To explore how paediatric residents experience a mandatory rotation within a hospital-based child protection team (CPT) from an emotional and professional development standpoint.

METHOD

Eight paediatric residents were interviewed following their CPT rotation and transcripts were analyzed using a phenomenological approach. Exemplar quotes were then highlighted.

RESULTS

FOUR MAJOR THEMES WERE IDENTIFIED: baseline experiences; individual resident factors; intrinsic CPT rotation factors; and overall rotation assessment. The themes and their subthemes were used to inform a conceptual model of residents' experiences.

CONCLUSIONS

The knowledge provided through residents' accounts can be applied to strengthen future educational opportunities in the field of child maltreatment and offer insight to help guide the development of support systems and debriefing processes that are important in this challenging field.

Child abuse physicians: coping with challenges

This article explores how child abuse physicians (CAPs) experience the unique challenges of the emerging field of child abuse pediatrics. Practicing CAPs completed a written survey about known challenges in their field. Fifty-six CAPs completed the written survey and reported experiencing many negative consequences including: threats to their personal safety (52%), formal complaints to supervisors (50%) and licensing bodies (13%), negative stories in the media (23%), and malpractice suits (16%). A purposeful sample of CAPs participated in telephone interviews about these challenges. The 19 physicians who were interviewed described the challenges, while they spontaneously expressed satisfaction with their career and described some strategies for coping with the stresses of child abuse pediatrics. The findings highlight the stressors and challenges that may affect the ability to maintain an adequate CAP workforce. Better understanding of the challenges should help prepare physicians to practice this subspecialty.

Nurses' experience in clinical encounters with children experiencing abuse and their parents

AIM AND OBJECTIVES

The aim of this study was to identify nurse's experiences in the clinical care of children experiencing abuse. The objective was to assess how nurses remain professional especially when the suspected perpetrator is a parent.

BACKGROUND

The diagnosis of child abuse is a difficult one, yet essential because of the high morbidity and significant mortality rates. Young children may be unable to give a clear history; parents may be unwilling to be truthful, and the signs and symptoms of abuse are often not conclusive. A contributing factor to the challenges of providing nursing care to children in a context of abuse is the lack of education in this field. Nurses working in the care of paediatric patients may not be familiar with situations in which they cannot rely on histories provided by parents.

DESIGN

A qualitative study.

METHODS

Investigators used a qualitative design with a critical incident technique. Eleven nurses who cared for abused children and their parents at a tertiary care children's hospital were interviewed.

RESULTS

We highlighted three areas in the analysis of the interviews: Feelings of ambivalence, nurses' professionalism and the nurses' care strategies. Participants expressed difficulties in maintaining a professional role in clinical encounters with the parents. The nurses were unhappy in their conflicting roles of both policing (a judging function) and nursing (a caring function).

CONCLUSIONS

The nurses expressed that they had devised strategies to remain professional in the clinical encounter with abused children and their parents. To remain professional, education, counselling and experience was essential.

RELEVANCE TO CLINICAL PRACTICE

By identifying nurses' experiences in clinical encounters with children experiencing abuse and their parents, nurses can assess what kind of specific interventions should be used to improve the caring situation.

Positive and negative work characteristics associated with burnout among primary care pediatricians

BACKGROUND

There is little research regarding specific work features that might cause chronic stress and burnout among primary care pediatricians. The aim of the present study was first, to assess specific negative and positive characteristics of the job that might be related to burnout; and second, to compare burnout levels and work characteristics among board-certified versus general pediatricians; and clinic directors versus non-directors.

METHODS

Questionnaires were sent to 200 pediatricians employed full-time in pediatric primary care community centers in the largest Israeli Health Maintenance Organization (HMO). Respondents replied anonymously. The questionnaires assessed sociodemographic details, burnout levels, and negative and positive job characteristics.

RESULTS

There were no differences in burnout levels between board-certified and general pediatricians. Positive job features had stronger associations with burnout than negative features. Compared with general pediatricians, board-certified pediatricians reported significantly higher levels of negative features (e.g. conflicts between the medical and administrative system in the HMO; parents disregarding instructions); but higher levels of autonomy and appreciation from patients. Compared with regular pediatricians, clinic directors had significantly higher levels of negative job features (e.g. less access to resources); and higher levels of positive work features.

CONCLUSIONS

The absence of positive job features (e.g. autonomy, recognition for one's work and utilization of skills) may be more important in causing burnout than the presence of negative characteristics (e.g. overload, demanding and noisy parents). It is consistent with recent suggestions that in the presence of positive features, employees can better tolerate stressful aspects of the job and still feel motivated and engaged.

The intimidation of British pediatricians

British pediatricians who diagnose and treat child abuse cases have come under attack by the British press and by parents who have been investigated for possible abuse. Now the General Medical Council also is intimidating these pediatricians. The General Medical Council is the licensing authority for physicians in the United Kingdom. This has resulted in fewer pediatricians being willing to care for abused children or to testify in child abuse cases. In the United States, the recent recognition of the pediatric subspecialty of child abuse pediatrics should help set standards for child abuse medical evaluation and testimony.

Role of the tertiary child protection paediatrician: expert and advocate

AIM

The role of the child protection paediatrician is varied. This study examines perceptions of how tertiary child protection (tCP) paediatricians view their multifaceted roles, perceived adequacy of length of pre-FRACP training and how this relates to confidence and satisfaction in their roles.

METHODS

An anonymous self-report survey was distributed to child protection paediatricians working in tertiary hospitals across New Zealand and Australia. The survey addressed the adequacy of training and confidence within the diverse roles encountered within child protection work. It also identified perceptions of stress and satisfaction.

RESULTS

Responses were received from 32 out of 45 of eligible tCP paediatricians (72%). The majority (71.8%) had entered directly into a tCP unit in their first consultant position. Two-thirds (65.7%) of tCP paediatricians received less than 4 months of pre-FRACP child protection training while a third received no training at all. Generally tCP paediatricians perceived their training in all domains of child protection to be inadequate although their current confidence levels in all roles are high. They expressed most concerns within their role as forensic expert.

CONCLUSION

Despite receiving little or no training pre-FRACP in child protection, this group of tCP paediatricians function in their specialised roles in tCP and feel confident in fulfilling the dimensions of forensic expert and child advocate. As the field of medical child protection continues to evolve, it is important for training to keep pace with expectations of the varied roles of the paediatric specialist in child protection.

Burnout, psychological morbidity, job satisfaction, and stress: a survey of Canadian hospital based child protection professionals

AIMS

(1) To measure the prevalence of burnout, psychological morbidity, job satisfaction, job stress, and consideration of alternate work among multidisciplinary hospital based child and youth protection (CYP) professionals; (2) to understand the relations between these variables; and (3) to understand the reasons for leaving among former programme members.

METHODS

Mailed survey of current and former members of all Canadian academic hospital based CYP programmes. Surveys for current members contained validated measures of burnout, psychological morbidity, job satisfaction/stress, and questions about consideration of alternate work. Surveys for former members examined motivation(s) for leaving.

RESULTS

One hundred and twenty six of 165 current members (76.4%) and 13/14 (92.9%) former members responded. Over one third (34.1%) of respondents exhibited burnout while psychological morbidity was present in 13.5%. Job satisfaction was high, with 68.8% finding their job "extremely" or "quite" satisfying, whereas 26.2% found their job "extremely" or "quite" stressful. Psychological morbidity, job satisfaction, and job stress were not associated with any of the demographic variables measured, but burnout was most prevalent among non-physician programme members. Almost two thirds of current members indicated that they had seriously considered a change in work situation. Former members indicated that burnout and high levels of job stress were most responsible for their decision to leave and that increasing the number of programme staff and, consequently, reducing the number of hours worked would have influenced their decision to stay.

CONCLUSIONS

Current levels of burnout and the large proportion of individuals who have contemplated leaving the service suggest a potential crisis in Canadian hospital based CYP services.

Child sexual abuse

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.