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Attitudes of a selected population of community health nurses toward parents or guardians who physically.. Murphy, Norma Jean 1982

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ATTITUDES  OF A SELECTED P O P U L A T I O N OF COMMUNITY  HEALTH NURSES TOWARD PARENTS OR GUARDIANS WHO P H Y S I C A L L Y ABUSE  CHILDREN  by NORMA J E A N MURPHY B.N.,  A THESIS  Dalhouse  SUBMITTED  University,  1975  I N PARTIAL FULFILMENT  THE REQUIREMENTS FOR THE DEGREE OF MASTER OF S C I E N C E  IN  NURSING  in THE FACULTY  OF GRADUATE  (School  We a c c e p t to  this the  of  Nursing)  thesis  required  THE U N I V E R S I T Y  Norma  as  conforming  standard  OF B R I T I S H  September,  _)  STUDIES  COLUMBIA  1982  Jean Murphy,  1982  OF  In p r e s e n t i n g requirements  this thesis f o r an  of  British  it  freely available  agree that for  for reference  permission  h i s or  understood that  be  Library  shall  and  study.  I  her  g r a n t e d by  shall  not  be  <  ?L^«^,  The U n i v e r s i t y o f B r i t i s h 1956 Main Mall V a n c o u v e r , Canada V6T 1Y3  Date  DE-6  (3/81)  -M^tt-^^AjiAj  •&/• '•)S3-.  Columbia  make  further this  thesis  head o f  this  my  It is thesis  a l l o w e d w i t h o u t my  permission.  Department o f  the  representatives. of  the  University  the  copying or p u b l i c a t i o n  f i n a n c i a l gain  the  f o r extensive copying of  s c h o l a r l y p u r p o s e s may by  f u l f i l m e n t of  advanced degree a t  Columbia, I agree that  department or for  in partial  written  i i  ABSTRACT  A replication describe  the  of  Reilly's  attitudes  and  children  toward  the  attitudes  of  of  variables;  attitudes  the  the  attitudes  group  with  ience  group;  health  the  last,  in  regard  The p o p u l a t i o n population from  the  of  of  Health  Units  attitudes ured  by  of  was  obtained  (1980). child from  of  the  attitude  collected scores  data  social sheet  community by  and  the  these  (1980);  nurses  in  by  child  the  also  background  data  selected  subjects two  of  abusers  the  by  Reilly  by  The  The  were  meas-  (1980).  variables Reilly  experiences  sheet  was  Vancouver.  developed  questions.  sample  Columbia  in  Greater  nurses'  community  One  fifteen  developed  conven-  randomly  British  child  compare  selected  the  nurses. was  the  abuse.  employed  of  to  randomly  and p r o f e s s i o n a l  health  open-ended  to  of  toward  Instrument  selected  nurses  subjects  Services  nurses  of  health  nurses  between and  with  the  parents  social  presented  by  to  selected  the  population  health  Health  a biographical  were  community  health  the  data  employed  in  order  relationship  Reilly  health  experiences  Attitudinal the  by  nurses  the  sample  community  community  regarding by  nurses  Metropolitan  the  studied  fifty-seven  A second  Data regarding  abuse the  from  of  and  in  who w o r k w i t h  the  attitudes  community  their  and  health  a Likert-type  Information  to  conducted  nurses  nurses  health  the  consisted  Health.  self-selected  nurses  was  determine  the  describe  one hundred  community  Ministry  to  health to  compare  of  (1980)  health  community  attitudes  and  nurses  to  registered  of  the  abusers;  community  professional of  community  child  the  study  with  correlated  were  analyzed  data  through  the  process  Data  regarding  ized  by  the  The  finding  nurses' the  the  the  study  whether  affected  the  group.  findings  that  the  subjects'  subjects  have  met  an a b u s i n g  significantly The  study  multitude tion, a need  it  affected  of was  for  also  the  found  frustrations found  further  that  The  more  parent  attitude  in  unfavorable.  it  education  registered  was  shown  child,  health  support  nurses'  that  signifi-  nurses  Reilly's  in (1980)  and w h e t h e r  a case  of  child  nurses  experience  the  abuse  scores. health  management  a significant  instruction  of  not  detected  community  the  community  did  health  regarding  addition,  summar-  statistics.  than  seen an abused the  statistics.  abuse were  community  finding  In  level or  the  favorable  (1980)  study  present  that  that  of  child  and d e s c r i p t i v e  have  scores  and d e s c r i p t i v e  with  abusers.  subjects  attitude  selected  were  Reilly's  child  the  analysis revealed  abusers  toward  analysis  experiences  content  child  attitudes  randomly  of  substantiated  variable,  cantly  of  toward  inferential  subjects'  process  results  attitudes This  the  of  of  child  percentage  regarding  the  of  abuse. the  treatment  In  nurses of  child  a addi-  expressed abuse.  iv  TABLE OF CONTENTS  Page ABSTRACT  i i  T A B L E OF CONTENTS  iv  LIST  OF TABLES  v i i  LIST  OF FIGURES  .  x  ACKNOWLEDGEMENTS  xi  CHAPTER •I.  INTRODUCTION  1  Problem Area Statement Purposes The  I I .  1  of of  the the  Implication  Problem Study  .  3  of  Study  3  the  Justification  for  Definition  Terms  of  3  the  Replication  of  the  Study  4 6  Assumptions  of  the  Study  7  Limitations  of  the  Study  7  L I T E R A T U R E REVIEW Definitional  Aspect  Epidemiological Etiological  8 .  8  Aspect  11  Aspect  13  V  CHAPTER  Page Nurses  Need  Attitude The to  Have  Identify  Child  as  Attitudes  an O b j e c t i v e  Child  Qualifications  Attitude  I I I .  to  toward  of  Professional 20  Community H e a l t h  Nurses  Abuse  a Concept  Toward  and  Abusers  Child  22  .  24 Abuse  .  .  .  25  METHODOLOGY  29  The I n s t r u m e n t  29  Sample  32  Data  Selection  Collection  33  Data Analysis IV.  DATA A N A L Y S I S Section  33  .  .  the  Analysis of  Results  the of  35 Results  Reilly's  of  the  Study  Present  (1980)  .  Study .  .  .  .  .  .  I I  Content  V.  35 35  A Comparison  Section  .  I  Inferential  to  .  58 Analysis  Derived  from  the  Responses  o f t h e S u b j e c t s i n t h e Random G r o u p (N = 1 3 2 ) . . . . Content A n a l y s i s D e r i v e d f r o m t h e Responses of the  58  Subjects  60  SUMMARY, Summary  in  the  Convenience  DISCUSSION, and  Group  (N = 1 5 )  CONCLUSIONS AND I M P L I C A T I O N S  . . . .  Discussion  62 62  Conclusions  68  Implications  for  Nursing  Education  Implications  for  Nursing  Research  BIBLIOGRAPHY  37  69 . . .  70 72  vi Page APPENDIX A  77 Attitude  Scale  Who P h y s i c a l l y Answer  Toward P a r e n t s Abuse  Their  or  Guardians  Children  78  Sheet  Background Questions  81  Data  Sheet  Related  to  82 Child  Abuse  .  .  86  APPENDIX B  87 Covering  Letter  from Researcher  88  APPENDIX C  89 Descriptive  APPENDIX D .  Analysis  .  .  .  90 113  D e s c r i p t i v e A n a l y s i s o f t h e Community H e a l t h N u r s e s ' Experiences w i t h C h i l d Abuse Random G r o u p (N = 1 3 2 )  114  Comments  120  (N = 1 3 2 )  D e s c r i p t i v e A n a l y s i s o f t h e Community H e a l t h N u r s e s ' E x p e r i e n c e s w i t h C h i l d Abuse C o n v e n i e n c e Group (N = 1 5 )  124  Comments  125  (N = 1 5 )  v i i  LIST  OF TABLES  Table 1.  2.  3.  4.  Page A n a l y s i s o f V a r i a n c e o f Raw S c o r e s S c a l e A c c o r d i n g t o A g e (N = 1 3 2 )  on  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s S c a l e A c c o r d i n g t o A g e (N = 1 5 )  on t h e  6.  7.  8.  9.  10.  11.  12.  13.  Attitude 36 Attitude 37  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o M a r i t a l S t a t u s (N = 132) Analysis Scale  5.  the  of  Variance  According  to  of  Raw S c o r e s  Marital  Status  on  the  37  Attitude  (N = 1 5 )  38  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o E t h n i c B a c k g r o u n d (N = 1 3 2 )  38  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o E t h n i c B a c k g r o u n d (N = 1 5 )  39  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o Whether S u b j e c t s Have C h i l d r e n (N = 132) .  40  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o Whether S u b j e c t s Have C h i l d r e n (N = 1 5 ) .  40  Analysis of S c a l e As t o  V a r i a n c e o f Raw S c o r e s t h e Number o f C h i l d r e n  on the A t t i t u d e (N = 132)  Analysis S c a l e As  V a r i a n c e o f Raw S c o r e s t h e Number o f C h i l d r e n  on t h e A t t i t u d e (N = 1 5 )  41  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Childhood R e l i g i o u s Background (N = 1 3 2 )  42  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Childhood Religious Background (N = 1 5 )  42  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n Scale According to Father's Education  43  of to  the A t t i t u d e (N = 1 3 2 )  .  41  v i i i Table 14.  15.  Page A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n Scale According to Father's Education  the A t t i t u d e (N = 1 5 )  Analysis  the  Scale 16.  Analysis Scale  17.  of  of  21.  22.  23.  24.  25.  26.  Raw S c o r e s  of  Raw S c o r e s  Mother's  on  Education on  Education  Attitude  (N = 1 3 2 ) the  44  Attitude  (N = 1 5 )  44  (N = 1 3 2 )  45  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Educational Preparation for (N = 1 5 )  45  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Present Level of Education (N =  20.  to  of  Mother's  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Educational Preparation for  Registration 19.  to  Variance  According  Registration 18.  Variance  According  43  132)  46  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Present Level of Education (N = 1 5 )  46  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Years of Nursing Experience (N = 1 3 2 )  47  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Years of Nursing Experience (N = 1 5 )  48  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Formal I n s t r u c t i o n i n Child A b u s e (N = 1 3 2 ) .  48  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n Scale According to Formal I n s t r u c t i o n A b u s e (N = 1 5 )  49  the A t t i t u d e in Child  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o H a v i n g Seen an Abused C h i l d (N = 1 3 2 ) Analysis Scale  of  Variance  According  (N = 1 5 )  .  to  of  Raw S c o r e s  Having  on  the  Seen an Abused  49  Attitude Child 50  ix Table 27.  Page Analysis  of  Variance  Scale  to  Whether  As 28.  30.  a Child  Variance  to  Whether  Analysis S c a l e As to  Analysis S c a l e As a Child  32.  Analysis S c a l e As A Child  33.  Analysis S c a l e As Abuse  34.  36.  38.  Attitude Abused  of  Raw S c o r e s  Subjects  on the  Attitude  Were P h y s i c a l l y  Abused  (N = 1 5 )  51  an Abused of to  (N = 1 5 )  52 the A t t i t u d e Contact With  (N = 1 3 2 )  53  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e W h e t h e r S u b j e c t s Have Had C o n t a c t W i t h  Abuser of to  Child  V a r i a n c e o f Raw S c o r e s o n Whether S u b j e c t s Have Had  Abuser of to  52  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Whether S u b j e c t s Have P r o v i d e d N u r s i n g  (N = 1 5 )  53  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Whether S u b j e c t s Have D e t e c t e d C h i l d  (N = 1 3 2 )  .  .  54  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Whether S u b j e c t s Have D e t e c t e d C h i l d  (N = 1 5 )  55  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e S c a l e As t o W h e t h e r S u b j e c t s Had R e p o r t e d A b u s e (N = 1 3 2 )  Attitude Child  Analysis S c a l e As  Attitude Child  Abuse 37.  of to  Analysis of S c a l e As t o Abuse  35.  the  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o W h e t h e r S u b j e c t s Have P r o v i d e d N u r s i n g C a r e t o a n A b u s e d C h i l d (N = 1 3 2 )  Care 31.  on  Were P h y s i c a l l y  51  of  a Child  Raw S c o r e s  (N = 1 3 2 )  Scale  As  of  Subjects  Analysis As  29.  As  of to  (N =  V a r i a n c e o f Raw S c o r e s o n t h e W h e t h e r S u b j e c t s Had R e p o r t e d  55  15)  56  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o W h e t h e r S u b j e c t s Have Been I n v o l v e d in a C o u r t H e a r i n g i n R e g a r d t o C h i l d A b u s e (N = 1 3 2 ) . . . . Analysis S c a l e As a Court  of to  56  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Whether S u b j e c t s Have Been I n v o l v e d in  Hearing  in  Regard  to  Child  Abuse  (N = 1 5 )  . . . .  57  X  LIST  OF•FIGURES  Figure 1.  Page Gelles' Social Psychological o f t h e Causes o f C h i l d Abuse  Model 14  ACKNOWLEDGEMENTS  The Erickson  author and D r .  Appreciation  is  participation who  typed  extended  expresses  this to  Marv Westwood, expressed  in  gratitude  this  study.  manuscript.  my f a m i l y  to  and  the  for  to  their  Community  Special And,  her  committee,  guidance  and  Health  Nurses  thanks  a very  friends.  thesis  is  special  given note  Ms.  Janet  support.  to of  for Mary thanks  their Vorvis is  CHAPTER  I  INTRODUCTION  Problem  Area  In  the  last  increasingly  decade,  concerned  identification  Canadian h e a l t h  with  and r e p o r t i n g  mary means  to  process  identification  the  of  child's  tive  prevention  safety  position  community is  the  health  to  the  and  of  have  child  The  abuse.  problem have been viewed  (McKittrick,  abusive  in  abusive  parent  tion  (Heifer  sion  of to  part,  abuse  of At  cribe  or  1981).  reporting, the  As  a direct  measures  family's  can be  entry  child  their  or  become early  as  the  result taken  into  a  pri-  of  to  the  assure  rehabilita-  1968;  is,  children  abuse. child  The  are  in  success  abuse,  effectively  of  the  believed  to  promote  McAnulty, by  process,  (Lipner,  of  to  part  attitude  there  ability  of  and  of  however,  communicate  guardians.  is  child  of  identification  guardian  & Heifer,  It  occurrence  on t h e  attitudes  guardians:.  parents  attitude  t h i s ''time,  the  who w o r k w i t h  the  upon  communication  the  the in  parents  an u n f a v o r a b l e the  nurses  nurses  An o b j e c t i v e  or  of  facilitate  identify  health  dependent,  with  tal  and  prevention  professionals  program. Community  key  the  care  are  1975).  professional  In  a professional but  is  also  toward  the  effective  communica-  contrast,  the  is  not  only  contributory  to  expres-  detrimenfuture  1975). no  community therefore,  available health not  research  nurses  studies  toward  known w h e t h e r  the  which  abusive  des-  parents  attitudes  of  the  a  2 community  health  nurses  tend  to  facilitate  the  identification  of  child  abuse. The in  literature  regard  to  illustrate,  Golub  registered Kliot  experience  child  have  stated  know  in  management  antipathy In child  that  order  due  it  refute the statements  in  tudes.  Reilly  that  abusers  were more  that  the  cation,  social  then  parents  and  (1980)  study  will  are  the  children w i l l  be  in  they  literature  out  admit  to  of  that  regarding  factors  important and 1976).  nurses  with  of  this  study  nurses' toward  addition,  it  was  affected  present  toward  registered  findings  significantly  (nurse's  registered  enmity  attitudes  In  abusers.  toward  is  registered  nurses'  were  child  & Kaufman,  study  The  nurses  although  registered  a research  To  registered  attitude  Neill  the  authors  attitude  feeling  1975;  unfavorable.  attitudes  toward  a professional  registered  than  registered  feelings,  New Y o r k C i t y .  to  to  of  child  conducted  the  factors  attitudes  toward  order  examine  professional  abusers.  feelings  negative  some  level  of  a t t i child found  by edu-  experience).  health, nurses: i n study  their  attitudes  and p r o f e s s i o n a l  nursing  What  nurses'  child  generally,  been p o i n t e d  conducted  the  favorable  registered  specific  the  of  toward  (McAnulty,  the  (1980)  views  and u n d e r s t a n d i n g  abusers  hospitals  found  their  abuse,  determine  in  with  to  has  child  Reilly  employed  that,  in maintaining  child  to  subjective  attitudes  dealing  a sympathetic  ^toward  abusers,  nurses  in  that,  of  the  proposed  Further,  nurses the  nurses'  difficulty  abusers.  describe  (1977)  difficulty  (1968)  nurses  does  abusers?  with  ascertain  significant the  community  population  attitudes.  relationship  attitudes.  nurses  A replication  a sample their  health  of  In  who w o r k  of  of  Reilly's  community  addition,  selected  with  social  the and  3 Statement  of,:the Problem  What are the a t t i t u d e s of community h e a l t h nurses who p a r e n t s and c h i l d r e n toward c h i l d  work w i t h  abusers?  Purposes of the Study 1.  To d e s c r i b e the a t t i t u d e s o f community h e a l t h nurses who  w i t h p a r e n t s and c h i l d r e n toward 2.  3.  abusers.  To determine the r e l a t i o n s h i p between the a t t i t u d e s o f commun-  i t y health, nurses toward sional  child  work  c h i l d abusers and s e l e c t e d s o c i a l and  profes-  variables. To compare the a t t i t u d e s o f community h e a l t h nurses who  work  w i t h p a r e n t s and c h i l d r e n to the a t t i t u d e s o f r e g i s t e r e d nurses who i n h o s p i t a l s e t t i n g s , as s t u d i e d by R e i l l y 4.  work  (1980).  To compare the a t t i t u d e s of community h e a l t h nurses  toward  c h i l d abusers i n the random group w i t h the a t t i t u d e s of community h e a l t h nurses i n the convenience 5.  group.  To d e s c r i b e d a t a p r e s e n t e d by the community h e a l t h nurses i n  r e g a r d to t h e i r n u r s i n g e x p e r i e n c e s w i t h c h i l d  abuse.  The I m p l i c a t i o n s of the Study T h i s study c o u l d have i m p l i c a t i o n s f o r n u r s i n g e d u c a t i o n and vice.  The r e s e a r c h f i n d i n g s w i l l determine a t t i t u d e s which may  ser-  indicate  a need f o r i n s e r v i c e e d u c a t i o n programs f o r the improvement of n u r s e s ' performance  i n the management of c h i l d abuse.  could s i g n i f i c a n t l y  These e d u c a t i o n programs  i n f l u e n c e the p r e v e n t i o n of c h i l d abuse.  The  atti-  tude instrument c o u l d be used a second time t o measure changes i n the a t t i t u d e s of nurses a f t e r an e d u c a t i o n a l program ( R e i l l y , 1980,  p.  108).  4 As w e l l ,  the  research  development  in  Justification  The  schools  for  "Attitudes  conducted  registered  drawn  sample  used  selected The  in  in  clinical  a background a later The  F-test,  data were  tudes:  data  abusers  mean  Study  Registered  1980)  child  in  order  to  abusers,  (1)  and  nurses'  attitudes  hundred  and  employed  the  in  seven  describe  the  measure  the  (2)  and  selected  numbers  of  by  the  This  eighty-five clinical  weighted  different  were  the  present  by  level  subjects  areas  of  random sampling  registered  nurses  was  four  method from  the  hsopitals.  attitude attitude  study, level  of  . 0 5 was range  affecting  indicated  generally that  a one-way  multiple  scores  analysis  revealed in  in  analyzed  of  pairs  included  of  the  scale  developed  by  scale  is  described  analysis  of  variance.  Reilly in  detail  chapter.  locate  data  three  sheet.  Scheffe's  the  of  collected  hypothesis.  child  of  survey  A stratified,  areas  a significance  The  registered  nurses  data  curriculum  Study  (Reilly,  toward  proportionate  data were  the  Population  Abusers"  population  select  for  variables.  New Y o r k .  to  implications  and Data A n a l y s i s  nurses  the  from registered  hospitals  of  an e x p l o r a t o r y  and p r o f e s s i o n a l  The  have  nursing.  Selected  Child  between  could  Replication  a  Reilly  social  and  of  Toward  of  of  Design  Nurses  relationship  was  the  Research  attitudes  findings  four had of  that  more of  used  tests  registered  social  a significant  education,  for  rejection  than  and  nurses'  experience  used  to  variables.  As  toward well,  variables,  subjects' in  a  null  attitudes  unfavorable.  on t h e  the  were  different  professional  effect  nursing  of  comparisons  significantly  favorable  the  for  Using  a  a t t i -  psychiatric  5 setting,  and w h e t h e r  a case  of  nurses  who  degree), had met  child  abuse.  had  a higher  who h a d  Difference  The p r e s e n t  community employed  the  in  in  a randomly  nurses  in  work w i t h working  in  experiences Fifth, by  The  nurses  area  were the  not  study  and  hospital  child  master's  following  ways.  and  who  abuse.  Study  in  the of  registered parents  nurses  and  is  drawn  children  of  community  group  the  attitudes  of  the  to  from  and who  are  of  the  children  settings  two  clinical  appropriate  to  and have  to  community  the  community  as  nurses  health  the are  in  the  of  background deleted  study  same n u r s i n g  nurses  registered  community  background data  relate  and n u r s i n g  present  of  health  who  nurses  well.  a description  from that  of  attitudes  included  practice  the  the  questions  deleted  questions  attitudes  is  abuse.  last,  health  group.  child  community  of  detected registered  setting,  attitudes  with  of  a psychiatric  or  the  presents  two  the  compares  study  are  for  (baccalaureate  a case  who w o r k w i t h  the  Reilly  study.  Present  favorable  or  Columbia.  selected  and  in  detected  population  nurses  parents  education  parent  Study  a comparison  Fourth,  oped  the  a convenience  Third,  or  differs  sample  the  of  an a b u s i n g  were more  experience  (1980)  British  Second,  level  parent  study  health  had met  Attitudes  Between  Reilly's  First,  subjects  nursing  an a b u s i n g  and  the  t i t l e .  since  t i t l e  to  all  health  data  sheet the  sheet used  devel-  in  this  registered  These subjects  (community  nurses'  questions work  health  in  nurse).  6 The V a l u e  of  the  A replication ways.  The  health  nurses'  mine  the  sional  may  ment  in  of  research  Reilly's  findings  attitudes  relationships  variables;  data  Replicated  they  indicate the  regarding  community  w i l l  between  a need  management  (1980)  toward  may  child the  nurses'  Reilly's for  the  attitudinal  present  study  reliability.  Although  population  registered  in  of  eliciting  nurses  in  the  of  by  or  is  a Likert-type Registered  Ministry  of  Vancouver.  the  instrument's  instrument  nurses  in  has  profes-  findings;  programs  for  data w i l l  be  and  improvecollected  with  child  abuse.  data  sheet  were  acceptable  been used w i t h  New Y o r k C i t y ,  a sample  it  population  Nurse: in  Health  summated measure  who p h y s i c a l l y  scale  nurse  Community professional  and  deter-  level a  of  sample  should of  selected  be  effective  community  health  Columbia.  guardians  professional  Finally,  w i l l  social  Reilly's  following community  findings  the  education  and b a c k g r o u n d  the  of  and  experiences  the  reliability, The  substantiate  in  Terms  Attitude: parents  the  atttitudes  British  Definition  to  value  Instrument  scale  due  of  with  attitudes  abuse.  The Use o f R e i l l y ' s ( 1 9 8 0 ) i n the Proposed Study  is  abusers.  in-service  child  health  study  describe,  further  for  of  Study  (Reilly, is  abuse  is  Columbia.  Nurse:  is  Columbia  British  Health  or  the  their  employed  British  in  individual  feelings  children,  as  toward  measured  1980).  o n e who  nurse  of  o n e who  Metropolitan  is  full-time  registered  a n d who Health  is  as  registered  full-time  employed  Services  a  of  by  as  either  Greater  a the  7 Child be  Abuser:  inflicted  creates  or  is  serious  allows  a parent  injury  to  be  or  upon  created  g u a r d i a n who  a child a  inflicts  or  less  than  18 y e a r s  substantial  risk  of  allows  to  of  or  serious  age  physical  inj ury.  Assumptions  of  the  Study  Registered  Nurses  have  attitudes  Registered  Nurses  w i l l  express  child  child  truthfully  abusers.  their  attitudes  toward  abusers. The L i k e r t - t y p e  Limitations Due to  toward  the  to  of the  the  validity  ( R e i l l y , . 1980)  accurately  measures  attitudes.  Study  small  population  external  scale  sample  population,  of  community  is  limited.  health  generalizations  nurses  in  British  are  confined  Columbia.  The  8  CHAPTER  LITERATURE  The the  literature  definitional,  lem.  The  qualify presents studies  community  Kempe  of  injury  or  end o f  repeated  hematoma);  at  deprivation  and  the  df  the  other  the  defined  intentional,  intentional, the  parent  his  care  (p.  6)  as  the  a  as  child  concept,  attitudes  first  aspects  need  as w e l l  or  child  is  is  the  at  abuse  part of  nurses  the  factors  abuse. and  toward  to  The  three child  presents  the  for  of  extreme  child  who  (fractured who  is  is  described,  caretaker  appears  emotional  of  abuse,  limited  physical  interacting  injuring  in  of  omission or  a range  probhave  an  which third  part  research abusers.  and to  bones  force, the  forms:  emotional  physical  considered  or  abused a  subdural  rejected  or  by  of  child  in  the  child,  physical  of  the  part  neglect.  abuse  spectrum  as:  on t h e  with  a  physically  destroying  of  is  passively  phenomenon,just use  It  long  nurturance.  acts  form of  children.  emotional  hurting,  is  the  child  non-accidental  other  discussion  the  injuries  and/or  the  as  deprivation  non-accidental  aimed  neglect,  present  end  physical  has  physical  of  identify  abuse  spectrum  serious  Gil  As d e f i n e d ,  The  Aspect  non-accidental  and has  to  professionals'  child  one  parts.  and e t i o l o g i c a l  attitude  viewed  at  three  abusers  nurses  (1971)  that  the  child  health  examine  REVIEW  a discussion  toward  a discussion  Definitional  of  presents  attitude  which  contains  epidemiological,  second  objective  review  I I  The  abuse, focus  children.  of  9 It a  follows  child  has  from  the  definition  been p h y s i c a l l y  variables:  the  physical  that  abused,  and  emotional  accompanying  the.injury,  or  Usually,  child's  evidence  to  stances was  harm  or  to  the  If  physical  (Reilly,  abuse the  toward  in  use  was  within  of  the  is  is  to  the  or  the  of  parent  the  case,  physical  harm or  of  the  by  force  as  a  the  limits  circuminjury  Did  the  allow the  the  parent injury,  Was t h e  injury  disciplinary  a disciplinary  acceptable  the  child's  intentions.  :  sufficient  an a c c i d e n t .  an o m i s s i o n  not  child,  provide  this  the  cause  of  of  not  In  cause  guardian's  socially  intention does  act  through  result  the  or  distinct  determine-whether  or  the  three  of  abuse.  willfully  occur  measure,  for  was  discipline  through  definition,  crucial  to  the  the  is  the  not  questions  the  parent's  only  or  factor  guardian's  professional's  a differentiation  developed  judgement  between  to  be  from con-  behavior concerning  an a b u s i v e  the  and  injury.  child's  ifestations  gathered  abusive;  Manifestations  cations:,  the  assessing-whether  a child  accidental  the  or  child  determining  parent's  information,  information  in  injury  injury  force  guidelines  sidered  the  in  the  an a b u s i v e  example,  the  and  be d i s c u s s e d  for  Also,  appearance  appearance  of  of  consider  whether  1980)?  This the  Did  consider of  must  consequence  guardian?  measure? the  the  guardian,  result  a diagnosis  injury  occur?  one must the  the  actually  parent  or  of  support  the  determining  one must  circumstances guardian.  in  of  physical  physical  include  and b e h a v i o r a l  bruises,  lacerations,  child  welts,  poisoning,  abuse.  Child  appearance.  burns,  depressed  long skull  bone  abuse  is  manifested  The p h y s i c a l  man-  fractures,  dislo-  fractures,  hematomas,  10 brain  damage,  1970;  Kempe,  course often  are  neurological  1971; McKittrick,  the  take  easiest  less  authors  who h a v e  experienced  tioning  and  Wrench,  1974).  less  social in  found  that  showed  roundings;  eleven  ren w i t h this  last  lishment  of  The  age  time,  i t  infants.  of  abuse  an  and  sex  have  not  yet  in  (1981)  relationships,  though shown  ten  of  and  emotional  been  ability poor  frustration; toward  of  twelve twelve  their  sur-  pseudo-adult  problems. were  that  and  for  self-esteem,  school,  seeking  develop  (enuresis,  learning  have  children.  who h a d  demonstrated  stated  indiscriminate  not  (Childincluded  behavioral affection,  social  maniestab-  withdrawal,  self-concept.  distribution  seemed as  Studies  or  low  &  children  an i m p a i r e d  turmoil  had  (Maden  abused  hypervigilant  children  McKittrick  inadequate  had  tolerance  compulsivity,  func-  depression,  obviously  eleven were  problems,  superficial and  a low  studies.  children  problems  children  of  which  than non-abused  f i f t y  emotional  showed  thirty-four  include  of  of  (Gil,  These  cognitive  that  and  children  of  twenty-six  category.)  of  aggression,  one  these  neurological  festations  1  of  had marked  b e h a v i o r ; and n i n e  in  thirty  signs  found  anxiety  group  1977).  proportion  impaired  1981)  death  o b s e r v e d : i n many  adjustments  a  tendencies;  have  more  f e a r f u l , and had  resistive  been  and  manifestations  psychological  (Behsid,  of  relationships);  were withdrawn,  and  a study  had  have  abuse  and p e r s o n a l  thirty-one  & Wrench,  a significant  experience  illness,  Behavioral  forms  social  One s t u d y  (1980),  enjoyment;  assess.  that  chronic  1 9 8 1 ; Maden  physical  significant  adequate  abused,  peer  concur  intelligence,  Martin  to  recognizable  Numerous  lower  problems,  of  child that,  physically abuse  in  abused  occurred  fact,  abuse  children.  primarily occurs  with  through  At  childhood more  are  number  child  more  of  1979  319  abused  cases,  were  found  that  11 years  as n a t u r a l Matthews  and  Habbish, were  are  10 y e a r s  who  physically  boys  after  under  of  of  age;  the  are  which  presented  by  1 9 8 1 ; Maden & W r e n c h ,  were  (Report  that  years,  791 r e p o r t e d  victims  to  findings  older  abuse  There  a  1977).  cases  of  probable  3 years  of  age;  and  in  Social  imately  314  in  cases,  Service  the  Ministry,  or  children  teachers,  nurses  abuse  in  Canada.  However,  based  (1973) year  estimated in  child  1977  per in  as  that  well  & Wrench,  not  suspected  million  Columbia,  the  reported. of  true  also  there  it  1977).  may  is  for  also  suggested abused  abuse have  of  are that  by  the  that  approx-  caretakers  these  problem: of  offered  Mary  physically  791 r e p o r t e d  failure  been  occurrence  statistics,  suggested  the  the  children  were  incidence  Reasons  child  250  physically  Furthermore,  reflect  cases  (1981)  are  regarding  on A m e r i c a n  approximately  Habbish  British  abuse.  actually are  that  Canada.  children  of  cases  parent  suggest  and b a b y s i t t e r s  statistics  do n o t  a  companions,  (Maden  national  probable  by  Many a u t h o r s  parents  abuse  abused  (1970)  Aspect  In  report  foster  Gil  children.  each year.  to  that  living.  children.  were  accurate  250  the  physically  was  studies  no  per  of  child  abuse  are  Stolk  abused  children  parents,  added  Epidemiological  the  whom t h e  parents,  physically  of  adoptive  (1981)  child  guardians  with  stepparents,  ures  3  shown  adolescent  These  there the  were and  86 p e r c e n t  guardian  Van  1973;  cases,  victims  until  also  1980). Parents  of  girls  Columbia,  158  They have  abused.  (Frazer,  In  the  years.  than  frequently  British  abuse.  B.C.,  adolescent  authors  in  victims  or  the  frequently  girls  In  to  cases figmany  professionals by  several  authors.  Chisholm  to  report,  of  child  the  foremost  abuse.  identified  as  has  identified  being  the  Practically,  abuse  some p r o v i n c e s others  (1980)  vary  regard  identify  only  this  emotional physical  occur  presents  is  the  variation  among  9 of  twelve  provinces  and  system,  but  three  third  reason  abuse  once  i t  procedures deterrent (or  is  and to  the  factors  McKittrick further taken in  the  contends  if  past;  to  trust;  that  they  are  Heifer reluctance  they  that  is  fear  also  in  systems ;  reporting  dealing with  a  The child  regarding  are  cited  failure  fear  that  believe  to  assume  with  her  involvement  to  the  the  as  being  recognize need  for  that the  understanding in  child  reporting  that  especially  if  client  w i l l  cause  action w i l l  abuse has  a change they  abuse.  in  believe by  not  be  happened  professional that  report-  destroying  a  entanglements.  discussed  involved  she  system program.  family  is  abuse  reason  reporting  in  explanations  reported;  legal  second  Chisholm mentions  they  hesitant  that  problem.  these  relationship  has  become  the  abusive;,;  a mandatory  the  definition  example,  suggest  the  failure  injuries  For  uncertainties  explanation  reported,  case  their  (1975) to  a  have  to  professional  child; is  that  to  in  procedures  Lastly,  of  as  The  a monitoring  professionals  case  impair  and  adds  that  once  only  consequences  regarding  others  the  useable  types  neglect  provinces  territories  abuse.  the  injury.  Professionals'  hinder  the  the  A fourth  the  responsibility ing w i l l  (1981) which  injury  even  child  a physical  for  provinces.  and y e t  consistent  possible  education  McKittrick  of  that  and p h y s i c a l  have  reported.  acknowledge)  the  lack  reporting.  professional  of  provinces  the  is  without  reasons  a standard,  Canadian  abuse,  can  of  means  among t h e  and n e g l e c t  the  lack  five  cases  various of  reasons  child  abuse  for and,  physicians' as  Reilly  (1980)  suggested,  health  care  these  could  providers.  Heifer  have  the  knowledge  and  lem.  In  addition,  physicians  interpersonal  skills  Also,  cases  there  are  lem.  Physicians,  by  community other  and  try  support  of  initiating  reasons, child  or  seen  research  on  child  dynamics  of  abusive  to  Within  in  are  child  of  have  prob-  the abuse.  because  fearful  always  the in  treatment  physicians  frequently  of  the  a  court  rarely  prob-  been  some h a v e b e e n e f f e c t i v e  status  image  in  the  in  community  quo.  is  literature  is  have  I t  appropriate,  not  the  ex post is  all  of  facto,  the  the  restricted.  know w i t h  factors  first  the  real  be  of  qualified.  extent  actual  cases  are  since  almost  all  analysis Finally,  families  certainty  of few  and,  which  child  the  of  the  of  the  underlying  studies without  factors  such are  1972).  limitations  formulated  must  Second,  and n o n - a b u s i v e to  etiological  demonstrate  settings.  & Rigler,  restrictive  the  do n o t  First,  difficult  been  in  data  abusive  (Spinetta the  found  behavior  theories seems  the  of  clinical  abuse  compare  comparison, i t significant  for  a discussion  the  abuse.  reported  attempt  the  treat  suspected  other  do n o t  have t r a i n i n g  maintain a positive  of  and  of  Aspect  generalizations  several  that  although  to  physicians  been r e p o r t e d  professionals,  and,  reluctance  diagnose  resources  agents most  that  do n o t  have  change change,  the  investigate  suggested  Before  problem  to  a b u s e may n o t  like  to  to  usually  Heifer  Etiological  For  child  conservatism  abuse,  required  Lastly, as  promoting  skill  apply  suggested  required  inadequate  hearing. trained  of  also  to  therefore,  explain to  of  the  the  select  data,  dynamics  a model  however, of  from  the  many problem.  Gelles  (1973),  a  Figure 1 G e l l e s ' S o c i a l P s y c h o l o g i c a l Model of the Causes of C h i l d Abuse  SOCIAL POSITION OF PARENT Age Sex Socioeconomic Status  SOCIALIZATION EXPERIENCE Abuse Role Model of Violence Aggression  9  CLASS AND COMMUNITY Values and Norms regarding violence "Subculture of Violence"  SITUATIONAL STRESS A. R e l a t i o n s Between Parents 1. Inter-marriage 2. M a r i t a l d i s p u t e s B.  S t r u c t u r a l Stress 1. Excess c h i l d r e n 2. Unemployment 3. Social isolation 4. Threats to p a r e n t a l authority, values, self-esteem  CHILD ABUSE 1. Single Physical Assault IMMEDIATE PRECIPITATING SITUATIONS Child misbehaves Argument Etc.  2.  Repeated Assaults  3.  "Psychological Violence" a. verbal attacks  G e l l e s , Richard J . " C h i l d Abuse As Psychopathology: A S o c i a l C r i t i q u e and American J o u r n a l of O r t h o p s y c h i a t r y , J u l y 1973, 43 ( 4 ) .  Reformulation."  C.  PSYCHOPATHIC STATES Personality Traits Character T r a i t s Poor C o n t r o l Neurological Disorders  C h i l d Produced S t r e s s 1. Unwanted c h i l d 2. "Problem c h i l d " a. c o l i c k y b. incontinent c. d i s c i p l i n e problem d. i l l e. p h y s i c a l l y deformed f. retarded  •  who  in  ical  turn  has  relied  formulations  and  relationships  are  postulates,  mits  regard  is to  the  causal  that  "the  parents  authors, of  which  Although  many  deprivations  similar  Further, occurs ence  of  in  the  are  vented  to  in  abusing  1970;  ally  women h a v e  the  fathers  Resnick,  are  the  p.  & Oliver,  primary  that  abusive is,  i t  per-  perspective  levels  according are  prim-  Galdston,  1965;  to  regard  factors  (1967),  for  class  behavior  frus-  children.  inclined  causal  the  generates  of  of  Gil  of  problems  abuse  in  position  recognized.  1975;  and u p p e r  there  since  social  poverty  less  factors  delineates,  Indeed,  employment  physical  middle  the  860).  of  theoret-  problem.  that  and Wasserman  in  of  child  example,  families.  toward  however,  the  children  a higher  incid-  groups. the  social  position,  speaking,  abuse  Steele  and  contact.  are  studies  children  & Pollock,  caregiving  caretakers  suitable,  sociological  stress  the  Generally  1969;  extended the  as  model  occupational  some a r e  groups;  within  and  and  etiological  prominently  and  the  (1968)  lower  of  1970,  the  suggested  parent.  is  (Baldwin  view,  poverty  research  the  most  abuse,  1)  (Gil,  through  m o r e women t h a n men p h y s i c a l l y Gil,  child  that  behavior  be n o t e d ,  the  Gil's  education  Gil's  the  of  Figure  socio-economic  reporting  Also of  proposed  (1978)  as  educational  Gil  abusive  all  of  low"  and P o l l o c k  Pelton  view  behavior  caused by  Steele  in  limited  support  Although  multidimensions  of  very  abusive  1964).  abuse.  were  empirical  social-psychological  adopted  factors  concluded  trations  found  the  box  causes  Young,  of  been  left  several  ary  has  Gelles'  (top  abusive to  i t  (1970)  development.  understandable,  parents  (1970)  its  which  an e x a m i n a t i o n It  the  in  on G i l ' s  the  have  (Bennie  t h e women a r e  shown  1979;  that  financial  age  that  because  suggested the  and  & Sclare,  1968), perhaps Gil  sex  normwhen  providers,  16 then  the  that  an e q u a l  which  fathers  parent Gil  for  for  women i s  (1980)  as  has  men  all  is  other  to  This  of  prevalent again,child  the  abuse.  He  is  however,  used that  among l o w e r and>while 1971),  primary  adult  of  years  parents parents corporal  lends  found  that  of  age  age  is  of  twenty-six,  the  average  However,  which  found  abused  the  the  of  in in  the  that  age  Reilly  that  approx-  their  children  middle of  his  1969)  child  abuse.  have  shown  that  causal  directly  for  class.  Other  the  and  is  with  the  is  more  in used  studies  where indicated,  equally  pervasive  Strauss,  (Satlin his  occupational  of  that  discipline,  1974;  personality  factors  reasoned  class  contended,  second p o i n t  background  the  children  classes  disagreed  the  and  within  punishment -i s  (Steinmetz,  in  primary  of  and  children  in  aggression  Gil  abuse  groups  prevalent  forth  1).  corporal  families  & Blake,  to  which-results  lower  with  set  Figure  punishment  class  is  physical  stress  the  violence"  approval  violence"  also  educational  authors  of  socio-economic  generates  factors  are  average  1974)  subculture  value  lower  (Paulsen  causal  regardless  twenty-eight.  & Adler, twenty  some a u t h o r s - . a g r e e d  income,  found, however,  children,  the  (1973)  men,  (top r i g h t box  and m i d d l e  Several abusive  by the  others  financial  "the  suggested by  for  under  cultural  poverty  frequently  and  communities  factor  among  abuse  Frazer  "subculture  this  (1971)  together.  Gil,  that  reason  women who  (Roberts  adults  Zalba  contact.  thirty.  adults  community  because  more  for  socio-economic  violence. and  most  a study  as many  frequently.  men a n d women a b u s e  twenty-two,  According lower  of  the  that  i t  cited  imately  number  noted  and  abuse more  &  1971);  Miller,  emphasis position  traits problem  of  on as  the  (Fontana,  1968;  Kempe,  authors in  the  suggested presence  expression true,  the  reported  of  Wrench,  an a b u s i v e  stress, in  does  come  allow the  from  further  fact  their  that  the  children account  between  majority  suggests  for  child  experience  integral  aspect  of  child  abuse.  to  and  this  determine  It  the  abuse  may  number  groups.  child  which,  physical  While  socioeconomic  These  traits  a disproportionate  poverty  of  the  abused  as  children  1968).  a parent  who u s e d  f l i c t  to  or  discipline  abusive to  children.  parents  communicate Also,  their  be of  seems, signifi-  (Maden &  they  vidualistic recognized  have care"  as  Possibly  never  a pattern due  to  the  factor  of  experienced 1971, p.  of  ". 30).  interaction  interest  of  as  .  they . In  which  either is  physicians  the  a role resolve It  are  actually  &  model a  con-  seems experwith  adult  who  abused  but  generous  case,  or  manner  the  1)  a  Steele  abusive  sensitive,  not  that  own c h i l d h o o d  were  do  Figure  1972).  socialization  not  physically  to  & Rigler, their  of  1970;  a means  do  included  box  has  an a g g r e s s i v e ,  so much b e c a u s e  (Kempe,  as  alone  indicated  Gil,  adult  through  in  left  themselves  1973;  (Spinetta  adults  this  not  violence  poverty  therefore  Studies  were  in  conditions  has  abusive  learned,  as  within  children  the  live  (middle  (Fontana,  children  have  Gelles  parents  or  who  environment  parents  Consequently, aggression  families  phenomenon.  emotionally Pollock,  of  the  abusive  because  1967).  personality  required  abuse;  of  abuse  has  that  that  number  iences,  of  is  Wasserman,  an u n c o n t r o l l a b l e  lower  research  significant  that  for  form  the  1968;  adult  indicate  relationship  socialization an  do  & Pollock,  1977).  adequately  as  of  that  the  The abuse  that  feeling,  cases  of  Steele  literature  therefore, cance  1971;  child  and  abuse  intergenerational. in  child  abuse,  indi-  the  is  causal  factors  (bottom  left  abuse was & Evans, ing  the  found  Early  psychopathology  fact,  last  approximately of  the  support  suffer  mental  the  view  that  illness  has  psychodynamic  for  in which  example,  the  love;  parent  Steele  unrealistic  found was  of  changed.  for  of  percentage  of  1972).  and  psycho-  l i t t l e  authors,  abusive  par-  they  traits  Morris  and  Gould  parent  and  child,  reassurance,  abusive  only  Most  Instead,  the  for  that  example,  personality  between  child  regard-  involve  effectively.  found  child  cases  Woolley  and a p p r o x i m a t e l y  abuse w i t h  the  1959;  for  psychopathic.  & Rigler,  on  (1968) the  as  child  thinking  Kempe,  the  type,  reversal  dependent  expectations  the  a small  child  a role  and P o l l o c k  however,  described  (Spinetta  believed (Miller,  percent  only  psychopathology  behavior  depressive  are  of  investigators  impair the a d u l t ' s a b i l i t y to parent  (1963),  terms  decades,  five  or  parents  the  two  only  a delusional  of  in  and p s y c h i a t r i c  of  associate  parents  empathy  for  security have  its  needs  abilities.  sion needs  On t h e  whole,  of  frustration  the  are  not  Adults single, the  neurotic  1).  presence  percent  and  to  Figure  described  the  five  and  of  been  In  either  which  also  1955).  that  ents  box  due  sis,  in  have  fulfilled  and  parents:  Hurley,  1969;  (Cohen,  by  abusive  unmet  Steele  abuse  and anger the  of  is  regarded  a parent  personality have  dependency  & Pollock,  a l . ,  1974;  Steele  1966;  Smith  & Hanson,  as  a physical  when h i s / h e r  expres-  emotional  child.  who p h y s i c a l l y  characteristics  abusive  Green e t  child  guardians  coherent,  following  then,  abuse  has  not  their been  children.  identified.  been recognized  as  needs  a l . ,  1968);  & Pollock, 1975);  (Green  lack  of  1968); rigid  or  et  One  common  identity  impaired  1974;  among Melnick  (Elmer,  impulse  inadequate  However,  1967; control  defenses  &  ( M e l n i c k & H u r l e y , 1969; S t e e l e spouses ( G a l d s t o n ,  & Pollock,  1968); r o l e r e v e r s a l between  1965).  In an e f f o r t t o reduce t h e phenomenon t o simple and e x p l i c a b l e terms, attempts have been made t o c l u s t e r the p e r s o n a l i t y tics  and to e v o l v e a psychodynamic w i t h i n  each c l u s t e r .  characterisThe f i r s t  endeavor t o develop such a t y p o l o g y , and the most f r e q u e n t l y was  developed by M e r r i l l  p r e s e n t e d by Smith  (1962).  quoted,  The t y p o l o g y has been summarized and  (1976).  Merrill identified  three  c l u s t e r s of c h a r a c t e r i s t i c s found t o be  t r u e o f abusing mothers and f a t h e r s , and a f o u r t h found t o be t r u e o f fathers.  The f i r s t  group of a b u s i v e a d u l t s was c h a r a c t e r i z e d  c o n t i n u a l and p e r v a s i v e  h o s t i l i t y and a g g r e s s i o n .  by a  The second group was  i d e n t i f i e d by r i g i d i t y , compulsiveness, l a c k o f warmth, l a c k o f r e a s o n a b l e n e s s , and a l a c k of p l i a b i l i t y  i n t h i n k i n g and b e l i e f ;  e n t s were s e l f - r i g h t e o u s r e g a r d i n g  t h e i r abusive b e h a v i o r s .  group showed s t r o n g  The f o u r t h group was composed o f f a t h e r s  who were young, i n t e l l i g e n t and unemployed; the m a j o r i t y  in  The t h i r d  f e e l i n g s o f p a s s i v i t y and dependence; they tended  to be depressed and immature.  home as c a r e t a k e r s .  these p a r -  remained a t  M e r r i l l suggested t h a t the f r u s t r a t i o n e x p e r i e n c e d  t h i s arrangement l e d t o the abuse. Gelles  (1973) proposed t h a t the elements o f the p a r e n t s '  social  p o s i t i o n , c l a s s and community, s o c i a l i z a t i o n e x p e r i e n c e s and p e r s o n a l i t y t r a i t s weave t o g e t h e r t o produce a p o t e n t i a l l y a b u s i v e s i t u a t i o n i n which the s i t u a t i o n a l s t r e s s ifier.  He has d e l i n e a t e d  ( c e n t r e box o f F i g u r e  s i t u a t i o n s which c o u l d produce s t r e s s and h i s  f i n d i n g s a r e supported by many authors ( E l l i s 1981^  1) i s o n l y an i n t e n s -  & Milner,  1981; F r o d i , o  G a r b a r i o s & Sherman, 1980; Maden & Wrench, 1977; Z a l b a ,  1967).  20 The  last  itating of a  situation  food,  or  crisis  ever,  (right  results  crisis  model which In  factor box  .(1980)  to  Figure  cited  thetdcally  cause  (1977)  is  as  to  1).  example,  of  summary  The  the  immediate  time, As  factors  may  of  citation  was  earlier,  abusive  events  refusal  trigger  presented  an a b u s i v e  precip-  a child's  stated  potentially  development  abuse.  For  various the  an a b b r e v i a t e d  child  is  attack.  the  produce  the  included  an extended  an a b u s i v e  to  explain  be  over  secondary  interrelate  order  and  is  in  to  of  highpitched.crying  which  the  Reilly  etiological  how-  in  the  situation.  incident^  which  developed  hypoby  Steele  follows:  As a l l p a r e n t s k n o w , c r i s e s a r e a f a c t o f l i f e . . . . S e l f c o n f i d e n c e , i n g e n u i t y , and u s e f u l k n o w l e d g e o f how t o s e e k h e l p are n e c e s s a r y t o cope w i t h c r i s e s . A b u s i v e p a r e n t s do n o t have t h e s e a b i l i t i e s and any c r i s i s has a g r e a t e r impact on them. I f a c r i s i s cannot be coped w i t h a d e q u a t e l y i t lasts l o n g e r , becomes more d i s t r e s s i n g , and can d e v e l o p i n t o an even more s e r i o u s c r i s i s . E v e n t u a l l y t h e s i t u a t i o n may b e c o m e d i s a s t r o u s and unmanageable. P a r e n t s become pushed beyond t h e i r s t r e n g t h , f e e l d e s p e r a t e l y h e l p l e s s and end up a b u s i n g t h e child. ( p . 54) It  is  resolved Further  clear  in  that  order  research  to is  there  a r e many  establish required  the  in  controversial  etiological  order  to  problems  factors  accomplish  of  this  to  be  child  abuse.  task.  N u r s e s Need t o Have an O b j e c t i v e and P r o f e s s i o n a l A t t i t u d e toward Child Abusers The  identification  relationship & Heifer, part ent  is or  1968). critical  child  develops  An o b j e c t i v e to  the  abuse  with  is  dependent,  an a b u s i v e  and  parent  professional  development  of  the  in  part,  or  guardian  attitude  relationship  on  upon  the  with  the (Heifer  nurse's  the  par-  guardian.  Heifer sional  a nurse  of  (1968)  attitude.  identified He s u g g e s t e d  the  advantage  that  the  of  abusive  an o b j e c t i v e parent  is  and  profes-  usually  willing  to  co-operate  in  an open and n o n - j u d g e m e n t a l  ent  or  sional  in  a discussion  guardian would conveyed  for  example,  ful  and  feel  a sense  lonely,  might  verbally,  an unfavourable  munication lem  is  nurturing and  (1981)  In and  openly  who  already  the the  abusive i f  and a c c e p t a n c e .  expressed,  impeded  more  emotionally  attitude.  or  talk  guardian,  withdraw  thereby  the  (1981)  cope  family  of  view  the  a  par-  profes-  In  contrast,  felt  distrust-  and  socially  from  either  verbally  or  latter  case,  of  identification  and  the  proposed this  attitude  and  the  Heindl provide  problem  (1981), quality  identify  their  nize  cope w i t h  and  of  child  likewise, nursing  feelings  a  non-  course,  of  the  com-  prob-  the  factors  its  is  of  of  the  that the  a professional  family's  nurse  and  isolation,  the  parent  resolution.  the most  important  an u n d e r s t a n d i n g  attitudes  and  of,  steps  and  feelings  an  toward  in ability  the  suggested  that  before  to  these  families,  the  child  and  which  the  contribute  nurses  they  are  must  parents,and to  their  prepared  f i r s t then  emotional  recogres-  ponses. Even  though  (Alexander, parent insight  or  anger  may b e  1972), nurses  guardian  regarding  in  have  a natural  response  a responsibility  a professional  one's  and  abuse.  care  toward  to  one  constructively with, one's  stating  between  means that  by  breakdown  communication  problem  development  this  facilitates  promotes  Ebeling the  supported  attitude  regarding  to  or  a professional  distorted  to  an  talks  hindered. Hayes  to  which  Understandably,  understanding  well  in  p r o b l e m when a p r o f e s s i o n a l  manner.  parent  situation  the  encouraged  of  an a b u s i v e  of  emotions  and  manner  to  which  to  child  abuse  communicate w i t h is  self-discipline.  based  on  an  a  To s u m m a r i z e ,  as E b e l i n g  stated:  The w a y we d e a l w i t h o u r e m o t i o n s — a n d w h e t h e r o r n o t we m a i n tain o b j e c t i v i t y — p l a y a crucial part in being able to help these seriously troubled f a m i l i e s . I f we a r e t o b e h e l p f u l , we c a n n o t i n d u l g e o u r s e l v e s by a c t i n g u p o n a n g r y f e e l i n g s , n a t u r a l as t h e y m i g h t b e , t o w a r d s a p a r e n t . ( p . 8)  The Q u a l i f i c a t i o n s Nurses to I d e n t i f y Community a key  position  the  early  that  the  contact son  to  nurse with  be  to  have  the  ability  tional  stress  from such her/him In a  an  to  potentially crisis  the  to  event  emotional, of  abusive thus  child  the  by  to  say,  normalcy  and s o c i a l  the  family's  and means  a decision  develops, that  judge  of  problems, is  of  a nurse  is  child  abuse.  in  through stated  frequently  the  logical  in per-  abuse. of  community  The  their  health  discussion  education,  and  the  for  example,  of  coping  development; interactional  the  which  provides  sufficient  situations,  the  problems  preventing  the  occurrence  occurred,  future  can be of  these  age and  situa-  and,the gathered  child  for abuse.  corrected  child  attacks  nur-  growth  evidence  actual  of  physical  information  or  the  patterns  pattern;  The  potential  have  that  a child's  coping.  regarding  abuse has  is  are  characteristics.  virtue  the  That  child  abuse (1981)  who  f a m i l i e s , and of  children  child  characteristics  identify  by  and  Grindley  prevention  nurses,  assessment  make  to  needs,  level  the  of  professionals  their  these  appropriateness  family's  phenomenon.  and  in  parents  prevention  some o f  families.  and i n t e l l e c t u a l ,  the  with  professional  them  the  the  the health  involved  health  Health  who w o r k  children  consider  and  of  of  distinct  assess  individuals  one  qualify  Community  ses  is  abused  are  w i l l  ability  nurses  to contribute to  closely  which  follows  health  identification  There nurses  o f Community C h i l d Abuse  abuse.  can be  before In  prevented  23 by  therapeutic  interventions  identification  of  Community Heindl  (1981)  fessionals ilies  who  think, the  view  other  that  this  kind  discuss,  abuse.  In  abusive  family  these  fact,  Reilly nurses the  tends  minimal  In visits  to  over  develop  assess  home  or  noted  of to  that  such  and  illustrate,  to  of  and  would  facilitate or  guardian  rise  to  child  role  in  usefulness  of  the  abuse. between  clients  suggested,  make  the  frequent  the  health  a mother  fam-  One  nurse's  the  and  further,  that  constructive  and for  individual  nurses  during  home  opportunity  comprehensive  community  social  the  by  adult  give  promote  creates  make  would  pro-  endeavor.  nurses  This  for  a child's  that  She  as h e l p i n g  acceptance  which  child  community.  scepticism.  communication  health  and  stress  of  the  abusive  because  therapeutic  relationships  assess  out  a relationship  any  seen  the  problems  pointed  the  are  acceptance  in which  the  in  with  and p o s i t i v e .  community  of  and  prevention  time.  levels  to  the  an e x t e n d e d  To  image  overestimated  be n a t u r a l  addition,  of  (1978)  be  in  necessary  assessments. to  cannot  tensions  interaction  to  McKeel  (1980)  assessment  image  immediate  professionals  confidence,  relationships  nurse's  nurses  a rather  a relationship  with  the  a positive  generally  gain  to  of  have  that  therefore,  development  could  nurses  suggested  tend  by  problem.  health  and,  then,  the  initiated  have  school nurses  and  the  opportunity  postpartum v i s i t s  emotional  adjustment  family  to  during  the school  visits. Community of  health  professionals  munity. ilies'  In  in  allied  addition,  utilization  nurses  of  have  disciplines  community these  access  health  both  and  to  consultative  to  the  resources  nurses  can  facilitate  professional  and  community  services  of  the  the  resources.  com-  fam-  Community identify health  health  child  nurses  abuse.  of  Newberger  (1975)  account  Lalonde nurse  in  in  to  stated  be  ensure  communities  the  they  serve  it  seems  (p.  the  to  to  observations  role  recognized,  adequate and  numbers  of  not  taken  abuse. health  appropriate  nurses  surveillance  proven.  be  public  and  were  yet  child  the  community  who  should  of  of  to  that  children  management  be  services  recommended  follow  important  are  avail-  required  in  the  45).  discussion  be  the  qualified  s u c h abuse was  nurses'  the  that  to  where  abuse must  constant  summarizing  cations,  that  child  to  that  related  identifying taken  but  as b e i n g  strongly  physicians  abused  decisions  provide  In  been  recognized  (1973)  by  recommended  (1974-76)  measures able  having  are  Frazer  be r e q u e s t e d  suspected  into  nurses  suitable  of  to  community  refer  to  health  McAnulty  nurses' who  qualifi-  stated:  A n u r s e ' s a c c u r a t e assessment and a c c e p t a n c e o f her r e s p o n s i b i l i t y t o a i d t h e f a m i l y and t o communicate appropriately w i t h other professionals is c r u c i a l to the early diagnosis and t r e a t m e n t o f t h e s e t r o u b l e d f a m i l i e s . Indeed, the n u r s e ' s s k i l l e d a p p r a i s a l and her s e n s i t i v i t y t o t h e s i t u a t i o n may d e t e r m i n e t h e s p e e d a n d e f f i c i e n c y o f t h e family's e n t r y i n t o a s y s t e m o f h e l p i n g s t r u c t u r e . . . ( p . 70)  Attitude  as  a  Concept  An a t t i t u d e toward item,  is  the  a psychological person,  differently  in  slogan  intensity object.  or  phrase  of  a positive  A psychological toward which  or  negative  object  individuals  regard  to  positive  or  negative  feelings  is  composition  of  an a t t i t u d e ?  is  feeling  any  can  symbol,  respond  (Thurstone,  1946). What (1967) which  then  stated is  based  that  the  an a t t i t u d e  on a c o g n i t i v e  is  composed  process.  In  of  Shaw a n d  an a f f e c t i v e  addition,  it  is  Wright component antecedent  to  behavior.  lowing.  An i n d i v i d u a l  actions which,  Rosenberg  with in  who  distrust,  turn,  (1960)  illustrated  encounters  develops  motivates  the  this  a group,and  negative  individual  toward  to  the  avoid  Accordingly,  the  term a t t i t u d e  negative  dimension  the  motivation-producing  & Wright, It  on  is  also  Beliefs  other  a  rather,  tude  composed  acceptance  or  subjects'  to  the  The in  rejection.  also  Toward  his  whether in  Child  earliest  sample  has  is  The  express  expression  a unidimensional 1980,  as  falsehood Attitudes,  acceptance of  is  p.  45).  Given  to  Thurstone  that  object,  attempt (1946)  even a t t a c h  It  an  and  a t t i not  an e x p l o r a t i o n has  the  solely  pointed  same  of  out,  cognitive  discussion.  Abuse to  toward  purporting  to  examine  child  attitudes  abusers.  study  perceptions  the  and  attitudes  of  Although, the  the as  public  Reilly  researchers  of  the  total  and (1980)  have  beliefs.  a t t e m p t t o e x a m i n e t h e p u b l i c b e l i e f s was made by, G i l  survey  or  feelings  focus.  a psychological  subjects  or  1967).  unnecessary  fact,  a l l  do n o t  & Wright,  toward  h a v e b e e n made  studied  feelings.  (Reilly,  i t In  professionals  only  evaluative,  (Shaw  feelings  object  stated,while  actually  (Shaw  and  or  study,  beliefs.  attitudes  acceptance  dislikes" of  between  of  express  rejection,  irrelevant  Attempts  has  or  differentiate  a degree  this  selected  or  reaction  a truth  in  Attitudes  the  positive  of  "Attitude,  meaning  affective  in  evaluation  beliefs  is  group  an  of  is  the  group  this  fol-  their  as  component  likes  i t  to  regarded  express  denotes  the  are  hand, while  rejection but, not  important  therefore,  the  to  the  1967).  beliefs. and,  applies  in  perceives  feelings  future.  of  definition  noninstitutional  population,  (1970)  twenty-one  years this the  of  age  one  and  older  question  perpetrators  in of  in  the  regard child  to  chose  to  j a i l  the  cent  believed  that  treatment  preferred  injuries agreed that  were  with  they  not  all  did  that  the  child  abusers.  beliefs  or  was:  "What  injured more  than  15 or  believed  that  be  receive should child punish from  in  the  to  their  chose the  to  and  their  care,  if  with  This  response  to  f i r s t  that  parents  the  it  or  is  from  or  time  receive  i t  home;  per-  66.4  attitude  i t  toward  professional study,  Frazer  community  health  question  posed  intentionally Slightly  or  j a i l  approximately  39  percent  or  who h a v e  that  that  question  the  the  incident  family  posed was:  intentionally  "What  injured  Almost  47  percent  sentence,  or  to  remove  the  times  higher  than  three  percentage  a warning  or  is  a fine  recommended  almost  dis-  admitted  reported?"  with  4.4  data  who h a v e  is  per-  child's  this  first  a warning  second  j a i l  in  others  27.1  percent  the  The  the  others  The  of  that  interviewed  on  studied  aspect  with  the  favorable  parents  The  rated  question.  a  the  receive  or  Based  Gil,  repeated?"  a fine  response  should  first  42 p e r c e n t  parents  .4  who p r a c t i c e d  punish  should  about  parents  one  that  and  done  required;  subjects  questions.  the  child  has  parents  supervision.  home.  the  about  done  the  two  care,  parents  and  In  128 n u r s e s  be done  the  appropriate.  abusers. of  of  posed  be  manner;  was  given  Gil  should  indicated  supervision  with  study  some o t h e r  alone,  represented,  following  remove the  was  analysis in  the  "What  alternatives,  consultation  investigated;  be  the  as  child  in  therapy  in  suggested  know what  percent  sentence  should  percent  should  a child  close  1.5  public,  to  and  serious;  responses  pediatrics  punish  family  (1973) ,  the  The  the  the  regarding  explored  or  In  abusers:  leave  of  not  clear  Frazer  to  adult  States.  child  abuse?"  cent  percent  United  of  that  nurses the  chose  who  incident  a  to child the  believed should  be  investigated  those  who  decreased  in  that  slightly  37  the  pose abuse  the  in  changes  (1980)  toward of  one  the  interviews  of  six  respectful angry  of  were  toward  from  the  behavior  of  economic  families  receive  b i l i t y  for  The was  their  designed  Two o f  study  to  questions  findings  indicated  believed  that  ically  abused  avoided,  as  that  1976)  related  to  from  social the  of  the  deny  hospital pur-  child  interviews included  nursing, and as  in  emerg-  social  cautious  socio-economic  children  and  groups,  socio-economic  report from  concluded  lower  attention  socio-  whereas  them f u r t h e r  be p r e s e n t e d  beliefs was  to  29 p e r c e n t or  to  of  described  personal  i f  staff  be  actual  for  the  to  of  The  procedures  lower  injury  the  responsi-  48).  physicians'  were  presented.  from  authors  of  attitudes  of  of  supervision  approach  and m e d i c a l  were  "abused  questionnaire  a police child  (p.  (Chang,  examine  the  and  the  directors  the middle  that  the  a result  abusers  percentage  repetition  The h o s p i t a l  considerable  children"  A nine-item  the  staff  deliberately  final  neglect.  summary,  the  As  supervisors  child  the  which were  The a t t i t u d e s  the  regarding  radiologist,  of  and  therapy  reporting  State.  abusers  in  the  compiled.  chief  Furthermore,  in  1973)  evaluate  hospitals.  and p u n i t i v e  are  (Burns,  were  child  beliefs  a report  maternal-child  toward  Obviously,  cited  New Y o r k  the  receive  problem.  groups.  parents  family  the  to  staff  room n u r s e s ,  workers  but  of  seven p e r c e n t ,  percent.  of  was  county  attitudes  the  abusers  report  only  some n u r s e s '  also  child  the  ency  to  management  Reilly staff  to  recommended  significantly used  decreased  of  beliefs the  about  agency  to  abuse  1367  who  should  percent  discussion  child  child  physicians  Fifty  this  regarding  administered  service  parents.  in  and  physicians.  abusers.  The  responded  remove  believed  a  phys-  that  a  judicial  hearing  however,  as  are  a comment  more  rights,  or  children.  should  Reilly  the  be h e l d  stated,  i t  regarding  rights  of  is the  parents  before not  taking  really  agencies or  such  action.  known w h e t h e r  mandated  guardians  to  In the  protect  who p h y s i c a l l y  the  end,  responses children's abuse  29  CHAPTER  I I I  METHODOLOGY  This  s t u d y was  community abusers;  health to  community to  tered  determine  the  nurses  community tudes  of  nurses  health  compare  the  describe  to  their  nurses  community the  data  selected  registered cribes data  The  for  four  parts  collection,  these  social  nurses  randomly  health  nurses by  child  study,  the  and d a t a  due  and  between  in  the  describe  parents  (1980);  descriptive  of  to  Reilly  attitudes  to  of  toward  attitudes  of  child  the  and p r o f e s s i o n a l  variables;  the  the  attitudes  compare  the  attitudes  children  the  selected  in  the  to  the  the  attitudes  group  with  convenience  community  of  health  regisof  the  group;  the  a t t i and  nurses  in  regard  abuse. research to  the  toward  design  dearth  child  methodology  -  (Brink  of  literature  abusers.  the  & Wood,  This  instrument,  1978)  regarding  chapter  sample  des-  selection,  analysis.  Instrument A Likert-type  measures The  of  with  this  nurses'  selected  presented  experiences  order  relationship  and  by  An e x p l o r a t o r y was  the  attitudes  studied  in  who w o r k w i t h  nurses  health  to  conducted  scale  attitudes was  toward  composed  abusers.  Each  ing  (Strongly  scale  Attitude  of  statement Agree  Scale,  child  developed  a b u s e r s , was  thirty-six  by R e i l l y employed  statements  was  followed  by  to  Strongly  Disagree).  in  in  (1980), this  regard  a Likert-type  to  five  Subjects  which  study. child point  were  rat-  asked  to  respond  to  statement.  each  The n u m e r i c a l  A background collected In  information  the  values  in  were  to  open-ended  with  child  the  a numerical  the  social  opportunity they  scale.  The  to  data  and p r o f e s s i o n a l  questions  abuse w h i c h  value  the  summated.  accompanied  regard  The D e v e l o p m e n t  of  Reilly  that  this  included, the  for  type and  of  "the  same a t t i t u d e " The  abuse,  scale  and  sentative nurses ings  the  wrote  toward  s t a n d why .";  was  the  the  were  to  posed  express  considered  scale  of  statement (p.  in  any  to  variables. order  of  be  sheet  to  their  important  to  (Reilly,  scale  .  .  from  two  summated  attitudes  a variety  used  of  .  of  1980)  toward  scores child  statements  supposedly  to  related  was  abusers,, be  and  :".  reflected  51).  generated  responses  of  of  forty-five  physical three  the  child  abuser.  (1)  "It's  a  shame  abusers  "Speaking  Scale  measuring  permitted  approximately  child  (4)  Attitude  a Likert-type  task  case, s t u d i e s  sentences:  .  believed  suitable  since  p.  assigning  study.  most  .  with  by  sheet  four  subjects  experiences the  data  addition,  provide  statement  .  to  .  sources:  registered  child  abuse.  sentences  Respondents child  .";  a child  (3)  the  which also  nurses After  "Seeing  a child  parent  .";  (2)  repre-  each  case,  the  their the  "I  abuser,  . . . "  child  three  completed  .  on  to  described  abusers  abusing  .  literature  feel-  following  can't I  under-  would  (Reilly,  1980j  52). From b o t h , o f  related  these  sources,  s t a t e m e n t s - was- c o m p o s e d .  were worded  positively  and h a l f  a pre-pilot  instrument  Approximately worded  half  negatively.  of  of the  eighty statements  31 To d e t e r m i n e submitted ment  as  to  to  the  ten  content  judges.  whether  i t  validity  The j u d g e s  was  positive  of  each  were  or  item,  requested  negative,  the to  instrument  rate  according  each  to  a  was  state-  specific  scale. Based itive  the  instrument  randomly  was  and  "strongly ments.  Subjects of  hundred  Sheet  This  questionnaire  most  of  were  demographic  the  with  were  agree,  labeled The  undecided,  statements as  sympathy  response disagree,  indicated  by  to  "strongly  agree"  choices  reversed  for  up  to  the  attitudes  t h e most  The  was  assigned  favorable  study.  and a p a t h y .  remaining  discriminated  compiled.  a pilot  attitude  were  which  pos-  a  five  unfavorable  a  with  for  negative  received  low  state-  summated  received one-  Background  1980) was  developed  variables.  with, the  effects  variables  the  those  (Reilly,  the  The v a r i a b l e s  to  of  Data  correlated  agree,  eighteen  eighty.  professional  cant  the  and  The D e v e l o p m e n t  and  to  for  were  statements  one was  The s c o r e s  with  thirty-six and  of  responses,  statements,  enmity  A favorable  assigned  disagree".  as  strongly  value  their  attitudes,  prepared  negative  as:  disagree.  values  then  of  negative  The p o s i t i v e  the  a numerical  successive  score  was  structured  strongly  score:  eighteen  ordered.  and h e l p f u l n e s s scale  and  analysis  favorable-and-unfavorable  The  and  statistical  statements,  between  were  on  data,  data  obtain  data  in  regard  to  subjects'  attitudinal  variables  on  were  then  The  to  selected  formed. i.e.  The  the  scores  attitudinal  from  the  on v a r i o u s  these  to  social  variables  ascertain  were  signifi-  scores.  literature.  first  cluster  of  age, -marital  status,  ethnic  Four  questions  clusters was  background,  of  related and  32 family  size.  Family  background,  including  childhood  and p a r e n t s '  education were included  in  the  posed  third  to  nursing  in  the  cluster,  fixed  regarding  experience  A pilot  puted  the  Formula.  In  study  was  conducted  the  clarity  and  were  Study  used. method,  the  the  other,  indicated  showed,  scores  in  and  in  of  And,  for  eight  in  questions the  last  questions  the  1980)  to  test  background  the  that  the  data  the  sheet. of  .86.  "In  discriminated  total  questions  scores"  in  the  the  r e l i -  .82 was  com-  Prophecy  addition,  among  (p.  of  Two  Spearman-Brown  a l p h a was  low  reliability  coefficient  by  instrument with  the  persons  55).  background  an  The data  sheet  Selection  A sample ected  from  nurses  in  population  the  of  registered  British  one-hundred  nurses  Columbia.  A random  health  nurses  was  community  health  nurses  employed by  Health.  The names  A convenience the  included  sample  community  Metropolitan as  an e a r l y  of  of  selected  nurses  thirty  Services  a result in  of  an  the  of  from the  were  British  from  hundred  two  the  nurses of  Vancouver.  contact  made w i t h  of  study.  the  community  the  fifty-seven  and  fourteen of of  Health.  self-selected  Health Units  This- sample the  sel-  and  Ministry was  was  health  Columbia M i n i s t r y  health in  as  subjects  one-hundred  three  obtained  Greater  planning  of  the  employed  i n i t i a l  employed  sample  community  health, nurses  Health  phase  the  and n i n e t y - s e v e n  currently  community  ing  The  understood.  Sample  from  order  corrected  those  addition,  (Reilly,  coefficient  that  career.  structured  A reliability  split-half  high, t o t a l  study  were  were  cluster.  background  abuse.  Pilot  item analysis with  child  the  techniques  by  with  answers  of  scale  ability  referred  dichotomous  The R e p o r t  attitude  cluster  second  religious  Health  of  the  was Units  dur-  33 Data  Collection One-hundred  addressed the  to  nursing  Ministry  to  individual  of  Health. to  the  whom t h e  At  fifty-seven  the  of  the  community  time,  health  community  The n u r s i n g  instruments  same  instruments  community  supervisors  instruments and  and  health  letters,  nurses,  were m a i l e d  directly  health  nurses  instruments  directly  to  the  two  nursing  nurses  employed  by  the  Metropolitan were  nurses  were  letters  supervisors Health  of  Services  to  distribute  nurses  interested  in  participating  community  health  nurses  who  to  participate  convenience A separate  the  community  sheet  health  and d i s t r i b u t e d  in  the  The forward  Data  nurses'  with  each  the  were  directly  forward  the  addressed. letters  community  of  Greater  were health  Vancouver.  instruments in  in  the  the  to  study.  study  the The  formed  open-ended  instrument.  All  of  and  explanatory  instrument to  complete  child  questions  with  same  the  four  experiences  requested  to  the  abuse was  attached  subjects  involved  the  the  regarding  letters.  questionnaire  and  then  investigator.  Analysis The d a t a  descriptively tude  containing  received  subjects i t  the  group.  to  study  were  the  health  to  supervised,  the  community  the  to  and e x p l a n a t o r y  asked  agreed  employed by  asked  whom t h e y  and e x p l a n a t o r y  thirty  supervisors  explanatory  supervisors  mailed  The n u r s i n g  and  scores  relative  obtained (Appendix  are  analysis  for  data  Means  background  and  standard  each v a r i a b l e  sheet  as w e l l  for  each, c a t e g o r y  differences- i n  the  attitude  variance.  Using  were  deviations  responses  of  of  the  C).  presented  frequency  Significant one-way  from  as  the  within  scores- were  an F - t e s t ,  presented of  the  a t t i -  absolute  the  and  variables.  computed by  a significance  level  a of  .05  was  tests ing  set  for  for  comparisons  significantly The d a t a  by  rejecting  content  into  gories,  (Appendix  different  analysis.  and  the  D).  were  collected  categories.  the  The range  by  null  used  to  hypothesis.  Scheffe's  locate  of  pairs  scores  range  affect-  variables. the  open-ended  questions  The f i n d i n g s  for  frequency  responses  of  means  multiple  remarks  of  within  each  the  question to  each  have"been:summarized have  been  question,  categories  have  organized the  been  catetabulated  35  CHAPTER  DATA  Chapter tains  an  scale  and  and  IV  is  inferential the  cription  of  into  analysis  biographical  convenience  posed  divided  group  the  data  regarding  is  ANALYSIS  two  of  data  sections.  the  experiences  data  sheet.  included.  collected  IV  by  with  ponded the  to  the  the  deviation 71.25. group  of  group  12.57.  score  calculated  as  scores  had  a range  (1980)  study,  the  mean  with  deviation  a median  of  To a n a l y s e was to  calculated determine  if  of  score  71.53  vidual  standard  was  Individual  The mean a t t i t u d e was  f i f t y  of  For  14.98.  the  for  attitude  both  the  presents  questions  random of  random a  that  the  as  des-  were  a median  the  with  the  of  In  scores  as had  random  a  standard of  convenience of  70.7.  in  a median  deviation  calculated  individual  in  73 w i t h  in  res-  subjects  71.37  a range  a standard  group  sample  subjects  s c o r e was  The  the  total  had  the  35 w i t h  attitude  in  percent  scores  with  the  con-  I  calculated  for  section  abuse.  subjects  and  by  section  open-ended  child  responded.  mean a t t i t u d e of  the  questionnaire,  convenience  group,  percent  collected  second  Section  Eighty-four  first  An a n a l y s i s  The the  The  10.81.  Indi-  Reilly's  83.34  with  a range  a  of  96  an  F-test,  82.95. the  for the  data, each  of  a one-way the  analysis  nineteen  mean a t t i t u d e  scores  of  social for  variance, and  using  professional  the various  variables  categories  36 (within  the  level.  Scheffe's  pairs  of In  The  variables)  mean  analysis  scores, fixed  and  the  and  details  to  of  the  comparisons  analysis and  were  computed  frequency  of  to  Appendix  C.  analysis  variables,  w i l l  w i l l  be  below to  the  .05  locate  variables. both of  groups.  the  responses  variables.  nineteen  used  deviations  nineteen  inferential  or  for  the  refer the  was  at  different  standard  and r e l a t i v e to  different  significantly  t h e means  answers  A presentation corresponding  testsfor  descriptive  frequency  for  significantly  affecting  provided  alternative  ulated,  multiple  scores  addition,  were  The  attitude to  the  d a t a was  be made.  tab-  Headings,  used.  A&e Table  1  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o Age (N= 1 3 2 )  Variable  Between  Age  Sum o f Squares  "Source of Variation  Within  if  the  attitude  scores  way  analysis  of  indicated  that  F-test  4  124.4670  0.778  20160.3037  126  160.0024  20658.1720  130  497.8681  Total  To d e t e r m i n e  Squares  Groups Groups  t h e r e was of  the  variance there  was  Mean  Degrees of Freedom  no  a statistically  subjects  was  '  in  computed. significant  the The  significant  various  age  results,  difference.  as  difference  categories, shown  in  a  in one-  Table  1,  37 Table  2  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e . S c a l e A c c o r d i n g t o Age (N = .15)  Source Variable  Age  Sum  of  Variation  Between Within  Groups Groups  Total  As the tude  time  shown of  in  Table  testing,  scores  of  Reilly  (1980)  ferences  in  the  the  of  Degrees  2,  there  attitudes  4  1540.3330  10  1637.7395  14  analysis  were  subjects found,  97.4066  the  in  of  Mean  Freedom  Squares  of  24.3517  variance  indicated  significant  differences  the  convenience  group,  scores  that  of  there were  subjects  in  0.158  154.0333  no  as w e l l ,  F-test  Squares  no  the  that,  in  the  according  to  significant  various  age  at a t t i age. dif-  categor-  ies .  Marital  Status Table Analysis  Variable Marital  3  o f V a r i a n c e o f Raw S c o r e s Scale According to M a r i t a l (N = 132)  Source of Variation  B e t w e e n : Groups-'  Sum o f Squares  on the Status  Degrees Freedom  of  Attitude  Mean Squares  188.5713  4  47.1428  20528.2423  127  161.6397  20716.8130  131  Status Within Total  Groups  F-test  0.292  38 The  test  for  significance,  a t t i t u d e ; scores  for  cantly  at  different  the or  as  subjects  below  found in  the  .05  the  Sum  Marital Status  Between Within  Groups  Total  The there  is  results no  Ethnic  the  significant  Reilly, significant  of  likewise, effect  on  of  on t h e Status  Degrees  were to  not  of  55.3178  1416.4641  10  141.6464  1637.7351  14  as  effect  marital  that  shown i n  the  attitude  status.  Mean Squares  4  found  the  signifi-  marital  221.2711  of  that  Attitude  Freedom  analysis,  the  revealed  4  Squares  Groups  3,  according  o f V a r i a n c e o f Raw S c o r e s Scale According to M a r i t a l (N = 15)  Source of Variation  Variable  Table  random group  level,  Table Analysis  in  Table  status  subjects'  on  4,  F-test  0.391  indicated  the  marital  attitude status  that scores.  had  no  scores.  Background Table Analysis of Scale  Variable  Ethnic Background  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e According to Ethnic Background (N = 1 3 2 )  Source of Variation  Between Within Total  5  Groups Groups  Sum o f Squares  Degrees of Freedom  Mean Squares  F-test  1.446  902.4385  4  225.6096  19814.3730  127  156.0187  20716.8120  131  As the  evident  attitude  nficantly  in  Table  5,  scores  of  the  different  at  or  the  test  subjects below  for in  the  Analysis of Scale  Source Variable  Between Within  of  Sum  indicated group Table  the  that  Groups Groups  were  not  subjects  the  random group were  that  not  sig-  level.  6  of  Degrees  Squares  Total  As w i t h  revealed  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e According to Ethnic Background (N = 15)  Variation  Ethnic Background  the  .05  Table  significance  in  attitude  significantly  of  Mean  Freedom  Squares  F-test  32.8003  1  32.8003  1604.9275  13  123.4559  1637.7278  14  the  random  scores  of  different  group,  the at  the  test  subjects  in  or  the  below  for  the .05  0.266  significance convenience level,  6. Reilly  significant  found effect  as w e l l on  the  that  the  attitude  subjects' scores.  ethnic  background  had  no  40. Children Table Analysis Scale  of as  Source Variable  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e t o Whether S u b j e c t s Have C h i l d r e n (N = 1 3 2 )  of  Sum  Variation  Do Y o u Have Any  Between  Children?  Within  had no  data,  Groups Groups  shown i n  significant  of  Degrees  Squares  Total  The  7  on  of as  17.9998  20698.8083  130  159.2216  20716.8083  131  7,  revealed that  the  Do Y o u Have Any  Between  Children?  Within  as  in  results  Groups Groups  the  the random group,  significant Reilly score  of  effect also  according  on  children,  8  this  Mean Squares  F-test  1.0.38  1  121.1516  1516.5884  13  116.6606  1637.7400  14  as  the variable, attitude  that  Degrees of Freedom  121.1516  analysis,  the  found to  variable,  attitude scores.  Sum o f Squares  Total  The  the  0.113  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e t o Whether S u b j e c t s Have C h i l d r e n (N = 1 5 )  Source of Variation  Variable  F-test  1  Table Analysis Scale  Mean Squares  17.9998  Table  effect  of  Freedom  there  variable.  revealed  do y o u h a v e  scores was  in  no  Table any  8,  indicated  c h i l d r e n , had  that no  a  significant  difference  in  attitude  41 Number  of  Children Table Analysis  Number  o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o t h e Number o f Children (N = 1 3 2 )  Sum o f  Source of Variation  Variable  of  9  Between  Degrees  Squares  Groups  of  Mean  Freedom  Squares  F -• t e s t  0 . 134  61.6127  3  20.5376  8554.3214  56  152.7557  8615.9342  59  Children Within  Groups  Total  The in  test  for  significance,  a t t i t u d e scores  between the  Table two  9,  categories  Table Analysis  Number o f Children  Between  Within  test  differences  in  Groups  Groups  results, the  the  differences  insignificant.  10  Sum o f Squares  Total  The  was  that  o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o t h e Number o f Children (N = 1 5 )  Source of Variation  Variable  determined  Table  attitude  Degrees of Freedom  Mean Squares  F -• t e s t  1 . 694  510.8750  3  170.2917  402.0000  4  100.5000  912.8750  7  10,  indicated  scores,  that  according  to  there  was  no  significant  the v a r i a b l e ,  number  of  children. When R e i l l y this  variable,  performed  the  the  differences  one-way among  analysis  the  groups  of  variance,  were  not  according  significant.  to  42 Childhood  Religious  Background Table  11  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Childhood R e l i g i o u s Background (N = 1 3 2 )  Source Variable  of  Sum o f Squares  Variation  Childhood  Between  Religious Background  Within  Groups Groups  Total  When Table  the  analysis  of  Degrees of Freedom  Mean Squares  216.5169  3  72.1723  20307.9469  126  161.1742  20524.4640  129  variance  was  11,  i t  was  determined that  the  according  to  the  subjects' religious  computed  scores  for the  did  random  not d i f f e r  F-test  0.448  group,  significantly  background.  Table  12  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Childhood Religious Background (N =  Source Variable  of  Sum o f Squares  Variation  Childhood  Between  Religious Background  Within  Groups Groups  Total  As the  in the  attitude Reilly  nificantly  random  scores found  effect  group ,  in  that  Degrees of Freedom  Mean Squares  68.9718  1  68.9718  1568.7683  13  120.6745  1637.7400  14  there  w e r e no  the convenience  also, the  15)  childhood  attitude  scores.  significant  group,  F-test  0.572  differences  in  Table 12.  religious  background  did  not  sig-  43 Father's  Education Table  13  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Father's Education (N = 1 3 2 )  Source  Father's Education  of  Sum  Variation  Variable  Between Within  Groups Groups  Total  The  data,  Table  13,  of  Degrees  Squares  of  Mean  Freedom  Squares  F-test  1.160  1090.5759  6  181.7626  19275.7036  123  156.7130  20366.2800  129  indicated  no  significant  difference  in  attitude  scores.  Table  14  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Father's Education (N = 1 5 )  Source of Variation  Variable  Father's Education  Between Within  Sum o f Squares  Groups Groups  Total  The no  test  significant Reilly's  effect  of  study  on a t t i t u d e  on  also  6  95.0820  1067.2500  8  133.4063  1637.7419  14  Table  t he a t t i t u d e indicated  scores.  Mean Squares  570.4921  significance,  effect  Degrees of Freedom  28, revealed  that  this  F-test  0.713  variable  scores.  that there  was no  such  significant  had  44 Mo t h e r ' s  Education Table  15  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Education Scale According to Mother's (N = 1 3 2 )  Source Variable  Sum  of  Variation  Between  Mother's  of  Groups  Mean  Degrees of Freedom  Squares  Squares  F-test  1.160  1090.5759  6  181.7626  19275.7036  123  156.7130  20366.2800  129  Education Within  Groups  Total  The 15,  results  indicate  no  of  the  one-way  significant  analysis  difference  Table Analysis of Variance Scale According  Mother's Education  Between Within  Groups Groups  Total  The ficant age  analysis  differences  the  attitude  given  in  Table  scores.  o f Raw S c o r e s o n t h e A t t i t u d e to Mother's Education (N = 15)  Mean  Degrees of Freedom  Squares  F-test  0.996  583.2421  5  116.6484  1054.4998  9  117.1666  1637.7419  14  variance,  in  the  as  Table  attitude  16,  scores  computed of  the  that  there  subjects  in  was the  no  signi-  various  categories. Reilly's  of  of  variance,  16  Sum o f Squares  Source of Variation  Variable  in  of  registered  findings nurses.  revealed  the  same  result  for  the  sample  population  45 Educational  Preparation  for  Registration Table  Analysis of According  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e to Educational Preparation for Registration (N = 1 3 2 )  Source  of  Sum  Educational Preparation  A m o n g G r o u p s v.  for  Between  Regis-  Degrees  of  Squares  Variation  Variable  17  of  Freedom  Mean F-test  Squares  50.3465  1  50.3465  Groups 20666.4630  130  158.9728  20716.8100  131  0.317  tration Total  As to  evident  registration  in  Table  had no  17,  the  subjects'  signficiant  effect  Table Analysis of According  Among  for Registration  Between  Groups Groups  Total  the  analysis  subjects  attitude  in  scores,  of  the  the  attitude  prior  scores.  18  variance  18.  Degrees of Freedom  Mean Squares  10.6810  1  10.6810  1627.0549  13  125.1581  1637.7358  14  revealed  convenience  Table  15)  Sum o f Squares  Source of Variation  Educational Preparation  The  on  preparation  V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e to Educational Preparation for Registration (N =  Variable  educational  group  that had  no  the  educational  significant  F-test  0.085  preparation  effect  on  the  of  46 Reilly's were  not  tion  prior  Present  study  indicated  significant to  Level  at  the  as w e l l  .05  level,  of  Level  Source of Variation  to  attitude  educational  score  prepara-  Between  19  o f Raw S c o r e s Present Level (N = 1 3 2 )  Sum  of  the A t t i t u d e Education  Degrees of Freedom  Squares  Groups  on of  Mean Squares  F-test  1.085  689.4457  4  172.3614  20021.7038  126  158.9024  20711.1490  130  of Within  Education  Groups  Total  For that  according  in  Education  Analysis of Variance Scale According to  Present  differences  registration.  Table  Variable  that  the  their  attitude  subjects  present  scores,  in  level  Table  the of  random g r o u p , education  Analysis of Variance Scale According to  Source of Variation  Present  Between  Level of Education  Within Total  not  one-way  analysis  significantly  indicated  effect  the  19.  Table  Variable  did  the  Groups Groups  20  o f Raw S c o r e s Present Level (N = 15)  Sum o f Squares  on of  the A t t i t u d e Education  Degrees of Freedom  Mean Squares  F-test  0.858  101.4033  1  101.4033  1536.3325  13  118.1794  1637.7356  14  As did  not  shown  The  had  Table  significantly  Reilly tion  in  found  20,  effect  however,  a significant  results  difference  of  the  the  between  the  that  effect  Scheffe the  attitude  and  the  registered  higher.  "As  the  amount  of  attitude  toward  child  present  attitude the  on  test  diploma,  average  subjects'  present  attitude  scores  indicated  that  scores  the  nurses higher  of  with  education  there  level at  the  was  registered  a baccalaureate  education  abusers  of  scores.  subjects'  the  level  in  nursing  became more  a  of  educa-  .05  level.  significant  nurses degree  with or  increased,  favourable"  a  the  (pp.  70-  71).  Years  of  Nursing  Experience Table  21  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e Scale According to Years of Nursing Experience (N = 1 3 2 )  Source of Variation  Variable  Years of Nursing Experience  Between Within  Groups Groups  Total  Analysis dom 21.  of  Sum o f Squares  Mean Squares  F-test  0.942  597.1004  4  149.2751  20119.7127  127  158.4229  20716.8130  131  variance determined  group, differences  Degrees o f Freedom  in attitude  that for  scores were  the  subjects  i n the  not significant ,  ran-  Table  48 Table Analysis Scale  of  Source Variable  Variance  According  of  Between  Experience  Within  variance  the  Groups Groups  subjects  determined  significant, Reilly  Formal  Table had  (N =  15)  of  on  Nursing  the  Attitude  Experience  Degrees .of Freedom  Mean Squares  F-test  105.6677  2  52.8338  1532.0663  12  127.6722  1637.7339  14  in  the convenience  group,  that  the differences  in  as w e l l ,  the  a t t i t u d e scores  0.414  analysis were  of  not  22.  the  Instruction  of  Squares  Total  For  Raw S c o r e s  Years  Sum  Variation  Years of Nursing  of  to  22  same  in  finding  Child  in  her  study.  Abuse Table  23  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o Formal I n s t r u c t i o n i n C h i l d Abuse (N = 1 3 2 )  Source of Variation  Variable  Formal Instruction in Child Abuse  Between Within  Groups Groups  Total  The  data,  Table  23,  significantly  according  tion  abuse.  in  child  Sum o f Squares  Degrees o f Freedom  Mean Squares  64.5564  1  64.5564  20645.2927  129  160.0411  20709.8520  130  indicate to whether  that the the  a t t i t u d e scores  subjects  received  do  F-test  0.403  not d i f f e r  formal  instruc-  49 Table  24  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e A c c o r d i n g t o Formal I n s t r u c t i o n i n C h i l d Abuse (N =  Source of Variation  Variable  Formal Instruction  Between  in Child Abuse  Within  evidenced  Groups Groups  in  Degrees o f Freedom  Sum o f Squares  Total  As  15)  Table  Mean Squares  32.0234  1  32.0234  1605.7131  13  123.5164  1637.7366  14  24,  the  attitude  scores  did  that  attitude  not  F-test  0.259  differ  signi-  ficantly. Reilly's fer  study  significantly  also  indicated  according  to  the  the  variable,  formal  scores  did  instruction  not in  difchild  abuse.  Having  Seen an Abused  Child Table  25  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e S c a l e A c c o r d i n g t o H a v i n g Seen an Abused (N = 132)  Variable  Seen  an  Abused Child  Source of Variation  Between Within Total  Groups Groups  Sum  of  Squares  Degrees of Freedom  Attitude Child  Mean Squares  1309.6731  1  1309.6731  19407.1398  130  149.2857  20716.8130  131  F-test  8.773  The jects ward  data  presented  who h a v e child  seen  There  mean a t t i t u d e  scores  abused  and h a v e  of  variance,  scores  was  Table  Table C-25, Appendix  an abused  abusers.  child,  in  of  25,  the not  child  is  have  an a l m o s t  subjects seen  Scale  that  of  Variance  According  of  Sum  Source of Variation  Variable  an  Between  Abused Child  Within  point  two  the  attitude  difference  categories; The  have  one-way  differences  in  in  subtothe  seen  an  analysis  the  attitude  the  Groups Groups  convenience  subjects' Reilly's to  attitude study this  26  Raw S c o r e s  Attitude Child  of  Degrees of Freedom  Mean Squares  F-test  1  14.0432  1623.6914  13  124.8993  1637.7346  14  scores,  t h e r e was Table  indicated  variable.  the  14.0432  group,  also  on  Seen an Abused  15)  Squares  Total  according  favourable  child.  the  to Having (N =  the  the  that  significant.  Analysis  In  twelve  in  Table  Seen  a more  an abused  determined  C indicates  no  no  significant  0.112  difference  in  26. significant  difference  in  scores  51 Physically  A b u s e d As  a  Child Table  27  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e As t o W h e t h e r S u b j e c t s Were P h y s i c a l l y A b u s e d As a (N =  Source Variable  Physically Abused a  of  Sum  Variation  Between  of  Degrees  of  Freedom  327.5791  Mean Squares  Child  Within  According attitude  1  327.5791  Groups  20389.2367 .  130  156.8403  20716.8160  131  to  the  scores  results  were  not  of  the  analysis  significant,  Table  of  Table  variance,  Source Variable  of  Between Within  Groups Groups  Total  For as  the a  subjects child,  in  the  had no  the  Degrees o f Freedom  Scale Child  Mean Squares  F-test  60.8113  1  60.8113  1576.9277  13  121.3021  1637.7390  14  convenience  significant  differences  28  Sum o f Squares  Variation  Physically A b u s e d As a Child  Table  2.089  27.  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e As t o W h e t h e r S u b j e c t s Were P h y s i c a l l y A b u s e d As a (N = 1 5 )  abused  F-test  As  Total  in  132)  Squares  Groups  Scale Child  group,  effect  on  the  variable,  the  attitude  0.501  physically scores,  28. Reilly  attitude  found  scores  as w e l l ,  for  the  two  that  t h e r e was  categories.  no  significant  difference  in  the  52 Nursed  an Abused  Child Table  29  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o W h e t h e r S u b j e c t s H a v e P r o v i d e d N u r s i n g Care to an Abused C h i l d (N = 1 3 2 )  Nursed  Sum o f Squares  Source of Variation  Variable an  Between  Abused Child  Within Total  The tude  results,  Table  29,  1  9.0190  20707.7935  130  159.2907  20716.8130  131  indicate  no  significant  F-test  Squares  9.0190  Groups Groups  Mean  Degrees of Freedom  difference  0.057  in  a t t i -  scores.  Table  30  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o W h e t h e r S u b j e c t s H a v e P r o v i d e d N u r s i n g Care t o an Abused C h i l d (N = 1 5 )  Source Variable  Nursed  an  Abused Child  of  Sum  Variation  Between Within  Groups  in  analysis  of  had no  significant  6.5388  1631.1992  13  125.4769  1637.7380  14  Table  as w e l l ,  effect  on  Squares  1  variance,  the convenience group  Mean  Degrees of Freedom  6.5388  Groups  Total  The  of  Squares  the  the  30,  indicates  variable,  scores.  that  nursed  for  the  an abused  F-test  0.052  subjects child,  53 Reilly variable,  Contact  determined  were  With  not  that  differences  in  scores,  according  to  this  significant.  a Child  Abuser Table  31  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o W h e t h e r S u b j e c t s Have Had C o n t a c t W i t h a C h i l d A b u s e r (N = 1 3 2 )  Source of Variation  Variable  Contact With a  Between  Child Abuser  Within  Sum  Groups Groups  Total  One-- w a y no  analysis  difference  in  the  of  of  Degrees of Freedom  Squares  Mean Squares  F- • t e s t  0 . 803  127.2058  1  127.2058  20589.6078  130  158.3816  20716.8140  131  variance,  Table 31,  determined  that  t h e r e was  scores.  Table  32  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o W h e t h e r S u b j e c t s H a v e H a d C o n t a c t W i t h ,a C h i l d A b u s e r (N =  Variable  Source of Variation  Contact  Between  With a Child  Within  Groups Groups  15)  Sum o f Squares  Degrees of Freedom  F- • t e s t  2 . 653  277.5423  1  277.5422  1360.1912  13  104.6301  1637.7334  14  Abuser Total  Mean Squares  As  for  indicated  the  no  subjects  in  difference  in  the  convenience  group,  Table  Reilly  found,  however,  at  .01  significant  Detected  the  Child  the  random  group,  attitude  the  scores  of  test the  for  significance  subjects  in  the  32. that  the  difference  in  attitude  scores  was  level.  Abuse Table  33  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o W h e t h e r S u b j e c t s Have D e t e c t e d C h i l d Abuse (N = 1 3 2 )  Source of Variation  Variable  Detected Child Abuse  Between Within  Sum o f Squares  Groups Groups  Total  The of  the  data  in  variable,  subjects  in  the  Table  33  detected random  Mean  Degrees of Freedom  Squares  15.9341  1  15.9341  20693.9136  129  160.4179  20709.8480  130  indicates child  group.  that  abuse,  on  there the  is  no  F-test  0.099  significant  attitude  scores  of  effect the  55 Table Analysis  of  Attitude  Variance Scale  Have  As  Source  Detected  of  Sum  Variation  Detected Child  Between  Abuse  Within  scores  between  Reilly abuse  the  Groups Groups  there  results the  found was  two that  Raw S c o r e s  Child  =  the  Abuse  of  Degrees  of  Freedom  Mean Squares  12.8444  1  12.8444  1624.8884  13  124.9914  1637.7327  14  indicate  no  categories, according  a significant  on  Subjects  15)  Squares  Total  Again,  of  to Whether  (N  Variable  34  to  significant Table  in  0.103  attitude  34.  whether  difference  difference  F-test  in  subjects  had  detected  attitude  scores  at  the  child .05  level.  Reported  Child  Abuse Table  Analysis As  Variance  Whether  Source of Variation  Variable  Reported Child Abuse  of  to  Between Within  data  Groups Groups  indicated  Raw S c o r e s  no  on  the  S u b j e c t s Had R e p o r t e d (N = 1 3 2 )  Sum o f Squares  Total  The  of  35 Attitude  Child  Degrees of Freedom  Scale  Abuse  Mean Squares  7.1854  1  7.1854  20709.6291  130  159.3048  20716.8140  131  significant  F-test  0.045  d i f f e r e n c e i n a t t i t u d e scores, Table 35.  56 Table Analysis As  of  to  Variance  Whether  of  Raw S c o r e s  Subjects  Between  Reported Child Abuse  Within Total  The nificant group,  data  effect  Table  Reilly  Court  reveal  Degrees of Freedom  Mean Squares  F-test  1  58.8036  1578.9314  13  121.4563  1637.7349  14  that the  on t h e  Scale  Abuse  58.8036  Groups Groups  Attitude  Child  15)  Sum o f Squares  Source of Variation  on t h e  Had R e p o r t e d  (N =  Variable  36  variable,  attitude  scores  reported of  the  child  subjects  0.484  a b u s e , had no in  sig-  the volunteer  36. also  Hearing  in  found  that  Regard  this  to Child  variable  had no  significant  effect.  Abuse  Table  37  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s o n t h e A t t i t u d e S c a l e As t o W h e t h e r S u b j e c t s Have Been I n v o l v e d i n a Court H e a r i n g i n Regard t o C h i l d Abuse (N = 1 3 2 )  Variable  Sum o f Squares  Source of Variation  Between  Court Hearing in Regard t o  Within  Child Abuse  Total  T h e r e was no  Groups Groups  Degrees of Freedom  Mean Squares  F-test  1.577  248.2785  1  248.2785  20468.5331  130  157.4503  20716.8120  131  significant  effect  in  the  attitude  scores  of  the  subjects  57 in  the  ing  in  random g r o u p , regard  And, venience  to  the  child  test  group  according abuse,  for  showed  to  subject's  Table  performed  same r e s u l t ,  Table  Table  Source o f Variation  Variable  Between  Court Hearing in Regard t o Child Abuse  Within  child In  addition,  ing  to  the  clinical  of  the  setting ses' no  likewise,  abuse had  the  no  have  area  (of  indicated the  found  most  significant  effect  of  Degrees  Squares  F-test  12  that  in  involvement effect  on  the  a one-way  areas  of  attitudes, Nurse)  attitude  and  hearing  attitude  scores.  that  years  of  the  in  variance  of  regard  accord-  practice  t i t l e .  practicing  and  scores.  of  years  and n u r s i n g  nurses  0.006  a court  analysis  nursing,  practice),  registered  the  - Mean  of '  Freedom  :  1022.7693  Staff  con-  on t h e A t t i t u d e Been I n v o l v e d C h i l d Abuse  92.9317  favorable  the  38.  11  current  on  in  1022.2490  clinical  (Head N u r s e ,  subjects  0.5203  performed  that  the  1  significant  Reilly  variables;  test  titles  Groups  on  0.5203  Groups  hear-  15)  Squares  Total  Reilly, to  Sum  a court  38  A n a l y s i s o f V a r i a n c e o f Raw S c o r e s S c a l e As t o W h e t h e r S u b j e c t s Have i n a Court H e a r i n g i n Regard t o (N =  in  37.  significance the  involvement  in  The a  in results  psychiatric  registered  clinical  nur-  practice  had  Section  This  section  open-ended responses  to  each the  responses.  For  Appendix  their  indicated,  community  experiences  valuable  to  this  the  the  content  includes  categories  further  analysis  both  the  derived  details  of  the  frequency  through  regarding  the  of  the analysis  D.  As p r e v i o u s l y  of  presents  The p r e s e n t a t i o n plus  refer  the  chapter  question  of  provide  the  questions.  analysis to  of  I I  health in  the  questions  nurses  regard  to  with  child  were  the  posed  in  opportunity  abuse,  which  order to  they  to  express  any  considered  study.  The C o n t e n t A n a l y s i s D e r i v e d From t h e Responses o f t h e S u b j e c t s i n t h e Random G r o u p (N = 1 3 2 )  Frustrations Experienced Health Nurses i n Dealing Eighty-^five  percent  Twelve  categories  tion.  The  of  public  the  tion  following  related  to  beliefs  regarding  fessional  the  in  t a t i v e -programs pected  child  abuse;  and,  a list  judicial the  the  of  in  system;  right  role  for  fact  in  of  of  child  the  reluctance that  child  of  professionals  laws  the  for  communicaand  and  com-  problems general  practices; of  the  need  report to  frustraeducation  families;  neighbors  is- d i f f i c u l t  the  treatment  nurse;  to  of  abuse;  management  health  reluctance  abuse  child  to  question.  need  child-rearing  hinder  community  this  source  protection  related and  to  the  professional  child  parents  of  the  regarding  factors  that  to  categories:  of  the  abuse;  responded  regard  the  provision  and f e e l i n g s  abuse; the  subjects  professionals  limitations  attitudes  limitations  is  inadequate  resources;  the  identified  and a l l i e d  problems;  munity  were  of  by t h e Community w i t h C h i l d Abuse  to  for  problem; preven-  report  suspected  prove.  pro-  suschild  59 The A g e n c i e s I d e n t i f i e d as t h e Most H e l p f u l i n A s s i s t i n g t h e Community H e a l t h Nurses i n t h e Management o f C h i l d Abuse Eighty-one agencies  that  of  child  abuse.  Columbia  do n o t  the  response  are  as  they  workers;  school  to  Development  Units;  hospital;  in  the  the  of  Family  the most  communities  w i l l  Life  identified  in  the  throughout  identified  not  by  Child  family  health  nursing;  British subjects,  The  Abuse  physicians;  Crisis  Association;  Volunteer  Groups;  Day  Systems;  Health  Care w i t h  Parent  Help  churches; Health  Depression  Group  Line  Centres;  personnel;  Post-partum  Mental  social  counsellors;  Services;  Support  agencies  Team;  Home M a k e r  of  the  management  the  be p r e s e n t e d .  police;  other. M i n i s t r y  Group;  nurses  helpful  Human R e s o u r c e s ;  Houses;  Centre;  health  agencies  community  Family  Services  be  personnel;  Transition  Child  Youth  community  each agency  Ministry  Parents-In-Crisis;  Local  some o f  for  colleagues  Children;  the  considered  have  rate  Centre;  of  S i n c e many o f  follows:  Health  for  percent  Group;  Training.  Community H e a l t h N u r s e s ' P e r c e p t i o n s Regarding Whether They a r e A d e q u a t e l y I n f o r m e d on C h i l d Abuse f o r t h e Management o f t h e P r o b l e m Eighty-three this  question.  they  were  percent  Thirty-four  adequately  responsibilities. percent abuse, an  of but  abused  gested  the  child  subject.  they  And,  Forty-one  require and  the  were  one  the  community  percent  informed  subjects  would  that  of  for  the  percent  suggested  informed,  community  the  nurses  respondents  fulfillment indicated  that  assistance family.  of  health  in  the  they  were  order  to  Eighteen  of  responded  indicated  present  provide  percent  but  could  use more  health  nurse  was  of  the  Fifteen  regarding  nursing  child  care  subjects  information  undecided.  that  nursing  opposite.  informed  to  on  to  sugthe  60 Comments Forty The as  percent  categories follows:  need  for  of  that  the  ceived  a social  as of  sexual  for  community  ing  the  the  community identified  for  preventative perceived  Content  were  need  research;  problem  the  worker's  Analysis in  the  Derived the  Seventy-five question.  responses. inadequate  for  definition; for  need of  for  the  responses  need  for  a  for  mandatory  from  the  Responses  team  child  a specialized abuse  reporting;  are  approach;  education;  families;  emotional  need  comments.  of  professional  assisting  problem  Convenience  percent  Seven  The  Group  need  abuse  per-  worker;  the  and n e g l e c t ; and  remarks  for  need regard-  of  the  are  were  as  attitudes  treatment;  of 15)  community  for  the  identified  in  and  children  abuse;  fact  nurses the  responded content  communication  treatment  toward  child  and,  health  follows:  professional  programs  (N =  by t h e Community w i t h C h i l d Abuse  categories  and p r o f e s s i o n a l  toward  of  categories  provision  preventative  family  in  the  included  questionnaire.  Subjects  public  content  problem;  Frustrations Experienced Health Nurses i n Dealing  this  in  need  difficulties  resources;  nurses  a standard  measures;  abuse;  health  behavior  that  child  child  and  abuse  of  resources; abuse;  attitudes is  the  problems;  community and  to  need of  difficult  to  prove.  The A g e n c i e s I d e n t i f i e d as t h e Most H e l p f u l i n A s s i s t i n g t h e Community H e a l t h Nurses in t h e Management o f C h i l d Abuse Sixty-nine  percent  question.  The a g e n c i e s  Resources;  Child  Abuse  of  the  community  identified Team;  Mental  are  health  as  Health  nurses  follows: Centres;  responded  Ministry  of  to  this  Human  Parents-in-Crisis;  61 Health  Units;  House;  Schools;  Society;  and  Family  Services;  Carefree  Family  Ministry  Society;  Support  of  Education;  Home M a k e r  Chesterfield  Services;  Children's  Aid  Workers.  Community H e a l t h N u r s e s ' P e r c e p t i o n s R e g a r d i n g Whether They a r e A d e q u a t e l y I n f o r m e d on C h i l d Abuse f o r t h e Management o f t h e P r o b l e m This Almost to  the  well  was  fifty-three  f u l f i l  cated  question  present  answered  percent nursing  opposite.  by  one h u n d r e d  indicated  that  they  responsibilities.  Twenty-three  percent  percent were  of  the  adequately  Twenty-three  indicated  subjects.  that  informed  percent they  indi-  were  fairly  informed.  Comments Twenty-three gories  percent  identified  role  of  the  need  for  in  the  community  qualified  of  the  content  health  subjects of  nurse  professionals;  the in  and,  included  responses  the  comments. are  treatment  remarks  as  of  cate-  follows:  child  regarding  The  the  the  abuse;  a  question-  naire. The c a t e g o r i e s random group i t  would  iences  of  and  the  seem t h a t the  identified  by  convenience  there  subjects  in  is  no  the  the group  community are  appreciable two  groups.  health  similar. difference  nurses  Based  in  on t h i s  between  the  the data, exper-  62  CHAPTER V  SUMMARY, DISCUSSION, CONCLUSIONS AND IMPLICATIONS  Summary and D i s c u s s i o n An e x p l o r a t o r y  d e s c r i p t i v e study was  a t t i t u d e s of community h e a l t h nurses who ren  toward c h i l d abusers, and  social  conducted  to d e s c r i b e the  work w i t h p a r e n t s and  t o determine  child-  the r e l a t i o n s h i p of s e l e c t e d  and p r o f e s s i o n a l v a r i a b l e s t o the a t t i t u d e s .  In a d d i t i o n ,  f i n d i n g s of the p r e s e n t study were compared to R e i l l y ' s  the  (1980) study  and  the d a t a c o n c e r n i n g the community h e a l t h n u r s e s ' e x p e r i e n c e s r e g a r d -  ing  child  abuse was  d e s c r i b e d and t a b u l a t e d .  A sample p o p u l a t i o n of one-hundred and n i n e t y - s e v e n s u b j e c t s  was  s e l e c t e d from the r e g i s t e r e d nurses c u r r e n t l y employed as community h e a l t h nurses  i n B r i t i s h Columbia.  A random sample of one-hundred  f i f t y - s e v e n community h e a l t h nurses was  s e l e c t e d from the community  h e a l t h nurses employed by the B r i t i s h Columbia M i n i s t r y of H e a l t h . convenience  and  sample of t h i r t y community h e a l t h nurses  from the community h e a l t h nurses employed i n two  was  A  self-selected  of the H e a l t h U n i t s of  the M e t r o p o l i t a n H e a l t h S e r v i c e s of G r e a t e r Vancouver. The  a t t i t u d e s of the s e l e c t e d community h e a l t h nurses were measured  by the L i k e r t - t y p e a t t i t u d i n a l by R e i l l y  (1980).  s c a l e and background d a t a sheet  developed  Four open-ended q u e s t i o n s were posed i n o r d e r to c o l -  l e c t data r e l a t e d to the community h e a l t h n u r s e s ' e x p e r i e n c e s w i t h  child  abuse. Almost s e v e n t y - f i v e p e r c e n t of the community health, nurses  responded  63 to  the  study  questionnaire. is  regarded  practice  of  The of  nursing  the  the in  reliability  community  0.88.  by  This  This  health  that  the  that  i t  was  instrument was  found  the  instrument  designed  to  to  of  The  research  were more  true  the  for  groups. suggested  that  or  favorable  finding  in  relevant  1980)  refuted  was  this  to  the  nurses  nurses  the  sample  alpha  consistently  of  measuring  that  in  the who  both  statement feel  Analysis  Groups  guardians  the  with  a coefficient  attitudes  This  the in  enmity  of  physically  than unfavorable.  health  registered  as  and D e s c r i p t i v e  determined  parents  community  This  Inferential  findings  children  addressed  measure.  Random a n d C o n v e n i e n c e  toward  nurses  have  Both  nurses  issue  (Reilly,  for  health  the  health  The F i n d i n g s the  the  that  community.  nurses  indicated  attitudes  community  the  of  suggests  community  abuse  was  found  random and  the  their be  convenience  literature  and a n t i p a t h y  to  which  toward  child  abusers. The ship and  study  between the  the  group  orable  than  child  scores.  who h a d the  The e x p e r i e n c e the  determined  variable,  attitude  random  ection,  also  whether That  is,  there  of  seeing  development  the  the  of  the  a  significant  have  scores  child  subjects  an abused  was  subjects  seen an abused  scores of  that  seen  of  were  the  child  community  subjects  child,  in  the  more  seen an abused  influenced, health  an abused  significantly  who h a d n o t  relation-  in  nurses'  favchild.  a positive attitudes  dirtoward  abusers. It  is. i n t e r e s t i n g  education  prior  instruction  to  note  that,  to ^registration,  regarding  child  in  comparison,  present  abuse - d i d  level  not  of  three  variables  education,  significantly  and  affect  -  formal the  64 attitude  scores.  ficantly  influence  tudes  toward  That the  child  child  regard  to  that  the  is  abusers  component  would  affective finding the  for  domain  supports  affective  tudes  be  than  of  (1967) that  to  of  shaped  the  experiences  community  domain  learning  that upon  a more  (seeing that  a more  through  prior  is  did  health  not  signi-  nurses'  experiences to  a t t i -  appreciable  an a t t i t u d e  favorable  learning  powerful  is  that  is  recalled of  toward  In  an  Accordingly, child  address  child).  to  i t  the  essence,  experiences t h a t the  experiences t h a t address  development only  an  in  composed  attitude  through  means  when  process.  experiences  an abused  (seeing  registration)  a cognitive  educational  belief is  attitudes  that  by  educational  education  based  learning  the  these  stated  is  think  of  of  example,  development  reasonable  educational  development  effects  Shaw a n d W r i g h t  affective i t  and,  these  abusers.  The d i f f e r i n g abused  is,  the  this  address of  a t t i -  cognitive  domain. Specific relation is  to  the  required.  learning For there  This  the  of  information for  convenience  no  regarding  development  experiences  were  attitude  information  favorable would  students group,  significant  in  the  of  this  attitudes to  experience  toward  child  educators  in  in  abusers planning  nursing. test  for  significance  between  the  computed  variables  and  that the  scores.  Three  graphical  nature  be u s e f u l  relationships  The F i n d i n g o f t h e D e s c r i p t i v e o f t h e A t t i t u d e Scores and t h e  analysis  the  interesting  of  the  data.  observations  correlated  data  from  Analysis Variables were made, based the  attitude  on  the  scores  descriptive  and  the  bio-  First, seven  there  subjects  was  a wide v a r i a t i o n  the  random  in  children.  It  has  a noticeably  either  health be  would  nurses'  Second,  seem t h a t  could  a considerable  detected  and/or  This  strongly  supports  a key  position  suggest  that  to  their  identification Third, actively only a  a  made b y formal  of  it  was  the  role  legal  system  Comparison to  the  This tered  study  unfavorable.  studied  In  two  this  the  wide  of  that  child  abuse.  toward  community  the  community  yet  to  health  C-32-35,  community  child  experience  Variables  (Table  It  upon  as  variation.  the  abuse  abused  childhood  effect  the  health  would  be  abusers  nurses  Appendix  nurses  are  reasonable  have  C). in  to  facilitated  the  although  detection (Table  raises nurse  (i.e.  and/or  C-36,  a question in  court  the  of  Reilly's  (1980)  the  substantiated  the  favorable  to  nurses child  have been  the  exact  are  abuse,  involved  in  contributions  process  within  the  hearing).  Findings  fact,  as  C)  of  decision-making  of  toward  health  reporting  Appendix  the  further  community  child  Present  Reilly's abusers  finding  are more  attitude  scores  than  attitudes  the  Study  Study  for  the of  that  the  favorable  community  the  registhan  health  registered  nurses  Reilly,  A twelve the  the  attitudes  were more by  of  Finding  nurses'  nurses  This of  for  child  that  the  percentage  hearing.  scores: of  problem.  found in  of  abusers.  belief  attitudes the  involved  small  court  identify  attitude  negative  proportion  reported the  impact  child  account  the  who h a d b e e n p h y s i c a l l y  or  toward  also  have  the  positive  attitudes  identified  group  in  point  samples  of  difference registered  separated nurses.  t h e mean a t t i t u d e  (The  attitude  scores  scores of  th.e  for  subjects'random in  the  scores  experiences The two  and  could  of  respects.  favorable had  the  toward  a diploma.  was  computed  a diploma  had  the  received  the  two  in  the  study.  two  nurses  were  abusive however,  of  is  the  that  the  score  of  the  in  for  of  Reilly  than  as  degree. as  two  regard  to  could  favorable  required  in  be  the  the  who  present  who h a d  in  more  nurses  differences  received  nurses  who  findings in  the  the  children  of  for  may  subjects  a function  of  edu-  opportunities  abusive of  explain, a  health  example, of  had  of  in  differences  nurses.  more  a case  relationships  For  also  significantly  these  of  proportion  the  detected  community  treatment  that  or  nurses  The d i s c r e p a n c y  found  parent  the  in  in  level  To  registered  health  a function  a significant  registered  the  the  study  present  degree  in  settings.  scores.  investigated  samples.  difference  variations  subjects'  a baccalaureate  sample  The  from R e i l l y ' s  attitude  community  The d i s c r e p a n c y  groups  on t h e  the  be v i e w e d  learning  Second,  data  could  been p r o v i d e d  Reilly's  With  the  abusers  same a t t i t u d e  experiences  experiential have  child  same,)  and h o s p i t a l  differ  that  effect  the  community  study  found  a baccalaureate  studies  cational  present  were  demographics, or  in  had r e c e i v e d  i t  had  of  nurses  Reilly  who  attitude  groups  a function  a significant  nurses  received  study,  of  First,  had  registered  be  registered  findings  education  convenience  attitude  of  were  when  child  found  order  to  understand  Findings  of  the  scores  to  the  abuse. be n o t  this  of  the  subjects In  the  registered had met present  significant.  difference  in  the  an study,  Further findings  studies.  Descriptiye The d a t a experiences  provided  with  child  Open-Ended  Questions  information regarding abuse.  The  content  of  the the  community  health, nurses'  experience  for  the  67 subjects  in  Therefore,  the the  random and summary  convenience  reflects  the  groups  was  experiences  essentially  of  the  the  subjects  same.  in  both  groups. Eighty-six tified  a variety  primary  sources  Examples cation the  of  the  the  of  of  The  powerlessness  of  on t h e  the  between  the  of  of  health  child  or  need  identhe  for  edu-  regarding  inaccessibility  resources  the  as  families  for  professionals;  of  clearly  abuse.  the  and a b u s i v e  care  treatment  have  perceived  following:  unavailability  problem;  the  of  families;  limitations  and  in  frustration  resources.  responses  part  have  management  and community  monetary  these  the  conveyed  community  to  the  health  author  nurses  a sense  in  of  response  to  frustrations. An e x a m i n a t i o n  tions also  are  based  on v a r y i n g  more,  i t  is  treatment the  abuse;  treatment  of  the  nurses  they  professionals  regarding  a lack  in  health  which  included  allied  problems  content  community  factors  factors  child  nursing  from  the  frustration  professional  role  the  of  of  concrete  public,  communication  arising  of  of  phenomenon  adequate  the  percent  of  factors  tional  not  only  that  on these  combinations  clear  that  child  of  these  abuse.  identified  by  the  factors  these  factors  In the  community  considered  factors also  recognition community  health  as  hinder of  this,  health  in  they the  frustra-  isolation,  interact. prevention  the  nurses  nurses'  but Further-  and  significance assume  an  of  addi-  weight.  In health  revealed  an attempt nurses'  tigation  is  experienced  to  role  in  required by  the  alter  to  the  effectively prevention  ascertain  nurses  in  the  more  the  of  impact  child  abuse,  precisely  management  of  of  the  community  a critical  the  Issues  child  abuse.  and  invesproblems  The the  community  most  helpful  in  Human R e s o u r c e s tigation  of  Ministry. were  of  formal  child  abuse  Eight  that  a definition  expressed may h a v e  by  through  examine  the  study.  It  clearly  indicated,  attitude, for  each  have  had  scores as  of  the  the  of  reflect  intended  by  it  if  more  in  in  of  of  of  this  personnel  responses  in  situation  relat ion  relation  to  discussion  to  in  the  structure  to  the  subjects  statements  this  time  to  findings  of  the  Thurstone of  a  cognitive this  statements,the  and d i s l i k e s  was  been  in  regarding  (1946) group's  meaning  study  points:  on  these  findings,  the  child  abusers,  instrument.  researcher  concluded  the  may  attitude  Conclusions Based  -  fact  have  measurement  the  the  of  could  that  same  to  The b e l i e f  the  the  problem  additional  the  at  has  the  the  related  precise  seems n e c e s s a r y  indicated  counselling).  on  included.  although  the  (i.e.  comments  abusive  to  assume  been  discussion  likes  nurses  predominantly  earlier  Thus,  to  families  irrelevant,  subjects'  design  It  health  approaches  they were  these  comment  is  visions  the  the  community  had n o t  from  issue  been  inves-  school  a specific  subjects.  a range  do  that  the  and  therapeutic  of  that  recalled  that  Parents-in-Crisis  the  a definition.  be  whether  of  abuse  this  in  mandate  were  of  The M i n i s t r y  the  comments  if  have  within  These  validity will  is  provided  been p o s s i b l e  visualized  abuse  subjects  subjects  abuse.  that  helpful.  regarding  child  agencies  as h e l p f u l  the  of  these  as  treatment  of  questionnaire.  Centres,  the  child  regarded  be n e c e s s a r y  the  percent  of  child  one-half  would in  of  cited  instruction  responsibility  the  Health  than  identified  management  cases  frequently more  nurses  frequently  reported  Also, that  the  was  Mental  also  health  following  69 1.  The a t t i t u d e s  abusers  were more  2. tude  of  favorable  A significant  scores  and  the  the  community  than  nurses  toward  child  unfavorable.  relationship  variable,  health  exists  whether  the  between  the  subjects  subjects'  have  a t t i -  seen an  abused  child. 3.  Community  identify child  child  abuse  nurses  since  are,  a high  in  fact,  percentage  in  a key  have  position  detected  and  to reported  abuse. 4.  the  health  The  community  management 5.  health  The  of  child  factors  nurses  health  nurses  experience  various  frustrations  in  abuse.  that  may a l s o  cause  hamper  the  the  frustrations  prevention  for  and  the  community  treatment  of  child  abuse.  tion  6.  Many  in  order  Implications  community to  provide  for  Nursing  The r e s e a r c h nursing  nifcantly the  to  expose  services  found  health the  Such e x p o s u r e development  need  students  that  of  that  the  have  provide should  additional  nursing  the  implications  care  to  formal  these  instruc-  families.  nurses for  development  programs.  experience  of  an abused  toward  nursing  treatment  an o b j e c t i v e  the  education  nurse  provide  for  in-service  development  in  require  Education  and n u r s i n g  affected  community  attention that  study  nurses  comprehensive  findings  curricula  The  health  of  favorable  child  to  community  for  abused  learning attitude  attitudes  abusers.  educators or  seeing  plan  children  child  nurses and  that  child the  finding  learning  health  experiences toward  This  on  sig-  part  of  directs  experiences to  their would  abusers.  of  clinical families. foster  An a p p r e c i a b l e the  need  child  for  additional  abuse.  programmers of  child  of  nursing  This to  abuse;  practice known  abusers  is  crucial  its  i t  is  fore  have  ment  of  nursing  such  in  for  the  need on  for  the  the  prevention  that  the  health  regarding  nursing  should  and  of  treatment  development  educational  responsibility  of  the  to  begin  aspects  the  modes  problem.  attitude  toward  child  of  abuse.  Fur-  child  an o b j e c t i v e  process.  to  treatment  of  of  education  be d i r e c t e d  treatment  expressed  t h e management  and  an o b j e c t i v e and  nurses  in-service  preventative  attention  presence  Nurse  attitude  educators  has  there-  and n u r t u r e  the  develop-  implications  for  future  Research  findings  the  education  abusers.  information  is  have  experience  in  in  the  following  required  w i l l the  in  be needed community  the  child  This  these to  of  the  has  nurses of  seeing  favorable  attitudes however,  Further  to  abused for  experiences  aspects  critical  an  implications  learning  specific  are  this  t h e management  of  of  experiences,  abusers.  obtain  health  finding  planning  which  child  to  experience  development  regard  toward  to  the  planning  an abused  relation  to  the  to  that  scores.  regard  foster  attitude  Second,  indicated  attitude  Prior  seeing  favorable  trations  instruction  prevention  a planned  study  child  a  community  research.  effectively  of  the  the  Nursing  which  ience  to  the  of  attitudes.  affected  nursing  that  research  First, child  in  a particular  Implications The  specific  recognized  beginnings  the  attention  also,  is  formal  implies  focus  It  ther,  proportion  the  study  of  toward additional  the  exper-  development regarding  of this  information. experience child  a multitude  abuse w h i c h  of  often  frushinder  the of  prevention the  community  thereby  experienced  As  a  study.  As  been  a  of  nursing  required  community  remark,  phenomenon u n d e r  the  of  to  the of and  child  in  the  and  abuse.  treatment  this  study. to  these  in  the  has  been  the  in  of  the  nursing  the  abuse,  and  a  issues  value  of  their  to  1980)  dimensions the  families  research,  abuse.  replicated  (Reilly,  further study  problems  child  a  role  critical  and  of  findings  this  and  alter  problem,  shed upon  children  findings  child  the  research  The b e n e f i t  abused  of  to  management  reinforces  study,  light  of  order  precisely  nurses  author  In  management  determine  health  delivered  utilization  practice.  nurse  consequence  care  of  prevention  substantiated  the  and  by  final  of  upon  is  treatment  health  facilitate  investigation  have  and  quality depends  education  72  BIBLIOGRAPHY  Alexander, Heifer  H.  The  (Eds.),  Philadelphia:  social In  worker  helping  the  Lippincott,  Soled.  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Transacation,  July-August  77  APPENDIX  A  A T T I T U D E SCALE TOWARD PARENTS OR GUARDIANS WHO P H Y S I C A L L Y ABUSE T H E I R C H I L D R E N  The p u r p o s e  of  toward parents or findings  of  of  abuse.  child  this  questionnaire  guardians  the  study  who  could  is  to  physically  have  determine  abuse  nurses'  their  implications  for  the  Answer  feelings  children.  the  nursing  The  management  Instructions Please represents cern try  circle your  parents to  number  feelings  or  avoid  the  regarding  guardians  the  on  attached  each  statement.  who p h y s i c a l l y  undecided  category  abuse  unless  Sheet All  their  this  which  best  statements  children.  clearly  con-  Please  represents  your  feelings. The numbers  on  the  Answer  Sheet  correspond  to  the  following:  1 = Strongly Agree 2 = Agree 3 = Undecided 4 = 5 =  1.  Parents a  life  who h a v e  Disagree Strongly  physically  Disagree  abused  their  children  should  be  given  sentence.  2.  Helping  child  abusers  3.  Given  the  4.  Child  abusers  5.  One c a n s y m p a t h i z e  would  opportunity, deserve  I  be  would  satisfying verbally  as much h e l p  with  the  as  parent  work.  attack  anyone  who  an a b u s i v e  parent.  else.  physically  abuses  his  or  or  her  child. 6.  Child  abusers  7.  Given  the  enjoy  chance,  I  hurting would  their  help  kids.  a parent  stop  abusing  his  child. 8.  Child  abusers  don't  deserve  to  have  children  in  the  f i r s t  place.  her  79  9. 10.  It  is  With  impossible a  l i t t l e  to  1 = 2 =  Strongly Agree  3 =  Undecided  4 = 5 =  Disagree Strongly  sympathize  help,  abusive  Agree  Disagree  with  an a b u s i v e  parents  parent.  can resume n o r m a l  parental  duties. 11.  One c o u l d  12.  Parents  13.  Child  abusing  parents  14.  Child  abusers  should  15.  I  16.  Abusive  who  would  abused  say,  "Once  abuse  not  always  are  successfully.  up.  someone who h a s  need  abuser."  psychotic.  can be h e l p e d locked  a child  physically  as much l o v i n g  care  as  abused  their  a  child.  physically  child.  Child  abusers  18.  Child  abuse  19.  Child  abusers  don't  20.  Child  abusers  are  21.  I  22.  What  23.  Stiff  24.  You have  25.  One c o u l d  26.  Parents  27.  Child  abusers  don't  Child  abusers  should  would  sincerely  is  help  child  to  want  only  abusive  feel  being  Child  abusers  them  arrested.  to  stop  hurting  their  children.  do  help.  doing what  to  for  comfort their  work  their  should  sorry  abuse  any  parents  penalties  offer  who  want  sinful.  abusers  legal  without 29.  abuser,  children  be  to  17.  28.  child  their  apeak  parents  a  to  out  their  imposed child  a child  children  know how t o b e made  done  children  be  the  was  to  is  to  them as  children.  problems. unforgiveable.  on abusing  parents.  abuser. abuser.  should be show  their  feel  that  treated love they  for  as  criminals.  their  children.  can ask  for  help  unless  you  have  criticized. won't  stop  hurting  their  children  80 1  = Strongly  2 =  Agree  Agree  3 = Undecided 4 = Disagree 5 = Strongly Disagree  30.  Child  31.  It's  32.  Once p h y s i c a l l y the  abusers a  shame  should that  b e made  to  feel  worthwhile.  child  abusers  don't  receive  abused,  a child  should  more  understanding.  be p e r m a n e n t l y  removed  home.  33.  Child  34.  Helping  abusive  35.  A child  abuser  36.  It  is  abusers  should  be  parents should  pointless  to  sterilized. would  not  help  Copyright  Rights  Permission  Norma J .  Muir  to  Reilly,  has  Murphy 1981.  feel  experience.  like  parents.  Sandra Muir  questionnaires to  a worthwhile  b e made  abusing  All  Note:  be  Reilly  1978  Reserved  to  use  been by  these granted  Sandra  a  criminal.  from  81 ANSWER SHEET  A t t i t u d e Scale Toward P a r e n t s Who P h y s i c a l l y A b u s e T h e i r  1  =  2 = 3 =  Strongly  or Guardians Children  Agree  Agree Undecided  4 =• D i s a g r e e 5 = Strongly  Disagree  (1)  1  2  3  4  5  (19)  1  2  3  4  5  (2)  1  2  3  4  5  (20)  1  2  3  4  5  (3)  1  2  3  4  5  (21)  1  2  3  4  5  (4)  1  2  3  4  5  (22)  1  2  3  4  5  (5)  1  2  3  4  5  (23)  1  2  3  4  5  (6)  1  2  3  4  5  (24)  1  2  3  4  5  (7)  1  2  3  4  5  (25)  1  2  3  4  5  (8)  1  2  3  4  5  (26)  1  2  3  4  5  (.9)  1  2  3  4  5  (27)  1  2  3  4  5  (10)  1  2  3  4  5  (28)  1  2  3  4  5  (ID  1  2  3  4  5  (29)  1  2  3  4  5  (.12)  1  2  3  4  5  (30)  1  2  3  4  5  (13)  1  2  3  4  5  (31)  1  2  3  4  5  (14)  1  2  3  4  5  (32)  1  2  3  4  5  (.15)  1  2  3  4  5  (33)  1  2  3  4  5  (16)  1  2  3  4  5  (34)  1  2  3  4  5  (.17)  1  2  3  4  5  (35)  1  2  3  4  5  (18)  1  2  3  4  5  (36)  1  2  3  4  5  82 BACKGROUND DATA  SHEET  Instructions Please  answer  next  to  appropriate  1.  Age:  the  each o f  19 a n d  the  response.  under  20-29 30-39 40-49 50-59 60 and  2.  Marital  above  Status: Single Married Widowed Separated Divorced  3.  Ethnic  Background: Caucasian Black Oriental Hispanic Other  following  questions  with  a check mark  (/)  Do y o u h a v e  any  children?  Yes  If  yes,  how  No  many? 1  Childhood  2  Religious  3  4  5  More  Background:  Protestant Catholic Jewish Other None  What  is  the  highest  level  Completed  less  2.  Completed  7 grade  3.  Completed  at  4.  Graduated  from high  5.  Completed  at  Completed  four  bachelor's 7.  is  the  education  1.  6.  What  of  than  7  but  least  level  your  father?  than  grade  but  10  grade  less  than  12  school 1 year  years  of  of  college  college,  but  received  less  than  a  degree  Completed graduate or leading to a graduate  highest  by  grade less  10  least  achieved  of  professional degree  education  1.  Completed  less  than  2.  Completed  7 grade  3.  Completed  at  4.  Graduated from h i g h  least  7  but  achieved  education  by  your  mother?  grade less  10 g r a d e school  than but  10  grade  less  than  12  4  5. 6.  7.  Completed  at  Completed  four  degree  Completed  graduate  is  your  basic  Basic  of  or  of  college  college,  less  than  a  education  education,  leading  to  registration?  diploma degree  No p r e p a r a t i o n  beyond b a s i c  Some p o s t - b a s i c  credits  Baccalaureate  degree  Baccalaureate  degree,  Master's  degree  Doctoral  degree  have  in  education  diploma  toward  a baccalaureate  degree  nursing  other  you p r a c t i c e d  level of only.)  as  than  nursing  a registered  professional  nurse? up  Have y o u  to  1 year  3-4  years years  1-2  years  4-5  2-3  years  more  ever  received  formal  instruction  Yes  Have y o u e v e r Yes  4  degree  one o f t h e f o l l o w i n g d e s c r i b e s t h e h i g h e s t y o u h a v e now c o m p l e t e d ? ( P l e a s e check one  How m a n y y e a r s  but  received  professional  a graduate  nursing  Bachelor's  Which which  to  1 year  years  bachelor's  leading  What  least  than  abused No  years  regarding  No  seen a p h y s i c a l l y  5  child?  child  abuse?  85 14.  Were y o u p h y s i c a l l y  abused  as  a  child?  Yes  15.  Have y o u  ever  No  given nursing  care  to  Yes  16.  Have  you  ever  Have y o u  ever  been  in  contact  with  Have y o u  ever  detected  a case  Have y o u child  ever  abuse? Yes  parent?  of  child  abuse?  No  reported  a case  Yes  19.  an abusing No  Yes  18.  child?  No  Yes  17.  an abused  of  child  abuse  for  further  action?  No  been  involved  in  a court  " No  hearing  regarding  a case  of  86 QUESTIONS RELATED TO C H I L D  These  questions  any  of  your  you  consider  are  thoughts,  designed  feelings  valuable.  What  frustrations  2.  What  agencies  have  you  management  of  child  3.  Do y o u  feel  that  t h e management  4.  Other  comments:  of  have  you are child  to  you had  found  give  you an o p p o r t u n i t y  experiences  Responding  1.  the  or  to  the  ABUSE  about  question  child is  in  dealing  with  most  helpful  in  to  abuse,  optional,  child  write which however.  abuse?  assisting  you  with  abuse?  adequately abuse?  informed  about  child  abuse  for  87  APPENDIX B  April,  1982  Dear I the a  am a r e g i s t e r e d  University  research  toward  of  study  child  nurse  British in  regard  in  the  Columbia. to  Master's I  community  Program  in  am i n t e r e s t e d  in  health  nurses'  Nursing  at  conducting attitudes  abusers.  R e c o g n i z i n g t h e n a t u r e o f t h e p r o b l e m and t h e u s u a l therapeutic approaches employed i n the t r e a t m e n t o f the f a m i l y , I propose t h a t a study of community h e a l t h n u r s e s ' a t t i t u d e s toward p a r e n t s or g u a r d i a n s who p h y s i c a l l y a b u s e t h e i r c h i l d r e n w o u l d be s i g n i f i c a n t . I would a p p r e c i a t e i f you would complete the two (2) q u e s t i o n naires enclosed. The q u e s t i o n n a i r e s r e q u i r e f i f t e e n m i n u t e s t o complete. Responding to the open-ended questions i s o p t i o n a l . You a r e n o t r e q u i r e d t o s i g n y o u r name s o t h a t y o u r a n o n y m i t y a n d c o n f i d e n t i a l i t y is assured. Your p a r t i c i p a t i o n i n the study i s v o l u n t a r y . Completion of the questionnaire indicates your consent to p a r t i c i p a t e . You a r e f r e e t o w i t h d r a w f r o m t h e s t u d y a t any t i m e w i t h o u t j e o p a r d i z i n g your employment. Please complete the a t t i t u d e scale f i r s t , then proceed to the background data sheet. I would appreciate i f you would r e t u r n the q u e s t i o n n a i r e b y May 1 0 , 1 9 8 2 . Please f i n d enclosed a self-addressed envelope. The f i n d i n g s o f t h i s r e s e a r c h s t u d y w i l l be a v a i l a b l e to you upon r e q u e s t . Thank you f o r y o u r a t t e n t i o n t o t h i s request. Sincerely,  89  APPENDIX C  90 DESCRIPTIVE  Table Means  and  As W e l l of  Standard As  C-l  Deviations  Frequency  Responses  of  Attitude  and R e l a t i v e  According  (N =  Mean  Variable  ANALYSIS  to  Scores  Frequency  Age  132)  Standard Deviation  Relative Frequency  Frequency  -  -  Age: 19 a n d  -  -  20-29  68.9697.  12.3250  33  25  30-39  71.5870  11.1347  46  34.8  40-49  74.1212  13.5272  33  25  50-59  69.5000  15.5177  16  12.1  71.6667  11 .2398  3  2.3  1  0.8  60  1  under  case  and  above  missing  91  Table Means  and  As W e l l of  Standard  Deviations  of  Attitude  Scores  As F r e q u e n c y Responses  and R e l a t i v e Frequency A c c o r d i n g; t o A g e  (N =  Mean  Variable  C-2  15)  Standard Deviation  Relative Frequency  Frequency  Age: • 19 a n d  under  20-29  70.5000  4.6547  4  26.7  30-39  76.0000  16.9706  2  13.3  40-49  69.3333  15.2927  6  40.0  50-59  74.0000  4.2426  2  13.3  75.0000  0.0000  1  6.7  60 and  above  92 Table  C-3  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e Scores As W e l l A s F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f Responses A c c o r d i n g t o M a r i t a l Status (N = 1 3 2 )  Relative  Standard Mean  Variable  Marital  Deviation  Frequency  Frequency  Status:  Single  70.7073  15.1001  41  31.1  Married  71.1842  10.7786  76  57.6  Widowed  75.3333  18.5023  3  2.3  Separated  75.8333  15.3547  6  4.5  Divorced  71.8333  12.8906  6  4.5  Table  C -4  A t t i t u d e Scores Means and S t a n d a r d D e v i a t i o n s o f As W e l l As F r e q u e n c y and R e l a t i v e F r e q u e n c y o f Responses A c c o r d i n g t o M a r i t a l Status (N = 1 5 )  Mean  Variable  Marital  Standard Deviation  Relative Frequency  Frequency  Status:  Single  73.0000  5.6569  2  13.3  Married  73.4286  11.1184  7  46.7  Widowed  64.0000  0.0000  1  6.7  Separated  60.0000  0.0000  1  6.7  Divorced  72.2500  14.6373  4  26.7  93 Table Means  and  As W e l l of  Standard As  Deviations  Frequency  Responses  According  to  Attitude  Ethnic  Scores  Frequency Background  132)  Standard Deviation  Mean  Variable  of  and R e l a t i v e  (N =  Ethnic  C-5  Relative Frequency  Frequency  Background:  Caucasian  71.7540  12.5314  126  95.5  Black  62.5000  6.3640  2  1.5  Oriental  74.5000  12.0208  2  1.5  Hispanic  49.0000  0.0000  1  0.8  Other  57.0000  0.0000  1  0.8  Table  C-6  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e Scores As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f Responses A c c o r d i n g t o E t h n i c Background (N =  15)  Standard Variable  Ethnic  Mean  Relative  Deviation  Frequency  Frequency  Background:  Caucasian  71.9286  11.1111  14  93.3  Oriental  66.0000  0.0000  1  6.7  94 Table  C-7  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y and R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o W h e t h e r S u b j e c t s Have C h i l d r e n ( N = 132)  Variable  Mean  Do Y o u H a v e A n y  Standard Deviation  Frequency  Relative Frequency  Children?  Yes  70.9667  12.0844  60  45.5  No  71.7083  13.0454  72  54.5  Table  C-  8  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y and R e l a t i v e F r e q u e n c y o f Responses As t o W h e t h e r S u b j e c t s Have C h i l d r e n ( N = 15)  Variable  Do Y o u H a v e A n y  Mean  Relative  Standard Deviation  Frequency  Frequency  Children?  Yes  68.8750  11.4198  8  53.3  No  74.5714  10.0309  7  46.7  95  Table  C-9  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e Scores As W e l l as F r e q u e n c y and R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o t h e Number o f Children (N = 1 3 2 )  Relative  Standard Mean  Variable  Number  of  Deviation  Frequency  Frequency  Children: 54.5  None  71.7083  13.0454  72  One  69.0833  11.9731  12  -  Two  71.5714  11.7298  28  -  Three  70.8571  10.0679  14  -  Four  72.1667  19.7222  6  -  Five More  Than  Five  -  -  -  -  -  -  -  -  96  Table Means  and  As W e l l of  Standard  Deviations  As F r e q u e n c y  Responses  As  C-10  to  of  Attitude  and R e l a t i v e the  (N =  Number  of  Scores  Frequency Children  15)  Relative  Standard Mean  Variable  Number  of  Deviation  Frequency  Frequency  Children:  None  74.5714  10.0309  8  46.7  One  77.0000  0.0000  1  6.7  Two  64.0000  9.6437  3  20.0  Three  65.0000  10.3923  3  20.0  Four  87.0000  0.0000  1  6.7  Five More  Than  Five  -  -  -  -  -  -  -  -  97 Table  C-ll  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e Scores As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o C h i l d h o o d R e l i g i o u s B a c k g r o u n d (N =  132)  Mean  Variable  Childhood  Relative  Standard Deviation  Frequency  Frequency  Religious Background:  Protestant  71.5158  12.4754  95  72  Catholic  69.4545  12.1684  22  16.7  -  -  -  Jewish  -  Other  74.3000  15.7977  10  7.6  None  67.3333  12.7017  3  2.3  2  1.5  2 cases  missing  Table  C-12  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e Scores As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o C h i l d h o o d R e l i g i o u s B a c k g r o u n d (N =  Mean  Variable  Childhood  15)  Standard Deviation  Relative Frequency  Frequency  Religious Background:  Protestant  70.6923  10.5149  13  86.7  Catholic  77.0000  15.5563  2  13.3  98  Table  C-13  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y and R e l a t i v e F r e q u e n c y o f Responses A c c o r d i n g t o F a t h e r ' s Education (N = 132)  Mean  Variable  Father's  Relative  Standard Deviation  Frequency  Frequency  Education:  Less  than  Grade  7  67.0000  11.5326  15  11.4  Less  than  Grade  10  71.4828  11.0215  29  22.0  Less  than  Grade  12  75.6111  11.8129  18  13.6  71.9091  10.8185  22  16.7  65.7000  14.4994  10  7.6  B.A.  73.4731  15.0347  19  14.4  M.A.  69.2941  14.1896  7  12.9  H.  S.  Diploma  1 Year  2 missing  of  cases  College  1.5  99  Table Means  and  As W e l l  Standard As  Deviations  Frequency  Responses  C-14  According  to  (N =  Mean  Variable  Father's  of  Attitude  and R e l a t i v e Father's  Scores  Frequency  of  Education  15)  Standard Deviation  Relative Frequency  Frequency  Education:  Less  than  Grade  7  88.0000  0.0000  1  6.7  Less  than  Grade  10  69.0000  0.0000  1  6.7  Less  than  Grade  12  68.0000  7.5277  4  26.7  68.7500  8.4212  4  26.7  81.0.000  8.4853  2  13.3  H.  S.  1 Year  Diploma of  College  B. A .  70.5000  24.7487  2  13.3  M.A.  66.0000  0.0000  1  6.7  100  Table Means  and  As W e l l  Standard  Deviations  As F r e q u e n c y  Responses  C-15 of  Attitude  and R e l a t i v e  According (N =  to  Mother's  Scores  Frequency  of  Education  132)  Standard Variable  Mother's  Relative  Mean  Deviation  Frequency  Frequency  Education:  Less  than  Grade  7  70.9091  13.1107  11  8.3  Less  than  Grade  10  71.1492  13.1274  21  15.9  Less  than  Grade  12  69.0769  10.8048  13  9.8  72.9737  10.8690  38  28.8  71.9091  15.4482  33  25.0  B. A .  67.6000  13.1673  10  7.6  M.A.  71.0000  8.0623  5  3.8  1  0.8  H.  S.  Diploma  1 Year  1 missing  of  case  College  101  Table Means  and  As W e l l  Standard  C-16  Deviations  Responses  Attitude  Scores  and R e l a t i v e Frequency o f Education According to Mother's (N =  :  Mean  Variable  Mother's  of  As F r e q u e n c y  15)  Standard Deviation  Frequency  Relative Frequency  Education:  Less  than  Grade  7  88.0000  0.0000  1  6.7  Less  than  Grade  10  78.5000  13.4350  2  13.3  69.7500  10.6201  8  53.3  77.0000  0.0000  1  6.7  B.A.  66.0000  0.0000  1  6.7  M.A.  63.5000  9.1924  2  13.3  H.  S.  1 Year  Diploma of  College  102 Table  C-17  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s According to Educational Preparation for Registration (N =  Variable  132)  Relative  Mean  Standard Deviation  Frequency  Frequency  71.9437  12.4532  71  53.8  70.7049  12.7872  61  46.2  Educational Preparation for Registration: Diploma Baccalaureate  Degree  Table  C-18  M e a n s a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s According to Educational Preparation for Registration (N =  Variable  Educational for  15)  Relative Frequency  Mean  Standard Deviation  Frequency  70.5000  12.2597  6  40  72.2222  10.4616  9  60  Preparation  Registration: Diploma Baccalaureate  Degree  103 Table  C-19  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As As F r e q u e n c y and R e l a t i v e F r e q u e n c y o f Responses According to Present Level of Education (N =  Present  132)  Standard Deviance  Mean  Variable  Level  of  to  Relative Frequency  Frequency  Education:  Diploma Credits  Well  B.A./B.S.  7 3 . 2000  1 2 . 0546  15  11. 4  73. 1667  1 2 . 8656  30  22. 7  B. S.  (Nursing)  7 0 . 6625  1 2 . 6200  80  60. 6  B.A.  (Non-Nursing)  79. 5000  1 4 . 8492  2  1. 5  6 1 . 7500  1 1 . 3248  4  3. 0  Master's  Degree  Doctoral  Degree  1 missing  -  case  0.8  Table  C-20  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s According to Present Level of Education (N =  Well  15)  Standard  Present  Level  Credits B.S.  of to  Relative Frequency  Deviation  Frequency  66.3333  11.7189  3  20  72.8333  10.7097  12  80  Mean  Variable  Education: B.A./B.S.  (Nursing)  104 Table  C-21  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y and R e l a t i v e F r e q u e n c y o f R e s p o n s e s According to Years of Nursing P r a c t i c e (N = 1 3 2 )  Mean  Variable  Years  of Up  Nursing to  1  Standard Deviation  Relative Frequency  Frequency  Practice:  year  —  —  —  1-2  years  49.0000  0.0000  1  0.8  2-3  years  67.7500  15.2197  4  3.0  3-4  years  73.2500  15.0703  12  9.1  4-5  years  71.5556  5.8760  9  6.8  71.4906  12.5927  106  80.3  More  than  5  years  Table  C-22  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s According to Years of Nursing P r a c t i c e (N = 1 5 )  Mean  Variable  Years  of  Nursing  Standard Deviation  Frequency  Relative Frequency  Practice:  3-4  years  71.5000  7.7782  2  13.3  4-5  years  66.3333  5.5076  3  20.0  73.1000  12.5206  10  66.7  More  than  5  years  105 Table Means  and  As  Standard  Frequency  According  to  Deviations  and R e l a t i v e Formal  of  Attitude  Frequency  Instruction (N =  in  of  Scores  As  Well  Responses  Child  Abuse  132)  Relative  Mean  Standard Deviation  Frequency  Yes  71.0187  12.5713  107  81.8  No  72.8333  13.0106  24  18.2  Variable  Formal in  C-23  Frequency  Instruction  Child  Abuse:  Table  C-24  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s A c c o r d i n g t o Formal I n s t r u c t i o n i n C h i l d Abuse (N =  15)  Relative  Mean  Standard Deviation  Yes  71.1429  11.1138  14  93.3  No  77.0000  0.0000  1  6.7  Variable  Frequency  Frequency  Formal Instruction i n Child Abuse:  106 Table  C-25  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l Frequency and R e l a t i v e Frequency o f Responses A c c o r d i n g S u b j e c t s H a v i n g Seen an Abused C h i l d (N = 1 3 2 )  As to  Relative  Standard Variable  Seen an Abused  Mean  Deviation  Frequency  Frequency  Child:  Yes  7.0.4215  12.4075  121  91.7  No  81.8182  9.6625  11  8.3  Table  C -•26  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y and R e l a t i v e F r e q u e n c y o f Responses A c c o r d i n g t o S u b j e c t s H a v i n g Seen a n Abused C h i l d (N = 1 5 )  Relative  Mean  Standard Deviation  Yes  71.1538  11.5675  13  86.7  No  74.0000  4.2426  2  13.3  Variable  Seen an Abused  Frequency  Frequency  Child:  107 Table Means  and  Frequency  Standard  Deviations  and R e l a t i v e Subjects  of  Frequency  Were P h y s i c a l l y (N =  Attitude of  Abused  As  a  Scores  Responses  Abused As  a  As  As W e l l to  As  Whether  Child  132)  Mean  Variable  Physically  C-27  Relative  Standard Deviation  Frequency  Frequency  Child:  Yes  64.7143  21.0543  7  5.3  No  71.7440  11.9575  125  94.7  Table Means and Frequency  C-- 2 8  S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As and R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o W h e t h e r S u b j e c t s Were P h y s i c a l l y A b u s e d As a C h i l d (N = 1 5 )  Mean  Variable  Standard Deviation  Relative Frequency  Frequency  •  Physically  A b u s e d As  a  Child  Yes  64.0000  0.0000  1  6.7  No  72.0714  11.0137  14  93.3  108 Table  C-29  Means and S t a n d a r d D e v i a t i o n s o f Frequency and R e l a t i v e Frequency S u b j e c t s Have P r o v i d e d N u r s i n g (N =  to  Nursing  an Abused  Relative  Standard Deviation  Frequency  Frequency  Care  Child:  Yes  71.1176  12.4763  68  51.5  No  71.6406  12.7732  64  48.5  Table Means and S t a n d a r d D e v i a t i o n s o f Frequency and R e l a t i v e Frequency S u b j e c t s Have P r o v i d e d N u r s i n g (N =  Mean  Variable  Provided to  132)  Mean  Variable  Provided  A t t i t u d e S c o r e s As W e l l As o f Responses As t o W h e t h e r Care t o an Abused C h i l d  Nursing  an Abused  C-30 A t t i t u d e S c o r e s As W e l l As o f R e s p o n s e s As t o W h e t h e r Care t o an Abused C h i l d 15)  Standard Deviation  Frequency  Relative Frequency  Care  Child:  Yes  72.0000  12.7279  10  66.7  No  70.6000  6.5803  5  33.3  109 Table  C-30  Means and S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o W h e t h e r S u b j e c t s Have Been i n C o n t a c t w i t h an A b u s i n g P a r e n t (N =  Mean  Variable  Contact  132)  with  an Abusing  Relative  Standard Deviation  Frequency  Frequency  -  Parent: Yes  71.0902  12.6000  122  92.4  No  74.8000  12.3810  10  7.6  Table  C-• 3 1  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f Responses As t o W h e t h e r S u b j e c t s Have Been i n C o n t a c t w i t h an A b u s i n g P a r e n t (N =  Mean  Variable  Contact Parent:  with  Standard Deviation  Frequency  Relative Frequency  an Abusing  Yes No  15)  -  69.8462  10.4071  13  86.7  82.5000  7.7782  2  13.3  110 Table Means and Frequency  S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o W h e t h e r S u b j e c t s Have D e t e c t e d C h i l d Abuse (N = 1 3 2 )  Mean  Variable  Detected  Child  C-32  Relative  Standard Deviation  Frequency  Frequency  Abuse:  Yes  71.5288  12.5055  104  78.8  No  70.6667  13.2810  27  20.5  1  0.8  1 missing  case  Table Means  and  Frequency  S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o W h e t h e r S u b j e c t s Have D e t e c t e d C h i l d Abuse (N = 1 5 )  Mean  Variable  Detected  Child  C-33  Standard Deviation  Frequency  Relative Frequency  Abuse:  Yes  70.7778  11.7237  9  60  No  72.6667  10.2502  6  40  Ill Table  C-34  Means and Standard D e v i a t i o n s o f A t t i t u d e Scores As W e l l As Frequency and R e l a t i v e Frequency o f Responses As t o Whether S u b j e c t s Have Reported C h i l d Abuse (N = 132)  Mean  Standard Deviation  Frequency  Relative Frequency  Yes  71.2941  12.8758  119  90.2  No  72.0769  9.7763  13  9.8  Variable Reported C h i l d Abuse:  T a b l e C-35 Means and Standard D e v i a t i o n s of A t t i t u d e Scores As W e l l As Frequency and R e l a t i v e Frequency of Responses As to Whether S u b j e c t s Have Reported C h i l d Abuse (N = 15)  Relative Frequency  Mean  Standard Deviation  Yes  72.7273  11.7140  11  73.3  No  68.2500  8.3016  4  26.7  Variable  Frequency  Reported C h i l d Abuse:  112 Table  C-36  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o W h e t h e r S u b j e c t s Have Been I n v o l v e d i n a C o u r t H e a r i n g i n Regard t o C h i l d Abuse (N = 1 3 2 )  Standard Deviation  Yes  68.6667  13.3848  27  20.5  No  72.0667  12.3298  105  79.5  Involvement in  Relative  Mean  Variable  Regard  to  in  a Court  Child  Frequency  Frequency  Hearing  Abuse:  Table  C-37  Means a n d S t a n d a r d D e v i a t i o n s o f A t t i t u d e S c o r e s As W e l l As F r e q u e n c y a n d R e l a t i v e F r e q u e n c y o f R e s p o n s e s As t o W h e t h e r S u b j e c t s H a v e B e e n I n v o l v e d i n a C o u r t H e a r i n g i n Regard t o C h i l d Abuse (N = 1 5 )  Variable  Mean  Standard Deviation  Relative Frequency  Frequency  Involvement i n a Court Hearing i n Regard t o C h i l d Abuse: Yes  71.0000  0.0000  1  6.7  No  71.7500  9.6401  2  80.0  113  APPENDIX D  Descriptive  Analysis of the Experiences w i t h  Community H e a l t h C h i l d Abuse  Nurses'  Random G r o u p (N = 132)  Frustrations  Experienced  by  the  Community H e a l t h Range  Category 1.  Need f o r e d u c a t i o n o f t h e p u b l i c and a l l i e d professionals regardi n g t h e phenomenon o f c h i l d abuse  need  for  means need  for  ment Communication problems  of  of  with  Child  of  the  social  to  Frequency problem  and  the  court  know t h e  emotional  and  physical 1  l a w y e r s , and  education  registered  regarding  the  treat3  problem  and  "helping professionals"  the  of  the  problem  workers,  have more  Abuse  1  to  the  related to: t h e f a m i l y and the nurse  the  Dealing  Remarks  awareness  teachers  for  nurses  in  prevention  indications need  2.  public  to  of  Nurses  development and c o n t i n u a t i o n of a r e l a t i o n s h i p w i t h the family which w i l l facilitate t h e i d e n t i f i c a t i o n a n d ". treatment of the problem  6  i n s u f f i c i e n t evidence presented to the court r e g a r d i n g t h e home s i t u a t i o n ( c h i l d t h e r e b y s e n t home prematurely or the case i s rejected)  4  the  Remark  Range o f  -Category 2.  Communication problems (continued)  related the from of  to:  social the  lack workers  of  the  regarding  Human R e s o u r c e s  of  and t h e community health nurses  the  the (the  Inadequate provision of professional t r e a t m e n t and community resources  inadequate  knowledge  professionals, the  for  and  the  agencies  the  management 8  family  issue  of  confidentiality  meaning  was n o t 3.  of  this  remark  skill,  on  effective  part  of  management  the  of 13  lack  of  counselling  lack  of  support  5  services  number  insufficient  follow-up  irresponsibility for  of  of  insufficient  the  1  professionals treatment  and  15  support  10  professionals  a multidisciplinary of  6  services  insufficient  treatment  approach  to  the 4  problem  time  to  work  therapeutically  with  the 9  families lack (lack  of of  1  explained)  problem  need  of  communication  between  Ministry  Frequency  Remarks  continuity  in  co-ordination  the  treatment  between  the  of  the  families  agencies)  12  the  Remark  3.  Inadequate p r o v i s i o n of p r o f e s s i o n a l treatment and community r e s o u r c e s (continued)  Frequency o f the Remark  .Range of Remarks  Category  i n a b i l i t y to p r o v i d e the type o f immediate or support t h a t i s r e q u i r e d by the f a m i l y inadequate  treatment 2  5  f u n d i n g f o r community r e s o u r c e s  l a c k of support  f o r the a d o l e s c e n t who i s abused  minimal p r o f e s s i o n a l help p r o v i d e d f o r c h i l d n e g l e c t and sexual abuse inadequate 4.  management o f mental and emotional  1  2 abuse  3  L i m i t a t i o n s i n the c h i l d p r o t e c t i o n laws  need f o r the r e v i s i o n o f the l e g i s l a t i o n r e g a r d i n g the p r o t e c t i o n of c h i l d r e n ' s r i g h t s  5  Problems r e l a t e d to the j u d i c i a l system  r i g h t s of the parents a r e p l a c e d b e f o r e the r i g h t s of the c h i l d  2  c h i l d r e n can be r e t u r n e d to the custody o f the parents w i t h o n l y minimal p r o v i s i o n made, by the c o u r t , f o r s u p e r v i s i o n o f the home, or f o r a treatment p l a n f o r the f a m i l y  6  d e l a y s i n c o u r t hearings  3  u n p r e d i c t a b i l i t y of c o u r t h e a r i n g s  2  a d e c i s i o n r e g a r d i n g a c h i l d ' s f u t u r e placement should be made by more than one person (the judge)  1  as  Range  ' Category 5.  Factors families  related  to  the  the  parents  regarding (i.e.  of  insufficient  their  need  or  for  lack  general  lack  social  of  family  desire  to  and p e r s o n a l hinder  history low  (father's)  the the  community problem  2  problems  change:  1 of  child  abusive  many  behavior  of  is  form of  2 behavior  regarded  by  parents  inadequate  or  in to  lack  the  1  manage of  support  systems  expectations  children  1 1 1  motherhood  unwanted  an  1  family  dependency  unrealistic  as  3  discipline  2  children baby"  4  patterns  problems  "difficult  alcohol  2  unemployment  acceptable marital  1  abuse  self-esteem  "deep-rootness"  young  6  change  money  parents'  too  assistance  7  inadequate  sometimes  of  awareness  professional  the f a m i l y ' s disappearance from f o l l o w i n g the i d e n t i f i c a t i o n of  the  of  resistance)  family's  that  Frequency  Remarks  of  the  baby  1 1  the  Remark  Range o f  Category Factors r e l a t e d to the f a m i l i e s w h i c h impede treatment (continued)  general that  social  and p e r s o n a l  sometimes  frequent no  hinder  moves  interests  situations change,  by  the  home  there  is  i.e.  mother  is  i l l  and i s  unable  mentally  the  Remark  (continued)  (relocation)  in which  of  problems  change:  outside  Frequency  Remarks  the  1  family  1 l i t t l e  mentally to  hope  for  retarded  care  or  for  children General b e l i e f s regarding the r i g h t s of p a r e n t s , and c h i l d rearing practices  people that  have  one  right  to  (professional,  interfere rearing  the  with  unless  parent  as  neighbor)  a parent's requested  they  do  1  not  1  should  approach to  wish  to  so b y  childthe  parent A t t i t u d e s and f e e l i n g s of professionals that h i n d e r management o f t h e problem  the  presence  before  of  a feeling  attempting  to  the  belief_that.the.child  the  parents:  suffer  further  feelings guilt  'often  of  of  change  defeat, the  should  even  situation remain .with  t h i s "causes "the  child  to  1  abuse  1  anger  (following  the  identification  of  the  1 1  rebuke frustration  problem)  (due  to  the  attitudes  of  allied  professionals)  00  Range  Category 7.  A t t i t u d e s and f e e l i n g s of professionals that h i n d e r management o f t h e problem (continued)  helplessness  or  of  belief  fere  in  matters,  fear  and  do n o t  anxiety  for  acknowledge  working with  that  one  should  unless  not  the  children  when  behavior  as  parents  inter1  requested  their  abusive  is  the  parents 1  abusive  emotionally 1  draining 8.  Limitations i n the of the community h e a l t h nuse  role  the  role  of  clearly  the  input  by  decision-making the 9.  Need f o r programs abuse  preventative for child  for  regarding need their  for  11.  Reluctance of neighbors t o r e p o r t c h i l d abuse Reluctance sionals child  to  abuse  of  nurse  is  not 4  community process  health  regarding  nurses  to  treatment  the of 1  education  of  high  school  students 1  "parenting" parenting  classes  for  parents  who  abuse 1  children for  problem 10.  health  problem  need  need  community  identified  limited  of 2  hopelessness  professionals' family  Frequency  Remarks  an i n t e r d i s c i p l i n a r y  approach  to  the 4  3  profes-  report 3  the  Remark  Range  Category 12.  C h i l d abuse - a c u l t problem to  d i f f i prove  difficult without there  to  being  may b e  enough often  determine  to  in  prove  parents  is must  difficult  to  the must  the  to  Frequency  Remarks occurrence  home  evidence  a crisis  behavior  the  of  of  child  a  suspicion,  but  for  the  Remark  not 5  case develop  before  the  abusive 1  recognize  distinguish  the  need  for  an a c c i d e n t a l  1  change  and  abusive 3  injury need  Remark  1  identified first  the  abuse  extensively support  of  physical  marking  before  there  is  a  1  case  Comments (N = 1 3 2 ) Range  Category 1.  Need f o r of child  a definition abuse  need of  2.  Need  for  3.  Need f o r measures  a team  for  a standard  professionals child  in  of  definition  the  Frequency  Remarks to  be used by  identification  and  a l l  treatment 2  abuse  1  approach  preventative  of  Means: post-natal visits fathers involvement increased increased  public family  in  pre-natal  awareness awareness  of of  the the  and p a r e n t i n g problem community  groups  resources  1  Range o f  Category 3.  Need f o r measures  preventative (continued)  development  of  high  preparation  school  parenting more  4.  Need  for  professional  education  Need 6.  for  research  Perceived difficulties in assisting families  self-esteem,  through  of  adolescence  education  of  high  risk  regarding  regarding  the  regarding  t h e management  -  the  parents' difficult  treatment  etiology  resistance to  child  insufficient and  follow-up  are time  of  child  sexual  2  abuse of  child  refuse  abuse  help)  the  child  while  1 1  scarce to  social  3 1  problem  the safety of counselling  for  2  abuse  parents  are  attitudes, of nursing  4  (i.e.  hesitant  cases  feelings, provision  of  the  1  abuse  treatment  facilities  professionals  2  2  families  and  identify  d i f f i c u l t to ensure the family receives treatment  parenting  2  r e g a r d i n g t h e management o f b e l i e f s t h a t may h i n d e r t h e care  focus  for  of  1  schools  groups  supervision  public  Frequency  Remarks  become workers  involved to  investigate  3  the  Remark  Range o f  Category 6.  Perceived difficulties in assisting families (continued)  lack  of  a screening  of  abuse  home  a protocol,for  to  be used by  cultural abuse social  a  perceived worker's  the  all  detection  of  the  Remark  the  are  the  management  between  inadequate  child's  differences  of  child 1  professionals  communication  studies  regarding  Child  for  of  1  inadequate  as  tool  problem lack  7.  Frequency  Remarks  for  professionals a court  decision 1  placement in  1  disciplining  1  children  c h i l d abuse i s r e g a r d e d as a s o c i a l p r o b l e m a n d , as s u c h , s h o u l d be d e a l t w i t h by s o c i a l w o r k e r s  1  issue 8.  Need  for  specialized  a  specialized  have  worker  the  worker  in  responsibility  each h e a l t h of  providing  unit  should  care  to  these 1  families 9.  The p r o b l e m abuse  of  sexual  need f o r incest  strict  increase public t h i s problem 10.  11.  The p r o b l e m o f e m o t i o n a l abuse neglect Need  for  resources  these  problems  there  is  enforcement  of  legislation,  and p r o f e s s i o n a l  awareness  regarding  1  of 1  are  seldom  treated  professionally  1  and  community  day  cares  a need f o r  volunteer  groups  and  1 2  to  Range o f  Category 12.  The need  for  reporting  mandatory  fines child  13.  Questionnaire  should  citizen  the  or  be  the  punishment  professional  Frequency  Remarks  to  for  report  the  were  too  s i n f u l i s n o t a word t h a t can be o f t h e p a r e n t s , make i t s o , t h a t f o r what t h e y have done t h e s e s t a t e m e n t s may a p p l y but n o t a l l cases questionnaire  the in  was  a b u s e was n o t  questionnaire  nurses  of  Remark  a  known  general  t h e q u e s t i o n n a i r e does n o t c o n s i d e r t h a t can be o b s e r v e d i n c h i l d abuse  the  or  the  abuse  questions  child  failure  suspected  of  -  since  child  abuse  to  the  differences  used- the conditions one can f o r g i v e them -  a percentage  difficult  to  answer  of  cases,  because  defined  is  they  not are  appropriate not  the  to  the  front-line  work  of  workers  most q u e s t i o n s were easy t o answer by t h e o b v i o u s n e s s of the attitudes b e i n g a t r a i n e d p r o f e s s i o n a l , one c a n q u i c k l y see how one s h o u l d b e a n s w e r i n g -  there  is  a difference  upon n a t u r e multiple since  of  choice  no answer  the  in  one's  feelings  dependent  abuse  questions  are  difficult  to  answer  fits CO  .Range o f  Category 13.  the  Questionnaire (continued)  responses  were not child as  (strongly  appropriate  abusers  are  agree :to  for  only  all  doing what  Analysis of the Experiences w i t h  (N =  by  Community  Communication  problems  was  social  Resources  and  Community H e a l t h C h i l d Abuse  Health  to  parents  receive  example  not  P u b l i c and p r o f e s s i o n a l a t t i t u d e s toward c h i l d r e n and c h i l d abuse  child  Nurses'  Nurses  in  Dealing with  Child  Abuse Frequency  of. Remarks  our  is  are  society  minimal  health  of  Human  nurses 1  counselling  3  cited  abuse  a punitive  Remark  them  Group  workers from the. M i n i s t r y o f community  Inadequate p r o v i s i o n of professional treatment and community r e s o u r c e s  children  the  i.e.  done  between t h e community h e a l t h n u r s e and t h e family a f t e r the i d e n t i f i c a t i o n of a c a s e . o f c h i l d abuse (issue of mistrust involved) between  Remark  15)  Range  Category 1.  the  1  Convenience  Experienced  of  strongly-disagree)  questions,  children  Descriptive  Frustrations  Frequency  Remarks  accepted  given  attitude  low  in  our  priority  toward  1  society  child  (example abusers  not  cited)  exists  in  1  Range o f  Category 4.  5.  Need f o r programs abuse  preventative for child  Behavior  and/or  attitudes toward 6.  of  need for  for  the  preparation  Frequency  Remarks of  high  school  for  lack  of  day  the  Remark  the  Remark  students 1  parenting  need  of  care  centres  co-operation  for  from  1  children  1  parents  family  treatment  C h i l d abuse - a d i f f i c u l t problem to prove Comments  15)  (N =  Range o f  Category 1.  2.  Need  for  education  of  professionals  professionals  have  The r o l e o f community health nurses i n the p r e v e n t i o n and t r e a t ment o f c h i l d abuse  nurses problem  of need the  for  to  to  take  to  political  abuse  place  families  need  to  through  the of  action the  regarding  the 1  R.N.A.B.C.  protection  of  self  interacting  when  children 1  professionals..  develop  a policy,  recording  questions  these  (many)  of  within  physical  poorly  worded  the  child  health  unit, 1  abuse  because  of  double 1  negatives answers the  could  abuse  of  1  protection  allied  the  working with training  child  before  need  Questionnaire  need  nurses with  3.  formal  Frequency  Remarks  have been d i f f e r e n t  had been  identified  if  the  nature  of 1  

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