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首页> 外文期刊>Prehospital emergency care >BARRIERS AND FACILITATORS TO RECOGNITION AND REPORTING OF CHILD ABUSE BY PREHOSPITAL PROVIDERS
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BARRIERS AND FACILITATORS TO RECOGNITION AND REPORTING OF CHILD ABUSE BY PREHOSPITAL PROVIDERS

机译：障碍和促进者通过预播种提供者承认和报告儿童虐待

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Background: Prehospital care providers are in a unique position to provide initial unadulterated information about the scene where a child is abusively injured or neglected. However, they receive minimal training with respect to detection of Child Abuse and Neglect (CAN) and make few reports of suspected CAN to child protective services. Aims: To explore barriers and facilitators to the recognition and reporting of CAN by prehospital care providers. Design/Methods: Twenty-eight prehospital care providers participated in a simulated case of infant abusive head trauma prior to participating in one-on-one semi-structured qualitative debriefs. Researchers independently coded transcripts from the debriefing and then collectively refined codes and created themes. Data collection and analysis continued past the point of thematic saturation. Results: Providers described 3 key tasks when caring for a patient thought to be maltreated: (1) Medically managing the patient, which included assessment of the patient's airway, breathing, and circulation and management of the chief complaint, followed by evaluation for CAN; (2) Evaluating the scene and family interactions for signs suggestive of CAN, which included gathering information on the presence of elicit substances and observing how the child behaves in the presence of caregivers; and (3) Creating a safety plan, which included, calling police for support, avoiding confrontation with the caregivers and sharing suspicion of CAN with hospital providers and child protective services. Reported barriers to recognizing CAN included discomfort with pediatric patients; uncertainty related to CAN (accepting parental story about alternative diagnosis and difficulty distinguishing between accidental and intentional injuries); a focus on the chief complaint; and limited opportunity for evaluation. Barriers to reporting included fear of being wrong; fear of caregiver reactions; and working in a fast-paced setting. In contrast, facilitators to reporting included understanding of the mandated reporter role; sharing thought processes with peers; and supervisor support. Conclusions: Prehospital care providers have a unique vantage point in detecting CAN, but limited resources and knowledge related to this topic. Focused education on recognition of signs of physical abuse; increased training on scene safety; real-time decision support; and increased follow-up related to cases of CAN may improve their detection of CAN.
机译：背景：预孢子护理提供者处于一个独特的位置，以提供有关孩子滥用或被忽视的场景的初始纯粹的信息。但是，他们对虐待儿童滥用和忽视（CAN）的检测获得最小的培训，并少数关于疑似愿意涉及儿童保护服务的报告。目的：探索障碍和促进者通过预休霍惠护理提供者来认可和报告。设计/方法：二十八个预科护理提供商在参加一对一半结构定性汇率之前参与了婴儿滥用头部创伤的模拟案例。研究人员从汇报中独立编码成绩单，然后是集体精制的代码和创建主题。数据收集和分析仍在继续进行主题饱和点。结果：供应商描述了3患者认为患者虐待的3个关键任务：（1）医学管理患者，其中包括对患者的气道，呼吸和流通和管理的评估，然后进行评估; （2）评估现场和家庭互动的迹象表明可以提出俱乐部的迹象，其中包括收集有关出现物质的存在并观察儿童在照顾者存在的情况下的信息; （3）创建安全计划，其中包括呼叫警方的支持，避免与护理人员的对抗，并与医院提供者和儿童保护服务分享愿意。报告的识别障碍可以包括儿科患者的不适;有关的不确定性（接受父母的故事，关于替代诊断和难以区分意外和故意伤害的困难）;专注于首席投诉;和评估机会有限。报告的障碍包括害怕错了;害怕照顾者反应;并在快节奏的环境中工作。相比之下，促进者报告包括对授权的记者作用的理解;与同龄人分享思维过程;和主管支持。结论：预孢子护理提供者在检测中具有独特的有利程度，但与本主题相关的资源和知识有限。专注于认可身体虐待迹象;增加了现场安全培训;实时决策支持;与可以提高他们对罐的检测的情况有关的随访。

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