Bakgrund: Sexuella övergrepp mot barn (CSA) är ett globalt problem och mörkertalet är omfattande. Cirka sex barn i varje klass drabbas någon gång av CSA i Sverige. Sjuksköterskan har en nyckelroll att upptäcka CSA då de oftast först kommer i kontakt med barnet och dess vårdnadshavare inom vården. Det är därför viktigt att sjuksköterskan kan urskilja tecken på våld mot barn i ett tidigt stadie för att skydda och lindra utsatta barns lidande. Syfte: Syftet med denna litteraturstudie var att beskriva strategier sjuksköterskan behöver i mötet med barn som visar tecken på eller berättade om sexuella övergrepp. Metod: En allmän litteraturstudie baserat på tio vetenskapliga artiklar, sju av artiklarna var kvalitativa och tre var kvantitativa. Resultat: Resultatet av denna litteraturstudie visade att sjuksköterskans strategier innefattade att ha kompetens om CSA, följa vårdenhetens riktlinjer och handlingsplaner samt handha ett professionellt tillvägagångssätt. Slutsats: Det fanns ett stort behov av att implementera adekvat kompetens om CSA inom vården och i utbildningar. Att internationellt tillföra gemensamma riktlinjer, handlingsplaner, checklistor samt en allmän definition av vad CSA innebar, underlättade sjuksköterskans proaktiva arbete. Klinisk betydelse: Tydliga riktlinjer, kompetens och professionellt bemötande i kontakt med CSA underlättar sjuksköterskans omvårdnadsarbete. Korrekta omvårdnadshandlingar bör bidra till ett bättre välbefinnande för barn och minskar mörkertalet för folkhälsoproblemet.

Background: It's a fundamental principal to protect children's rights. Through legislation, child abuse has been prohibited in many countries. Nurses working with children has a frontline role in identifying and reporting suspected or known child abuse. Mandatory reporting is one of the nurse's duty, reluctancy to report can lead to misconduct but it also leads to children suffering. Aim: The purpose of this degree project was to identify factors preventing nurses from mandatory reporting of children in health care. Method: A literature study based on using and analysing nine qualitative articles. Results: Three themes emerged in the result. The first theme was knowledge deficit, with two subthemes which were the need of education of signs and symptoms and the other subtheme was insufficient experiences. The second theme was nurses strained work environment with three subthemes. The first subtheme was the lack of routines, the second one miss information and the third one lack of cooperation and communication. The third theme consists of two subthemes, which were the lack of emotional support and the experience of fear. The results showed that nurses due to different factors relinquished from mandatory reporting.  Conclusion: The results highlighted that education and training was needed among nurses to gain knowledge on how to safeguard children and establish mandatory reporting. Thus, support from colleagues and managers agencies dealing with child safety was highly valued by nurses. Implementation of education, training and support could improve the cooperation in protecting children.

Bakgrund: Barn som far illa är ett vitt begrepp och innefattar såväl fysiskt som psykiskt våld mot barn samt omsorgssvikt. Forskning visar att all form av vanvård och omsorgssvikt i barndomen har samband med ökad risk för en rad konsekvenser även i vuxenlivet. Hit räknas flera sjukdomar, ökat riskbeteende, sämre självskattad hälsa samt sämre socioekonomisk status. Staten har det yttersta ansvaret för alla barn under 18 år. Som ett led i detta har bland annat sjukvårdspersonal en plikt att anmäla till socialtjänsten vid misstanke om att ett barn far illa. Dock finns undersökningar som visar på underrapporteringar från just hälso- och sjukvården. Syfte: Att beskriva sjuksköterskors erfarenheter av att i sin profession möta barn som far illa. Metod: En beskrivande litteraturstudie av tio artiklar med kvalitativ ansats. Huvudresultat: Att möta barn som far illa genererar många gånger starka känslor hos sjuksköterskorna och det finns ett stort behov av emotionellt stöd. Många sjuksköterskor beskriver att de känner sig oförberedda på uppgiften att möta dessa barn. De finns även en osäkerhet över när misstankar anses giltiga att anmäla varför både utbildning och handledning återkommande efterfrågas. Slutsatser: Sjuksköterskor behöver stöd i arbetet med den här frågan. Specifik utbildning och utarbetade riktlinjer skulle utgöra bra verktyg, samt om stöd och debriefing också arrangerades från ledningsnivå. Ett förbättrat samarbete med socialtjänsten skulle kunna avdramatisera processen att anmäla. / Background: Child abuse leave marks into adulthood. Research shows that abused children take higher risks in their teens, report lower self-estimated health as adults, are overrepresented in several physical and psychological conditions, and also hold lower socioeconomic status. Child abuse includes all forms of physical, psychological and emotional abuse as well as neglect. It is the outermost responsibility of the Swedish state to protect all children under the age of 18. As a part of that responsibility some professions, including health care personnel, are legally liable to report to social services. However, figures indicate that health care personnel in comparison to other professions with duty of mandatory reporting are under-reporting. Aim: To describe nurses’ experiences of in their role as professionals meeting abused or neglected children. Method: A descriptive literature review of ten studies with a qualitative approach. Main results: Meeting abused or neglected children is often a very emotional experience and several nurses express a need of support. A feeling of being unprepared is common and an insecurity of when to report a case is shown among many nurses. More education on the subject is requested as well as guidelines and support from the employer. Conclusion: Nurses are in need of support regarding these issues. Specific education, guidelines and a better communication with the child protective services has all emerged as possible improvements that can be implemented.

Background Child maltreatment has increased over the past years. There is no direct relation-ship between child maltreatment and the actual living condition of the children. All children should be protected against all types of physical, mental and sexual abuse. It is of great im-portance that nurses have knowledge of how to report when they suspected child maltreatment. Aim The aim was to describe nurses´ experiences of reporting when child maltreatment is sus-pected. Methods A method to contribute to evidence-based nursing with ground in analysis of qualita-tive research was performed. In this study nine qualitative articles were analyzed. Results From the analysis three main themes were identified; a difficult task, need of support and create a holistic view of children. Seven subthemes were identified; manage their own lack of knowledge, uncertainty and fear, trust their judgment and courage to act,protection of children's safety and well-being, support from colleagues and management, interact with child protection services, strengthen trust with related parents of the child and environment affecting children.Conclusion Conclusions that can be deduced from this study are to highlight the need for support and knowledge of how a report is conducted. Consequences to not report child maltreat-ment is described in this study as well as which benefits a report of child maltreatment may give for both children and close relatives.

Knowledge concerning the social services’ use of the Care of Young Persons (Special Provisions) Act 1990:52 (CYPA) is relatively scarce, especially when it comes to the protection of adolescents victimized by abuse. The overall aim of this thesis is to investigate and discuss different conceptualisations of abuse, adolescents’ agency regarding abuse, victimization and social intervention, and how abuse and adolescent victimization are responded to, primarily by the social services. This is done from a stance influenced by critical realism as well as victim- and child-centred responses. The dissertation consists of four papers and examines these themes in two samples of judgments and related documents concerning applications for care of adolescents aged 13-17 under the CYPA. The findings from the total study of all judgments in the selected year clearly confirm § 2 CYPA as a rare intervention to protect adolescents. In only 85 of Sweden's 290 municipalities was a CYPA application made, but a main finding is that such care to a large extent was used to protect adolescents from various forms of abuse. In the total study, the applications of § 2 CYPA concerned 196 adolescents, for 70 per cent of whom abuse was described, and where more girls (96) than boys (41) were being considered for care based on abuse. Of all the girls, 79 per cent were described as subjected to abuse and of the boys 55 per cent. Also in the smaller sample consisting of judgments for 37 girls in care under § 2 CYPA and §§ 2 and 3 CYPA, abuse was described for many. For several adolescents in both samples abuse was described as having been exerted to maintain standards of honour, shame and virginity, and/ or to enable a forced marriage. The initiative and agency of the adolescents themselves in both the disclosure of abuse as well as the decision on alternative care is one of the most striking findings in the thesis. The majority of the adolescents, 71 per cent, were categorized as having intentionally disclosed the abuse. The aftermath of the disclosure was for many of the adolescents described as intensely challenging. For the majority the abuse was denied during the investigation, not only by the alleged abusers but also by non-abusing parents and other relatives. The findings relating to the social services responses suggest that the initial response to a high degree could be understood as parent-oriented. For 33 per cent, the judgment also revealed that the abuse had been disclosed to authorities one or several times prior to the investigation leading to the application for care under the CYPA. That the abuse in these cases had been known to the social services for on average 5 years can from a child-centred position be seen as a major failure regarding the system’s ability to reach children and stop abuse. A central conclusion is that the various forms of abuse described seem more connected to domination, fear, power and control than to conflict; to some extent mirroring the kind of systematic oppression described for victimized adults seeking the protection of NGOs and public authorities. The findings imply that interventions under the CYPA may enable more child-centred, safe and stable protection of children subjected to this kind of abuse. Given the findings in the present thesis it is argued that it may be important to differentiate the concept of abuse as well as to acknowledge the agency of children in both research and in practice. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Manuscript.</p>

M.A. (Clinical Psychology) / The present study explores, through means of a selective literature study and the presentation of a descriptive single case study, whether fairy tales can be used as a viable medium or tool in therapeutic work with children. This involves an examination of a central debate between theoretical perspectives that advocate an understanding of fairy tales based on their intrinsic or absolute meaning or those that view fairy tales from a relational perspective where meaning is consensually negotiated and validated through its interpersonal locatedness. A single descriptive case study, in which fairy tale telling was a feature of a therapeutic case conducted with a five-year-old client at a children's home, is presented and evaluated in light of the literature reviewed. It was found that themes similar to those reflected in the review of the literature were present and evidenced by the therapist involved wi th the clinical case study. These themes are conceptualised using a constructivist framework that offers an integrative conceptualisation accommodating both intrapsychic as well as inter-personal theoretical distinctions.

Afrikaans: In hierdie proefskrif word die pastorale begeleiding van gesinne waarin kindermishandeling voorkom, nagevors. Die navorser het toenemend met gesinne waarin kindermishandeling voorkom te doen gekry. Daar bestaan by pastorale werkers (almal wat op een of ander wyse pastorale hulp verleen) onsekerheid en onkunde oor die begeleiding van hierdie gesinne. Daar bestaan ook 'n behoefte aan 'n pastorale benadering, aangesien kindermishandeling nog altyd binne die maatskaplike en psigologiese studievelde geressorteer het. Samelewingsprobleme, soos geweld, immorele dade en emosionele probleme gee dikwels tot kindermishandeling aanleiding. Hierdie studie neem die narratiewe benadering as uitgangspunt en wil aan die hand van enkele gevallestudies, op die bruikbaarheid van die narratiewe benadering reflekteer. Die mens word binne sy lewensverhaal en konteks verstaan, want die praktiese teologie as handelingswetenskap, kies sy uitgangspunt in die ervaringswêreld van mense en die situasie van die kerk in die samelewing. God het die mens as Sy verteenwoordiger en as kroon van die skepping gemaak. Met die sondeval het daar 'n skeiding in al die mens se verhoudings gekom. In sy genade rig God 'n verbond op waarin Hy homself aan die mens verbind. Die pastorale perspektief maak ems met die verhaal van 'n handelende Verbondsgod wat verlore mense red en in die versoeningswerk van Jesus Christus, Sy oneindige liefde vir die sondaar bewys. Die Koninkryk van God kry in elke mens gestalte as die mens die waardes van die Koninkryk erken en daarvolgens lewe. Die waardes is Iiefde, geregtigheid, vrede en hoop. In die gesin waarin kindermishandeling plaasvind, ontbreek hierdie waardes dikwels, want mishandeling is teenstrydig met God se plan vir die gesin en kinders. Deur die simbiotiese werk van die Heilige Gees word die mens in nood op die toekoms gerig, met hoop, nuwe groeipotensiaal en oorwinning. Die navorsing toon dat ‘n gesin wat met sy noodstorie van mishandeling weer oor die toekoms, onder leiding van ‘n bekende God begin droom, in die hede weer liefde, vrede, duursaamheid en veiligheid kan vind. Die benaderings van Müller en Freedman&Combs, asook die benutting van die genogram, stel pastors in staat om, saam met die gesin waarin kindermishandeling voorkom, dominante verhale te dekonstrueer en ‘n nuwe realiteit te konstrueer. English: This dissertation reports on a study of the pastoral counselling of families in which child abuse occurs. As research progressed, the researcher came into contact with increasing numbers of such families. Many pastoral workers (this includes all those who render pastoral assistance of some kind) are not adequately qualified to work with these families, and their lack of knowledge gives rise to uncertainty. There is also a need for a pastoral approach, since child abuse has always fallen with the specific fields of study of Social Science and Psychology. This study is based on the narrative approach and reflects on its usefulness by referring to a number of case studies. Since practical theology as an active science chooses as its point of departure the world as experienced by individuals, and the role of the church in society, man is viewed in the context of all his life experiences or his personal history. God created man as His representative on earth and as the pinnacle of His creation. The Fall resulted in the disintegration of man's relationship with God and with his fellow men. In His mercy God established a covenant, binding himself to mankind. The pastoral perspective is serious about this God of the Covenant who acts to save those that are lost and who, through the redeeming work of Jesus Christ, demonstrates His boundless love for sinners. The Kingdom of God is reflected in every person who acknowledges the values of the Kingdom and lives according to them. These values are love, justice, peace and hope. In families where children are abused, these values are often absent, since abuse is in conflict with God's plan for the family and for children. Through the symbiotic working of the Holy Spirit, people in need are helped to face the future with hope and a new potential for growth that can ultimately lead to victory. The research revealed that a family with a history of abuse can, under the guidance of a God that they know, again begin to dream about the future and can once again experience love, peace, stability and security. The approaches followed by Müller, Freedman&Combs, as well as the use of the genogram, enable pastors to assist members of families where child abuse occurs in deconstructing dominant experiences and constructing new realities. / Thesis (PhD (Practical Theology))--University of Pretoria, 2007. / Practical Theology / unrestricted

The study examines the nature and extent of child labour in Goromonzi District farms in Zimbabwe. The main objective of the study was to investigate the nature and extent of child labour in Goromonzi District farms. The study reveals high levels of child exploitation and abuse. A qualitative design was chosen and purposive sampling was used. Interviews were used to collect data. The sample consisted of 40 children between 7 and 16 years. Interviews were also conducted with the Coalition Against Child Labour in Zimbabwe (CACLAZ). CACLAZ is an NGO that specializes in the elimination of child labour in Zimbabwe through the provision of education. The study reveals different forms of child labour. These include children working in communal and commercial farms, children working in domestic set up and child prostitution. The study exposes some of the causes and effects of child labour. Poverty, increased cost of education, and cultural practices were some of the causes of child labour. The study also reveals gaps that exist in the LRA. In view of the findings, the study makes recommendation on how to curb child labour and protect the rights of children as enshrined in various international instruments such as the CRC and ILO Conventions.

Although there is an increasing amount of literature on child sexual abuse, there is a dearth of information on the experiences of non-offending fathers of sexually abused children. Uncovering the issues that these fathers encounter after learning about the abuse of their children is essential in designing a therapeutic framework to help these men and their families. This qualitative study explored the experiences of four non-offending fathers of sexually abused children. Each subject was interviewed on video tape for approximately one hour using a general interview guide. The results were categorized into four areas: initial reaction to disclosure, changes in relationships, self issues, the recovery process. Two general themes emerged from these categories: disruption in the father's role as protector and the process of regaining a sense of normalcy. These findings point to the importance of including non-offending fathers in the treatment plans of counselling agencies working with victims of child sexual abuse. / Arts, Faculty of / Social Work, School of / Graduate

Two-hundred and twenty-four participants who reported a history of child abuse trauma were recruited from the internet, clinical (community outpatient) and prison settings and completed a battery of assessment measures, including Briere's Child Maltreatment Interview Schedule (CMIS) (slightly modified), Detailed Assessment of Traumatic Stress (DAPS), Cognitive Distortion Scale (CDS), and Inventory of Altered Self Capacities (IASC); van der Kolk's Self Inventory of Disorders of Extreme Stress (SIDES-SR); Nijenhuis's Somatoform Dissociation Questionnaire (SDQ-20); and a modification of the CMIS to assess for adult victimization experiences (Adult Victimization Survey or AVS; Dietrich, unpublished instrument). It was hypothesized that Posttraumatic Stress Disorder (PTSD), Affect Dysregulation, and Problems with Interpersonal Relatedness would be associated with later revictimization experiences during adulthood with this sample, and that disturbances in ability to regulate self capacities and other complex posttraumatic sequelae would be associated with perpetration of physical or sexual violence during adulthood. Data were analyzed for 207 individuals who reported childhood maltreatment per the CMIS. Results provide partial support for the hypotheses. Women were significantly more likely to report revictimization, and male inmates were significantly more likely to perpetrate against others. Whereas PTSD and Somatoform Dissociation are the strongest dynamic predictors of any sexual or physical revictimization, Impaired Self Capacities are more often associated with revictimization by intimate partners in particular. Trauma-specific dissociation was associated with a decreased risk of revictimization, whereas peritraumatic and trait dissociation did not enter predictive models. Posttraumatic sequelae were not associated with increased risk of physical perpetration with these samples; however, IASC scores were associated with an increased risk of sexual perpetration and victim-based cognitive distortions were associated with decreased odds of sexual violence. These findings provide partial support for the Complex PTSD (Herman, 1992a) construct. Results are discussed in terms of implications for treatment, further study, and classification. Limitations are noted. / Arts, Faculty of / Psychology, Department of / Graduate