The role of nurses in child abuse situations: a systematic review
Article information
Abstract
Purpose
Nurses play a crucial role in cases of victims of child abuse; however, but there is a need for a comprehensive understanding of their specific roles, responsibilities, and best practices is needed.
Methods
This integrative review aims to synthesize existing evidence on the role of nurses in cases of victims of child abuse. A literature search was conducted using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Scopus databases. A literature search was conducted using PubMed, CINAHL, PsycINFO, and Scopus databases. This review included 12 qualitative and quantitative studies.
Results
This review identified the following four themes: nurses’ responsibility, intention to report child abuse, perceptions of child abuse, and risk assessment of child abuse. The findings revealed that nurses play a multifaceted role in child abuse situations. Evidence-based practices and guidelines were identified to optimize recovery outcomes among children who have experienced abuse.
Conclusion
This integrative review contributes to the body of knowledge on nurses’ role in cases of victims of child abuse by providing valuable insights for nursing practice, education, and policy. These findings can help guide nurses in developing evidence-based interventions and collaborative approaches to support the recovery of victims of child abuse.
INTRODUCTION
Child abuse, a pervasive and detrimental problem, encompasses various forms of physical, emotional, and sexual maltreatment, and neglect. Such harmful experiences exert long-lasting effects on the psychological, social, and physical well-being of affected children [1,2]. The World Health Organization (WHO) estimates that approximately one billion children aged 2–17 years have experienced some form of physical, sexual, or emotional violence, or neglect [3]. In the United States (USA), nearly 700,000 children were victims of abuse and neglect in 2020, with infants under the age of one being the most vulnerable [4]. According to the Centers for Disease Control and Prevention, at least one in seven children in the United States experienced abuse or neglect in the past year, although this is likely an underestimate due to underreporting. In 2021, 1,820 children died from abuse and neglect [5].
Considering the complex and detrimental effects of child abuse, nurses’ role in recognizing, reporting, and providing the necessary care for victims of child abuse becomes extremely crucial [6]. Nurses typically the first point of contact for children and their families provide essential services, such as assessment, intervention, and support throughout the recovery process [7,8]. Despite the critical nature of nurses’ roles in managing child abuse cases, there is a noted lack of a comprehensive understanding regarding their specific roles, responsibilities, and optimal practices is lacking. Additionally, several nurses hesitate to report child abuse and maltreatment [9]. To fill this knowledge gap, integrative reviews can synthesize existing evidence; identify unexplored areas, and inform future research, education, and policy initiatives [10].
Childhood is a crucial period in which an individual's physical, emotional, and mental development occurs [1,2]. Child abuse emerges as a particularly significant issue during this developmental process and abuse can impede a child’s healthy development and growth, with its effects potentially lasting throughout one’s lifetime. Nurses play a vital role in the prevention of and response to child abuse [7,8]. Moreover, the well-being of children during this period can be promoted by holistic nursing during this period can promote the well-being of children that considering considers their physical, emotional, and mental needs [1].
This study integrative review aimed to thoroughly examine the nurses’ role of nurses in addressing child abuse cases and to developing effective nursing strategies for the future. Nurses play a crucial role in facilitating early identification, intervention, and ongoing support for these vulnerable individuals. By clarifying their role, training programs can be enhanced, multidisciplinary collaboration can be improved, and the effective implementation of ensure that evidence-based practices can be ensured, ultimately resulting in better outcomes for children who are abused [11]. This review follows the integrative review framework proposed by Whittmore and Knafl [10].
METHODS
Ethical statements: This study is a literature review of previously published studies and was therefore exempt from Institutional Review Board approval.
1. Study Design
This integrative review was conducted in accordance with the framework proposed by Whittemore and Knafl [10]. This methodology is useful for integrating and summarizing evidence derived from multiple methodological approach [10]. An integrative review comprises the following five steps: problem identification, literature search, data evaluation, data analysis, and presentation. This integrative review’s results were reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [12].
2. Search Strategy
The PRISMA flowchart [12] was used to search for relevant literature. A comprehensive literature search was conducted using the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Scopus databases to identify relevant studies nurses’ role in the recovery process of victims of child abuse. The search strategy combined terms related to child abuse (e.g., “child abuse,” “child maltreatment,” “child neglect,” “child victimization”) and nursing (e.g., “nurses,” “nursing,” “registered nurse,” “nurse practitioners,” “nursing staff”) and terms related to nursing’s role, function, and impact (e.g., “role,” “function,” “responsibility,” “impact”). The search was limited to English-language articles. This study did not limit the search by publication year, ensuring the inclusion of all studies examining nurses’ role in child abuse cases. The included studies’ reference lists were reviewed to identify additional relevant publications. Studies were included in the review if they fulfilled the following criteria: (1) focused on nurses’ role in the recovery process of victims of child abuse; (2) employed qualitative, quantitative, or mixed-methods research designs; (3) were peer-reviewed; and (4) were published in English. This review’s exclusion criteria were as follows: (1) studies not specifically focusing on nurses’ role in the recovery process of victims of child abuse, (2) literature reviews, editorials, commentaries, or opinion articles; and (3) articles published in languages other than English.
Two reviewers independently screened the identified articles’ titles and abstracts to assess their eligibility for inclusion. Subsequently, full-text articles were obtained from potentially relevant studies, and the two reviewers independently assessed their eligibility for inclusion based on the aforementioned criteria. Disagreements between the reviewers were resolved through discussion, if necessary.
3. Search Outcomes
We used the PRISMA flowchart to select the relevant literature [12] (Figure 1). The initial databased search identified 1,624 articles. After removing 74 duplicates, 1,550 articles were retained for title and abstract screening.

Flow chart of study selection. a)PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Scopus.
After reviewing the titles, 78 studies were selected. Subsequently, 42 studies were selected after reviewing their abstracts. Finally, after reading the full texts, 12 studies were selected. Two reviewers independently extracted data from the included studies using a standardized data extraction form. The extracted information included study characteristics (e.g., authors, publication year, country of origin, study design), population characteristics (e.g., sample size, age, gender, type of abuse), details regarding the nursing role (e.g., specific responsibilities, interventions, collaboration with multidisciplinary teams), and key findings related to nurses’ role in cases of victims of child abuse.
4. Quality Appraisal
The included studies’ methodological quality was independently assessed by two reviewers using the Crowe Critical Appraisal Tool (CCAT) [13]. This tool provides a consistent and comprehensive approach for evaluating the credibility, reliability, and validity of research studies, irrespective of their design. Disagreements between the reviewers were resolved through discussion or consultation, if necessary. The quality appraisal results were used to assess the included studies’ credibility, transferability, dependability, and confirmability, and inform the finding’s interpretation.
Assessing the studies using the CCAT revealed that the scores were relatively low in some crucial categories (Table 1). Specifically, in Category 3, “Design”, a considerable number of studies lacked sufficient consideration of the appropriateness of the research design and potential biases. Additionally, in Category 4, “Sampling”, some studies omitted explanations for the chosen sampling method and its rationale, and suitability. In Category 5, “Data collection”, some studies did not describe the data collection methods. In Category 6, “Ethical Considerations”, several studies did not provide adequate information regarding participant compensation and privacy protection. However, barring these areas, most studies performed reasonably well across other categories (Table 1).
5. Data Extraction
Data extraction was conducted according to the framework by Whittemore and Knafl [10]. To facilitate data extraction, we developed a tool to summarize and analyze the data related to the study objective: research design, research setting, study aim, key variables, main results, and recommendations. A narrative synthesis of the extracted data was performed to summarize the key findings and to identify common themes and patterns related to nurses’ role in the recovery process of victims of child abuse. The results are organized and presented according to the identified themes in Table 2.
6. Synthesis
Each theme reflects key concepts that repeatedly appeared in the findings of multiple included studies, and these themes were identified accordingly. The first theme, the burden on parents, reflects the psychological, emotional, and economic burdens that parents experience in child abuse situations, as highlighted by multiple studies [14,15]. This burden significantly impacts the recovery process of victims of child abuse and provides essential information for nurses to support parents effectively. The second theme involves the factors affecting the burden on parents, such as the level of social support, economic status, and the child abuse incidents’ severity [16,17]. Understanding these factors enables nurses to assess parents’ situations more accurately and offer tailored support. The third theme, coping strategies to reduce the burden, is based on findings indicating that the various coping strategies that parents use in child abuse situations significantly affect their psychological well-being [18,19]. This information is crucial for nurses to suggest and support effective coping strategies for parents. Finally, suggestions for clinical practice were derived from studies emphasizing the importance of educational programs that equip nurses with the necessary knowledge and skills to respond more effectively to child abuse situations [20,21]. These suggestions provide practical guidance for nurses to apply directly in their practice. The four themes derived offer a comprehensive understanding of nurses’ role in child abuse situations, serving as essential foundational data. This integrative approach can significantly aid the development of education and training programs for nurses and ultimately contribute to the recovery and protection of victims’ child abuse.
RESULTS
1. Selected Studies’ Characteristics
Regarding this study’s general characteristics, an analysis was conducted on the years of research implementation, research designs, countries of research, research participants, and sample sizes (Table 2). The years of research implementation ranged from 2004 to 2023. The research designs included Delphi, vignette, descriptive, and qualitative studies. The countries of research included Australia, Korea, Hong Kong, Taiwan, the USA, the Philippines, Ireland, and the United Kingdom. The research participants comprised nurses and midwives, emergency room nurses, pediatric nurses, and pediatric nurse practitioners (PNPs), with some studies lacking specific participant descriptions. The sample sizes ranged from 10 to more than 1,000 participants. Regarding the outcome variables, two, six, three, and one studies focused on nurses’ responsibility, intention to report, perceptions of child abuse, and risk assessment of child abuse, respectively (Table 3).
1) Nurses’ responsibility
Two studies (A5 and A12) focused on nurses’ role in child abuse situations. Nurses perceived maintaining safety in the child abuse context as their primary role (A12). However, numerous nurses were unaware that identifying and detecting child abuse were part of their responsibilities (A5). Additionally, consensus regarding nurses’ role in child protection issues, particularly the extent to which they should actively seek protection against child abuse, was lacking (A5). Therefore, a need exists for social discussions on nurses’ role in child abuse situations and continuous education for nurses to clarify their roles.
2) Intention to report child abuse
Six studies (A1, A3, A6, A7, A10, and A11) focused on nurses’ intention to report child abuse. These studies explored nurses’ attitudes toward abuse (A10), knowledge about abuse (A6, A11), perceived behavioral control (A10), nursing autonomy (A11), nurses’ attitudes (A1, A3, A6, and A7), workplace factors (A7), and training (A7). Nurses exhibited an intention to report and an understanding of the importance of reporting. Therefore, policy and system improvements are needed to ensure that their intention to report translates into actual reporting behavior (A10).
3) Nurses’ perceptions of child abuse
Three studies (A2, A4, and A9) focused on nurses’ perceptions of abuse. Regarding sexual abuse, factors affecting the perception of sexual abuse included victim age, perpetrator age, cross-gender abuse, victim resistance, and the sexual act’s frequency and intrusiveness (A9). Additionally, other studies examined nurses’ knowledge of abuse (A4). Nurses reported experiencing psychological difficulties when confirming the evidence of child abuse and were aware of their role in child protection and advocacy (A2). In child abuse situations, nurses relied on informal support from colleagues (A2). Nurses acknowledged the presence of violence but expressed difficulties in providing interventions, primarily owing to a lack of knowledge (A4). Consequently, nurses expressed a desire for child abuse-related education (A4).
4) Risk assessment of child abuse
One study examined nurses’ risk assessment of abuse, focusing on child abuse PNPs (A8). A significant number of child abuse PNPs did not routinely screen for psychosocial risk factors associated with child abuse. Only approximately 50% of PNPs conducted anorectal genital examinations among children at risk of sexual abuse, while only 12% confirmed the potential for sexual abuse to parents. These factors were attributed to time constraints and a lack of training. Recognizing psychosocial risk factors is essential for preventing child abuse and providing relevant interventions. Therefore, enabling nurses to accurately and effectively assess the risk of child abuse by addressing the identified factors of time constraints and lack of training is necessary.
DISCUSSION
This integrative review aimed to provide a comprehensive understanding of the nurses’ role in child abuse situations. This section explores the implications of this review’s findings, identifies its limitations, and suggests directions for future research. This review identified the following four themes: nurses’ responsibility, intention to report child abuse, perceptions of child abuse, and risk assessment of child abuse. These themes highlight nurses’ multifaceted role and underscore the challenges that they face in addressing child abuse in healthcare settings.
Nurses, particularly those working with children, play multiple roles in ensuring their safety, including the prevention of and early intervention in child abuse as well addressing the physical and psychosocial needs of children who are abused [22]. According to the WHO [23], healthcare and other professionals involved in the care of children bear the responsibility to ensure that they have the opportunity to grow up in healthy environments, free from abuse, and with their dignity preserved, thus emphasizing professionals’ crucial role in safeguarding children’s well-being, promoting environments conducive to their health and development, and protecting them from mistreatment. Although nurses in child abuse situations recognize their role in ensuring children’s safety of children, they face difficulties in identifying and detecting abuse [14]. Additionally, clear consensus regarding the scope of nurses’ responsibilities in child abuse situations is lacking [14]. Standardized protocols and continuous education are essential to ensure that nurses are equipped to effectively identify and manage child abuse cases.
Evidence clearly indicates that nurses in child abuse situations are aware of their intention to report abuse, and this awareness is influenced by their knowledge of and attitudes toward abuse [15-18]. However, the frequently subtle and inconclusive nature of abuse indicators makes them difficult to recognize, which can reduce their intention to report child abuse [24,25]. To address this issue, comprehensive training programs that enhance nurses’ ability to recognize and report abuse are crucial. These programs should focus on improving knowledge, attitudes, and perceived control over reporting behaviors.
In pediatric and child health settings, nurses have daily contact with children and therefore require knowledge and skills to identify and respond to child abuse. In settings such as emergency departments, nurses use formalized assessment tools (e.g., screening guidelines) to evaluate suspicious physical injuries [26]. However, in pediatric and community child health settings, nurses rely on their clinical judgment to suspect possible child abuse and decide whether to refer cases to child protection authorities [27,28]. While nurses recognize their role in child protection and advocacy in child abuse situations [29], they often lack the knowledge of the specific actions that they must perform [30]. Early and accurate assessment and identification of child abuse cases are critical for improved outcomes [8]. Nurses play a significant role in this process, and the use of evidence-based assessment tools and procedures is vital to accurately identify abuse cases [22,31]. Integrating evidence-based tools and consistent training can enhance nurses’ capabilities for early detection and intervention, ultimately improving better outcomes for abused children.
Nurses experience emotional difficulties in child abuse situations and rely on informal support systems to overcome them [31,32]. They report a lack of knowledge regarding child abuse situations and difficulties in understanding the psychosocial factors related to abuse [32]. Psychosocial support and advocacy have emerged as critical components of nursing care for victims of child abuse. Essential aspects of this support include building trusting relationships with victims and their families, providing information about available resources, and assisting with decision-making processes [6,11]. Fostering strong communication and interpersonal skills among nurses is crucial to effectively support victims of child abuse and their families. Additionally, providing emotional and psychological support to nurses dealing with such cases can mitigate their emotional burden and improve care quality.
This integrative review exhibits its limitations, such as the exclusion of non-English language articles and the potential for publication bias. A significant limitation of the included studies is their reliance on cross-sectional designs, which provide only a snapshot in time and do not capture the nursing interventions’ longitudinal impact on child abuse cases. Additionally, these studies’ focus of the studies varies, with some examining nurses who directly care for abused children and others surveying examining general nurses. This variation results in a heterogeneous dataset, making rendering it challenging to draw comprehensive conclusions about regarding nurses’ overall role of nurses in child abuse situations.
Furthermore, there is a limitation exists in vis-à-vis understanding the impact of the nurses’ role on the child, as most studies were conducted from the former’s perspective of nurses, and outcomes from the child's latter’s perspective were not assessed. To address these gaps, future research should focus on longitudinal studies that explore the long-term effects of nursing interventions’ long-term effects on child abuse victims of child abuse. Further, including children’s perspectives in research will can also provide a more comprehensive understanding of the outcomes of these interventions’ outcomes.
Moreover, future studies should aim to identify and evaluate specific evidence-based practices and interventions for nurses working with victims of child abuse victims. Investigating the effectiveness of interprofessional collaboration during the recovery process is also essential. Finally, longitudinal research could offer valuable insights into the long-term outcomes for child abuse victims of child abuse and how nursing care contributes to their recovery.
CONCLUSION
This study analyzed the nurses’ role in child abuse situations, aiming to elucidate their contributions to nursing interventions and holistic care provision for children who are abused. Through this analysis, this study seeks to contribute to future efforts in nursing interventions and comprehensive care for children who are abused. In conclusion, this integrative review provides a comprehensive understanding of nurses’ multifaceted role in case of victims of child abuse. This review’s findings underscore the importance of assessment and identification, therapeutic interventions, psychosocial support and advocacy in nursing care for these vulnerable children. By informing future research, education, and policy initiatives, this review’s findings can help to enhance the quality of care provided and support optimal outcomes for victims of child abuse.
Notes
Authors' contribution
Conceptualization: all authors; Data collection, Formal analysis: all authors; Writing-original draft: all authors; Writing-review and editing: all authors; Final approval of published version: all authors.
Conflict of interest
No existing or potential conflict of interest relevant to this article was reported.
Funding
None.
Data availability
Please contact the corresponding author for data availability.
Acknowledgements
None.