Emergence of child abuse diagnostic education in emergency care: a common concern

Abstract

Child abuse prevalence in South Africa is high. Despite this the pedagogy of child abuse education of emergency care practitioners is deficient. This thesis, conducted in the field of emergency medical care, intended to elucidate the emergence of child abuse diagnostic education in emergency care as a common concern. In order to achieve this, the treatment of child abuse victims needs to be understood within an out-of-hospital setting as well as from an emergency medical care student’s perspective. The research paradigm is that of critical pragmatism. A concurrent mixed-methods approach was followed. Retrospective archival data (1 323 pediatric cases) was retrieved from 12 365 pre-hospital medical records. The researcher established a pre-training workshop survey, followed by a training workshop intervention to inform participants on law and ethics as well as a screening tool for child abuse. A post-training workshop survey was conducted. The quantitative data analysis was conducted using ‘R’ Statistical software. The researcher used FreeMind® to synthesis and construct themes from the focus group qualitative data. The quantitative and qualitative data were contrasted and associations between child abuse knowledge (mediated by training) and self-reported diagnostic practices were identified. The probable historical “missed” case detection for pre-hospital presentation of child abuse and neglect is an alarming 19%. The study found that all participants demonstrated knowledge of antecedent factors for child abuse such as what constitutes risk and vulnerability for abuse. However, the knowledge of conceptual definitions from the Children’s Act was lacking. There was also statistical significance showing that collectively, the training workshop intervention had a positive impact on those who attended. In addition to this, the study also found that the policies and emergency care training of child abuse and neglect are deficient. This study’s theoretical contribution is that it validates Archer’s Morphogenesis as an analytical frame for child abuse diagnostics in emergency care. Socio-cultural actions such as clinical practice, diagnostic training, activism, learner engagement and reflective practice all have the latency for improved child abuse diagnostics, but if not sustained, prioritized and mainstreamed, ‘morphostasis’ rather than ‘morphogenesis’ is likely to prevail. It is recommended that future research concerning the topic of child abuse diagnostics is conducted to reduce the gap in the emergency care knowledge. Higher education institutions offering emergency care qualifications are encouraged to incorporate ‘child abuse and neglect’ into their existing curricula for the ‘common good’.