Saudi Cultural Missions Theses & Dissertations
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Item Embargo The Impact of Child Protection Training on Nurses’ Self-Efficacy in Detection and Reporting of Child Abuse in Saudi Arabia(Trinity College Dublin, the University of Dublin, 2024) Almutairi, Albandari; Corry, Margarita; Hughes, MaryBackground: The World Health Organisation (WHO) has reported that child abuse and neglect constitute major international health problems that cause unacceptable morbidity and mortality. These forms of maltreatment can have severe physical and psychological effects on children’s development that persist into adulthood. Early detection of abuse and removing children from potentially hazardous and perilous conditions pose significant challenges. Nurses who care for children and families are uniquely positioned to identify children at risk of abuse and neglect during visits and have the opportunity to initiate interventions to prevent future harm. However, barriers such as a lack of experience, training, and confidence in handling abuse cases exist. Several training programmes have been developed to enhance nurses’ abilities to recognise and report child abuse. Studies demonstrate that these training programmes effectively improve nurses’ awareness, detection, and reporting of child abuse and neglect. In Saudi Arabia, The National Family Safety Program provides non-mandatory training to healthcare practitioners to support them in identifying and reporting child abuse cases through the Child Protection Multidisciplinary Training Programme (CPMTP) in multiple healthcare sites. The concept of self-efficacy has been used to assess the outcomes of clinical training programmes in other fields, as positive effects on self-efficacy should translate to desirable practice patterns. To date, few studies have explored the impact of child abuse training on nurses’ self-efficacy in recognising and responding to known and suspected cases of child abuse and neglect. Furthermore, none of these studies have been conducted in Saudi Arabia. Aim: To explore the impact of child abuse training on nurses’ self-efficacy in recognising and responding to known and suspected cases of child abuse and neglect (CAN) in Saudi Arabia. Methods: This study was conducted across three regions of Saudi Arabia, with participation from nurses caring for children, using the Child Abuse Neglect Reporting Self-Efficacy Questionnaire (CANRSEQ). The questionnaire was administered in online and hard-copy formats across all three regions, with a completion time averaging under 20 minutes. Data were analysed using descriptive statistics and correlation analyses using Statistical Package for Social Sciences (SPSS) version 28 software. Findings: The response rate was 77% (n = 247) among staff nurses. The majority (75.5%) had not reported any cases of child abuse or neglect in the past. The findings indicate that 73.2% (n = 164) did not receive any formal CAN cases. Additionally, 19.2% (n = 43) of the respondents had undergone formal training sessions concerning CAN, and 10.4% (n = 23) attended the CPMTP provided by NFSP. The study’s findings showed a significant difference in self-efficacy expectations (EEs) on the SE-CAN scale. However, there was no significant difference in outcome expectation (OE) scores between those who attended CAN training and those who did not, as measured by the OE-CAN scale. The respondents generally reported being more confident in handling known abuse cases than in suspected abuse cases. Self-efficacy in detecting and reporting CAN differed among education groups when measuring the relationship between personal characteristics and professional self-efficacy in nurses. Those who had a postgraduate degree and attended a training programme reported a statistically significant higher self-efficacy score (i.e., EES, EEK, OE; mean = 3.4864 ± 0.56619) compared to those with a bachelor's degree (mean 3.2337 ± 0.59468, p < .05). Conversely, no significant differences were found in self-efficacy based on other personal characteristics such as age, gender, or marital status (p > 0.05). Regarding knowledge of the law, most of the participants, 70.7% (n = 164), believed they had a legal obligation to report cases where a child or young person was at risk of physical or sexual abuse. However, the lowest percentage, 42.1% (n = 98), was recorded for cases where a prenatal report was made, but the birth mother did not receive adequate support services. Conclusion: This study is the first in Saudi Arabia to investigate the impact of child abuse training on nurses’ ability to identify and respond to CAN. The results provide an important contribution to our understanding of nurses’ self-efficacy in managing such cases, as they highlight the specific areas where nurses feel most confident and capable. Additionally, the findings shed light on potential areas for improvement and the need for targeted interventions to enhance nurses’ self-efficacy in specific aspects of CAN. The underreporting of child abuse is attributed to various barriers, but training programmes can significantly improve nurses’ confidence in reporting abuse cases. Notably, nurses are more confident in reporting known cases rather than suspected cases, and the ability to detect abuse is dependent on the type of abuse being investigated (physical, emotional, and sexual abuse). Therefore, training programmes must enhance nurses’ confidence and provide them with clear guidelines for mandatory reporting and support in navigating these challenges.22 0Item Restricted The utility of computed tomography in evaluating rib fractures in live children investigated for suspected physical abuse(The University of Sheffield, 2024) Alzahrani, Nasser; Offiah, Amaka; Jeanes, AnnmarieRib fractures are strongly associated with physical abuse in infants and young children. Computed tomography (CT) may be an accurate diagnostic tool when compared to chest radiography, the current imaging standard, for detecting rib fractures in children with suspected physical abuse (SPA). A systematic review showed that CT has better diagnostic accuracy than initial chest radiographs (CXR) for detecting rib fractures in children with SPA. A multicentre retrospective observational study was conducted to assess the diagnostic accuracy of chest CT for detecting rib fractures in children under 2 years investigated for SPA, using initial and follow-up CXRs as the reference standard. An analysis of 64 of these cases showed overall accuracy of CT as 83.72%, 93.46% and 96.47%, per-patient, rib and location, respectively. A sub-study of the multicentre study, conducted to assess the feasibility of dating rib fractures using CT, showed substantial agreement between chest radiography and CT in estimating broad timeframes for rib fracture dating (acute vs. healing) (kappa (k)=0.76). Callus formation features on CT scans showed a discriminative pattern for estimating the specific age range of rib fractures. Concerns regarding higher radiation exposure of CT compared to chest radiography have made CT less desirable in routine clinical practice when evaluating children with SPA. A study using post-mortem animal models at two paediatric centres to optimise chest CT scanning parameters gave these sets with the lowest radiation dose and acceptable diagnostic image quality (≥3 out of 5): Centre 1: 80 kV/30 mA, effective dose 0.32 millisieverts (mSv), 93.5% sensitivity; Centre 2: 80 kV/40 mA, effective dose 0.2 mSv, 84.3% sensitivity. Compared to the current clinical standard (initial and follow-up CXRs), chest CT shows high diagnostic accuracy. Furthermore, dating rib fractures from chest CT and optimising its radiation dose seems to be possible.37 0