Mental health nurses’ perceived preparedness to work with adults who have child sexual abuse histories

Abstract

Accessible summary What is known on the subject? The high prevalence of adults presenting to the mental health services places mental health nurses (MHNs) in a unique position to help to identify and support the person with the associated challenges of child sexual abuse (CSA). Feelings of discomfort have been identified by mental health nurses (MHNs) when working with survivors of CSA due to a lack of knowledge, poor confidence and feeling unprepared to inquire and respond to such a sensitive topic. What does the study add to existing knowledge? MHNs are willing to engage in CSA dialogue; however, the level of engagement is often conditional with clear parameters set by participants. Whilst all participants reported they were willing to engage in conversation initiated by the service user, some were unwilling to listen to details of the CSA and used strategies to censor service users from providing details of the CSA. What are the implications for practice? Whilst self‐protecting boundaries helped MHNs to engage in CSA dialogue, strategies to censor aspects of the service user’s dialogue may reinforce the belief that their experience of CSA is too shameful to talk about, hence denying the reality of their experience and contributing to feelings of re‐shaming. MHNs need a combination of theoretical knowledge and psychosocial skills to achieve clinical competence when working with CSA; therefore, training should not only include information pertaining to facts and statistics but also case presentations, clinical training and supervision. Clinical supervision was highlighted by all participants as a necessary means of formal support, more specifically group clinical supervision whereby peer support can also be availed of in a formalized setting. Abstract IntroductionThe high prevalence of adults presenting to the mental health services places mental health nurses (MHNs) in a unique position to support the person with the associated challenges of CSA, yet little is known about the preparedness of MHNs to work with this client population. AimTo explore MHNs’ perceived preparedness to work with adults who have CSA histories, and to elicit their views, skills and confidence in relation to working with this sensitive issue. MethodIn‐depth semi‐structured interviews were conducted with five consenting MHNs. A qualitative descriptive methodology informed the study. A thematic analysis framework guided the data analysis. ResultsThe findings assert that MHNs are willing to work with survivors of CSA despite feeling unprepared to so, MHNs described feeling ill‐prepared in how to respond to CSA, calling for not just education and training specific to CSA but also citing the need for clinical supervision and additional guidelines to enhance their preparedness. DiscussionResults of this study further highlighted the omission of CSA within nursing curricula and the absence of role models within clinical practice as a major barrier to preparedness to work with survivors of CSA. Recommendations are made for training, e...

Service User and Carer Views and Expectations of Mental Health Nurses: A Systematic Review

“…Supplementary Document S2 is a complete list of all included articles. Studies excluded at full-text screening (n = 27) [ 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 ] are listed in Supplementary Document S3 . Data extracted from included studies are summarised in Table 1 .…”

Mental health challenges facing male survivors of child sexual abuse: Implications for mental health nurses

“…Over the past 25 years, research has identified numerous reasons as to why practitioners are reticent to address CSA in those presenting with mental health problems. Reasons for reticence are complex, but include lack of knowledge; low level of interpersonal skills, discomfort in asking about and addressing disclosure of sexual abuse; fear of retraumatization, time and resource constraints; adherence to the medical model, beliefs and attitudes regarding sexual abuse and its place in relation to mental health problems; believing CSA is the concern of 'other' specialists, and a practitioner's own experiences with CSA (Kennedy et al 2021;Stige et al 2022;Walsh et al 2022;Warne & McAndrew 2005). These barriers perpetuate CSA not being addressed at all.…”

“…However, over a prolonged period, mental health professionals, such as nurses and psychiatrists, have been disinclined to routinely enquire about sexual abuse histories for numerous reasons; lack of confidence in how to ask and effectively respond, poor understanding and knowledge of CSA, and fear of reopening traumatic experiences (Dorahy & Clearwater 2012;Walsh et al 2022). Practitioners' avoidance of addressing CSA appears common throughout mental health care, including Child and Adolescent Mental Health Services (CAMHS) and male and female acute services (Kennedy et al 2021;Stige et al 2022;Walsh et al 2022;Warne & McAndrew 2005). Such lack of professional preparedness and/or willingness to address CSA could add to the distress and compromise the recovery of those they are providing care for.…”

“…CSA is associated with a range of short and long-term adverse effects which can have a lasting impact on the psychosocial development of children (Finkelhor et al 2007). The long-term effects can extend into adulthood, impacting on all areas of survivors' lives (Fisher et al 2017), and often manifesting as mental health problems (Finkelhor et al 2007;Kennedy et al 2021).…”

A retrospective study examining the adverse effect of childhood abuse among adult psychiatric service users in Britain

“…In addition, not only (TIC) training increases psychiatric nurses’ comfort, knowledge and screening confidence (Kalmakis et al . 2018), which are needed to support and maintain the well‐being of mental health nurses in clinical practice (Kennedy et al 2020), but also heighten their empathy on understanding their patients’ background (Kia‐Keating et al . 2019).…”