Nursing Interventions for DSED

• The nursing interventions for DSED are based on the nursing process and evidence-based practice. The nursing interventions for DSED aim to prevent further harm; protect the child’s rights; promote the child’s safety; report the suspected or confirmed neglect or abuse or caregiver changes; refer the child and the caregiver to appropriate services; educate the child and the caregiver about attachment development and disorder; support the child’s physical, mental, emotional, social, and spiritual healing; and evaluate the outcomes of care.

• Some of the common nursing interventions for DSED are:

  • Prevention: The nurse should implement primary, secondary, and tertiary prevention strategies to reduce the risk of DSED. Primary prevention strategies include providing education, information, and resources to children, caregivers, families, and communities about attachment, its development, importance, types, and signs; the available services and resources; and the coping strategies and self-care techniques. Secondary prevention strategies include screening children and caregivers for risk factors or signs of DSED; providing counseling, therapy, support groups, home visits, crisis intervention, and respite care to children and caregivers who have been exposed to neglect or abuse or caregiver changes or are at risk of developing DSED; and monitoring children and caregivers for changes in behavior or health status. Tertiary prevention strategies include providing medical care, legal assistance, social services, foster care, adoption, kinship care, group home, residential treatment center, shelter, protection orders, and advocacy to children who have developed DSED; and facilitating reunification or alternative placement for children who have been removed from their homes due to neglect or abuse or caregiver changes.

  • Protection: The nurse should protect the child’s rights according to the United Nations Convention on the Rights of the Child. The nurse should respect the child’s dignity, autonomy, privacy, confidentiality, and participation in decision-making. The nurse should also protect the child from further harm by ensuring a safe and secure environment; removing or minimizing any potential sources of danger; and providing appropriate equipment or supplies or medications to prevent or treat complications or infections. The nurse should also protect the child from re-traumatization by avoiding unnecessary or repeated examinations or procedures; using a trauma-informed approach; and providing emotional support and comfort to the child.

  • Reporting: The nurse should report any suspected or confirmed cases of neglect or abuse or caregiver changes to the appropriate authorities as mandated by the law and the professional code of ethics. The nurse should follow the reporting protocol of the institution or agency where he or she works. The nurse should document the facts and evidence of the neglect or abuse or caregiver changes in a clear, concise, and objective manner. The nurse should also inform the child and the caregiver about the reporting process and their rights and responsibilities. The nurse should cooperate with the investigation and provide any additional information or testimony as required.

  • Referral: The nurse should refer the child and the caregiver to appropriate services that can provide further assessment, treatment, support, and follow-up. Some of the common services that the nurse can refer to are:

    • Medical services: such as pediatrician, surgeon, dentist, ophthalmologist, otolaryngologist, dermatologist, gynecologist, urologist, endocrinologist, neurologist, psychiatrist, psychologist, nurse practitioner, physician assistant, nurse, social worker, pharmacist.

    • Legal services: such as lawyer, judge, prosecutor, defense attorney, police officer, detective, forensic examiner, child advocate, guardian ad litem, court-appointed special advocate (CASA).

    • Social services: such as social worker, case manager, counselor, therapist, support group facilitator, home visitor, crisis intervention worker, respite care worker.

    • Educational services: such as teacher, counselor, tutor, special education teacher, speech therapist, occupational therapist, physical therapist, school nurse, school social worker.

    • Community services: such as attachment disorder prevention program or crisis hotline or helpline or support group or peer mentor or mentor or volunteer or faith-based organization.

  • Education: The nurse should educate the child and the caregiver about attachment development and disorder. The nurse should provide accurate or relevant or understandable information about attachment or its development or importance or types or signs; the causes or effects or signs of neglect or abuse or caregiver changes; the reporting process and legal implications; the available services and resources; the treatment options and outcomes; the coping strategies and self-care techniques; the safety planning and protection measures; the rights and responsibilities of the child and the caregiver; and the importance of follow-up and adherence to care.

  • Support: The nurse should support the child’s physical or mental or emotional or social or spiritual healing. The nurse should provide holistic and culturally sensitive care that meets the child’s needs or preferences or goals. The nurse should also provide therapeutic communication or active listening or empathy or validation or encouragement or praise to the child. The nurse should also facilitate the development of a trusting or respectful or collaborative relationship with the child. The nurse should also promote the empowerment or resilience or recovery of the child. The nurse should also involve the family or significant others or community members in the care of the child as appropriate.

  • Evaluation: The nurse should evaluate the outcomes of care for the child and the caregiver. The nurse should use standardized tools or scales or questionnaires or interviews or observations to measure the progress or improvement or achievement of the expected outcomes. The expected outcomes may include:

    • The child is free from further harm or injury.

    • The child reports or demonstrates reduced pain or discomfort.

    • The child’s physical wounds or infections are healed or treated.

    • The child’s vital signs or laboratory tests or diagnostic tests are within normal limits or show improvement.

    • The child reports or demonstrates a consistent pattern of indiscriminate social behavior toward adult caregivers; showing excessive familiarity or lack of selectivity in choosing attachment figures; approaching strangers in an overly friendly or inappropriate manner; and having difficulty maintaining appropriate boundaries with others.

    • The child reports or demonstrates increased happiness or confidence or self-worth or self-esteem or social skills or trust in others or expression of emotions or coping with stress.

    • The child reports having a positive outlook on life and a sense of meaning and purpose.

    • The child reports having a supportive network of family members, friends, peers, mentors, professionals, and community members.

    • The child reports having a safe and secure environment at home, school, community, or institutional care. The child reports having a safety plan and protection measures in place.

    • The child reports or demonstrates reduced involvement or exposure to neglect or abuse or caregiver changes.

• The child reports or demonstrates increased involvement or participation in positive activities or hobbies or interests or goals.

• The child reports or demonstrates increased adherence to medical care, legal assistance, social services, educational services, community services, and follow-up appointments.

• The child reports or demonstrates increased satisfaction with the quality of care and the relationship with the nurse and other professionals.

• The nurse should also monitor for any complications or adverse effects of the neglect or abuse or caregiver changes or the treatment such as infection, bleeding, shock, organ failure, sepsis, death, re-injury, re-victimization, re-traumatization, non-compliance, relapse, recurrence, dissatisfaction.

• The nurse should also modify the plan of care as needed based on the evaluation of the outcomes and the feedback from the child and the caregiver. The nurse should also collaborate with other members of the interdisciplinary team to ensure continuity and coordination of care. The nurse should also document the evaluation of the outcomes and any changes in the plan of care in a clear, concise, and objective manner.