Unconscious Bias Influence on the Identification of Child Abuse

The urgency of this article is to underscore the pressing need to address the inequities and biases in child abuse reporting by health care professionals, including emergency nurses. Child abuse is a pervasive issue that crosses all countries, cultures, races, and socioeconomic groups. A lack of standardized protocols in most health care systems leaves children and their families vulnerable to the unconscious biases of health care professionals during emergency care. The implementation of standardized protocols is crucial to ensure unbiased, family-centered care and facilitate discussions about whether bias is affecting health care professionals' decision making. Traditionally, it is at the discretion of the provider to report child abuse if a child is seen in the emergency department with injuries or other signs of mistreatment. Health care professionals may not have protocols to evaluate for child abuse. Without well-defined protocols, health care professionals are left to their own judgment about whether to make a report to child protective services. This can result in children who are not safe at home being discharged home from the hospital. These children, who were not identified owing to the health care professionals' beliefs, may later return with sentinel child abuse injuries. Alternatively, clinician bias could lead to children who are not being abused or mistreated being referred for further evaluation.