AWARENESS OF GOOD AND BAD TOUCH AMONG CHILDREN

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Journal on Nursing

CONTENTS
ARTICLE
1 AWARENESS OF GOOD AND BAD TOUCH AMONG CHILDREN
By
RESEARCH PAPERS
7 PRE-EXPOSURE PROPHYLAXIS FOR HIV PREVENTION IN THOSE WITH SUBSTANCE USE DISORDERS
By
14 THE EFFECT OF RECORDED MOTHERS’ LULLABY ON THE HEART RATE OF PRETERM NEONATES
FOLLOWING ENDOTRACHEAL SUCTIONING: A CROSS-OVER CLINICAL TRIAL
By
23 WORKING ON SOCIAL INTERACTION AND WELLBEING OF ELDERLY - EXPERIENCES OF
A COMMUNITY BASED PROJECT
By
28 EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON POLYCYSTIC OVARIAN
SYNDROME AMONG NURSING STUDENTS
By
REVIEW PAPER
34 HEALTHCARE DISPARITIES FOR LOW SOCIOECONOMIC STATUS AND SKILLED FACILITY
PLACEMENT OPTIONS
By
CASE STUDY
40 DEPRESSION IN MEDICAL STUDENTS: A WORLDWIDE PSYCHIATRIC ISSUE OR MUCH
ADO ABOUT NOTHING?
By
Manisha Praharaj
Nancy Goldstein, Jared Carter-Davis, Ellen C. Seymour
Batool Pouraboli, Fatemeh Hosseini, Masoud Rayyani, Mahlegha Dehghan
Sarmad Muhammad Soomar, Salman Muhammad Soomar, Mashal Feroz Hirani, Sara Zafarullah Sheikh
Annie Chandra S., Santhi Appavu
Safiya Crocker, Leslee Battle
Farida Bibi Mughal

EDITORIALEDITORIAL
The scope of Nursing is wide, and in today's world, it plays a major activity in human life. In order to enhance the
ability to respond effectively to critical health issues, Nursing research need to be developed for promoting knowledge
about health. The current issue focusses on Awareness of Good touch and Bad touch in Children, Review on HIV pre-
exposure prophylaxis and substance use disorder, Effect of mother's lullaby on neonates, Study on helping elderly,
Effectiveness of structured teaching programme, Healthcare disparity between low-quality skilled nursing facilities and
high-quality skilled nursing facilities and Depression and mental health of students.
Manisha Praharaj has presented an article about the awareness of good and bad touch in children. The most
prevalent problem among children is sexual abuse. It is still a sensitive topic in society, where most of the parents hesitate
to discuss this issue with their children. Teaching children about the difference in the types of touches makes them
confident, emotionally strong, and helps them grow normally. The protection of children is not only an individual issue, but
the concern of the entire community as well.
Nancy Goldstein et al. have suggested a systematic review of publications related to both HIV pre-exposure
prophylaxis and substance use disorder. A total of 107 distinct articles were extracted from three databases and 11
articles were selected for final review based on the criteria designed to meet the objectives of the study. All studies have
focused on the use of PrEP in those with SUD. The results indicate that the relevant studies were mainly conducted in
community based settings such as opioid agonist therapy treatment centers. Further, programs that link eligible patients
at SUD treatment centers to PrEP services must be implemented and evaluated for their efficacy in engaging the SUD
population in PrEP uptake.
Batool Pouraboli et al. have studied the effect of recorded mother's lullaby on the heart rate of preterm
neonates using endotracheal suctioning. The samples were selected by convenience sampling. Data were analyzed
using various tests and SPSS version 23 software. The results of this study can be used in clinical serv ices to help stabilize
vital signs in premature incubated newborns, which can also be effe ctive in reducing the compli cations of
sucti on.
Sarmad Muhammad Soomar et al. have investigated the strategies which should be taken into
consideration to work with the elderly and help them out to live a healthy life. The whole process from assessment,
developing the plan, and implementing activities was done under the faculty super vision and after discussion with
stakeholders. Strategies that were planned and implemented were divided into overall health domains, which
include physical, social, psychological, spiritual, and sexual issues. Continuous practice of these activities and
monitoring helps the sustainability of this work. Also, the authors recommend encouraging elderly to come over and
practice a healthy life.
Annie Chandra and her co-author Santhi Appavu have explained about the effectiveness of structured
teaching programme on Polycystic Ovarian Syndrome among nursing students. The study was validated with a
quantitative approach with pre-experimental; one group of pretest and posttest design and the sample consists of 30
nursing students from Kanyakumari District in Tamil Nadu. The results showed that the Structured Teaching Programme
was very effective for improving the knowledge level among nursing students.
Safiya Crocker and her co-author Leslee Battle have reviewed the healthcare disparity between low-quality
skilled nursing facilities and high-quality skilled nursing facilities. Computerized search was done using the databases
CINAHL and ProQuest. With the elderly population in the U.S. at a staggering 15% and continuously growing, skilled
nursing facilities will continue to be an area of interest. In light of this knowledge, the healthcare providers advocate for
better quality care for all skilled nursing facilities irrespective of socioeconomic status.
Farida Bibi Mughal had analysed a case scenario of medical students who had committed suicide due to
depression or other psychological issues. Personal factors impact on mental health of the patient. The measures that

reduce mental illness as well as suicidal rates among medical students include primary preventive measures,
counseling sessions, physical activities, and music therapy.
We hope this issue enlightens Nurse Educators, Practitioners, Health Administrators, and Policymakers in their
respective fields!
Warm Regards,
Rethinam C.
Junior Associate Editor
i-manager Publications
EDITORIAL

ABSTRACT
In current days, we hear a lot about child abuse and molestation from newspapers and media. Every single day, when
we read newspapers, watch news, or use internet, there is always news of young children (both boys and girls) being
sexually abused by an adult around them whom they trust or a stranger. The problem is that they do not even realize that
something wrong had happened to them. In India, this is widely spreading and occurs both within and outside a family
circle. A study says there is one in nine girls and one in 53 boys are abused sexually before the age of 18 years. About 90%
of victims are sexually abused by the person they know and only 10% children were abused by strangers (Deb &
Mukherjee, 2011). There are many negative consequences of child sexual abuse on children's mental health, which
may even continue throughout their life span. Everyday, safety of children throughout the country is threatened by child
abuse. Keeping our future generation safe is not only the responsibility of a family, teacher, any agency or a professional
group rather it is a responsibility of the whole community.
Keywords: Good Touch, Bad Touch, Child Sexual Abuse, Violence Against Children, Awareness.
By
MSc. Tutor, SUM Nursing College, Bhubaneswar, Odisha, India.
AWARENESS OF GOOD AND BAD TOUCH AMONG CHILDREN
Date Received: 08/06/2018 Date Revised: 25/07/2018 Date Accepted: 27/07/2018
MANISHA PRAHARAJ
there are 106,958 cases of crimes against children. Under
the POSCO (Protection of Children from Sexual Offences)
Act, the numbers of child abuse cases are increasing day
by day and it rose from 8,904 in year 2014 to 14,913 in year
2015 (BBC News, 2018). Many cases of child sexual abuse
are registered under POSCO act, but some states have
higher rates, such as Uttar Pradesh has the highest number
of child abuse cases (3,078), followed by Madhya Pradesh
(1,687), Gujarat (1,416), Tamil Nadu (1,544), and Karnataka
(1,480).
A survey was done with a sample of 45,000 children with
the age group of 12- 18 years. The children were selected
from 26 states. The survey depicts that one in every two
children is a victim of child sexual abuse. Another survey
was conducted by the humanitarian aid organization
World Vision India with a sample of 45,844 and the results
show that due to fear of being sexually abused, one in
every five do not feel safe and one in four families do not
report about child abuse (Hindustan Times, 2017).
According to the World Report on Violence against
Children by Pinheiro (2006), approximately 150 million girls
and 73 million boys were subject to contact child sexual
INTRODUCTION
Now-a-days, child sexual abuse is the most prevalent
health problem in children, where a child faces severe
consequences. It is still a sensitive topic for the society and
parents, where most of the parents hesitate to discuss
about the topic with their children. The same goes for
schools as well, teachers do not teach children about
good and bad touch. Gone are those days, where people
hesitate to speak on sensitive topics. The time has come
now, the parents and teachers should break the barriers
and start to talk and teach their children about “Good
Touch and Bad Touch” to secure the child's future. Many
times, the young children, below 10-12 years of age are at
risk or targets because many times they are unable to
differentiate between what is right and what is wrong.
Research has revealed that child sexual abuse can cause
difficulty in growth and development of child and children
may develop a long term mental and emotional disorders
(Foster, 2011).
In India, according to the latest government report on
crimes given by Indian home minister Rajnath Singh in
2016, a child is sexually abused in every 15 minutes and
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Even though, there can be many reasons for their changed
behaviours, there can be a combination of many signs,
then it is a matter of help. They include:
·An inappropriate sexual act with toys
·Sleeping problems and nightmares
·Becoming withdrawn or antisocial.
·Sudden unexplained changes in personality, mood
swings, and feeling insecure
·Behavioural disorders, e.g. enuresis
·Unusual fear to a particular place or people
·Often showing anger for no reason
·Changes in eating patterns like Anorexia, vomiting
·Talking about a new or older friend and unexplained
money or gifts
·Trying to injure herself/himself or suicidal activities
·Physical signs like unexplained bruises around genitals
or mouth, sexually transmitted diseases
·Running away
·The child does not want to be alone with a particular
person
A study conducted on Impact of sexual abuse on children
revealed that the signs of child sexual abuse are different
according to the developmental stage of the child. Anxiety,
nightmares, internalizing, externalizing, inappropriate sexual
behavior, fear, neurotic and general mental illness,
aggression, school problems, hyperactivity, and regressive
behavior were symptoms that preschoolers had. The most
common behaviors that adolescents had were depression,
withdrawn, suicidal, or self-injurious behaviors, illegal acts,
running away, and substance abuse. Therefore the
symptoms common for all age groups are nightmares,
depression, withdrawn behavior, neurotic mental illness,
aggression, and regressive behavior (Kendall-Tackett et al.,
1993).
3. Adult’s Signs in their Relationship with a Child for Sexual
Reasons
The signs include the following.
·They do not allow for a child’s sufficient privacy.
·They show more physical affection, such as kissing,
abuse worldwide and it also included 1.2 million trafficked
children, and 1.8 million exploited through prostitution or
pornography.
A face to face interview schedule, conducted in United
States with 34,000 adults shows that 10% of respondents
experienced child sexual abuse before they turn 18 years,
25% of whom were men. A study used a telephone-based
interview with 4549 children and their caregivers. The report
suggested that 6.1% children had experienced child
sexual abuse in the past year and 9.8% in their lifetime;
whereas for an adolescent aged 14 to 17 years, these
numbers had increased to 16.3% and 27.3%, respectively
(Pérez-Fuentes et al., 2013).
1. Child Sexual Abuse
There are two types of child sexual abuses, i.e. contact
abuse and non-contact abuse. Contact abuse means
touching a child and making physical contact with a child,
including penetration by an abuser. Non-contact abuse is
non-touching activities like grooming, exploitation,
persuading children to perform sexual acts over the
internet, and flashing.
According to violence, abuse, and crime exposure in a
national sample of children and youth, sexual abuses
means any sexual act which is forced upon an individual.
Child sexual abuse means any kind of sexual act that
occurs between a child and an older child, an adolescent,
or an adult for the gratification of the older individual
(Carson et al., 2013). Child sexual abuse, includes rape,
inappropriate touching, physical, or verbal harassment.
The United Nations has defined “child sexual abuse as
contacts or interactions between a child and an older or
more knowledgeable child or adult may be a stranger,
sibling or person in position of authority, a parent or a
caretaker when the child is being used as an object of
gratification for the older child's or adult's sexual needs.
These contacts or interactions are carried out against the
child using force, trickery, bribes, threats or pressure”
(Bellamy, 2003).
2. Signs and Symptoms of Sexual Abuse
Children usually cannot explain something which upsets
them, but they show it through their changed behaviours.
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4. Effects of Child Abuse
The common effects seen in children are as follows.
·Depression
·Accidental Pregnancy
·Discrimination and social stigma
·Post-traumatic stress disorder and complex post-
traumatic stress disorder
·Psychological trauma
·Anxiety
According to various studies and reviews published in the
1990’s and early years of 2000, there is a long term
psychological and behavioral problems significantly
present with the sexually abused child. The experts in the
field suggested that child sexual abuse was a potential risk
factor for causing more negative consequences in
childhood, adolescence, adulthood, and cause
disturbances in mental health (Bajpai, 2018).
A comparative study conducted between 67 sexually
abused school going girls with a matched group revealed
that the sexually abused children had significantly
increased clinical level of dissociation and post-traumatic
stress symptoms, respectively than the non-abused
children (Collin-Vézina & Hébert, 2005).
The results of another comparative study revealed that
there are higher frequencies of dissociative symptoms
present among a group of 76 sexually abused children
aged 4 to 6 years than children of the comparison group
(Bernier et al., 2013). These symptoms were persisting over
a period of one year. It is also found that the post-traumatic
stress symptoms are more in the sexually abused children
than the children who have experienced other forms of
trauma.
Maikovich et al. (2009) have used a prospective method in
which they analyzed sexually abused children over 36
months, and revealed that both boys and girls exhibit same
level of post-traumatic stress symptoms.
A research also suggests along with post-traumatic stress
and dissociation symptoms, that there is a significant
number of other mental and behavioral disturbances, i.e.
mood disorders, depression, etc., found in children who
hugging, or wrestling even when the child does not
want it.
·They are more interested in the sexual development of
a child.
·They ask for more lonely time with a child with no
disturbances.
·They try to spend their free time with a particular child.
·They regularly ask to take care of child for free or take
child for overnight outings alone.
·They buy many gifts or give money for no reason.
·Frequently walk into there child's bathroom.
·They treat a particular child as their favourite, making
them feel 'special' compared with others in the family.
Allen and Pothast (1994) conducted a comparative study
between the sample of child sexual abusers, male (71) and
female (58) and a group of male (38) and female (52) non-
abusers from the general population, to know the
relationship between various demographic variables and
child sexual abusers. The study had revealed that the
proportions of inside and outside of family child sexual
abusers were not reported, and there were no significant
differences between the ages of abusers and non-abusers
(r=0.02). The child sexual abusers were mostly
unemployed (r=0.26), had significantly less income
(r=0.58) and less education (r=0.33) as compared to the
non-abusers. The child sexual abusers were more
masculine than non-abusers (r=0.18). Abusers scored
higher on the emotional need scale (r=0.33) and the
sexual need scale (r=0.26) compared to non-abusers.
Another study on sexually abused children in a national
survey of parents (Finkelhor et al.,1997; 2009) was also
conducted on the relationship between child sexual
abusers and their characteristics, with the sample of 521
Boston families who are having at least one child of age
between 6 and 14 years. Nine percent of the parents
reported that their children had been victims of either child
sexual abuse (23) or attempted child sexual abuse (23) and
the age of abusers were more than 21years. Further,
abusers were far more likely to strangers (45%) rather than
parents or relatives (10%).
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uncomfortable.
·Teach them to speak when they feel uncomfortable
about anything and to say 'No' or refuse anything which
cause discomfort.
·Teach them to be careful in public places.
·Parents should teach their children the correct names
of all different body parts, including their private body part
such as “tummy ”. Parents can also explain in simple words
that the body parts covered by a swimsuit are their private
body parts.
·Teach them “they are the owner of their own body”.
·Teach them to run away from that place as soon as
possible and not to stay alone with that person in the future.
·Teach them to call for help immediately, talk to people
whom they trust like parents, and explain in detail that had
happened.
·Teach children that it is not right to touch other's private
body parts and it is not right if anyone touches his or her own
private body parts in front of them or it is not right if anyone
asks to touch his or her private body parts.
·Teach them it is not right if someone asks them to
takeout clothes without any reason and it is not right if
someone takes photos or videos of their child without their
clothes.
Education on preventing child sexual abuse has
significantly improved the condition of children. Child
sexual abuse prevention programmes have given
emphasize on primary intervention focusing on potential
victims rather than perpetrators (NSPCC, 2018). Child
education programmes create environments in which
children are able to easily disclose prior to any form of
maltreatment.
A quasi experimental study was conducted to evaluate the
effectiveness of structured teaching programme on good
and bad touch among children with the sample of 60
children, of which 30 children attended the structure
teaching programme and 30 children did not attended.
Equal number of male and female children participated in
both groups. Findings of the study revealed that 60% of the
children had average knowledge and 4% of the children
had poor knowledge in the pre-test, whereas it was found
have been sexually abused. The teenagers exhibit
conduct problems and are more prone to substance
abuse, self-harm behaviors, and suicidal behaviours
(Houck et al., 2010).
5. Awareness about Child Abuse
It is necessary to teach children about Good and Bad
Touch.
·Good Touch or safe touch – A good touch feels
pleasant and safe. A safe touch is a way of showing care,
love, and affection. These touches keep children safe,
make them feel warm, creates smile and the children feel
cared and important. Parents can explain safe touch by
giving examples, such as mom's hug or papa's goodnight
kiss, or when grandparents hold their arms and even
holding their friend's hands while playing.
·Bad Touch – Bad touches are the touch that you feel
uncomfortable, unpleasant, and wants that touch to stop it
then and there. Again, when you feel hurt while touching,
when you do not want to be touched without your concern,
and without any reason if someone touches your private
parts, if someone touches you and tells you not to tell
anyone, etc., are examples of a bad touch (Wisdom Times,
2018).
6. Role of Parents
·As early as possible, parents should talk to their child
about the good and bad touch so that the child can
understand this.
·Parents should not hesitate to talk about these sensitive
topics because they are the first teacher and it is about
safety of their child.
·Begin to talk with their child in a simple way and with a
playful method.
·Parents should always be open to their child and make
sure the child knows that the parents are always there for
them to support (Parents Protect, n.d.).
·Parents should be child's best friend – Spend quality
time with children and have faith in them and always listen
to their complaints rather than underestimating them.
·Parents should not hesitate to use the exact terms while
describing situations. Young children are much fearless to
speak about matters which would make the adults
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sexual abuse in India: Current issues and research.
Psychological Studies, 58(3), 318-325.
[8]. Collin-Vézina, D., & Hébert, M. (2005). Comparing
dissociation and PTSD in sexually abused school-aged girls.
The Journal of Nervous and Mental Disease, 193(1), 47-52.
[9]. Deb, S., & Mukherjee, A. (2011). Background and
adjustment capacity of sexually abused girls and their
perceptions of intervention. Child Abuse Review, 20(3),
213-230.
[10]. Finkelhor, D., Moore, D., Hamby, S. L., & Straus, M. A.
(1997). Sexually abused children in a national survey of
parents: methodological issues. Child Abuse & Neglect,
21(1), 1-9.
[11]. Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. L.
(2009). Violence, abuse, and crime exposure in a national
sample of children and youth. Pediatrics, 124(5), 1411-
1423.
[12]. Foster, J. M. (2011). An analysis of trauma narratives:
Perceptions of children on the experience of childhood
sexual abuse (Doctoral Dissertation, University of Central
Florida).
[13]. Houck, C. D., Nugent, N. R., Lescano, C. M., Peters, A.,
& Brown, L. K. (2009). Sexual abuse and sexual risk
behavior: Beyond the impact of psychiatric problems.
Journal of Pediatric Psychology, 35(5), 473-483.
[14]. Kendall-Tackett, K. A., Williams, L. M., & Finkelhor, D.
(1993). Impact of sexual abuse on children: A review and
synthesis of recent empirical studies. Psychological
bulletin, 113(1), 164-180.
[15]. Maikovich, A. K., Koenen, K. C., & Jaffee, S. R. (2009).
Posttraumatic stress symptoms and trajectories in child
sexual abuse victims: An analysis of sex differences using
the National Survey of child and adolescent well-being.
Journal of Abnormal Child Psychology, 37(5), 727-737.
[16]. NSPCC. (2018). Child sexual exploitation. Retrieved
from https://www.nspcc.org.uk/preventing-abuse/child-
abuse-and-neglect/child-sexual-exploitation/
[17]. One in every two children victim of sexual abuse says
survey. (2017). In Hindustan Times. Retrieved from
https://www.hindustantimes.com/india-news/one-in-every-
two-children-victim-of-sexual-abuse-says-survey/story-
that 80% of the children had good knowledge and 20% of
the children had average knowledge in the post-test. The
calculated "t" test was of 12.03 at p: 0.05 level of significant,
which revealed a statistically significant improvement in
knowledge (Abujamand & Lillypet, 2017).
Conclusion
Every parent wants their children to be safe and secure and
they want to give them a safe environment, where a child
can grow without any fear. Parents want to protect their
children from every odd situation. In day to day life children
come in contact with many people who may be good or
bad. So, it is the responsibility of parents to train and teach
their children to face and handle any odd situation or any
bad person coming in their way. Teaching children about
good touch or bad touch makes them confident,
emotionally strong, and helps them to grow normally. We
can protect our children from the maltreatment first by
awareness. Every person who is involved with child care
should have the knowledge of child protection. The
protection of children is not only an individual issue, but a
community concern as well.
References
[1]. Abujamand, Y. & Lillypet, S. (2017). Effectiveness of
structured teaching programme on knowledge regarding
Good Touch and Bad Touch among children. Christian
Nurse International, 9(4), 18-24.
[2]. Allen, C. M., & Pothast, H. L. (1994). Distinguishing
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ABOUT THE AUTHOR
Manisha Praharaj is currently working as a MSc Tutor at SUM Nursing College of SOA (a deemed to be University), Bhubaneswar,
Odisha, India. She has received her MSc. Degree from College of Nursing, Berhampur and Post Basic Nursing from Oxford
College of Nursing, Bengaluru. She has three years of teaching experience and two years of clinical experience.
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8 No. 2 May - July 2018

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