Definition and identification of child abuse by Finnish public health nurses

The purpose of this study was to determine how public health nurses in Finland defined child abuse and how they assessed their capability to identify child abuse in the family. Public health nurses described child abuse as consisting of physical and emotional abuse. They described physical abuse as consisting of two categories, direct physical abuse towards children and other acts causing children physical harm. Emotional abuse included neglect, teasing the child, frightening the child, rejecting the child in the family, and forcing the child to assume an adult role. The nurses divided the identification of child abuse into two categories: tools for identifying child abuse and markers indicating child abuse. The tools for identifying abuse included knowledge acquisition and interactive skills, intuition, and the capacity of the nurse to handle problematic situations. Public health nurses identified child abuse in the child's behavior and appearance and in family behaviors. Public health nurses seem to be aware of child abuse, but further research is needed if they need more-specific skills regarding how to apply their theoretical knowledge to nursing practice to provide nursing care for abused children and their families.     

A theory of maternal engagement with public health nurses and family visitors

BACKGROUND: Home visiting by public health nurses and family visitors is promoted as an important intervention for enhancing parent and child development. Mothers of children at-risk for developmental delays tend to be the most difficult to access and engage, and commonly drop out of home visiting programmes prematurely. PURPOSE: This paper reports a study developing a theory that describes the process by which mothers of children at-risk engage with public health nurses and family visitors in a blended home visiting programme. METHODS: Grounded theory was used to guide the collection, recording, organization and analysis of the data. A purposeful sample of 20 mothers receiving public health nurse and family visitor home visits were recruited from a public health unit in Canada. Data were collected through client record reviews and 29 in-depth interviews that explored participants' experiences, beliefs and expectations about engagement. Data collection and analysis continued until all categories were saturated. FINDINGS: Mothers felt vulnerable and frequently powerless when they allowed the service providers into their home. Mothers with children at-risk engage with public health nurses and family visitors through a basic social process of limiting family vulnerability, which has three phases: (1) overcoming fear; (2) building trust; and (3) seeking mutuality. The personal characteristics, values, experiences and actions of the public health nurse, family visitor and mother influence the speed at which each phase is successfully negotiated and the ability to develop a connected relationship. CONCLUSION: Public health nurses working with families at risk need to identify client fears and perceptions related to home visiting, and to explain the role of public health nurses and family visitors to all family members. Given the importance that mothers place on the development of an interpersonal relationship, it is important for home visitors continually to assess the quality of their relationships with clients.     

How public health nurses understand mothers of abused and neglected children: The perception of 'Shindosa' in mothers

Aim: The purpose of this paper is to describe the practical knowledge that public health nurses use in identifying and providing assistance to the mothers of child abuse victims. Methods and Results: A grounded theory qualitative research method was used to collect and analyse semistructured interviews of 22 public health nurses from health centers in Osaka, Japan. The data was systematically analysed by using a constant comparison process. The participants had an average age of 46.2 years with an average of 21.6 years of experience in their profession. The research examined the perspective of the public health nurses regarding the mothers of child abuse victims. The key factor ‘shindosa’, which is a sense of fatigue, defeat, or lack of energy, emerged from the data. In addition, public health nurses used a two‐step process of perception. First, public health nurses began providing assistance to mothers by noticing the presence of shindosa in thems. Nurses became concerned by the state of the mothers and the way they interacted with their children. They perceived that the mother might be experiencing shindosa. Second, through continuous involvement with the mothers, public health nurses came to ascertain the essence of shindosa in mothers. Thus, their initial vague impression of the presence of shindosa became the catalyst to providing assistance to the mothers, and as a result, they gradually understood the fundamental nature of shindosa. Conclusion: By focusing on mothers as well as children, public health nurses successfully achieved their goal to provide the appropriate and specific care to each mother with shindosa as a solution in the prevention of child abuse.     

Supporting the case for ‘progressive universalism’ in health visiting: Scottish mothers and health visitors’ perspectives on targeting and rationing health visiting services,with a focus on the Lothian Child Concern Model

Aims and objectives. To explore parents and professionals’ experience of family assessment in health visiting (public health nursing), with a focus on the Lothian Child Concern Model. Background. Health visitors currently assess families as requiring core, additional or intensive support, and offer support at a corresponding level. The majority of families are assessed as core and receive no pro‐active support beyond the early days. Previous assessment tools, consisting of checklists, have been criticised as being ineffective in identifying a range of health needs and unacceptable to parents and health visitors. The Lothian Child Concern Model was developed and introduced in the study area to promote a partnership approach with parents and assess strengths as well as difficulties in parents’ capacity to care for their child. Methods. Qualitative methods were used. Ten mothers and 12 health visitors took part in individual semi‐structured interviews. Results. Most mothers were aware of the assessment process but some felt that they were not involved in the decision‐making process. Explaining the assessment process to parents is problematic and not all health visitors do so. The assessment process was stressful for some mothers. Health visitors find the model useful for structuring and documenting the assessment process. Many believe that most families benefit from some support, using public health approaches. Health visitors said that families are often assessed as core because there are insufficient resources to support all those who meet the criteria of the additional category and that managers assess caseloads in terms of families with child protection concerns. Conclusions. The study findings significant the concept of ‘progressive universalism’ that provides a continuum that intensity of support to families, depending on need. Mothers would like better partnership working with health visitors. Relevance to clinical practice. The study endorses proposed policy changes to re‐establish the public health role of health visitors and to lower the threshold for families to qualify for support.     

Working with vulnerable families: a health visiting perspective

The aim of this paper is to describe part of the findings of a research study which explored the health visitor's role in identifying and working with vulnerable families in relation to child protection One objective of the study was to describe and analyse the work which health visitors undertake with vulnerable families aimed at preventing crisis, ill-health and child abuse This paper outlines this aspect of the research and looks specifically at health visitors'perceptions of their work and interventions with vulnerable families and children Health visitors working m an inner city area and a suburban area were sampled and pilot work was undertaken in a third suburban area Stage one involved a postal survey of 102 health visitors, in which a response rate of 58 (57%) was obtained Stage two involved 12 in-depth interviews with health visitors One major finding of this study highlighted the fact that the health visitor's role when working with vulnerable families appears to be one of diversity and conflict In the light of the current National Health Service reforms it seems of paramount importance that health visitors illustrate to others, both managers and other health/social service professionals alike, the important function of their work with these vulnerable groups This is essential to ensure that health visitors'work with vulnerable families in relation to child protection is understood and valued and that the needs of vulnerable families continue to be identified This paper contributes to the knowledge base of health visiting and raises some important issues for professional health visiting practice     

Preventing child maltreatment through community nursing

The role of community nurses, such as health visitors, in the prevention of child abuse and neglect by home visits is reviewed The paper evaluates the potential of community nurses for predicting and identifying families at high risk for child maltreatment in order to support them through the promotion of positive parental knowledge, attitudes, skills and behaviour The success of health visitor interventions to prevent family problems is also evaluated The review concludes that accurate prediction of child-maltreating families requires more than one screening procedure to reduce the number of false alarms, and suggests that health visitors might be trained in the objective assessment of parent-child interaction Few health visitor interventions were deemed a success, indicating that greater support and training is required for community nurses if they are to be used to prevent child abuse and neglect However, recent changes in the community nursing services and the purchaser-provider split in health care has reduced this possibility     

Protecting children: intuition and awareness in the work of health visitors

Protecting children: intuition and awareness in the work of health visitors This paper is based upon an ethnographic study of a group of health visitors engaged in child protection work. The purpose of this paper is to explore the meanings individual health visitors attach to events concerned with identifying children who may be at risk of harm from child abuse, and also the idiosyncratic nature of health visiting in this complex but everyday social situation. The paper focuses on understanding the importance of a particular form of knowledge which the health visitors referred to as 'intuitive awareness'.     

The role of the health visitor in identifying and working with vulnerable families in relation to child protection: a review of the literature

This paper presents an overview of the research surrounding the role of the health visitor in identifying and working with vulnerable families in relation to child protection Only a limited number of empirical studies have been completed within the field of health visiting, so this review draws on most of the literature published over the last 15 years, which is mainly British in origin No previous reviews have focused on this specific area of health visiting Clearly with the recent increase in public and official recognition of child protection issues and the continuing debate of health visitor involvement within this area, this review takes a significant step forward in drawing together relevant research The review focuses on research within three main areas Firstly, the health visitor's role in working with vulnerable families in relation to child protection is explored The clients'perceptions of this role are also explored Secondly, the identification of vulnerable families by health visitors and non-health visitors is explored Within this area a number of studies by non-health visitors investigating screening approaches to child abuse have been reviewed, because they play such a major role in the literature and appear to have influenced subsequent health visitor research Thirdly, a review of health visitors'preventive work with vulnerable families is completed     

Deconstructing the role of the public health nurse in child protection

This paper argues that children who have been deemed to be 'at-risk' need specialist intervention and that the Irish public health nurse (PHN) cannot provide this intervention. It is further argued that a failure to acknowledge and act on this is placing children at further risk and it is suggested that the mismatch between actual and perceived (or expected) roles leads to practices which undermine rather than support child protection. The PHN's remit in protecting children is situated within the following contexts: the variety of client groups with whom the PHN works, overall provision of child health services in the community, her education and training, and primary, secondary and tertiary protection of children. Two recent reports on enquiries into the failure of the services to protect children living with their families are used to explore the discontinuity. Existing evidence on how personnel involved (directly and indirectly) in community care services perceive or understand the PHN's role in child protection is described in the context of what the PHN's role actually is. The evidence suggests that the PHN fulfils a range of prescribed roles but that there is a perception or expectation among other service providers that she is also fulfilling additional roles. The paper concludes by suggesting some possible solutions to this discontinuity with a view to improving child protection services.     

Public health nurses perception of clinical leadership in Ireland: narrative descriptions

Aim  The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses' in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background  Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method  Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results  Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions  Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers  Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.     

Development of the role of public health nurses in addressing child and family poverty: a framework for action

Title. Development of the role of public health nurses in addressing child and family poverty: a framework for action Aim. The purpose of this paper is to invite dialogue about how public health nurses could best address child and family poverty. Their current role is reviewed and a framework for expanding this role is presented. Background. The negative health consequences of poverty for children are well‐documented worldwide. The high levels of children living in poverty in wealthy industrialized countries such as Canada should be of concern to the health sector. What role(s) can public health nurses play in addressing child and family poverty? Method. A review of scholarly literature from Canada, the United States of America and the United Kingdom was conducted to ascertain support for public health nurses’ roles in reducing poverty and its effects. We then reviewed professional standards and competencies for nursing practice in Canada. The data were collected between 2005 and 2006. Findings. Numerous nursing scholars have called for public health nurses to address the causes and consequences of poverty through policy advocacy. However, this role was less likely to be identified in professional standards and competencies, and we found little empirical evidence documenting Canadian public health nurses’ efforts to engage in this role. Public health nurses’ roles in relation to poverty focus primarily on assisting families living in poverty to access appropriate services rather than directing efforts at the policy level. Factors associated with this limited involvement are identified. We suggest that the conceptual framework developed by Blackburn in the United Kingdom offers direction for a more fully developed public health nursing role. Prerequisites to engaging in the strategies articulated in the framework are discussed. Conclusion. Given more organizational support and enhanced knowledge and skills, public health nurses could be playing a greater role in working with others to make child and family poverty history.     

Functionalism and holism: community nurses' perceptions of health

This paper reports the results of a study that was designed to explore and examine the perceptions of two groups of newly qualified community nurses about the factors they considered to be embedded within the concepts of health, health-enhancing behaviours at individual, family and community levels and their 'innermost self'. The research was exploratory in nature, and included two sample groups: group 1 comprised 16 newly qualified health visitors; group 2 comprised 16 newly qualified community mental health nurses. Purposive sampling was used and data were collected using semi-structured interviews. The group of health visitors perceived health in terms of physical fitness and functional states. At a global level they perceived the need to provide education on health matters. They gave generously to 'charities' and perceived the 'inner self' as 'that part that matters'. The group of community mental health nurses perceived health in terms of holism and being states. Their concept of health was related to listening to each individual's perception of what is 'right' and 'health-enhancing' for them. At a global level they considered the protection of the ozone layer and the promotion of a just and equitable society which focused on the reduction of poverty, to be key health-enhancing activities. They perceived their 'innermost self' to be 'that part of me that makes life worth living', and the soul. The findings have implications for developing new and creative approaches for teaching the holistic concept of health and healing. Educational activities could be designed which strive to ensure that nurses themselves have safe and health embracing opportunities for exploring all the elements that are embedded within the topic of health. Their role in facilitating holistic health promoting activities for all clients also needs to be addressed.     

Health visiting and refugee families: issues in professional practice

AIM: This paper reports on the perceptions of experienced health visitors working with refugee families in Inner London. BACKGROUND: Women who are refugees and asylum seekers in the United Kingdom are more likely to experience depression than either non-refugee women or male asylum seekers. Health visitors provide a universal public health service to all women on the birth of a child, or with children aged under five, and as such are well placed to identify emotional and mental health problems of women who are refugees. Despite successive waves of refugees to the United Kingdom in the 20th century, there are no empirical studies of health visiting practice with this vulnerable group. There is also no body of evidence to inform the practice of health visitors new to working with asylum seekers and refugees. METHODS: An exploratory study was undertaken in Inner London in 2001. Semi-structured interviews were conducted with a purposive sample of 13 health visitors experienced in working with women and families who are refugees. FINDINGS: A range of structural challenges was identified that mediated against the development of a health-promoting relationship between health visitors and refugee women. With refugee families, who were living in temporary accommodation, health visitors were prioritizing basic needs that had to be addressed: in addition, they prioritized the needs of children before those of women. Health visitors were aware of the emotional needs of women and had strategies for addressing these with women in more settled circumstances. Health visitors considered themselves ill-prepared to deal with the complexities of working with women in these situations. CONCLUSIONS: This study identifies issues for further exploration, not least from the perspective of refugee women receiving health visiting services. Health visitors in countries receiving refugee women are framing their work with these women in ways that reflect Maslow's theory of a hierarchy of needs. This study suggests ways that public health nursing practice could be improved, and identifies issues for further study.     

Beyond and around mandatory reporting in nursing practice: Interrupting a series of deferrals

Nurses are well positioned to contribute to child protection efforts but are underutilised. This paper describes a critical discursive analysis of nursing responses to child neglect and abuse (CN&A) in British Columbia, Canada. Legal and practice guidelines were analysed alongside nurse interview texts, offering a glimpse into how nurses prevent CN&A in their everyday practice with families. Results show how the primacy of mandatory reporting to child protection authorities coordinates a series of deferrals and how nurses engage with and interrupt these deferrals in everyday practice. Nurses' relational approaches are essential to gain access to the private sphere of the family to assess, plan, elicit cooperation with interventions and monitor the situation. They considered reporting to be one among many possible responses. This study highlights how nursing contributions to prevention are largely overlooked and points to the potential for a more significant role for nurses in a public health approach to child protection.     

Invisibility of nurses and midwives in the public health response to child abuse and neglect: A policy review

BackgroundChild abuse and neglect need to be addressed through a public health approach that prioritises prevention and early intervention. Nurses and midwives are core to this public health response, yet little is known about how their roles are described in Australian policy.AimTo explore how nurses’ and midwives’ roles in a public health response to child abuse and neglect are described in Australian policies about child protection, health, welfare, or development.MethodsThis policy review used Internet searching to identify Australian policy documents relating to child protection, health, welfare, or development published from 2009 to 2021. Data were analysed using deductive coding and content analysis.FindingsNurses’ and midwives’ contributions to a public health response to child abuse and neglect were either absent or described in scant detail within Australian policy. The information that was available represented only a portion of nursing and midwifery practices from a limited range of practice contexts.DiscussionA lack of visibility and clarity of nurses’ and midwives’ roles in policy raises many challenges. This includes a lack of guidance for interdisciplinary collaboration, educational preparation of nurses and midwives, and appropriate resourcing for their interventions. Further research is urgently needed to guide future best-practice policy and practices for nurses’ and midwives’ contributions to a public health response to child abuse and neglect.ConclusionAn enhanced representation of nurses’ and midwives’ roles in Australian policy is required to guide a public health approach that promotes better outcomes for all children.     

The role of mental health nursing in the prevention of child sexual abuse and the therapeutic care of survivors

This paper is primarily designed to stimulate discussion and debate on the role of the mental health nurse dealing with survivors of sexual abuse. The authors contend that, in reality, all nurses should be prepared through education and training to treat the sufferers of emotional and spiritual pain, regardless of from where the hurting stems. The need for nurses to open their eyes and acknowledge the agony and distress caused to children as a result of abuse by adults is highlighted. So too is the necessity for nurses to enhance their own unique and specific practice. Nurses (and particularly mental health nurses) have a role in promoting a healthy generation of children — children who are looked after and protected by caregivers and not by caretakers. As the result of nurses advocating healthy caregiving and healthy relationships children may never need to suffer from inhumane and denigrating acts against their very beings. Nurses have no excuse for being unable to imagine child sexual abuse. Therefore they have no excuse for not being prepared to deal with the resulting, excruciating pain. It is both uncaring and inhumane for nurses not to be prepared to accept the sharing of such emotionally painful and disturbing experiences. Mental health nurses have a genuine role in offering therapeutic care to victims and survivors. This paper concludes by exploring and examining the nurse's role in counselling survivors of child sexual abuse.     

Health visitors'' perceptions of domestic violence: the private nature of the problem

This study investigates health visitors' perceptions of domestic violence with a focus on the abuse of women by their male partners. Criticism has been levied at health visitors for responding inappropriately to women who seek help. There has been limited research into the process of health visiting practice in dealing with this emotive health need. The extent of the problem is difficult to ascertain, but estimates would suggest that it is a major public health issue. The abuse frequently commences or intensifies during pregnancy, and many of the women who experience domestic violence have children of pre-school age. It is during this time that they are most likely to come into contact with the health visiting service. The research was carried out in two National Health Service (NHS) trusts, one in the London region and the other in the south-east of England. A brief questionnaire was sent to all health visitors within the NHS trusts to ascertain the numbers of abused women known to the health visiting service. The findings suggest that the majority of health visitors in both NHS trusts were involved with families where domestic violence occurs. One of the key themes which emerged from interviews with 12 health visitors from each NHS trust (n = 24) was the very private nature of domestic violence in terms of identifying the issue. Implications for practice are that health visitors need to be more proactive in their questioning techniques and in influencing public policy, but they also require support through the provision of appropriate training.