A qualitative study of public health nurses' experiences detecting and preventing child maltreatment in primary care settings

Abstract

AimTo explore how public health nurses in child and family health centres experience detecting and preventing child maltreatment.DesignQualitative study.MethodsFourteen semi‐structured individual interviews with public health nurses who worked in 11 different child and family health centres were conducted. The interviews were analysed using thematic analysis.ResultsThree themes were identified: (i) integrating knowledge to prevent child maltreatment as part of their everyday job, (ii) striving hard to detect child maltreatment and (iii) experiencing the assignment to be complex and demanding.ConclusionDespite extensive experience, knowledge and following the guidelines, public health nurses in this study had difficulties finding children exposed to child maltreatment in child and family health centres. Public health nurses called for mutual multidisciplinary cooperation with other services and organizational facilitation, such as enough time and clear guidelines to effectively address this issue.Implications for PracticeThis study provides knowledge about how public health nurses work with child maltreatment at the Child and Family Health Center, which can serve as valuable foundation for further research as well for collaborating services.Reporting MethodEQUATOR guidelines were followed, using the COREQ checklist.Patient or Public ContributionNo patient or public contribution.

Detecting and preventing child maltreatment in primary care and PHNs’ role—a cross-sectional study

“…These findings are consistent with the qualitative study conducted among PHNs in CFHC prior the survey, where the PHNs at CFHC systematically and deliberately integrated efforts to prevent and detect prevent child maltreatment as part of their regular practice [48]. Activities such as ongoing mapping and assessment of risk factors, educating parents about child maltreatment (eg.…”

“…Although our findings indicate a high level of availability and a strong commitment from PHNs, the Norwegian official reports contends that there are too few reports of child maltreatment and reported cases could have been detected earlier [34,35]. The thorough follow-up described by the PHNs may reflect concerns and uncertainty, which is considered a barrier in reporting child maltreatment [27,39,48,51]. A Danish study about management of child maltreatment suspicions in general practice found that GPs and practice nurses often felt left to themselves managing their suspicions, especially in cases without clear signs and emphasized the importance of scheduling new appointments as a strategy to track the child's progress and maintaining a relation to the child's family [51].…”

“…Findings from a quantitative study indicated that primary care professionals did not fulfill their mandatory obligation diligently; instead, they suggested addressing it through alternative means to provide assistance [52]. In Midtsund et al 's qualitative study, several PHNs reported negative experiences when reporting to CPS, such as CPS dismissing cases where the PHN had serious concerns and felt a strong commitment to follow up on the children [48]. The statistics from Statistics Norway (SSB) show a significant increase in the concern reports reviewed by CPS when children are older and done with the follow-up from the CFHC.…”

“…The questionnaire construction drew upon existing studies [44][45][46][47] and the National Clinical guidelines for PHNs within CFHC settings [28]. To ensure questionnaire validity, a qualitative study gathered insights from PHNs in CFHC on detecting and preventing child maltreatment during the development process of the questionnaire [48]. The completed survey comprised a total of 128 questions and 46 sub-questions, organized into five sections including demographics, guidelines and experience of child maltreatment, vignettes, knowledge and attitude (Supplementary file 1).…”

“…The response options regarding procedures were based on the recommendations and indicated whether a procedure should be universally implemented at each consultation, carried out during specific/targeted consultations (for example, parental education about Shaken Baby Syndrome at the first postnatal visit), or based on indications when presence of signs, symptoms, or information indicating risk. Due to findings from the qualitative study conducted prior to the survey [48], which revealed that PHNs had more experience in identifying emotional maltreatment and neglect compared to physical violence, we opted for specific yes/no questions for each type of child maltreatment to measure PHNs' experience in detecting child maltreatment at the CFHC. "Have you ever encountered any children in your work at the CFHC whom you suspected being a victim of physical violence?…”