Deconstructing the role of the public health nurse in child protection

Abstract

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.

Examining missed care in community nursing: A cross section survey design

“…While reporting child protection concerns and attending child protection meetings were rarely missed, additional visiting to support families was considered missed care in just over half of the PHN respondents. Although, PHNs are acutely aware of their responsibilities under the 1991 Child Care Act (Government of Ireland, ), the literature demonstrates an uncertainty around elements of scope of practice in child protection (Hanafin, ). However, there was a recognition that family support visits which should have been undertaken were not.…”

Child protection and public health: nurses’ responsibilities

“…2000). A lack of clarity about the roles and responsibilities of nurses in relation to child protection is also raised by Hanafin's (1998) deconstruction of the role of public health nurse in the Republic of Ireland. Hanafin argues that expectations of the role of these nurses with regard to child abuse are dangerously unrealistic.…”

Lessons Learned

“…Nonetheless, Irish studies identify child protection as a reluctant role 9 , 10 where concerns relate to the negative impact of “policing” on PHNs’ congenial public image, mirroring similar anxieties in other countries. 11 - 14 Yet Hanafin 15 suggests that the PHN has a role in primary prevention and secondary referral, although she argues that tertiary or ongoing care input is limited in child protection, particularly when monitoring rather than proactive intervention is the reality. However, under the Criminal Justice Act 2006, 16 the issue of reckless endangerment is raised that places a requirement on a person with authority or control over a child not to intentionally or recklessly endanger the child by leaving or placing them in a situation of substantial risk of serious harm.…”