Deconstructing the role of the public health nurse in child protection

Responding to the support needs of front-line public health nurses who work with vulnerable families and children: a qualitative study

BACKGROUND

This paper reports on a research study to inform the development of a specialist role to support front line public health nurses (PHNs) working with vulnerable families and at risk children in Ireland.

AIMS

This study aimed to investigate the position of a leading role and explore the implications of such change.

METHODS

Focus group and semi-structured individual interviews were conducted with ten purposively selected participants in public health nursing, social work and a non-governmental children's organisation working in disadvantaged areas in Dublin.

RESULTS

Assistant directors of public health nursing are in a key position to inform decisions regarding the children's services.

CONCLUSION

Access to support and appropriate supervision are fundamental resource requirements for PHNs who work with vulnerable families and at risk children. The introduction of a specialist-leading role to support these PHN's is essential to sustaining best practice.

Lessons Learned: Public Health Nurses Practice in Safeguarding Children in the Republic of Ireland

The public health nurses’ scope of practice explicitly includes child protection within their role, which places them in a prime position to identify child protection concerns. This role compliments that of other professions and voluntary agenices who work with children. Public health nurses are in a privileged position as they form a relationship with the child’s parent(s)/guardian(s) and are able to see the child in its own environment, which many professionals cannot. Child protection in Ireland, while influenced by other countries, has progressed through a distinct pathway that streamlined protocols and procedures. However, despite the above serious failures have occurred in the Irish system, and inquiries over the past 20 years persistently present similar contributing factors, namely, the lack of standardized and comprehensive service responses. Moreover, poor practice is compounded by the lack of recognition of the various interactional processes taking place within and between the different agencies of child protection, leading to psychological barriers in communication. This article will explore the lessons learned for public health nurses practice in safeguarding children in the Republic of Ireland.

Child protection and public health: nurses' responsibilities

BACKGROUND

Health care workers have been recognized as having a key role in the protection and care of Scotland's children, particularly in respect of identification and detection of child abuse. Nurses, especially health visitors, are often the first professionals to suspect that child abuse has taken place. While previous research has found that health visitors have primarily perceived their role as that of providing support and advice to vulnerable families, there are pressures on them to fulfil a more narrow surveillance role. Concurrent with a lack of clarity about the role of health visitors in child protection, there has been increasing recognition that other nurses can also make an important contribution, including those who do not work directly with children.

AIMS

The aim of the study was to explore nurses' understanding of their professional responsibilities in relation to child protection, and the potential for nurses to be involved in the protection of children from abuse.

METHODS

A qualitative interview-based design was used, and 99 nurses working in an National Health Service trust in a Scottish city were interviewed, either individually or in groups, about their professional involvements in child protection issues. Interview data were subjected to thematic analysis.

FINDINGS

There was lack of consensus among interviewees about the nursing remit in child protection issues, particularly with respect to the extent to which nurses should actively seek to detect cases of child abuse. An emphasis on identification and detection was not easily accepted by many nurses, and was perceived by some to be a change from their more traditional role of supporting families, as well as being potentially in conflict with some public health responsibilities.

CONCLUSION

In spite of the perception of some nurses that there is a sharp divide between child protection work and public health interventions, many of the child protection roles identified by nurses, such as supporting families, parenting education and service development, are clearly within the ambit of contemporary notions of public health. Furthermore, it is clear that there is a role in child protection for a much wider group of nurses than health visitors.

The concept of protection: a dimensional analysis and critique of a theory of protection

Dimensional analysis clarifies the concept of protection, which has a commonly understood definition but is used inconsistently in research literature. Concepts such as protective factors and protective behaviors are often used interchangeably without adequately representing the phenomenon of protection itself. This article critiques a situation-specific theory of protection and presents dimensions of a model with an ecological view of protection. It uses dimensional analysis methods to derive the social construction of protection from its use in a broad range of literature; vigilant management and vigilant communication are salient dimensions of protection. The article compares conceptual literature with research literature to identify inconsistencies in use.