Integrative review: nurses' roles and experiences in keeping children safe

Effects of COVID on Mandated Child Abuse Reporting Among Nurses: The Mediating Role of Compassion Fatigue

Because COVID triggered elevated rates of child abuse, but diminished rates of child abuse reporting, we explored predictors of nurses' attitudes toward reporting suspected child abuse during the COVID pandemic. In particular, we expected that compassion fatigue and compassion satisfaction would mediate the effects of COVID-related stressors (i.e., exposure to COVID patient death and suffering; COVID-related family income loss; frequent direct care of COVID patients; and parental burnout) on nurses' negative attitudes toward reporting suspected child abuse. Employing chain-referral sampling, we recruited a sample of 244 registered nurses (83% White; 87% women). Supporting hypotheses, compassion fatigue mediated the effects of job-related COVID stressors (exposure to COVID patient death and suffering; COVID-related family income loss; and frequent direct care of COVID patients) on nurses' negative attitudes toward reporting suspected child abuse. In addition, among nurses who were also parents, nurses' self-reported parental burnout mediated the relation between compassion fatigue and negative attitudes toward reporting suspected child abuse. In addition, compassion satisfaction mediated the effect of nurses' parental burnout on nurses' negative attitudes toward reporting suspected child abuse.

Associations between nurse characteristics, institutional characteristics and perceived nurse knowledge and self-efficacy of reporting suspected child abuse and neglect

AIM

To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self-efficacy of reporting child abuse and neglect.

DESIGN

A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey.

METHODS

A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores.

RESULTS

Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self-efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self-efficacy of reporting child abuse and neglect.

CONCLUSION

This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters.

IMPACT

This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self-efficacy in reporting suspected child abuse and neglect.

REPORTING METHODS

The authors of this study have adhered to relevant EQUATOR guidelines: STROBE.

PATIENT OR PUBLIC CONTRIBUTION

There is no patient or public contribution as the study only looked at nurses.

'We aren't valued for who we are': Australian nurses' and midwives' perceptions of challenges and barriers to safeguarding children

PURPOSE

Professionals working with children, including nurses and midwives, are foundational to effectively safeguarding children from maltreatment. However, little is known about the full nature and scope of nurses' and midwives' roles in safeguarding children in Australia presenting barriers to effective workforce preparation and support.

DESIGN AND METHODS

This study reports an inductive analysis of qualitative responses (n = 51 Round 1, n = 17 Round 2) from a two-round Delphi study. The Delphi study aimed to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children, and this manuscript presents findings of an inductive analysis of qualitative responses beyond the scope of the Delphi study. Participants were Australian nurses and midwives (n = 51, n = 17) from diverse child-focussed settings.

RESULTS

Nurses and midwives experienced many factors outside of their control that restricted their capacity to safeguard children. Influences included high workloads, burnout, lack of support, poor collaboration, structural barriers and inaccessible services for children.

CONCLUSIONS

Nurses and midwives are advocates for children but experienced many factors preventing them from effectively safeguarding children. Future approaches to reducing child maltreatment must be underpinned by support for frontline professionals to promote workforce capacity and sustainability.

PRACTICE IMPLICATIONS

Despite nurses' and midwives' best intentions, their attempts to prevent and respond to child maltreatment were hampered by systemic factors beyond their control. This study highlighted the need to address broader influences on nursing and midwifery practice to reduce the impacts of child maltreatment and support children to thrive.

Exploring public health nurses' acceptability of clinical assessment tools in a Norwegian child health centre

BACKGROUND

Infants' symptoms of mental struggle are often diffuse and undifferentiated, and health services do not identify many infants at risk of poor development. However, primary health care is advantageous for early identification, given there are frequent consultations during the infant's first two years. Health policy encourages using evidence-based screening but use varies in primary health care. The Alarm Distress Baby Scale (ADBB) is an assessment tool targeting social withdrawal in infants 2-24 months of age.

AIM

To explore contextual factors related to public health nurses' (PHNs) acceptability of clinical assessment tools in a Norwegian child health centre.

METHODS

Prior to an upcoming ADBB training, we used focus group discussions with PHNs to explore their views on their professional role and practice and how this concurs with using assessment tools.

FINDINGS

Thematic analysis resulted in the following themes: (1) A Role requiring Supporting the Parents and Safeguarding the Infant; (2) The Challenge of Interpreting Infant Expressions; and (3) Organisational Preconditions for Accepting New Methods.

CONCLUSION

Our findings show that PHNs regard assessment tools as an aid to detect infants at risk, but that systematic use of such tools can hinder their ability to be flexible, egalitarian, and resource-focused. We also find that acceptability of assessment tools requires a system for continuous training and a well-established referral routine.

Development and psychometric evaluation of the reporting suspected child abuse and neglect (RSCAN) scale for United States registered nurses

PURPOSE

In the United States (US), nurses have a mandated duty to report child abuse and neglect (CAN). Despite comprising the highest proportion of the US healthcare workforce, limited research has explored the institutional barriers they face in reporting suspected CAN. Furthermore, there is no existing valid and reliable measure of reporting relevant to US. The purpose of this research is to develop and psychometrically evaluate a scale to measure nurse knowledge and self-efficacy as CAN mandated reporters.

DESIGN AND METHODS

The Reporting Suspected Child Abuse and Neglect (RSCAN) tool was developed from two existing international tools to examine institutional barriers and facilitators to US nurses' professional knowledge and reporting of CAN. A convenience sample of one hundred and sixty-six US nurses primarily from the Pacific Northwest responded to an online survey. An exploratory factor analysis (EFA) and Cronbach's α were used to examine validity and internal consistency, respectively, of an initial 16-item scale.

RESULTS

A two-factor model consisting of eight items indicated good model fit (CFI = 0.986, RMSEA = 0.049, and SRMR = 0.028) and was internally consistent (Cronbach's α = 0.822).

CONCLUSION

RSCAN is the first US instrument to reliably measure nurses' professional knowledge and self-efficacy of reporting suspected CAN.

PRACTICE IMPLICATIONS

Future research can build upon these findings to recognize and support nurses in their mandated role to report CAN.

Nurses' and midwives' contributions to a public health response to keeping children safe from abuse and neglect - a Delphi study

Nurses and midwives can be instrumental to global efforts to address child abuse and neglect through a public health approach of prevention and early intervention. However, there is limited understanding of nurses' and midwives' roles, and no international or local guidelines to inform and evaluate their safeguarding practices. The aim of this modified Delphi study was to build consensus on the nature and scope of nursing and midwifery practice in safeguarding children in Australia. Sixty-four statements located within seven clusters were developed from a literature review and nursing and midwifery practice standards. Participants (N = 102) were nurses and midwives working with children in diverse contexts. They were asked to indicate the importance of each statement to their practice setting. Consensus (80%) was achieved on all statements in Round Two. Findings highlight that participating nurses and midwives agreed safeguarding children is a core component of their practice in diverse child-focussed settings. Findings can inform ongoing discussions about development of nursing and midwifery practice standards and guide effective workforce preparation, education, support and resourcing. Further research about ongoing development of nursing and midwifery roles in safeguarding children is essential to explore how to most effectively mobilise these professions to prevent child abuse and neglect.

A-TEAM: An Interprofessional Approach to Mandated Reporting in the Hospital Setting

Reporting suspected child maltreatment in pediatric settings presents unique challenges. Variation in mandated reporter training may lead to discomfort and emotional dysregulation. Failure to collaborate inter-professionally potentially results in suboptimal care for vulnerable children and families. A-TEAM promotes awareness, transparency, empathy, a nonjudgmental strategy, and management by an interprofessional team when referring patients for child protective services evaluation. A faculty trained in pediatric trauma nursing led the development of A-TEAM. Integrating nursing and social work expertise protects the integrity of family-centered patient care. The A-TEAM approach may be a valuable contribution to the continuing education of pediatric health care professionals.

Health and social care practitioners' experiences of exercising professional curiosity in child protection practice: An integrative review

This integrative review aims to evaluate the experiences of health and social care practitioners with regard to how they exercise professional curiosity in child protection practice. Professional curiosity gained significant currency following the Munro Review of Child Protection (2010) in England, as a means of seeking clarity on what is happening within a family. However, a recurrent finding from child safeguarding practice reviews is that practitioners continue to struggle to exercise curiosity. This is evident within both the United Kingdom and international literature, although descriptors for the concept may differ. This study attempted to identify facilitators and barriers to applying professional curiosity to provide a greater understanding of this theoretical concept. Title and abstract review of 1428 articles identified from databases and 11 from other sources resulted in 52 papers for full-text review. The quality of each article was appraised using the Critical Appraisal Skills Programme tool for qualitative studies, the Mixed Methods Appraisal Tool (MMAT) for quantitative/mixed method studies and the Joanna Briggs framework for theoretical/opinion papers. Key findings were recorded in the Summary Table of Literature Reviewed. Data extracts were thematically analysed. Twenty-four papers predominantly from the UK, but also from Australia, Italy, Sweden and USA formed the data set. Overarching themes that emerged from the thematic analysis included: noticing dissonance, emitting curiosity, constructing meaning, facilitators, individual professional challenges, organisational and macro-level influences and conceptual development. This review demonstrated that professional curiosity is multifaceted and involves a whole system approach, from empowered, knowledgeable and competent frontline practitioners to creative, innovative and empathic organisations, that value staff contributions and place the child's best interests at the forefront of service development. Recommendations are made for practice and further research.

Experiences of Norwegian child and school health nurses with the "Starting Right™" child health assessment innovation: a qualitative interview study

Background

Although child health services are well established in Norway, the use of information technology for the systematic collection of evidence-based child- and proxy-reported health measures may be beneficial in the early identification of child development problems. The Norwegian “Starting Right™” health service innovation consists of parent- and child-reported online structured health assessments tools, including practical routines for child and school health assessments. The aim of this study was to explore the experiences of child and school health nurses with the Starting Right innovation.

Methods

We used a qualitative design and conducted three focus group interviews with 18 child and school health nurses from three child health centres one year after the implementation of the innovation.

Results

The experiences of professionals with the Starting Right innovation were captured by three themes: (1) the digital innovation could be used to obtain a good overview of a child’s health and development; (2) interpreting the questionnaires was a challenge; and (3) implementing the new digital innovation was time-consuming.

Conclusions

Overall, the child and school health nurses experienced that the Starting Right innovation was useful for providing a comprehensive overview of child development and health. The challenges related to interpreting the parents’ scores and follow-up of children, as well as providing the questionnaires in relevant foreign languages, should be addressed to allow all children and families to be reached.

An Interprofessional Approach to Family-Centered Child Protective Services Referral: A Case Report

BACKGROUND

Members of the trauma team often find themselves in a uniquely challenging position wherein their role on the care team may necessitate developing a working relationship with alleged or confirmed perpetrators of abuse.

CASE PRESENTATION

A 9-week-old admitted to the hospital with hyponatremia and evaluation for suspected child physical abuse. Specific details of the case were a barrier to communication and interactions between the patient's mother and the trauma nurse. This report will provide a discussion of takeaway lessons to support communication with this patient population.

CONCLUSION

Peplau's Theory of Interpersonal Relations is utilized as a framework for engaging in therapeutic communication with a family that is part of a child protective services evaluation. The mnemonic, A-TEAM (Aware, Transparent, Empathetic, A nonjudgmental approach, and Managed by an interprofessional team), is introduced as a strategy for trauma nurses and other health care team members to engage in therapeutic communication with a family that is part of a child protective services evaluation during their admission.

Motivation of male adolescents to become perpetrators of violence: a study of phenomenology

BACKGROUND

Violence committed by adolescents is a serious public health problem. More than ten percent of youth violence have been subjected to violence and more than fifty percent attacks and serious violence.

DESIGN AND METHODS

A qualitative study with a phenomenological study design in which semi-structured interviews were conducted with participants who were once challenged by violence and are now kept in LPKA Class II Jakarta.

RESULTS

This qualitative study explores adolescent motivation to become violent perpetrators. This study discusses four major themes, namely, i) Unsafe environmental conditions; ii) Unpleasant past experiences; iii) Childhood trauma; and iv) Peer group solidarity or friendship.

CONCLUSIONS

Adolescent motivational advice provides protection for students in Indonesia to participate in discussions about children related to challenges or assistance that can be given to adolescents so as not to offend again.

Prevention of overweight and obesity in a Norwegian public health care context: a mixed-methods study

BACKGROUND

Greater understanding about the prevention and treatment of overweight and obesity in preschool children within public health care is needed. This study assessed the impact of The First Steps module in routine primary health care including mapping of height/weight and diet followed by parental counselling of healthy habits on overweight and obesity in children aged 2 to 7 years. Further, we explored the experiences of public health nurses (PHNs) with the module.

METHODS

Body weight and height obtained in 2014 and 2016 were extracted retrospectively for 676 children from the health records of children at 2, 4, or 6 years of age in five child health centers in Southern Norway. Sex- and age-adjusted body mass index (BMI) z-scores and weight status classifications were calculated according to the International Obesity Task Force reference values. Impact was assessed as change in mean BMI z-scores for children with under-, normal-, and overweight, respectively, and as proportion of children with overweight and obesity. In focus groups, PHNs described their experiences with the practical application of the module. Focus group transcripts were analyzed using Braun and Clarke's thematic analysis.

RESULTS

Mean BMI z-scores decreased from 2014 to 2016 in overweight children (- 0.26) and increased in children with under- (0.63) and normal weight (0.06), whereas the proportion of children with overweight and obesity was stable. PHNs believed that the module provides them with new tools that are useful for addressing the intricacies of childhood obesity. They described counseling sessions with families as "moving upstream in a river" and that overweight and obesity may be one of many complex challenges for these families.

CONCLUSIONS

Mean BMI z-score decreased in children with overweight during the 2 years after initiation of The First Steps module. PHNs considered the module as useful for addressing children's overweight and obesity, which was perceived as one of several complex challenges for most of these families. Specialist and evidence-based support is needed to address overweight and obesity in children in primary care. Further research should focus on integrating the issues relating to overweight and obesity within other family problems.

Public Health Nurses' Professional Practices to Prevent, Recognize, and Respond to Suspected Child Maltreatment in Home Visiting: An Interpretive Descriptive Study

The purpose of this analysis was to understand public health nurses’ experiences in preventing and addressing suspected child maltreatment within the context of home visiting. The principles of interpretive description guided study decisions and data were generated from interviews with 47 public health nurses. Data were analyzed using reflexive thematic analysis. The findings highlighted that public health nurses have an important role in the primary prevention of child maltreatment. These nurses described a six-step process for managing their duty to report suspected child maltreatment within the context of nurse-client relationships. When indicators of suspected child maltreatment were present, examination of experiential practice revealed that nurses developed reporting processes that maximized child safety, highlighted maternal strengths, and created opportunities to maintain the nurse-client relationship. Even with child protection involvement, public health nurses have a central role in continuing to work with families to develop safe and competent parenting skills.

Implementation of the norwegian 'Starting right' child health service innovation: implementation adjustments, adoption, and acceptability

BACKGROUND

An increased and/or stable proportion of the child and adolescent population reports symptoms of impaired health, and the symptoms can be identified early. Therefore, structured child- and parent-reported outcome measures need to be implemented in child and school health services for decision support and identification of children at risk. We aimed to (a) qualitatively examine adjustments of active implementation from the pilot implementation of the Norwegian 'Starting Right' health service innovation including an online child health assessment tool and practical routines, and (b) measure practitioners´ adoption and parental acceptability.

METHODS

We used a mixed-methods design to qualitatively examine adjustments from working notes and meeting memoranda, and quantitatively assess adoption and acceptability from user rates provided by the systems log. Twenty-one child and school health nurses (CSHNs) from two child health centers participated in the implementation pilot of online health assessments in children aged 2-, 4- and 6-year. We used a deductive and narrative analysis approach using Fixsen et al.´s core implementation components to code and sort adjustments.

RESULTS

Core implementation components were adjusted throughout the pilot implementation. Researchers´ increased their availability in reciprocity with staff evaluation to integrate active implementation adjustments. We launched a project for improved data systems integration. The overall CSHNs adoption rate was satisfactory and higher in center A, where a medical secretary supported the nurses through the entire pilot phase, than in center B (96 vs. 55 %). Parental acceptability rate was overall high (77 %) with increased rates among parents of 6-year-old children (98 %) compared with younger ones (78-85 %), and in cases where both parents received the questionnaires.

CONCLUSIONS

The 'Starting Right' health service innovation implementation was actively adjusted by integration of core implementation components mainly based on staff evaluation. The CSHNs adopted the innovation which was also acceptable to parents.

'How can we work together?' Nurses using relational skills to address child maltreatment in Australia: A qualitative study

BACKGROUND

Nurses working with children often encounter child maltreatment. Nurses' roles in mandatory reporting are well-documented, but less is known about additional ways nurses respond to child maltreatment. This is important because children experiencing less extreme maltreatment may have unmet needs without receiving a child protection intervention.

OBJECTIVES

This paper reports one key finding from a qualitative study exploring nurses' perceptions and experiences of keeping children safe from maltreatment. Specifically, it reports nurses' perspectives of their relational skills used to support children experiencing maltreatment.

DESIGN AND METHODS

Qualitative inductive thematic analysis followed by a secondary analysis using a social constructionist framework. Data were collected through in-depth, semi-structured interviews and data saturation was achieved. Transcripts were inductively analysed with support of NVivo software.

PARTICIPANTS

Registered nurses (n = 21) working with children in Australia.

RESULTS

Nurses saw relational practice as core to addressing child maltreatment. Key themes were: 1) 'Walking the line': relationships in the context of surveillance, 2) 'You are a good mum': focusing on the positives and 3) Seeing and being the voice of the child.

CONCLUSIONS

Nurses are uniquely positioned to identify and respond to child maltreatment through relational practices. Nurses maintained therapeutic relationships with parents to ensure ongoing access to vulnerable children. Although nurses recognised the importance of a child-centred approach, its enactment was varied and required ongoing critical reflection. This highlights the importance of supporting nurses to develop, maintain and continually improve their relational practices to enhance outcomes for children.

Nurses' intention to report child abuse in Saudi Arabia: A cross-sectional study

BACKGROUND

Child abuse is a prevalent problem with short and long-term consequences. While most countries have enacted child abuse reporting laws, the Saudi healthcare system has not paid sufficient attention to nurses' role in the reporting of child abuse.

OBJECTIVE

This study aimed to 1) identify the factors associated with nurses' intention to report child abuse by testing a hypothetical model; 2) examine the patterns underlying their intention to report child abuse; and 3) investigate the differences in reporting based on clinical practice areas.

PARTICIPANTS AND SETTING

A convenience sample of 248 nurses recruited from emergency and pediatric inpatient units and primary healthcare centers in Riyadh, Saudi Arabia was used.

METHODS

In this cross-sectional study, data were collected using the Child Abuse Report Intention Scale and another self-report measure in February 2019.

RESULTS

Most nurses had not reported even one case of child abuse during their clinical practice. Knowledge about child abuse (β = .210, P = 0.000), subjective norms (β = .218, P = 0.001), and organizational support in guideline implementation (β = .138 P = 0.038) were significantly associated with the intention to report child abuse. Nurses reported a stronger intention to report child sexual abuse than other types of abuse. Clinical practice areas were significantly associated with nurses' intention to report child abuse.

CONCLUSIONS

Nurses' professional preparation for child abuse reporting is inadequate. The findings underscore the importance of enhancing their knowledge about child abuse and reporting laws, promoting social support, and creating an empowering clinical environment.

Designing an adolescent safeguarding curriculum framework for preregistration nurse education programmes

Adolescence is a crucial period of transition during which young people are exposed to a range of safeguarding risks in the wider social context. However, it has been identified that the need to safeguard adolescents is less well recognised than the need to safeguard children. Furthermore, there is evidence that child development education provided as part of preregistration nurse education programmes tends to neglect adolescent development. Therefore, there is a need to adopt a life-course approach - which focuses on all stages of child development, including adolescence - and to review child development education to support future nurses in their role in safeguarding young people in practice. This article proposes a curriculum framework for adolescent safeguarding education, outlining a structure to support nurse educators when designing or reviewing preregistration nurse education programmes.

Exploring support systems for nurses involved with safeguarding children

BACKGROUND

Multi-agency working to safeguard children is increasing in the UK. Nurses encounter children who are at risk of, or subject to, abuse and neglect. They are required to be able to recognise indicators that suggest a child may have been abused or neglected and know what actions to take in response as part of their role. Without support to manage the negative effects of their involvement in safeguarding children, nurses can become stressed, and prolonged stress can lead to difficulty engaging in future cases.

AIM

To explore the experience of nurses involved in safeguarding children and to identify the systems they access to support them with the emotional effects of this work.

METHOD

This was a phenomenological study that involved semi-structured interviews. The eight study participants were hospital-based nurses who worked in children's areas and were involved in safeguarding children work. Thematic analysis was undertaken to identify themes from the data.

FINDINGS

The study identified some of the emotional effects of safeguarding children work experienced by nurses, which can be long lasting. It found that these nurses access various support systems in relation to their safeguarding work, such as case discussion, team support, child supervision and training.

CONCLUSION

It is important that managers understand the potential effects of safeguarding children work, so that they can ensure nurses have access to appropriate support. Managers should also promote access to support systems and address barriers that prevent nurses from accessing them.

Nurses' perceptions of systems and hierarchies shaping their responses to child abuse and neglect

Nurses have an important role in preventing and responding to child abuse and neglect. This paper reports on nurses' perceptions of how organisational systems and hierarchies shaped their capacity to respond to child abuse and neglect. This is one of four key themes identified through an inductive analysis of data from a broader qualitative study that explored nurses' perceptions and experiences of keeping children safe. The study was guided by social constructionist theory, and data were collected through in-depth interviews with nurses working with children in Australia (n = 21). Key findings showed that nurses experienced many challenges to responding to child abuse, including difficulties sharing information, fear of making mistakes and inflexible systems of care. This was underpinned by an organisational 'rule-centred' culture of following policies at the expense of maintaining an explicit focus on children's needs. These findings demonstrate first the importance of creative and flexible thinking from individual professionals, so policies are enacted with a clear child focus. Second, they highlight the need for leadership to enact organisational and systemic cultural change that maintains a genuinely child-centred approach.

Swedish School Nurses' Experiences of Child Abuse

Child abuse recognition and the protection of children is a global concern. In Sweden, the role of the school nurse (SN) is to promote schoolchildren's health and development and to identify and prevent harm. The aim of this study was to describe Swedish SN experiences of suspecting, identifying, and reporting child abuse and to compare them with respect to (a) years of experience as SN, (b) age of SN, and (c) pupil population size. A descriptive design was used. Two-hundred and thirty-three SNs completed a survey detailing their experiences. Most SNs (96%) reported having suspected a child suffering from physical or psychological abuse. Approximately half of them reported occurrences of honor-related violence (54%) and of child sexual abuse (57%). SNs with less nursing experience reported significantly less recognition and reporting of child abuse. The findings indicate that experiences of child abuse are common. Thus, it is vital that SNs have the necessary competency and support to identify and report suspected child abuse.

How Do Nurses Keep Children Safe From Abuse and Neglect, and Does it Make a Difference? A Scoping Review

OBJECTIVES

To explore the extent of child protection work performed by nurses and identify which interventions hold the strongest evidence for future practice.

DESIGN

This scoping review was guided by Arksey and O'Malley's framework for scoping reviews.

DATA SOURCES

Electronic databases (CINAHL, Medline, Scopus, Web of Science) and grey literature were searched in August 2017. Further studies were identified through manual literature searching.

RESULTS

Forty-one studies from seven countries met the inclusion criteria. The studies showed nurses keep children safe primarily through the prevention of abuse (n = 32), but also through detection of abuse (n = 1) and interventions to mitigate the effects of abuse (n = 8). Nurses' specific interventions most frequently involved post-natal home visiting (n = 20), parent education (n = 10) and assessment and care of children or adolescents following sexual abuse (n = 4). The main findings showed that although nurses did have positive impacts upon some measures of abuse and neglect, results were not consistent across studies. In addition, some studies used indirect measures of abuse and neglect, which may not impact children's experiences of abuse. It is difficult to extrapolate these findings to the broader nursing profession as literature did not accurately represent the range of ways that nurses keep children safe from abuse and neglect.

CONCLUSIONS

This review demonstrated nurses prevent, detect and respond to abuse and neglect in many ways. However, given mixed evidence and absence of some nurse interventions in the literature, further research is needed to represent the range of ways that nurses keep children safe and determine their effectiveness.

An exploratory study investigating perceptions, opinions and experiences of safeguarding education in pre-registration children's nursing curricula

AIM

To explore perceptions, opinions and experiences of safeguarding education within pre-registration children's nursing curricula.

METHODS

Using a qualitative research method, an online questionnaire was developed and disseminated to pre-registration children's nursing students to complete via a weblink added to their programme's virtual learning environment.

FINDINGS

This study highlighted the need to integrate other pedagogies in safeguarding education. These include implementing more practical-based workshops such as completing safeguarding referrals to social care and undertaking case vignettes from a multi-professional perspective.

CONCLUSION

The recommendations from this study for future safeguarding education in pre-registration children's nursing curricula include incorporating a hybrid experiential learning approach, through problem-solving and simulation-based learning, to bridge the theory-to-practice divide and ensure practitioners are fit for practice.

Family assessment conversations as a tool to support families affected by parental mental illness: a retrospective review of electronic patient journals

Background

Previous research has shown a link between parental mental illness and adverse development in their offspring. In Norway, it is mandatory for health professionals to identify if patients in adult mental health services have children, and subsequently to provide support for the children. An important tool to detect if families are affected by parental mental illness and to assess if there is a need for further intervention is the Family Assessment Conversation. Family Assessment Conversations is potentially a powerful tool for communication with families affected by parental mental illness because it facilitates early identification of children at risk of various adversities due to the family situation. Additionally the tool may initiate processes that enable children and parents to cope with the situation when a parent becomes seriously ill. Little is however known about how the mental health practitioners use the family assessment form in conversations, and to what extent they record relevant information in the electronic patient journals.

Methods

The main aim of the study was to provide information about the existing practice within mental health services for adults in terms of parental mental illness and family assessment conversations. The project is a retrospective journal review. The data base consists of relevant journal data from 734 patients aged 20-60 years admitted. In total, 159 recordings of family assessment conversations were discovered.

Results

The main result in this study was that many of the questions in the family assessment form lacked documented responses and assessments from the healthcare professionals. Only 17% of the participants had been assessed with the total family assessment form. Additionally, there was a lack of documentation about whether or not the children had been informed in a large proportion of the assessment forms (31%). A total of 55% say that the child has not been informed. This implies that there is still a long way to go in order to make sure that children of parents with a mental illness are given relevant information and support.

Conclusions

The documentation and family assessment frequency is low and reflects the challenges healthcare professionals and patient experience when the child's situation becomes the topic of assessment. There is a need to further investigate the challenges of changing the mental health systems to incorporate the children and families of patients. More research should promote knowledge on what may facilitate family assessment dialogue.

Health-promoting leadership: An integrative review and future research agenda

AIM

To provide a synthesis of the evidence of health-promoting leadership related to nursing by exploring definitions, core attributes and critical conditions.

BACKGROUND

Increasing pressure in healthcare settings due to efficiency requirements, population ageing with complex illnesses and projected global shortage of nurses, is a potential threat to nurses' health and job satisfaction, and patient quality of care and safety. New ways of thinking about nursing leadership and evidence-based human resource management are required to improve nursing environments.

DESIGN

Integrative literature review.

DATA SOURCES

Eight databases were searched: Academic Search Premier, CINAHL, Emerald, ERIC, Web of Science, MEDLINE, Psychinfo and Science Direct. Included papers were published between 2000-2016.

REVIEW METHODS

Of 339 papers, 13 were eligible for inclusion: eight qualitative and five quantitative. Studies were assessed for quality using standardized checklists. Framework-based synthesis was used, allowing for themes identified a priori to be specified as coding categories. This method also allows new themes to emerge de novo.

RESULTS

Four themes were identified. There are multiple definitions of health-promoting leadership, along with description of the non-health-promoting leader. The health-promoting nurse leader engages in employees' health promotion, and takes responsibility for actions and maintains open communication, accommodating nurses' participation in change processes. Through competence development, the health-promoting organization builds capacity.

CONCLUSION

Health-promoting leadership may be a promising path to optimizing nursing outcomes through holistic thinking, which emphasizes the importance of context. Accumulated research is required to build a stronger line of international research, with attention to underlying mechanisms, limiting conditions and behaviours known to health-promoting leadership.

Child neglect and abuse: a global glimpse within the framework of evidence perspective

AIM

This systematic review was conducted in order to integrate evidence-based knowledge and experience related to child neglect and abuse into the nursing literature.

BACKGROUND

The negative and intense effects of neglect and abuse on an individual can last into adulthood. Nurses who are in close contact with such cases have an important role to play in detecting child neglect and abuse and supporting the families involved. When nurses fulfil this role, it is important that evidence-based information and interventions are known to ensure that the process is a healthy one.

DATA SOURCES

Medline/Pubmed and Cochrane Library databases, from 2012 to 2016.

REVIEW METHODS

The PRISMA guide, a basic search algorithm, was used as a basis for the review.

RESULTS

This systematic research involved 32 articles that met the criteria. When the characteristics of the studies were examined, it was found that one study dealt with physical abuse, seven studies dealt with sexual abuse, 21 studies with neglect and abuse and three studies with all abuse types. It was also found that 16% addressed intervention, 22% addressed the relationship between abuse and other factors, 31% addressed prevention and 31% addressed the defining dimension.

CONCLUSIONS

It has been found that, in general, all types of negligence and abuse are studied together and that nurses lack the knowledge and skills needed to assess childhood neglect and abuse.

IMPLICATIONS FOR NURSING AND HEALTH POLICIES

Nurses have a critical role to play in identifying the dark spots and associated factors in the story of individuals because they are health professionals who are in close contact with patients. It is recommended that guidelines be developed and used in the diagnosis and treatment of abuse and neglect. Thus, in these cases, the standardization of care will be achieved.