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Lines LE, Kakyo TA, Grant JM, Hutton A. 'We aren't valued for who we are': Australian nurses' and midwives' perceptions of challenges and barriers to safeguarding children. J Pediatr Nurs 2024; 77:e16-e23. [PMID: 38458855 DOI: 10.1016/j.pedn.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 03/10/2024]
Abstract
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.
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Affiliation(s)
- Lauren Elizabeth Lines
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia.
| | - Tracy Alexis Kakyo
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia.
| | - Julian Maree Grant
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia; School of Nursing, Midwifery & Indigenous Health, Charles Sturt University, Panorama Avenue, Bathurst, New South Wales 2795, Australia.
| | - Alison Hutton
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide 5001, South Australia, Australia; School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia.
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Keller LA, Kayser K. The Impact of Training on Nurses' Attitudes Toward Reporting Child Sexual Abuse: a Pilot Study. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:373-381. [PMID: 38938958 PMCID: PMC11199467 DOI: 10.1007/s40653-023-00581-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 06/29/2024]
Abstract
The purpose of this project is to assess, for practicing pediatric nurses in the U.S., what is the impact of the Stewards of Children Child Sexual Abuse (CSA) program on their attitudes about reporting suspected CSA. A sample size of 32 nurses completed an online 2-hour continuing education course by Stewards of Children, with a pre/post-test survey. A modified 14-item version of the Teachers Reporting Attitudes Scale for Child Sexual Abuse (TRAS-CSA) was used to measure the nurses' attitudes before and after educational training. The surveys were analyzed to assess changes in attitudes using two-tailed sign tests. Nurses' commitment to reporting CSA is high, even before training. Nurses' confidence in the system of reporting and in the response of authorities related to CSA increased after taking the Stewards of Children online course. While these results are limited in strength by low sample sizes and some null changes, they indicate that trainings like the Stewards of Children course can positively impact nurses' attitudes towards reporting CSA, particularly with regards to confidence in reporting, and therefore warrant further investigation into CSA training for nurses and its effects. Supplementary Information The online version contains supplementary material available at 10.1007/s40653-023-00581-7.
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Affiliation(s)
- Lindsay A. Keller
- Department of Nursing, Otterbein University, Westerville, OH USA
- Tampa, FL USA
- Urgent Care, CityMD, New York, New York, United States
- Urgent Care, BayCare, Tampa, FL United States
| | - Kirk Kayser
- Department of Mathematics & Actuarial Science, Otterbein University, Westerville, OH USA
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Einboden R, Varcoe C, Rudge T. Extending the methodology of critical discourse analysis using Haraway's figurations: The example of The Monstrous Perpetrator within contemporary responses to child neglect and abuse. Nurs Inq 2024; 31:e12617. [PMID: 38059294 DOI: 10.1111/nin.12617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023]
Abstract
Critical discursive analyses offer possibilities for equity-oriented research, and are a resource for addressing resistant social problems, such as child neglect and abuse (CN&A). A key challenge for discourse analysts in health disciplines is the tensions between materiality and social constructions, particularly at the site of the body. This paper describes how Donna Haraway's ideas of figuration and technobiopower can augment critical discourse analysis to address this tension. Technobiopower, an intensification of biopower in the context of technoscience, is seen as underpinning the melding of material and semiotic practices. The subject is no longer a material body, but a hybrid body that exists in tropic figuration between the real and unreal. This paper uses an analysis of the figuration of The Monstrous Perpetrator from a study of nursing responses to CN&A to illustrate how Haraway's figuration aligns with and provides an analytical tool to extend critical discursive analyses. Specifically, this methodology offers new ways to identify the discursive qualities of bodies, and how material aspects of bodies are exaggerated, concealing their hegemonic ideologies and discriminatory effects. By identifying discourses within or inscribed upon the body, they can be disrupted, opening new possibilities for social change.
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Affiliation(s)
- Rochelle Einboden
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Colleen Varcoe
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Trudy Rudge
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Winquist A, Leiker CB, Landis T, Fraser J, Eddy LL, Burduli E. Development and psychometric evaluation of the reporting suspected child abuse and neglect (RSCAN) scale for United States registered nurses. J Pediatr Nurs 2023; 73:e319-e326. [PMID: 37863784 DOI: 10.1016/j.pedn.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/22/2023]
Abstract
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.
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Affiliation(s)
- Anna Winquist
- University of Colorado Anschutz, College of Nursing, Aurora, CO 80045, USA.
| | - Celestina Barbosa Leiker
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
| | - Tullamora Landis
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
| | - Jennifer Fraser
- University of Sydney, Medicine and Health, Sydney, NSW 2006, Australia.
| | - Linda L Eddy
- Washington State University, College of Nursing, 14204 NE Salmon Creek Ave, Vancouver, WA 98686, USA.
| | - Ekaterina Burduli
- Washington State University, College of Nursing, 412 E. Spokane Falls Blvd., Spokane, WA 99202-231, USA.
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Mawhinney B, Fraser JA. Engagement and Retention of Families in Universal Australian Nurse-Home-Visiting Services: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6472. [PMID: 37569013 PMCID: PMC10418844 DOI: 10.3390/ijerph20156472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023]
Abstract
Family support is offered to Australian parents of young children using a mix of targeted and universal child and family health services including nurse-home-visiting programmes. These rely on the voluntary engagement of families. In this study, the capacity to engage and retain families, including those at risk of becoming involved with child protection services, was examined. The broad objective was to identify nursing practices used at the interface of health and child protection services and to articulate those practices. Child and Family Health Nurses (CFHN) (n = 129) participated in a pragmatic, multilevel mixed-methods study. A questionnaire was used to identify nursing practices in the first phase of this study followed by focus groups in the second phase to describe these practices in more detail. Three practice themes were identified and described: enrolment, retention and conclusion of the nurse-family relationship. Universal child and family health services feature flexible, advanced, and multidimensional family support services including child protection practices. This paper focuses on practices employed by nurses to engage and retain families where child protection concerns are identified.
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Affiliation(s)
- Belinda Mawhinney
- Sydney Nursing School, University of Sydney, Susan Wakhil Health Building, Camperdown, NSW 2050, Australia;
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Invisibility of nurses and midwives in the public health response to child abuse and neglect: A policy review. Collegian 2022. [DOI: 10.1016/j.colegn.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Marcellus L, Tonmyr L, Jack SM, Gonzalez A, Sheenan D, Varcoe C, Kurtz Landy C, Campbell K, Catherine N, MacMillan H, Waddell C. Public health nurses' perceptions of their interactions with child protection services when supporting socioeconomically disadvantaged young mothers in British Columbia, Canada. CHILD ABUSE & NEGLECT 2022; 124:105426. [PMID: 34995927 DOI: 10.1016/j.chiabu.2021.105426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/10/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children of girls and young women experiencing socioeconomic disadvantage are at risk of maltreatment and associated health and developmental problems. Nurse-Family Partnership (NFP) is an early intervention program designed to improve child and maternal health outcomes. The effectiveness of NFP is being evaluated in British Columbia (BC) through a randomized controlled trial, augmented by a process evaluation to identify influences on how NFP was implemented. OBJECTIVE To describe how public health nurses providing NFP perceived their interactions with child protection professionals. PARTICIPANTS AND SETTING Forty-seven public health nurses across BC. METHODS The principles of interpretive description informed the qualitative component of the process evaluation. Data from interviews and focus groups were analyzed using the framework analysis approach. A thematic framework was generated through processes of coding, charting and mapping, with a focus on organizational and systems influences. RESULTS Nurses' practice in supporting families often involved engagement with child protection services. Four themes about the nature of this work were identified: 1) developing a deeper understanding of the disciplinary perspectives of child protection, 2) striving for strengthened collaboration, 3) navigating change and uncertainty, and 4) responding to family and community complexity. CONCLUSIONS Participants valued the contribution of child protection professionals and expressed willingness to collaborate to support families. However, collaboration was constrained by multiple structural barriers. Collaborative models offer possibilities for integrated practice, although can be difficult to implement within current health and child protection systems and child protection regulatory contexts.
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Affiliation(s)
- Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada.
| | - Lil Tonmyr
- Public Health Agency of Canada, Family Violence Surveillance, 785 Carling, AL 6807B, Ottawa, ON K1A 0K9, Canada.
| | - Susan M Jack
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Andrea Gonzalez
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8, Canada.
| | - Debbie Sheenan
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada
| | - Colleen Varcoe
- School of Nursing, T201-2211 Wesbrook Mall, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| | | | - Karen Campbell
- School of Nursing, Western University, London, ON N6A 3K7, Canada.
| | - Nicole Catherine
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.
| | - Harriet MacMillan
- Offord Centre for Child Studies, McMaster Innovation Park, Suite 201A, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada.
| | - Charlotte Waddell
- Children's Health Policy Centre, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC V6B 5K3, Canada.
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Antwi-Boasiako K, Fallon B, King B, Trocmé N, Fluke J. Understanding the overrepresentation of Black children in Ontario's child welfare system: Perspectives from child welfare workers and community service providers. CHILD ABUSE & NEGLECT 2022; 123:105425. [PMID: 34890960 DOI: 10.1016/j.chiabu.2021.105425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/14/2021] [Accepted: 11/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The overrepresentation of Black children in the child welfare system is a social problem that has received longstanding attention in the United States, but has recently received increasing attention in Canada. OBJECTIVE This qualitative study explores the findings of two quantitative studies (Antwi-Boasiako et al., 2020, 2021) in order to interpret them through the perspectives of child welfare workers and community service providers. The aim is to gain a deeper understanding on the potential factors that contribute to the overrepresentation of Black children in Ontario's child welfare system. PARTICIPANTS AND SETTING The study involved twenty-one child welfare workers from two child welfare organizations in Ontario serving lots of Black families and thirteen community service providers in Toronto. METHODS Six focus groups were completed with thirty-four participants. Each of the focus groups was audio recorded and manually transcribed verbatim. Constant comparison analysis was used to analyze the transcribed data. RESULTS Themes that emerged from the study include the following concerns: racism and bias from referral sources; racism and bias from child welfare workers; lack of cultural sensitivity; lack of workforce diversity/training; lack of culturally appropriate resources; assessment tools; duty to report; fear of liability; lack of collaboration; and poverty. CONCLUSIONS The results from this study reinforce the need to shift practice that acknowledges Black families as valuable stakeholders and experts of their own lives and involves them in the development and implementation of policies and practices that affect them.
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Affiliation(s)
| | - Barbara Fallon
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada.
| | - Bryn King
- Factor-Inwentash Faculty of Social Work, University of Toronto, Canada.
| | - Nico Trocmé
- School of Social Work, McGill University, Canada.
| | - John Fluke
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado, United States.
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Jack SM, Gonzalez A, Marcellus L, Tonmyr L, Varcoe C, Van Borek N, Sheehan D, MacKinnon K, Campbell K, Catherine N, Kurtz Landy C, MacMillan HL, Waddell C. Public Health Nurses' Professional Practices to Prevent, Recognize, and Respond to Suspected Child Maltreatment in Home Visiting: An Interpretive Descriptive Study. Glob Qual Nurs Res 2021; 8:2333393621993450. [PMID: 33628866 PMCID: PMC7882742 DOI: 10.1177/2333393621993450] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Lil Tonmyr
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | | | - Debbie Sheehan
- Simon Fraser University, Vancouver, British Columbia, Canada
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Lines MLE, Grant JM, Hutton A. 'How can we work together?' Nurses using relational skills to address child maltreatment in Australia: A qualitative study. J Pediatr Nurs 2020; 54:1-9. [PMID: 32473486 DOI: 10.1016/j.pedn.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
| | - Julian Maree Grant
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia; School of Nursing, Midwifery & Indigenous Health, Charles Sturt University, Bathurst, New South Wales, Australia.
| | - Alison Hutton
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia; School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.
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Lines LE, Grant JM, Hutton A. Nurses' perceptions of systems and hierarchies shaping their responses to child abuse and neglect. Nurs Inq 2020; 27:e12342. [PMID: 31899852 DOI: 10.1111/nin.12342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
| | - Julian Maree Grant
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Alison Hutton
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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