Working with vulnerable families: a health visiting perspective

Child-rearing anxiety and its correlates among Japanese mothers screened at 18-month infant health checkups

OBJECTIVE

To examine the level of child-rearing anxiety and to explore the variables correlated with child-rearing anxiety in a city in Japan.

DESIGN

Cross-sectional study.

SAMPLE

From July to September 2003, 371 mothers who visited community health centers in a city in Tokyo Metropolis for their child's 18-month health checkups.

MEASUREMENTS

Child-rearing anxiety was measured by the child-rearing anxiety scale. Questions in a self-reported questionnaire were on maternal variables, including maternal background information, child variables, and family system variables such as the presence of social support, and utilization of parenting support services. Also included within the questionnaire was the General Health Questionnaire-12.

RESULTS

Hierarchical multiple linear regression analysis revealed that mothers with higher child-rearing anxiety had less childcare satisfaction, more depressive symptoms, more worries about the child, less support from the husband, and less social support.

CONCLUSION

To identify mothers with high child-rearing anxiety in Japan, the infant health checkups should be utilized as an opportunity for screening, focusing on variables regarding mothers. Public health nurses can provide the necessary support after gaining an understanding of issues confronting mothers to prevent child-rearing anxiety and child abuse.

Nurse Reporting of Known and Suspected Child Abuse and Neglect Cases in Taiwan

Despite the frontline role of taking care of children, nurses in Taiwan have been reluctant to report known and suspected cases of child abuse and neglect (CAN). This problem threatens the success of legislation aimed at reducing CAN cases in Taiwan. The purpose of this study was to examine the influence of nurses' perceptions, attitudes, and knowledge on suspecting and reporting CAN cases in health care settings in Taiwan. Two hundred and thirty-eight nurses were surveyed using structured questionnaires with a return rate of 79.3%. Health care settings surveyed in this study included emergency units, pediatric units, and community centers from eight hospitals in southern Taiwan. Almost 3/4 (70%) of the sample of nurses thought they needed more training courses on CAN. Correlation analysis showed a significant relationship between suspecting and reporting CAN with perception, attitude, and knowledge. Stepwise multiple regression analysis revealed that perception (beta = 0.475), knowledge (beta = 0.265), and attitude (beta = 0.246) accounted for 60% of the variance in suspecting and reporting CAN. The focus and scope of training programs for nurses in Taiwan should take these findings into consideration.

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.

Finnish families' need for special support as evaluated by public health nurses working in maternity and child welfare clinics

The purpose of this study was to describe public health nurses' views of the everyday problems of families and their needs for special support. Seventy-four nurses filled in a tripartite questionnaire. The needs varied by region and were seen in 4% to 23% of all families expecting a baby or with a child younger than 3 age in the nurses' clientele. Approximately one-third of the families were considered to have a pressing need for support. More than half of families (54%) had difficulties coping with parenthood and family structure, almost one-third (30%) with raising their children and with childcare, and nearly one-third (27%) with their social network. In 20% of the families, the parents experienced problems relating to their relationship as a couple; 20% of the families had problems connected to the children's development, growth, and health; and in 19% of the families, the parents had health problems. Special needs were also caused by the parents' use of alcohol (15%) and by disputes over the children's custody and visiting rights (7%). The information provided by the study can be used in developing clinical services and the family work supporting them.

Early support needs of Finnish families with small children

AIMS

This study describes the early needs for support that families with small children have in the context of their own life situations. The study population consisted of Finnish families (n = 551) who participated in a project titled 'Families with Children' (1996-2001). The project supplemented the existing public services. The information provided by the study was utilized in supporting families and developing family work in seven experimental areas.

METHODS

The data were collected between 1997 and 2000 using family service plans and client reports. The data were analysed with inductive content analysis and using the SPSS software (version 7.5).

FINDINGS

The families needed support in the areas of parenthood, upbringing and child care, marital problems and social support networks. The need for early support was also connected to health problems of the children or the parents, problems with work or studies, unemployment, problems in economic or living conditions, or family crises. In addition to support, the families searched for help from family workers in disputes over child custody and visitation rights, intoxicant abuse and violence, and problems in adjusting to society. Each family had 4-5 needs for early support.

CONCLUSIONS

The results demonstrate that families with small children have many needs for which they seek help when there are available services supplementing the existing public services. The information provided by the study can be utilized in maternity and child welfare clinics, in social services and in family work provided by civic organizations to define the early needs of families for support and to develop services.

Definition and identification of child abuse by Finnish public health nurses

The purpose of this study was to determine how public health nurses in Finland defined child abuse and how they assessed their capability to identify child abuse in the family. Public health nurses described child abuse as consisting of physical and emotional abuse. They described physical abuse as consisting of two categories, direct physical abuse towards children and other acts causing children physical harm. Emotional abuse included neglect, teasing the child, frightening the child, rejecting the child in the family, and forcing the child to assume an adult role. The nurses divided the identification of child abuse into two categories: tools for identifying child abuse and markers indicating child abuse. The tools for identifying abuse included knowledge acquisition and interactive skills, intuition, and the capacity of the nurse to handle problematic situations. Public health nurses identified child abuse in the child's behavior and appearance and in family behaviors. Public health nurses seem to be aware of child abuse, but further research is needed if they need more-specific skills regarding how to apply their theoretical knowledge to nursing practice to provide nursing care for abused children and their families.

Caring for maltreated children: a challenge for health care education

AIM OF THE STUDY

The aim of this study was to establish whether paediatric nurses and doctors in a university hospital need supplementary training in the identification of child physical abuse and whether there is a need to develop health care education on child abuse issues.

BACKGROUND

Child physical abuse was defined as actions of a parent or a primary caregiver of a child under 18 years of age, which have caused physical injuries to the child.

METHODS

The sample consisted of paediatric staff (n=513) in a university hospital. Data were collected with a questionnaire, and the response rate was 62%. The data were analysed using statistical methods and quantitative content analysis.

FINDINGS

Sixty per cent of respondents needed supplementary training in the identification of child abuse. Those having experience in caring for abused children considered the identification most difficult (P < 0.001) and needed training more often (P < 0.005) than the others. The need for training was explained by stating that their basic education had not addressed child abuse issues, and by the complexity of the issue.

CONCLUSIONS

The findings indicate that research-based knowledge of the identification and treatment of child abuse should be incorporated into health care education. Supplementary education should address the management of complex and sensitive issues with customers, legislation, division of labour and multiprofessional collaboration in which nurses and doctors have an important, family wellbeing promoting role.

Identification of child maltreatment while caring for them in a university hospital

The purpose of the study was to look at how nurses and physicians of a university hospital rated their ability to identify child maltreatment while caring for those children. In this study, child maltreatment was defined as physical, psychological or sexual abuse or neglect of a child under the age of 18 by parents or caregivers. The total population of staff caring for children (N=513) in a university hospital were surveyed. Data were collected with a questionnaire developed for this study with reference to the literature. Altogether 317 questionnaires were returned, which yielded a response rate of 62%. The data were analysed using statistical methods and quantitative content analysis. Forty per cent of the respondents estimated that they had never cared for a maltreated child. Two-thirds of the respondents believed that they would be able to identify a child maltreatment case. The most distinct signs by which maltreatment could be identified were fractures, multiple bruises and the fact that the child had frequent injuries. The child's or parent's behaviour often aroused suspicion of maltreatment. Seventy-one per cent of the respondents rated the identification of maltreatment as rather difficult or difficult. Awkwardness of the phenomenon, the staff's pressure of work and relative unfamiliarity with the phenomenon were assessed as things that make the identification difficult. The fact that no jointly agreed guidelines were available for handling the matter was seen as a particular weakness. The respondents had fairly much theoretical knowledge about child maltreatment. However, child maltreatment is a multi-dimensional phenomenon that calls forth emotions. The development and improvement of practical nursing and medical care and of staff collaboration require that education be provided to different occupational groups and parties caring for children and that jointly agreed hospital-specific and regional models for operation be developed.

An evaluation of interventions to decrease intimate partner violence to pregnant women

Prevention of abuse to women is a national priority; however, research has focused on identification of abuse rather than evaluating interventions. To evaluate the differential effectiveness of three levels of intervention, Brief, Counseling, and Outreach, a longitudinal study with repeated evaluation interviews at 2-, 6-, 12-, and 18-months postdelivery was completed at two urban public health prenatal clinics. The participants were 329 pregnant, physically abused Hispanic women. Both physical abuse and women's use of community resources were measured. Repeated measures ANOVA showed that severity of abuse decreased significantly (p < 0.001) across time for all intervention groups. Violence scores at 2-months postdelivery were significantly lower for the Outreach group (p < 0.05) compared to the Counseling only group, but not significantly lower than the Brief intervention group. At 6-, 12-, and 18-month follow-up there were no statistically significant differences among the intervention groups. The use of lay outreach for abused pregnant women merits further research. Abuse screening by itself, however, may be the most effective intervention to prevent abuse to pregnant women.

Assessment of parents and young children (Children Act 1989)--a child psychotherapy point of view

The criteria used by professionals in assessing child care cases are not always made explicit, partly because of the ambiguity of the terms 'vulnerability' and 'at risk'. This paper presents a child psychotherapy view of what professionals may look at in terms of the interactions between parent and young child and how these may be understood. 'Reasonable expectations' of child development and parental care are considered. In terms of the child, overall attachment and communication needs and the specific developmental phase in terms child's maturing cognitive and socio-emotional functions are emphasized. In terms of the parent, the capacity to see the baby as separate from their own internal conflicts and to reflect upon the infant's mental state are seen to be pivotal to the infant's psychological well-being. The authors discuss the unconscious re-enactment of malignant patterns from the past through the relationship with the baby, and why parents are sometimes unable to avoid this. Finally, the authors suggest that assessment of the capacity for change in vulnerable parent-infant constellations must take into account the baby's developmental timetable.

Deconstructing the role of the public health nurse in child protection

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.

Establishing the validity and reliability of clinical practice guidelines used to identify families requiring increased health visitor support

One of health visitors' main roles is that of case finding and actively searching for health needs. This paper describes part of the findings of a study evaluating the clinical practice guidelines issued to health visitors to assist them in identifying families requiring increased health visitor support. A postal questionnaire was distributed to all Community Trust Chief Nurses in England (179), employing health visiting staff. The aim of the questionnaire was to assess the extent to which clinical guidelines are used throughout the country to identify families requiring extra health visiting support and to examine their validity and reliability. The survey results confirm the widespread existence of clinical guidelines in England to assist health visitors in identifying vulnerable families requiring extra support. The study provides evidence that the guidelines are largely subjective and invalid in nature. Questions are raised about the relationship between clinical guidelines and professional judgements.