More than mandatory reporting: nurses’ experiences of safeguarding children in Australia

Author: Lauren Lines

Lines, Lauren, 2020 More than mandatory reporting: nurses’ experiences of safeguarding children in Australia, Flinders University, College of Nursing and Health Sciences

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Child abuse and neglect is a global public health issue with significant short and long-term impacts for children, families and societies. The scale of child abuse and neglect and complexity of contributing factors means it is not easily resolved. Current approaches include a public health model, also known as safeguarding, whereby all individuals, communities and organisations have a responsibility towards the health, safety and wellbeing of children. This includes universal services for all families, through to targeted

interventions for more vulnerable families and statutory services for cases of severe abuse or neglect. Nurses are the largest group of health professionals and are well-placed to respond to child abuse and neglect through this whole-of-community approach. In Australia, nurses are mandated reporters of child abuse and neglect, however, little is known about other ways that nurses respond to child abuse and neglect in the broader domain of safeguarding. It is important to understand how nurses already respond to child abuse and

neglect to understand how to best support and mobilise the nursing profession to enact change for children. This qualitative study explored the perceptions and experiences of nurses working with children about how they keep children safe from abuse and neglect. A social constructionist lens underpinned the research and data was collected through semistructured in-depth interviews with registered nurses working with children in Australia (n=21). All interviews were audio recorded and transcribed. Data was analysed inductively supported by NVivo software and identified four key themes. The first theme ‘sociocultural contexts shaping nurses’ perceptions of child abuse and neglect’ demonstrated that nurses had difficulty concisely defining child abuse and neglect, and instead drew upon multiple sources to help them clarify instances of child abuse in their practice. The second theme ‘How can we work together?’: keeping children safe through therapeutic relationships’ outlined nurses’ recognition that meeting children’s needs was often best achieved by working with the parents to make gradual changes. However, on occasions nurses needed to act immediately to protect children despite the risks of damaging therapeutic relationships. Theme three, ‘Constructing a compelling case: complexities of communicating about child abuse and neglect’ highlighted how nurses experienced challenges when reporting concerns to child protection services such as feeling as though they were not taken seriously and had limited capacity to ensure children’s safety. Finally, theme four ‘systems and hierarchies shaping nurses’ responses to child abuse and neglect’ outlined how nurses perceived that systems and hierarchies that were intended to protect children, increasingly adopted a ‘rule-centred’ rather than child-centred approach. This thesis contributed to new knowledge through these four themes which together demonstrate that nurses enacted a range of complex skills to safeguard children extending far beyond mandatory reporting. The findings form a starting point to highlighting the complexity of nurses’ practices and the need for greater recognition, education and support. However, nurses’ safeguarding practices need to be underpinned by widespread policy and systems change to effectively address the challenges they face when addressing the complex problem of child abuse and neglect. More specifically, greater interprofessional collaboration is needed within organisational cultures that support professionals to

maintain child-centred approaches. All of these changes must be underpinned with quality evaluation to ensure they produce positive outcomes for children who are at risk of, or are experiencing child abuse and neglect.

Keywords: nurses, nursing, safeguarding, child abuse, child maltreatment, child abuse and neglect, Australia

Subject: Nursing thesis

Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Nursing and Health Sciences
Supervisor: Alison Hutton