NSG 410 Stratford University Qualitative Research Discussion Discussion Forum 4: Qualitative Research a. Read the posted article attached. b. Refer to Ch
NSG 410 Stratford University Qualitative Research Discussion Discussion Forum 4: Qualitative Research
a. Read the posted article attached.
b. Refer to Chapter 6 pages 120 to121 of your assigned textbook for more guidance.
c. To be more clear, respond to the following aspects of the article and support your findings with literature.
Your critique responses should reflect the following:
1. What type of qualitative method did the researcher use?
2. what type of sampling method did the researcher use? Is it appropriate for the study?
3. Was the data collection focused on human experiences?
4. Were issues of protection of human subjects addressed?
5. Did the researcher describe data saturation?
6. What procedure for collecting data did the researcher use?
7. What strategies did the researcher use to analyze the data?
8. Does the researcher address credibility (can you appreciate the truth of the patient’s experience), auditability (can you follow the researcher’s thinking, does the research document the research process) and fittingness are the results meaningful, is analysis strategy compatible with the purpose of the study) of the data?
9. What is your cosmic question? N E O NATA L , PAE D IAT RI C AN D CH I L D H EALT H N U R S I N G
Nurses’ contribution to child protection
Marie Land BN Master Mid
Current PhD Student Charles Darwin University, NT
Professor Lesley Barclay AO RN RM PhD
Graduate School of Health Practice, Charles Darwin University, NT
This qualitative study used interviews to explore nurses’ perceptions of their role in protecting children and to identify any
barriers to implementing the role. Participants in this study were recruited through purposive sampling. Ten nurses whose work
brings them into regular contact with children and their families were interviewed; the sample included nurses from acute care
and community-based nursing services in the Northern Territory (NT). Results from semi-structured, open-ended questions were
analysed using a process of coding and thematic analysis.
Three major themes, derived from aggregating related sub-themes, were identified and names as Drawing a line in the sand;
Mushrooms in the dark and Fear factor. Three broad areas that influence nurses’ effectiveness in the protection of children were
identified – organisational structures, institutional practices and legislative frameworks. Recommendations from this study
include a need for collaborative interdisciplinary practices, development of departmental protocols to support such practice, and
nurse-led models of care that aim for early identification of risk factors for child abuse and early intervention to support families
and improve family functioning. This exploratory research has provided baseline data for an action research study in progress on
the role of nurses in protecting children.
Key words: nurses; child protection; interdisciplinary collaboration; family support.
What is already known on the topic
What this paper adds
Rates of reported child abuse and neglect are escalating
in the Northern Territory as they are across Australia and
There are legal, institutional and professional impediments
that limit the ability of nurses to protect children through
recognising signs of family vulnerability and assisting
parents in child rearing.
Statutory child protection agencies focus their attention on
investigation of child abuse and neglect and do not have
the necessary resources to provide support to vulnerable
The Australian Institute of Health and Welfare (AIHW) 1 reports
that the incidence of child abuse reports, and substantiation
of reports, is rising. Legislation in the Northern Territory (NT)
mandates reporting of child abuse. Concern that nurses have
insufficient understanding of the requirements of the NT
Community Welfare Act 1983 and how to report child abuse
was a motivator for this investigation. The inconsistency of
legislation throughout Australia may also limit the ability of
a mobile nursing workforce to keep abreast of the legislative
frameworks that govern their practice. It is also unclear
whether nurses perceive that they have a role in protecting
children and, if so, what barriers they perceive may limit their
ability to perform this role.
Data suggest that some nurses may become desensitised
to the problems of marginalised groups of Aboriginal
children through constant exposure to their poor health
Most children in the NT come into contact with nurses
throughout their early years and at school; however, it is
unclear whether these contacts provide a mechanism for
protection, advocacy and general family support. Assessment
of the psychosocial and emotional wellbeing of clients occurs
in nursing interactions with children and their families 2. In
urban areas of the NT, child and family health nurses (CFHN)
provide regular services for developmental assessments and
immunisations in the first 2 years of life. Once at school,
children may seek consultation and be involved in education
sessions with health promoting school nurses (HPSN). Nurses
in the emergency department and paediatric/neonatal wards
of hospitals are also well positioned to assess the safety of
children in these areas.
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N E O NATAL, PA EDI AT R IC AND CHILD HEA LTH NU RSING
There is abundant international literature pertaining to
nurses’ involvement in child protection. Much is from the
United Kingdom following the Lord Laming inquiry in 2003
into the death of Victoria Climbié, an 8 year old who was the
victim of continual abuse leading to her death 3. Although
seen by many health professionals, including nurses, in
the months prior to her death, action to prevent abuse
was not taken 4-6. Nurses were criticised for failing to make
adequate documentation about her physical condition when
she presented to two hospitals 7. The inquiry found that
lack of communication, as well as assumptions about what
colleagues were doing for Victoria, led to her death 8.
Statistics published by the AIHW show an increase in both
reports and substantiation of child abuse 9. There is limited
literature that explores Australian nurses’ perceptions of
their role in protecting children, and none addressing the
NT context. This gap in research is significant considering
the large Aboriginal population in the NT and the overrepresentation of these children in child abuse reports 1.
A study by Nayda 10 about the decision making of South
Australian community health nurses in reporting of child
abuse concluded that nurses are constrained by a number
of factors including negative perceptions of the services that
may be offered to a family following a report of child abuse.
They were also concerned about the potential damage to
their therapeutic relationship with the family and preferred
to offer support to the family as a first step. Nayda 11 suggests
that, while nurses are in an ideal position to recognise child
abuse, they may not have a sufficient understanding of their
role to do so adequately. She listed constraints mitigating
nurses’ ability to report suspected child abuse as lack of
educational preparation, organisational structures, fear of
the legal process, perception of potential damage to the
nurse-patient relationship, and their relationships with other
This study therefore set out to investigate if dilemmas arise
for nurses in their mandated requirement to report cases of
suspected child abuse in the NT and in their effectiveness in
their role protecting children.
The aims of this study were to:
Explore, with a small sample of child health, paediatric
and school nurses, their understanding and knowledge of
child abuse and neglect.
Identify these nurses’ perceptions of their role and
involvement in protecting children.
Identify any perceived barriers to nurses having a role in
Study and method
Exploratory qualitative research was undertaken as a means
of capturing the perceptions and experiences of nurses
V O L . 1 1 NO.1 march 2008
about their professional role, and involvement in, protecting
children. This approach was chosen so the words and stories
of the participants could guide the exploration of their
professional and personal experiences in dealing with
potential, suspected or confirmed child abuse. According
to Roberts & Taylor “qualitative research is interested in
questions that involve human consciousness and subjectivity,
and value humans and their experiences…” 13.
Sample and setting
A purposive sample of eight participants who had more than
2 years’ experience in nursing which involved children and
their families was planned. Flyers seeking participation were
placed in urban workplaces where nurses were involved with
children. The sample increased to ten over the course of the
study. Although the sample size was small, saturation of
the data became obvious early in the analysis therefore no
further participants were recruited. Volunteers were recruited
from acute, community and school practice settings and
interviewed in their location of choice.
A series of core questions were used for interviews to ensure
that each participant had an opportunity to address all
areas of interest. Semi-structured and open-ended questions
facilitated a full exploration of experiences (Figure 1). Further
questions, prompted by cues from participants, were asked to
explore perceptions and clarify meanings. Interviews lasted
from a minimum of 30 minutes up to 1 hour. The interviews
were audiotaped and then transcribed verbatim by the
Interview transcripts were analysed through manual thematic
coding of concepts. Line-by-line coding of words and phrases
allowed concepts to emerge within the context of the
Figure 1. Guideline questions.
Tell me about your role as a nurse in ED/paediatrics/child health/
What have been your experiences in relation to child protection
or child abuse?
Can you tell me about how you felt about those experiences?
Tell me about the processes, if any, that you understand are
required to be followed if you suspect child abuse in any of your
What do you think is the best way of handling this situation?
What gets in the way of you acting in this way?
What is your understanding of risk factors that may lead to child
Can you tell me about your relationship with Family and
Children’s Services (FACS) workers?
N E O NATA L , PAE D IAT RI C AN D CH I L D H EALT H N U R S I N G
language used and the experiences described. Perceptions
of nurses’ role and involvement in protecting children, and
any barriers to their involvement, were elucidated and these
were synthesised into sub-themes. Three major overarching
themes, grouped by aggregating sub-themes, were identified.
These themes provide some explanation through critical
analysis as to how those perceptions may have developed.
have a role in protecting children, most of the participants
perceived that they were capable of keeping children
safe by supporting families. The practice setting, level of
seniority and previous professional experiences (identified
in participant data) influenced to some degree participants’
priorities concerning perceived barriers to protecting children.
However, all participants made some reference to concepts in
the sub-themes that emerged. All participants recognised
they had a role in keeping children safe and that there were
barriers to this role being performed well.
Ethical approval was gained from the Joint Human Research
Ethics Committee, Menzies School of Health Research, and
the Department of Health and Community Services (DHCS).
Participants were advised that they could withdraw at any
time. All participants signed a consent form agreeing to be
interviewed and for that interview to be tape-recorded. The
population of the NT is small, areas where health services are
provided are well known, and it is possible that nurses are
recognisable to a wide professional audience, therefore there
was potential for identification of participants; considerable
care was therefore taken in de-identifying data. Participant
identifiers, including their place of work, are not attached to
direct quotes included in the body of this paper.
Sub-themes were grouped to form three major themes and
named as Drawing a line in the sand, Mushrooms in the dark
and Fear factor. A diagrammatic representation of these
themes demonstrating the sub-themes that they represented
is shown in Figure 2.
Theme 1: Drawing a line in the sand
This theme arose from data suggesting contextual conditions
influenced the decision making of nurses regarding reporting
of suspected child abuse. The theme grouped sub-themes
of the caring profession, subjective decision making, scarce
resources, cultural perspectives, and protecting professional
Data confirmed nurses as a ‘caring’ profession with this
approach demonstrated by all participants. As one child and
family health nurse said,
All of the participants identified their legal responsibility to
report suspected child abuse to the child protection agency
and they related experiences of professional involvement
with abused children. While not overtly stating that nurses
2. A graphical representation of themes and sub-themes
emerged from the data.
This was equally so for school nurses in the study,
… we are ideally placed to build up that trusting relationship
with families so, and provide that early intervention sort of
This concept was less evident in the responses of the acute
care nurses with their focus of care appearing to be more task
driven and medically orientated. These nurses also, however,
demonstrated concern for their patients and families. As one
nurse put it,
… it did take patience and it did take chasing, that’s the
thing, I just didn’t give up on it.
… you… try to provide the safest and most comfortable
environment, and there are more people involved than just
one patient – it’s the mother, it’s the father and maybe other
Many of the participants stated they made a report when
obvious signs of physical abuse were noted. However, they
expressed concern about reporting suspicion of abuse and
How emotionally tied up in a knot we get about some of the
fine line ones.
It’s that grey stuff that’s hard, yeah.
They believed a lack of clear, prescriptive definitions of child
abuse in the NT Community Welfare Act 1983 left nurses in the
position of making subjective judgments about their clients’
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N E O NATA L , PAE D IAT RI C AN D CH I L D H EALT H N U R S I N G
Targeted service delivery to vulnerable families by CFHNs,
and reporting of suspected abuse, were determined in part
on available resources. While many participants were clear
about the needs of vulnerable families, they felt constrained
in their ability to ameliorate problems because of a lack of
resources. As one participant said,
to effective practices through communication and knowledge
The sub-theme of anonymous FACS workers arose from
responses that indicated many of the participants did not
know the child protection workers,
… we can’t do all the extended visiting that we could,
probably should do.
I think I would like to meet them, who they are, face to face,
it would be good.
Several participants also raised concern that Family and
Children’s Services (FACS) is poorly resourced. They believed
this limited its ability to respond to reports made. This was
indicated by comments such as,
There was also a perception that FACS workers had limited
knowledge of the professional roles and expertise of nurses,
… half the time they are not investigated…
People aged 15 are… often put to the bottom of the pile.
Another participant described FACS as,
… a little area that just runs on stress and crisis all the time…
sometimes, you know, they are out of their depth with the
Cultural perspectives appeared to influence participants’
views about the standards of care that were acceptable
for Aboriginal children which were seen by them to be
variable. Several participants made comments concerning
the difficulties faced by remote Aboriginal families in
securing resources required for wellbeing. Evidence, though,
of repeated skin infections, failure to thrive, or exposure to a
violent or substance abusing community constitute a threat
to the future wellbeing of the child. But for some nurses, the
constancy and alarmingly high rates of these situations in
Aboriginal families has had a desensitising effect,
It’s a normal type thing for people to have scabies or for
parents to come in intoxicated, or for, you know, parents
to yell and swear and scream at their children… and I think
what we do now is we say, that is culturally acceptable.
The sub-theme of protecting professional roles formed part
of this major theme because participants, particularly the
CFHNs and HPSNs, believed they had the ability to support
families and therefore protect children. However, they
expressed reservations about the skills of child protection
workers in this area. The majority of participants stated they
were able to deal effectively with issues of parenting support
and education. As one participant said,
I believe if you support people in the right way that the
abuse won’t be there… I’m not saying their life mightn’t be
perfect, but it’s not going to be abuse at a harmful level.
Theme 2: Mushrooms in the dark
This theme was named to describe the communication barriers
that appear to prevent interdisciplinary practice and the lack
of awareness by each individual professional group about the
roles and skills of other health professionals. The sub-themes
of anonymous FACS workers, one-way communication, lack
of multidisciplinary collaboration, absence of clear protocols,
and lack of appropriate education were grouped within this
theme. Each sub-theme contained elements of impediments
… they have no idea what our roles, as in registered nurse,
registered midwife, maternal and child health, they have no
idea the skills that are involved in all that.
Participants perceived FACS as the ‘black box’ of the DHCS in
that little is known about the services it provides. Comments
such as the following indicated a level of frustration at the
lack of interdisciplinary communication and collaborative
it’s this lack of, they don’t gi…
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