'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.

Interprofessional education within a nurse practitioner led paediatric service: A multi-methods study.

AIM: This project explored whether a nurse practitioner led mobile paediatric screening service in early learning centres could incorporate allied health and nursing students and develop their confidence in interprofessional collaboration. BACKGROUND: Interprofessional collaboration is essential for health professionals across all contexts of care, including early childhood screening and intervention that enables children to thrive. METHODS: This multi-methods study (pre-test/post-test design) was conducted with nursing, physiotherapy, occupational therapy and nutrition and dietetics students attending clinical placement within the nurse practitioner led mobile paediatric service. Data were collected via pre and post placement surveys (ISVS-21) and post placement semi-structured interviews. RESULTS: Twelve students participated from July to December 2022. Survey findings demonstrated students improved inter-professional socialisation and readiness, supported by qualitative findings that uncovered unique mechanisms for how positive experiences were achieved. Unique pedagogical elements included 1) the nurse practitioner's professional attributes and 2) the mobile nature of the service leveraging learning opportunities within the shared commute. CONCLUSIONS: This study provides proof-of-concept of a placement model that facilitates interprofessional collaboration in nursing and allied health students. Further research should explore longer-term outcomes and scalability.

Interprofessional Education in Child Protection for Preservice Health and Allied Health Professionals: A Scoping Review.

Health and allied health professionals are uniquely positioned to collaborate in prevention, early intervention and responses to child maltreatment. Effective collaboration requires comprehensive interprofessional education (IPE), and inadequate collaboration across sectors and professions continually contributes to poor outcomes for children. Little is known about what interprofessional preparation health and allied health professionals receive before initial qualification (preservice) that equips them for interprofessional collaboration and provision of culturally safe care in child protection. This scoping review aimed to identify what is known internationally about IPE in child protection for preservice health and allied health professionals. Thirteen manuscripts reporting 12 studies met the inclusion criteria and were included in the synthesis. Key characteristics of the educational interventions are presented, including target disciplines, core content and their learning objectives and activities. Findings demonstrated primarily low-quality methodologies and educational interventions that had not been replicated beyond their initial context. Many educational interventions did not provide comprehensive content covering the spectrum of prevention, early intervention and responses for all types of child maltreatment, and/or did not clearly indicate how IPE was achieved. Key challenges to delivering comprehensive interprofessional child protection include lack of institutional support and competing priorities across disciplines who must meet requirements of separate regulatory bodies. Consequently, there is a need for further development and robust evaluation of educational interventions to explore how interprofessional collaborative skills for child protection can be developed and delivered in preservice health and allied health professional education.

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.

Navigating and negotiating meanings of child abuse and neglect: Sociocultural contexts shaping Australian nurses' perceptions.

Nurses who work with children have the opportunity to make a difference by identifying and responding to child abuse and neglect. Little is known about the ways that nurses define, assess and respond to child abuse and neglect and how this subsequently affects children. This paper reports one of four themes identified through inductive analysis of a qualitative study exploring nurses' perceptions and experiences of keeping children safe from abuse and neglect. The aim of this paper was to report on how nurses understand and interpret child abuse, is found to be shaped by their own sociocultural contexts. A qualitative research design underpinned by social constructionism framed the study. Data were collected in 2016 and 2017 through 21 in-depth, semi-structured interviews with nurses who work with children in Australia. Key findings showed that nurses working with children had difficulty defining child abuse and drew upon multiple sources to construct a working definition. In addition to drawing from official legislation and guidelines, nurses compared and contrasted the level of abuse with their own personal and professional experiences of parenting. Nurses described the challenges of making assessments when faced with cultural practices different from their own. Nurses' descriptions of how they defined abuse showed that their assessments of child abuse and neglect were inextricably linked to their personal values and beliefs. As such, nurses were often working from their own value systems rather than consistently taking a child-focussed approach. There was an absence of consistent and explicit critical reflection on ways that values and beliefs might shape practice at individual and system levels. We propose this is a missing aspect of child safe practice. Reflection on how personal and professional values and beliefs interact with the implementation of evidence-informed approaches will increase nurses' capacity to maintain a child-focus.