The response of child and family health nurses to families in which there are concerns about the safety and wellbeing of young children aged from birth to five years within the family

Child safety is an important human rights and public health issue which has significant implications for long-term health and wellbeing. Despite child and family health (CFH) nurses offering a free health promotion service to all young children and their families throughout Australia, little is known about their practice in the context of child safety. The research question was as follows: What is the response of child and family health nurses to families in which there are concerns about the safety and wellbeing of young children aged from birth to five years within the family? An interpretive descriptive approach was used to understand how CFH nurses identify and respond to such families, and the way they experience working with them. Twenty-one CFH nurses in Tasmania were interviewed for this study. Three key themes were identified.

The first theme highlighted the way in which CFH nurses understood whether a child was safe within a family environment that provided sufficient support for their physical and emotional health and wellbeing. They identified child safety and wellbeing concerns by comparing a given child's family environment with their professional construct of what constituted a 'minimally acceptable family environment'. This understanding of child safety reflected, and was closely aligned with, the CFH nurse's role and responsibilities in promoting the health and wellbeing of the young child, as well as maternal and family health. CFH nurses aimed to reach consensus with colleagues around what constituted a 'minimally acceptable standard' through consultation and critical reflection.

The second theme described the way in which CFH nurses approached families in the context of child safety. They assumed that all families were vulnerable to child safety issues, and, using their specialist knowledge and skills in promoting child and family health, they engaged in primary prevention and early intervention strategies to help prevent child safety concerns from emerging and to identify and respond early when they did. They also supported a tertiary response to child safety issues, viewing their role as complementary to that of statutory services.

Theme three found that the overarching aim of CFH nurses was promoting child safety by forming a positive relationship with parents, promoting parenting capability, and monitoring the safety of the child within the family environment. Nurses engaged in a wide range of activities to address factors that reduced the ability of families to meet the changing physical and socio-emotional needs of children. These included, but extended well beyond, their mandatory reporting role. A range of professional and organisational challenges impeded CFH nurses' ability to effectively promote child safety, and CFH nurses drew upon a range of strategies to address these.

This thesis generated valuable insights into the contribution of CFH nurses to promoting the safety of young children within the family. It demonstrates the complexity of CFH nurses' practice in this context. If CFH nurses are to effectively fulfil this important role, they require organisational support that includes: opportunities to further develop relational and health promotion skills; to receive timely and individualised support and guidance when child safety issues arise in practice, and to engage in critically reflective conversations with colleagues; and access to emerging knowledge on the wide range of influences on child health and wellbeing and family functioning, as well as changes to child safety legislation. They also require support to have regular ongoing contact with children and their families via structuring of the universal health program, service delivery systems that allow for relational continuity of care, and flexibility in service delivery to allow for the provision of intensive and timely support to families when it is needed.

Organisational processes to further support CFH nurses include: mechanisms to build relationships with other service providers to allow for the sharing of relevant information, knowledge, and expertise; clear referral pathways; and clarity about the roles and responsibilities of all service providers. Parents also require clear information on the distinct roles of CFH nurses and statutory services in supporting children and their families.