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Skolsköterskans möjlighet att upptäcka och stödja barn som far illa eller riskerar att fara illa
Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). (Folkhälsovetenskap, Public Health Science)ORCID iD: 0000-0003-1370-9409
2018 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
The School Nurse’s Ability to Detect and Support Maltreated Children (English)
Abstract [en]

Since children are a vulnerable group, the society has a special responsibility to protect them. The school nurse sees all pupils at school at regular health visits and thereby gains knowledge of their health and living conditions. The overall aim of the thesis was to develop empirical knowledge and understanding of the ability of the school nurse to detect and support children who are maltreated or at risk to be maltreated. The thesis is based on four studies. Study I was based on focus group interviews with school nurses. Data was analysed in accordance with Grounded Theory. Study II was a secondary analysis of study I and performed with Thematic Analysis. Studies III and IV were based on population data which was analysed by univariate and multivariate logistic regressions. The results showed that the school nurse has ability to detect children who are maltreated or at risk to be maltreated. However, also obstacles for detection were found such as lack of trust, avoidance, strong feelings and insufficient documentation. The obstacles were partly due to organisational shortcomings and dearth of resources affecting also internal and external collaboration. The school nurse strived for building trustful relations to pupils, to parents and to professionals. If the school nurse failed to report suspected child maltreatment to the child protection services it was because of worries that the reporting did not benefit the child. The school nurse avoided addressing child sexual abuse because of its particular sensitiveness, which affected the possibility to detect the abuse. Pupils in foster care were at higher risk of health problems, a more risky lifestyle, a lower degree of school attachment and lower school performance compared to pupils not in foster care. The results emphasize the potential of the school nurse to detect and support maltreated children through regular contacts with pupils, their confidence in the school nurse and trustful relations with other professionals.

Abstract [sv]

Många barn som far illa eller riskerar att fara illa upptäcks inte och får inte det stöd de behöver. Skolsköterskan möter alla elever vid regelbundna hälsobesök och får därmed kunskap om elevernas hälsa och livssituation. Avhandlingens övergripande syfte var att öka kunskapen om skolsköterskans möjlighet att upptäcka barn som far illa eller riskerar att fara illa samt initiering av stödinsatser.

Avhandlingen grundar sig på fyra delstudier, som baseras på fokusgruppsintervjuer och populationsdata från elevhälsodatabasen ELSA. Resultaten visar att skolsköterskan har potential att upptäcka utsatta barn genom de regelbundna kontakterna och elevernas förtroende för skolsköterskan. För att stödinsatser ska kunna initieras måste barnet våga avslöja sin utsatthet eller att den upptäcks på annat sätt. Hinder för upptäckt och stöd som uppmärksammades var framförallt tillitsbrist, undvikande, starka känslor och bristande dokumentation. Dessa hinder hade delvis sin grund i organisationen av elevhälsoarbetet och bristande resurser, vilket även påverkade samverkan såväl internt inom skolan som externt med andra aktörer såsom socialtjänst samt övrig hälso- och sjukvård.

Place, publisher, year, edition, pages
Karlstad: Karlstads universitet, 2018. , p. 89
Series
Karlstad University Studies, ISSN 1403-8099 ; 2018:12
Keywords [en]
Child Maltreatment, Emotions, Foster Care, Public Health, Pupils, School Nurse, Sweden
Keywords [sv]
Skolsköterska, Elevhälsan, Hälsosamtal, Hälsa, Psykisk ohälsa, Livsstil, Barnmisshandel, Sexuella övergrepp, Familjehemsplacerade barn, Barnets rättigheter, Skolanknytning, Skolmisslyckande, Fokusgruppsintervju, Populationsstudie, Grounded Theory, Tematisk analys, Emotioner
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
URN: urn:nbn:se:kau:diva-66851ISBN: 978-91-7063-842-8 (print)ISBN: 978-91-7063-937-1 (electronic)OAI: oai:DiVA.org:kau-66851DiVA, id: diva2:1193284
Public defence
2018-05-18, 1B 306 Fryxellsalen, Universitetsgatan 2, Karlstad, 12:30 (Swedish)
Opponent
Supervisors
Available from: 2018-04-27 Created: 2018-03-26 Last updated: 2018-04-27Bibliographically approved
List of papers
1. The School Nurse's Ability to Detect and Support Abused Children: A Trust-Creating Process
Open this publication in new window or tab >>The School Nurse's Ability to Detect and Support Abused Children: A Trust-Creating Process
2015 (English)In: Journal of School Nursing, ISSN 1059-8405, E-ISSN 1546-8364, Vol. 31, no 5, p. 353-362Article in journal (Refereed) Published
Abstract [en]

Child abuse has negative health consequences. Early detection and preventive measures lead to avoidance of prolonged and more complex problems. School nurses have a child protection role and should pay attention to vulnerable children. Through health dialogues and other interactions with pupils, school nurses have the opportunity to detect child abuse. The aim of the study was to explore how school nurses detect child abuse and initiate support measures. Focus group interviews were conducted with 23 school nurses. The data were analyzed using a grounded theory approach. Results showed that the main concern of the school nurses was support and assistance to children who are abused which was preceded by a trust-creating and trust-strengthening process. Trust contains self-confidence and confidence in the system and trust can be strengthened or undermined. Building trustful relations is time consuming and is facilitated by networking, refined assessment instruments, and collaboration.

Keywords
hild abuse; child protection; focus groups; grounded theory; health dialogue; school nurse; social relations; trust
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-33806 (URN)10.1177/1059840514550483 (DOI)000361139600006 ()25239920 (PubMedID)
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2018-03-26Bibliographically approved
2. School Nurses Avoid Addressing Child Sexual Abuse
Open this publication in new window or tab >>School Nurses Avoid Addressing Child Sexual Abuse
2017 (English)In: The Journal of school nursing, Vol. 33, no 2, p. 133-142Article in journal (Refereed) Published
Abstract [en]

Child sexual abuse (CSA) is a global public health problem with major consequences for the individual child and society. An earlier Swedish study showed that the school nurses did not initially talk about nor mention CSA as one form of child abuse. For the child to receive adequate support, the disclosure is a precondition and is dependent on an available person prepared to listen. The aim of the study was to explore the ability of the school nurses to detect and support sexually abused children. It is a secondary analysis of focus group interviews with school nurses. Thematic analysis was performed. Results showed that the school nurses avoided addressing CSA due to arousal of strong emotions, ambivalence, and a complicated disclosure process. In order to detect CSA and support abused children, attentiveness of sexual abuse as a possible cause of physical and mental illhealth is crucial.

Place, publisher, year, edition, pages
SAGE Open, 2017
Keywords
Abuse, mental health, middle/junior/high school, school nurse knowledge/perceptions/self-efficacy, qualitative research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-41102 (URN)10.1177/1059840516633729 (DOI)000397984300006 ()
Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2018-03-26Bibliographically approved
3. Swedish population-based study of pupils showed that foster children faced increased risks for ill health, negative lifestyles and school failure.
Open this publication in new window or tab >>Swedish population-based study of pupils showed that foster children faced increased risks for ill health, negative lifestyles and school failure.
Show others...
2017 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 10, p. 1635-1641Article in journal (Refereed) Published
Abstract [en]

AIM: This population-based study explored whether foster children faced a higher risk of health problems than children of the same age who were not in foster care.

METHODS: Data for 13 739 pupils aged 10, 13 and 16 years were obtained from the Pupil Health Database in the county of Värmland, Sweden, for the school years 2012/2013 and 2013/2014. These included data on school performance, health, lifestyle and social relationships, based on children's interviews with school nurses.

RESULTS: Of all the pupils, 171 (1.2%) were in foster care. Children in foster care were generally unhealthier than other children. Both girls and boys were at higher risk of chronic health problems, daily smoking, use of drugs and school failure. When the girls in foster care were compared to other girls, we found that they faced a higher risk of psychological and psychosomatic symptoms. This difference was not found for boys. Foster children were also more likely to express a more negative view on life.

CONCLUSION: We confirmed earlier studies that children in foster care tended to have inferior health and well-being than other children. These findings emphasise that health, risky behaviour and school performance should be considered together when assessing foster children.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2017
Keywords
Foster children, Health problem, Lifestyle, Population-based study, School performance
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:kau:diva-62970 (URN)10.1111/apa.13966 (DOI)28664570 (PubMedID)
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2018-03-26Bibliographically approved
4. Can school attachment modify the relation between foster care placement and school achievement?
Open this publication in new window or tab >>Can school attachment modify the relation between foster care placement and school achievement?
Show others...
2018 (English)In: British Journal of School Nursing, ISSN 1752-2803, E-ISSN 2052-2827Article in journal (Refereed) Epub ahead of print
Place, publisher, year, edition, pages
Mark Allen group, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public Health Science
Identifiers
urn:nbn:se:kau:diva-67218 (URN)10.12968/bjsn.2018.13.4.178 (DOI)
Note

I avhandlingen med titeln Could school attachment modify the relation between foster care placement and school achievement : Results from s Swedish population-based study

Available from: 2018-04-27 Created: 2018-04-27 Last updated: 2018-06-25Bibliographically approved

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