The global and national figures of child abuse and neglect are overwhelming and highlight an
imminent need to focus on the well-being of tamariki1. Due to the long-lasting individual and
societal impact of child abuse and neglect, it is a profoundly important health issue. Nurses
are not only the largest group of health professionals, but they are typically at the forefront of
health care and have a unique and significant ability not only to detect, but also to intervene
in and prevent situations of child abuse and neglect. Despite their potential impact, they have
rarely been the focus of investigation in this area, particularly in New Zealand. This thesis
presents research undertaken to explore the current perceptions of nurses working in child
health in regards to their role in child protection.
A mixed method study was conducted using a sequential explanatory (two-phase) design.
These distinct stages comprised of a survey and subsequent, complementary interviews. The
quantitative aspect of the design was conducted through a survey; there were 134 surveys
included in the analysis and these data were used to inform the second phase which
comprised of six complementary interviews. This qualitative aspect of the design drew on
grounded theory approaches.
The main findings of this research can be divided into the following categories. Eyes and
ears: nurses are regularly exposed to children who have experienced child abuse or neglect
and are well positioned to detect abuse and neglect. Hands: Nurses engage in this sphere in a
number of ways-including medically caring for children who have been abused or neglected,
coordinating care, making referrals, and practically supporting in a wide variety of ways.
Head: Despite most nurses having received training in this area, only half of nurses describe
feeling confident to identify child maltreatment. Furthermore, although there are
discrepancies in area, there is little standardisation of how nurses engage with this sphere.
There are a number of both supports and barriers; the main barriers being lack of certainty
and limited confidence in social services. Heart: Nurses experience deep and profound
emotions when engaging in this sphere, which not only effects nurses personally, but also
affects decision making and quality of care. Gut: Nurses rely on gut feelings to make
decisions, an important and advanced way of knowing. Finally, it was clear, that nurses
deeply care for the children they work with and the wellbeing of children is at the centre of
all they do.