The Experiences of New Zealand Primary Health Nurses When Working With Children They Suspect are Being Abused or Neglected

Abstract

This study explored the experiences of primary (community) health nurses in New Zealand when working with children they suspect are being abused or neglected. It grew from a concern that little is known about what this experience is like. I was also concerned that primary health nurses did not seem to have a voice relative to this significant experience.

Child abuse is highly prevalent in New Zealand. Primary health nurses work across a variety of settings. They are, therefore, more likely than other health professionals to encounter children whom they suspect are at risk.

Hermeneutics, informed by Hans-Georg Gadamer [1900-2002], guided the research approach. During the analysis stage, the data required that I also draw on philosophical notions from Schön, Benner, Levinas, and Dewey.

Thirteen registered nurses and nurse practitioners working with children in primary health settings were interviewed using in-depth semi structured interviews which were audio-recorded and transcribed. Findings were developed through dialectical engagement in the activities of writing, reflecting, and rewriting.

The nurses’ experiences begin with what matters most. They must get to know the children and families with whom they work. They must also continually nurture and maintain these relationships, overcoming numerous obstacles.

What the nurse feels signals what matters. The bodily experience of a ‘gut feeling’ arouses suspicion. Yet, caution is essential. One has to have proof. Thus, to be with suspicion is secretive by nature. Importantly, it is being with suspicion which prompts action.

Working with at-risk children creates a significant burden for nurses. They carry this burden because they care about children at risk of harm. The burden is experienced emotionally, physically, and as a legal threat. The burden is further experienced as a weight—one which nurses often feel they carry alone. Understanding the nature and impact of this burden is an essential prerequisite to providing primary health nurses adequate and appropriate support.