Dancing around families: neonatal nurses and their role in child protection.

AIMS AND OBJECTIVES: To explore the processes neonatal intensive care nurses used in their child protection role with preterm infants.

BACKGROUND: Neonatal nurses' screening for family violence is important in identifying at-risk preterm infants requiring protection upon discharge from neonatal intensive care settings. We know little about neonatal nurses and their role in child protection.

DESIGN: A qualitative research design using Glaserian grounded theory.

METHODS: Ten in-depth semi-structured interviews were conducted with New Zealand neonatal intensive care nurses. Data were simultaneously analysed using constant comparative analysis and theoretical sampling to develop a substantive grounded theory.

RESULTS: Dancing around families is the substantive grounded theory explaining how neonatal intensive care nurses respond to and manage an infant needing child protection. Knowing at-risk families is the process these nurses used, which draws on their personal and professional knowledge to identify an infant's child welfare requirements. A tension exists for neonatal nurses in shaping and framing the baby's safety and protection needs between their role of nurturing and protecting an at-risk infant and it belonging to the family.

CONCLUSIONS: Child protection is a source of conflict for neonatal intensive care nurses. A lack of education, dodgy families and lack of confidence in child welfare services all compromise effective child protection. Their reality is tension between wanting the best possible outcomes for the baby, but having little or no control over what happens following its discharge.

RELEVANCE TO CLINICAL PRACTICE: Neonatal intensive care nurses are ideally positioned to identify and respond to those preterm infants at risk of child maltreatment. They need education in child maltreatment, and protection focused on preterm infants, collegial support and clinical supervision.