Navigating parenthood: a qualitative study of parental guidance and support in Norwegian child health clinics

To explore how public health nurses at child and family health clinics work to prevent maltreatment and the experiences of public health nurses in the maltreatment prevention efforts. Child maltreatment is a serious societal issue with major consequences. Preventive efforts are increasing and have broad political support. A key objective of the child and family health clinic services is to prevent, identify, and stop maltreatment, abuse, and neglect. National clinical guidelines outline, in general terms, how such work should be conducted. However, limited research exists on how public health nurses prevent maltreatment and the effectiveness of their methods. A qualitative and explorative design was used, based on semi-structured interviews with 14 public health nurses conducted as part of the project 'Public Health Nurses in Child and Family Clinics' Role in Preventing and Detecting Child Maltreatment' at Oslo Metropolitan University. The interviews were carried out between August and November 2021. We used qualitative content analysis with an inductive approach to analyse the data. Three main categories were developed: 1. Structure and system: weaving prevention into daily practice; 2. To dare and endure: a negotiation of courage and understanding, and 3. To empower and uphold: the goal of strengthening and supporting parents. The results show the importance of early intervention, barriers to discussing maltreatment with parents, and the importance of building trust and empowering parents. Preventing maltreatment is a key part of public health nurses' clinical work, focusing on early risk identification and parental guidance. While building trust with families is prioritised, structural, resource, and guideline-related challenges persist. This study provides knowledge about Norwegian public health nurses clinical work with child maltreatment at the child and family health clinics, which can serve as a valuable foundation for further research as well as for collaborating services. EQUATOR guidelines were followed, using the COREQ checklist. No patient or public contribution.

BackgroundThe study inquiries about the relationship between equitable family health care delivery with an increasingly diverse population. Child health clinics, primarily staffed by public health nurses, offer universal health promotive and disease preventive services to all families with children aged 0 - 5. This study delves into how the health care professionals adapt and use the services to meet the needs of the families, and how a diverse population experiences the services.Aims and objectivesThe aim is to obtain insights into the well-established and highly regarded framework of Child health clinics and how a diverse population access and engage with the public health nurses. Recognizing the previous limited research in this area, this investigation is essential for ensuring equitable health services for all families with children.Setting and methodsThe research is qualitative with individual interviews with users; parents of children 0 - 5 years old at Child health clinics and focus group interviews with providers; public health nurses. The setting is in Oslo and surrounding municipalities. The data collection will continue throughout 2025.Preliminary resultsPreliminary findings indicate a broad interpretation of diversity, with a focus on parental choices rather than primarily on cultural and ethnic diversity. The early findings also indicate that parents aspire to be perceived as competent and accomplished in their caregiving roles, actively seeking validation while simultaneously negotiating the complexities of sharing or not sharing information with public health nurses. Early findings also highlight the perceived importance of relational competence over strict professionalism.Key messages• Although Child health clinics are framed to deliver equal services in a diverse population, how parents navigate information-sharing processes can result in inequality of service.• The framework of the clinics may enforce expectations that pressure parents to normative models of parenting, a dynamic that does not align with the inclusive intention of the public health nurse.

Centers for Disease Control and Prevention Investments in Adverse Childhood Experience Prevention Efforts

BackgroundIn Finland, although families generally receive support from child health clinics, some need more help in dealing with their child's emotions, behaviour and psychosocial development. Public health nurses play a central role in providing vital psychosocial support for families, but they often lack the confidence and competence to tackle mental health problems.AimTo describe how public health nurses used and experienced a working model that combined a psychosocial tool (Strengths and Difficulties Questionnaire, SDQ) to identify disruptive behaviour in four‐year‐old children and an Internet‐based parent training programme with telephone coaching.MethodsThis is a descriptive, cross‐sectional survey study. The sample consists of public health nurses (n = 138) who were working in child health clinics in Finland that had used the working model. Statistical data were analysed using SPSS Statistics for Windows. The responses to an open‐ended question were analysed using inductive content analysis.ResultsThe experiences about the working model were mainly positive. The public health nurses felt that the psychosocial tool, the SDQ, was easy and suitable to use in child health clinics. The availability of an Internet‐based parent training programme provided greater support for parents by overcoming practical barriers. Overall, the working model helped nurses to develop their mental health competencies.ConclusionWithin primary care, the need to tackle psychosocial problems is increasing, and for this, public health nurses need extra support and tools. It seems that the working model, including the SDQ and the online and telephone coaching programme, worked well in child health clinics. This working model can be used to provide parental support and improve nurses' mental health competencies.

Violence against children is a major public health concern, yet detecting it, particularly in young children, can be difficult due to subtle signs and limited communication. In Norway, child and family health clinics provide universal services for children aged 0-5, with public health nurses in a key position to identify concerns. Despite frequent contact and a legal duty to report, few cases of violence are detected. Research highlights barriers such as uncertainty, lack of training, time pressure and unclear procedures, but little is known about public health nurses' own experiences with these challenges and what they perceive as supportive in their work. The purpose of the study is to explore what public health nurses experience as barriers and facilitators in their work to detect violence at child and family health clinics for children aged 0-5 years. Fourteen qualitative semi-structured interviews were conducted with public health nurses at eleven different child and family health clinics. We used qualitative content analysis with manifest and latent content to analyse the transcripts. An overarching theme identified in the data was 'Navigating the unspoken: Public Health nurses' conscious and subconscious effort to detect violence in everyday practice.' This theme was supported by five categories: (1) comprehensive assessment and observation, (2) flexibility as both opportunity and obstacle, (3) the value of experience and knowledge, (4) the need for procedures and tools and (5) the role of relationships in detection. The study highlights the complexity of public health nurses' work in detecting violence, emphasising challenges such as limited time and flexibility, as well as the importance of building trust with families. The findings underscore the demand for practical tools and continuous training to support early identification of violence against children. The study contributes to knowledge on how public health nurses work with violence against children, providing a basis for future research, improved collaboration across services, and the development of policies and training to support prevention in primary care.

To describe the perceptions of public health nurses (PHNs) working in child health clinics on media use of young children and to investigate what are the perceptions of PHNs on adults' role in young children's media use. An electronic cross-sectional survey with Likert-scaled and open-ended questions. The total of 183 PHNs working in Finnish child health clinics. Statistical descriptive analysis for Likert-scaled questions and thematic analysis for open-ended questions were used. Most (96.7%) PHNs agreed that media use was very common among young children. According to PHNs, the negative impacts of media use of young children included social, physical, and psychological impacts. The positive impacts included learning, communication, and access to information. PHNs stated that parents were most responsible for intervening in media use of young children, but PHNs have an important role in counseling families on it. Most PHNs (80.9%) stated that parents did not control media use of their children effectively. PHNs are aware of impacts of media use and its prevalence among young children. They agree to have an important role in counseling families in it. More work in research is needed to improve PHNs' expertise and resources for them to be able to guide families in young children's media use. A wider perspective from other health care professionals working with families should be studied to constitute multi-professional understanding.

In Norway, public health nurses (PHNs) are responsible for giving parents nutritional knowledge, but limited research describes how they perceive this task. This study explores PHNs' perceptions and experiences on nutritional guidance for parents of infants and toddlers. Semistructured interviews with six PHNs were conducted and transcribed verbatim. Data were subjected to thematic analysis. Five main themes were identified: (1) Dietary guidance for parents is central to the work; (2) PHNs perceive they have parents' trust, and parents are in general open to nutrition counselling; (3) food and meals must be seen in light of the family context; (4) The dialogue must be adapted to the individual family; and (5) PHNs have expertise on nutrition; however, updating knowledge is difficult. Nutritional guidance was perceived by PHNs as a core activity. They felt that they had parents' trust, and that parents were particularly open to nutritional guidance during the first 2 years. Counselling was generally well received, but conversations on overweight were perceived as difficult. PHNs strove to tailor their guidance to individual needs. However, providing guidance on a wide range of issues in different families and cultures could be challenging. They acknowledged a need for updating knowledge but the offer of courses was sparse. Our findings suggest a discrepancy between how nutrition is prioritized in the education of PHNs and what they encounter in clinical practice. In the future, this should be given more attention given the PHNs' unique position to promote healthy eating and long-term health.

This study investigated Norwegian public health nurses working in child and family health clinics’ decision-making practices concerning child maltreatment. A one-phase convergent mixed-method design was utilized, with quantitative and qualitative data concurrently collected and separately analyzed from a questionnaire that included patient vignettes. These vignettes described three potential child maltreatment scenarios to assess public health nurses’ competence and clinical decision-making processes. A total of 554 public health nurses participated in the study conducted from October 24 to December 31, 2022. Findings reveal a high level of recognition of child maltreatment among public health nurses. However, despite their self-perceived confidence, the qualitative data underscore the complexity and uncertainty inherent in their assessment process. The most supported management approaches involved further exploration of the situation. Few public health nurses would file a report of concerns to Child Protective Services or report the police despite their level of concerns. The findings underscore the necessity for additional training and support to enhance public health nurses’ confidence and competence in reporting suspected child maltreatment cases, as well as the need for increased information exchange regarding the procedures and services provided by the child if Child Protective Service is involved.

Issue/Problem Two key public health issues at present are mental health problems and obesity. Both typically begin before adulthood and once occurred, typically persist. Prevention would be important but also economically and humanely sensible. For this, competent experts in preventive work and health promotion are needed. Description of the problem Public health nurse education, originally known as health sister education, was initiated in Finland in 1924, by the Mannerheim League for Child Welfare. The six-month health sister education was targeted at nurses and began from the desire to focus not only on treating diseases but also on promoting health. In the 1940s, education was reformed and in the 1950s significantly expanded. In the 1970s, the professional title changed from ‘health sister’ to ‘public health nurse’. In 1987, the education was extended to 3 years, including the education of registered nurses. In 1992, the education was further extended to 3.5 years. By the beginning of the 21st century, education evolved into 4 years bachelor’s degree. Results In 2024, eighteen Universities of Applied Sciences provide public health nurse education in Finland. The 4-year Bachelor of Health Care in Public Health Nursing -degree (240 ECTS credits) also qualifies for a registered nurse. Nearly half of the education consists of clinical training. In addition, registered nurses can supplement their degrees by completing a one-year education (60 ECTS credits) that qualifies them as public health nurses. Lessons In Finland, approximately 700 new public health nurses graduate annually. They are trained to work independently as experts in preventive work, health promotion, and public health. Around 9,500 Finnish public health nurses work in settings such as maternity and child health clinics, school health services, occupational health care, and outpatient clinics. Key messages • Due to the overcrowding in many healthcare services providing treatment, educating experts in health promotion and disease prevention is crucial now and in the future. • By ensuring competent experts in health promotion and disease prevention, future healthcare services can continue to provide economically and humanely sensible and effective help for people.

BackgroundThere are a substantial number of children who are the next of kin of parents suffering from illness or substance abuse. These children can experience emotional and behavioral problems and may need support from professionals. In Norway, the specialist health service in hospitals is required to have a designated practitioner in each department to ensure support for and follow up of children who are next of kin; however, this is not regulated by law in the health care in the municipalities. The aim of this study was to explore public health nurse’s experiences working with children who are next of kin.MethodsQualitative interviews were conducted with 10 public health nurses working in the child health clinic and the school health service in four municipalities. Data were analysed using content analysis. Reporting of this study is conducted in accordance to COREQ’s checklist.ResultsThe analysis resulted in one main theme: ‘Lack of guidelines and routines among public health nurses working with children who are next of kin’. The main theme consisted of four categories: (1) identifying children who are next of kin are incidental; (2) public health nurses must be observant and willing to act; (3) communication is an important tool; and (4) follow up over time is not always provided.ConclusionThe public health nurses experienced uncertainty concerning how to identify and follow up children who are next of kin but were vigilant and willing to act in the children’s best interest. Doing so necessitated collaboration with other professionals. The need for guidelines around the role and responsibilities for the public health nurse were emphasized. The knowledge provided by the current study offers valuable insight into strengths and limitations in the support of children who are next of kin and can inform stakeholders in organizing sustainable support for this group.

Objectives This study targeted public health nurses in a Japanese municipality that had newly adopted the core components of the Finnish system to provide continuous support to families with children until preschool. It sought to analyze changes in their perceptions for activities in maternal and child health care before and after the adoption.Methods Relevant data were collected through semi-structured focus group interviews, following an interview guide, conducted from September to October 2020. The study protocol was approved by the Ethics Committee of Osaka City University in Japan.Results A total of 12 public health nurses participated. Prior to the adoption of the system modelled on Finnish practice, these nurses were dedicated to addressing the risks regarding families with children (especially those at high risk) through continuous engagement. However, they were hesitant to proactively engage with families at lower risk as non-continuous, one-off engagements resulted in a patchwork response. After the system was adopted, the nurses became aware of the trust cultivated with families under their care, which included those at lower risk, that enabled them to respond to the changing needs flexibly. The nurses recognized that they had acquired the capability to notice the subtle signs of changes, engage more proactively with the families under their care, and deliver the necessary preventive interventions at an early stage. They also demonstrated joy and satisfaction derived from the growth of children and mothers under their care, as well as keen awareness of the need to improve their professional skills, even though they were busy.Conclusion These findings indicate that the continuous support system modelled on the core components from Finland enables public health nurses to proactively engage with families at lower risk and deliver preventive interventions at an early stage. The system also motivated Japanese public health nurses who found greater pleasure in their work.

Changing praxis from within - an in-depth qualitative exploration of how home visits affected statutory service at a Child Health Clinic

To explore public health nursing consultations by providing reflections on the overt interaction between public health nurses, parents and young people during consultations. There is limited research on public health nursing strategies and intervention models. There is a need to observe and describe the content of public health nursing work. The study has an ethnographic design and this article focuses mainly on the observations. Five consultations at four different child health clinics, six consultations at two health clinics for young people and one consultation at the school public health nurse's office were observed. The sociological concept of role formats provides the analytical focus for the paper. There are differences between the overriding ceremonial order in the public health nursing consultations observed in this study and the dominant role format observed in Sociologist P.M. Strong's study of medical consultations. Gentility can be a common denominator, yet ease and focus on everyday issues seems consistent with public health nursing consultations. The 'personal professional format' seems to be the correct term for the overriding ceremonial order. The outward show of behaviour in nursing and medical consultations differs. Despite society's increased bureaucracy within health care systems, ease and a personal professional approach, not a rigid bureaucratic format, seems to be the dominant ceremonial order in public health nursing consultations. This study is relevant to clinical nursing practice as it can create awareness of the taken-for-granted subtleties in nursing consultations. The findings show the continued need for supportive universal services that focus on the everyday needs of parents, young people and families. The findings also reveal the need for further studies on the moral underpinnings of public health nursing practice.

Aims and objectivesThe purpose of the paper was to describe the perceptions of public health nurses’ roles in relation to psychotropic drug use by adolescents.BackgroundMental health problems among adolescents are documented with studies indicating an increased use of psychotropic drugs. In Norway, care for such adolescents may fall naturally into the remit of public health nurses.DesignA phenomenographic approach was used to analyse the data.MethodA qualitative interview study was made of 20 Norwegian public health nurses, strategically chosen using phenomenographic methodology.ResultsThe public health nurses described three categories: discovering public health nurses who become aware of psychotropic drug use in the health dialogue with adolescents and choose to either act or not act in relation to psychotropic drug use. Those public health nurses who take action are cooperating public health nurses, who cooperate with adolescents, their families, schools and others. If cooperation has been established, supporting public health nurses teach and support the adolescent in relation to psychotropic drug use.ConclusionThe public health nurses who do not act can hinder or delay further treatment. Public health nurses need to acquire knowledge about psychotropic drugs, to fulfil their role in nursing mental health problems among adolescents and the increasing use of psychotropic drugs.Relevance to clinical practiceThe results demonstrated that public health nurses, working in health centres and schools, have the responsibility and the opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others, e.g. parents and siblings. Intervention studies are needed with regard to health promotion programmes aimed at fortifying young people's mental health.

Building Infrastructure for Surveillance of Adverse and Positive Childhood Experiences: Integrated, Multimethod Approaches to Generate Data for Prevention Action