Invitations to participate in the child protection content mapping exercise have been sent to 34 universities across Australia offering nursing and midwifery education programs at undergraduate, graduate and postgraduate levels. Facilitators and barriers to including child protection content in nursing and midwifery education were highlighted in the literature, National Roundtable Forum discussions and survey responses.
Barriers
Where content is distributed incidentally but not explicitly linked to child protection, there are opportunities where the content may be conceptually linked to child protection. The final two sections of the survey provided the opportunity for respondents to record comments, issues or concerns about child protection in nursing and midwifery education and indicate any curricular issues their school or faculty were interested in exploring in a Forum National Table.
Facilitators
During the study, the need to promote child protection in nursing and midwifery education programs also became apparent. The Australian Child Protection Center looks forward to working with the nursing and midwifery professions to help build the capacity of nurses and midwives to respond to child protection and welfare issues.
Australian Context and Impetus for Change
Timeliness of this study
Child Abuse and Neglect – A Serious Problem
The long-term health effects of abuse and neglect have recently come to light in Australia. Furthermore, there is a growing awareness of both the short- and long-term costs, directly and indirectly, associated with the prevalence of child abuse and neglect in our society.
Nursing and Midwifery and Child Protection
As health care costs continue to rise in Australia, there is growing recognition that factors such as child abuse and neglect represent preventable increases in this financial burden (Australian Institute of Health and Welfare, 2007). With the advent of a public health approach to child protection, the role of nurses and midwives in the primary and secondary prevention of child abuse and neglect is receiving increasing attention (O'Donnell, Scott, & Stanley, 2008).
The Contemporary Role of Nurses and Midwives
In the field of child protection, nurses and midwives provide most of the primary prevention services. An evaluation of nurses' and midwives' attitudes towards the referral and early intervention tool was carried out.
Australian Studies of Child Protection in Nursing and Midwifery Education
As such, any factors that contribute to the disconnection of nurses and midwives from child protection related issues need to be urgently addressed, further emphasizing the importance of education and training in this area. Most of the clients interviewed wholeheartedly supported nurses and midwives asking questions of a psychosocial nature.
International Studies of Child Protection in Nursing and Midwifery Education
There was also a lack of consensus among nursing participants regarding the extent of their role in child protection; with the researchers concluding that safeguarding children was the responsibility of the wider nursing and midwifery community, as well as the role of dedicated health visitors. This study addresses some of the gaps and issues identified in relation to the inclusion of child protection content in nursing and midwifery education programs and will enable stakeholders to consider the basis of what is taught and options to build the capacity of nurses. and midwives to proactively respond and address child welfare issues. Prior to this initiative, the extent to which child protection issues were included in the curriculum of nursing and midwifery education courses and programs had not been determined at national level.
Overview
Despite this limitation, the curriculum mapping approach was considered an effective and theoretically appropriate way to map when and how child protection content is delivered at national level for two reasons. Firstly, the process promotes the identification of resource requirements and secondly, the procedure can potentially support the effective inclusion of child protection components in programmes. Third, in adopting the curriculum mapping approach there is the potential to promote 'second order' change.
The Process in Action
Curriculum mapping can be used at two different levels of interest – macro (eg national, state or professional) and micro (eg college, school or clinical practice) levels. Apart from meeting such statutory requirements, there may not be a unified understanding of child protection held by academics asked to contribute data to curriculum planning. Given that people may perceive child protection differently, it was found that the concept needs to be contextualized and clearly defined in the proposed curriculum planning process.
Feasibility
The process offers additional benefits, including:. the opportunity to gather comprehensive information about the enablers that can drive progress, and the barriers that can hinder any planned or desired change in practice. a collective knowledge base and group that can prioritize problems and generate viable solutions that take into account resource implications. the dissemination of information by members of the Round Table through their personal and professional networks. facilitating structural changes within their respective institutions. Carter and Mistry (2001) noted that respondents in their study distinguished between roundtable discussions as 'approach' and as 'methodology'. The first was seen as an opportunity to express ambitions and was associated with distributed leadership and collegiality, while the second idea suggested controlled directiveness.
Survey Design and Development
In support of the above results, the child protection content was mapped by a small selection of educators. This key contact assisted with the dissemination and collection of the survey data and further assisted in disseminating information related to the roundtable forum to their school/faculty. To conceptualize the study within a nursing and midwifery education framework, the study was shown to nominated members of the Council of Deans of Nursing and Midwifery for comments and changes.
Roundtable Approach – Procedure
A list of nursing and midwifery training programs identified as relevant to child protection content mapping was generated by accessing university websites. Surveys were sent to 34 universities across Australia that offer pre- and post-registration nursing and midwifery courses. The child protection subjects mapped were taught throughout undergraduate, graduate and postgraduate nursing and midwifery programmes.
Response Rates
Nursing and Midwifery Education Programs Represented in the Sample
Nursing/Bachelor of Applied Science (in Human Movement Studies) Bachelor of Arts/Nursing/Health Science (Aboriginal Studies). Bachelor of Nursing/ Bachelor of Applied Science (Psychology) Graduate Certificate in Nursing (Mental Health) Protection Graduate Diploma in Nursing (Mental Health). Caution is advised when viewing these categories as some Masters of Nursing and Midwifery programs are pre-registration courses.
Type and Length of Degree and Awards represented in the sample
Nursing in Health Sciences Nursing/Health Sciences Bachelor in Nursing/Bachelor in Paramedics Nursing/Bachelor in Public Health Bachelor in Nursing and Health Sciences. Examination of the data revealed that the majority of the courses mapped were offered within the broad category of nursing (n=34), followed by midwifery courses (n=17) and a small number offered as part of a mental health (n=2 ) or Health Science Program (n=2). The discussion of the National Nursing and Midwifery Education and Child Protection Roundtable forum follows the report of research analyses.
Software Packages
Overview of Data Entry and Analysis
To determine the range of discrete or standalone courses available to nursing and midwifery students across Australia, schools and colleges were asked to identify courses that specifically address child abuse and neglect issues.
Discrete Child Protection Units/Courses
In contrast to discrete content on child protection, to examine the extent to which child protection is included in nursing and midwifery education courses across Australia, nursing and midwifery educators were asked to identify courses/units that address issues of abuse and child neglect using an integrated approach.
Integrated Child Protection Content – Program Level
When examining integrated child protection content within degree type (see Figure 4.2), analysis showed that the majority of nursing and midwifery programs reported delivering integrated child protection content.
Integrated Child Protection Content – Course/Unit Level
Child Protection-related Content
To facilitate and simplify discussion of data reflecting broad areas of interest, intermediate levels were incorporated into macro levels of analysis, such as child-centered issues (including child development and mental and behavioral issues), family/environmental issues (e.g., family, community, violence, neglect and handling diversity) and Professional issues (namely prevention strategies and professional roles and responsibilities).
Analysis of Risk Factors and Strategies
About a quarter of the programs included information about risk and protective factors that were specifically related to child protection. Mean-level analysis showed that the clusters Coping with Difference, Prevention Strategies and Forensic Note-Taking represented the least likely to be learned risk factors and strategies related to child protection, such as shown in Table 4.2. On the other hand, risk factors and strategies under the "Violence" and "Professional Roles" clusters are more likely to be learned and related to child protection.
Further Comments recorded in Section 2
Comments / Issues / Concerns
Existing constraints
Meeting Legal Requirements
Resource Development
Collaborative Partnerships
Issues related to child protection content
Course Content
The Challenges
Further Exploration
On the 12th March 2008, a National Nursing and Midwifery Education and Child Protection Roundtable Forum was held at the National Wine Center in Adelaide from 10:00am - 2:30pm. All schools of Nursing and Midwifery that responded to the survey were invited to participate. Afterwards, the forum was attended by 38 participants representing 24 universities, the Council of Deans of Nursing and Midwifery of Australia and New Zealand, and representatives of state and territory nursing and midwifery accreditation agencies and employer groups.
Discussion
Topics
It was further noted that the shift towards local nursing and early intervention requires both a bottom-up approach from educators to address child protection and a top-down approach, especially with regard to the development of new national standards and the new national registration board . The need to address complex issues related to child protection within a supportive culture was seen as critically important. Encouragingly, it was identified that the need for a broader focus is already being addressed in some mental health and midwifery programmes.
Looking forward
Suggestions and comments directly quoted from respondents and participants
Analysis of delivery approaches revealed that: .. the nursing and midwifery courses mapped did not report time allocated to teaching discrete child protection content. What does the nursing and midwifery education community recommend to facilitate the promotion and effective inclusion of child protection components in future nursing and midwifery programs? It also has the potential to be used as baseline data for future comparative analysis in child protection content and nursing and midwifery education.
Survey Instrument
Title Page
Child Protection and Nursing and Midwifery Education
Section 1A: Child Protection - Discrete courses/subjects/units
Section 1B: Integrated Approach to Child Protection – courses / subjects / units
Child Protection-related Content
Excessive physical/emotional punishment Extreme/uncontrollable anger and aggression Constant criticizing, belittling, teasing the child Exposure to media abuse/violence (eg TV/internet) Parental aggression/conflict with people in authority Criminal record/criminal activity at home Neglect. Serious conflicts between parents and children and/or between parents Role of the child in the family (e.g. child as caregiver). Forensic logging and self-care training. Proactive strategies for suspected abuse and neglect. Awareness training - impact of child abuse and neglect. Strategies for working with abused/neglected children.
Professionals Protecting Children
Professionals Protecting
Children
Australian Centre for Child Protection
