In recent years, child abuse has been acknowledged as a growing problem in Ireland (DoHC, 1999). Since the publication of the Child Abuse Guidelines in 1987 (DoHC, 1987), a number of reforms have been introduced which aim to promote the protection and welfare of children. Healthcare professionals play an important role in child protection and care (Crisp and Lister, 2004). Community-based nurses, such as public health nurses, are frequently among the first to detect signs of child abuse and it is therefore important for them to have a full understanding both of their professional responsibilities in relation to this key role, and of relevant legislation, strategies and guidelines. In recent years, the Child Care Act 1991, Children Act 2001, Children First guidelines and the National Children’s Strategy have served to place children at the forefront of health and social care in Ireland.
There is a wide variety of legislation relating to children. The United Nations Convention on the Rights of the Child (UN, 1989) was the first legally binding document to address all aspects of human rights (i.e. civil, cultural, economic, political and social) in relation to children, and recognise that individuals under the age of 18 years require additional care and protection. The Convention states that the basic human rights of all children are: the right to survival; to develop to the fullest; and to participate fully in family, cultural and social life and is underpinned by 4 principles: non-discrimination; devotion to the best interests of the child; the right to life; and respect for the views of the child.
In Ireland, the main legislation relating to child care is the Child Care Act 1991, which contains provisions relating to the care, protection and welfare of children in Ireland (Government of Ireland, 1991). This Act contains 7 parts which covers the promotion of child welfare, including taking children into care, homeless children and adoption services; rules on the protection of children in emergencies and care orders; jurisdiction and procedures to ensure the welfare of the child is paramount in court proceedings; rules relating to children in care; and rules on the supervision of pre-school services and children’s residential centres. Under this Act, the Health Service Executive (HSE) has a duty to ensure the welfare of those children who are not receiving adequate care and protection through identification of children at risk, and the provision of child care and family support services.
Other key legislative provisions include the Domestic Violence Act 1996; Protection for Persons Reporting Child Abuse Act 1998; The Data Protection Act 1988; the Education Act 1998; the Non-Fatal Offences Against the Person Act 1997; and the Freedom of Information Act 1997.
Strategies and guidelines
The Children First: National Guidelines for the Protection and Welfare of Children guidelines (DoHC, 1999a) aim to offer assistance in identifying, reporting and responding to child abuse. Importantly, these guidelines promote an understanding of the relevant contribution of the different professions in cases of child abuse; in particular, the role of public health nurses in carrying out enquiries in cases where there are child protection concerns and where they already have a close relationship with the family involved. These guidelines highlight the need for family-centred child care and protection and the formation of effective partnerships for consistent service provision, as well as serving as a framework for multidisciplinary and inter-agency working practices. Throughout, the welfare of the child is emphasised as of paramount importance. Wider areas addressed within these guidelines include underage pregnancy, peer abuse, bullying, vulnerable children, abuse outside of the home, allegations of abuse against employees and volunteers, and organised abuse.
The Best Health for Children: Developing a Partnership with Families strategy (DoHC, 1999b) is based on a model that focuses on a holistic approach to child health promotion encompassing emotional and psychological aspects of health in addition to physical health. This strategy also acknowledges the importance of the family in this process, particularly the value of parental observations and concerns about their children. This report outlines a core programme for child health surveillance which documents the role of the public health nurse in making home visits soon after birth and throughout the child’s early development. A follow-up report published in 2005 (DoHC, 2005) has reviewed the original programme and made recommendations for greater observation of child behaviour and development and increased awareness of the determinants of child health, together with the formation of partnerships between parents and healthcare professionals to improve child health outcomes.
Role of the public health nurse
Public health nurses often carry out home-based parental assessment and ongoing surveillance, particularly working with high-risk families; however, in these situations, it can be difficult to build a trusting, supportive relationship if parents feel threatened, powerless, or concerned about possible action being taken against them. Marcellus proposed a framework of rational ethics to develop trusting relationships with high-risk families, based on four themes: mutual respect, engaged interaction, embodiment and creating environment (Marcellus, 2005).
Current legislation, guidelines and strategies emphasise the need for improved child protection and care to ensure the welfare of all children. The public health nurse can play a key role in surveillance of high-risk families and may be among the first to detect child abuse. Competence in procedures for identification, reporting and responding to child abuse are therefore essential. The public health nurse works as part of a multidisciplinary team and should promote effective inter-agency partnerships for optimum service provision for children and their families.
Crisp, B. R. & Lister, P. G. 2004, ‘Child protection and public health: nurses’ responsibilities’, Journal of Advanced Nursing, vol. 47, no. 6, pp. 656-63.
Government of Ireland 1991, Child Care Act 1991. Retrieved 11th December 2008 from: http://www.irishstatutebook.ie/1991/en/act/pub/0017/index.html
Government of Ireland 2001, Children Act 2001. Retrieved 11th December 2008 from: http://www.irishstatutebook.ie/2002/en/si/0151.html
DoHC 1999a, Children First: National Guidelines for the Protection and Welfare of Children. Retrieved 11th December from: http://www.dohc.ie/publications/children_first.html
DoHC 1999b, Best Health for Children: Developing a Partnership with Families. Retrieved 11th December from: http://www.hse.ie/eng/Publications/Children_and_Young_People/Best_Health_for_Children_Developing_a_Partnership_with_Families.pdf
DoHC 2005, Best Health for Children Revisited. Retrieved 11th December from: http://www.google.co.uk/search?hl=en&q=Best+Health+for+Children+Revisited&btnG=Search&meta=
Marcellus, L. 2005, ‘The ethics of relation: public health nurses and child protection clients’, Journal of Advanced Nursing, vol. 51, no. 4, pp. 414-20.
United Nations 1989, UN Convention on the Rights of the Child: the articles. Retrieved 11th December 2008 from:http://www.unhchr.ch/html/menu3/b/k2crc.htm