The School Nurse’s Ability to Detect and Support Maltreated Children

Since children are a vulnerable group, the society has a special responsibility to protect them. The school nurse sees all pupils at school at regular health visits and thereby gains knowledge of their health and living conditions. The overall aim of the thesis was to develop empirical knowledge and understanding of the ability of the school nurse to detect and support children who are maltreated or at risk to be maltreated. The thesis is based on four studies. Study I was based on focus group interviews with school nurses. Data was analysed in accordance with Grounded Theory. Study II was a secondary analysis of study I and performed with Thematic Analysis. Studies III and IV were based on population data which was analysed by univariate and multivariate logistic regressions. The results showed that the school nurse has ability to detect children who are maltreated or at risk to be maltreated. However, also obstacles for detection were found such as lack of trust, avoidance, strong feelings and insufficient documentation. The obstacles were partly due to organisational shortcomings and dearth of resources affecting also internal and external collaboration. The school nurse strived for building trustful relations to pupils, to parents and to professionals. If the school nurse failed to report suspected child maltreatment to the child protection services it was because of worries that the reporting did not benefit the child. The school nurse avoided addressing child sexual abuse because of its particular sensitiveness, which affected the possibility to detect the abuse. Pupils in foster care were at higher risk of health problems, a more risky lifestyle, a lower degree of school attachment and lower school performance compared to pupils not in foster care. The results emphasize the potential of the school nurse to detect and support maltreated children through regular contacts with pupils, their confidence in the school nurse and trustful relations with other professionals.Många barn som far illa eller riskerar att fara illa upptäcks inte och får inte det stöd de behöver. Skolsköterskan möter alla elever vid regelbundna hälsobesök och får därmed kunskap om elevernas hälsa och livssituation. Avhandlingens övergripande syfte var att öka kunskapen om skolsköterskans möjlighet att upptäcka barn som far illa eller riskerar att fara illa samt initiering av stödinsatser. Avhandlingen grundar sig på fyra delstudier, som baseras på fokusgruppsintervjuer och populationsdata från elevhälsodatabasen ELSA. Resultaten visar att skolsköterskan har potential att upptäcka utsatta barn genom de regelbundna kontakterna och elevernas förtroende för skolsköterskan. För att stödinsatser ska kunna initieras måste barnet våga avslöja sin utsatthet eller att den upptäcks på annat sätt. Hinder för upptäckt och stöd som uppmärksammades var framförallt tillitsbrist, undvikande, starka känslor och bristande dokumentation. Dessa hinder hade delvis sin grund i organisationen av elevhälsoarbetet och bristande resurser, vilket även påverkade samverkan såväl internt inom skolan som externt med andra aktörer såsom socialtjänst samt övrig hälso- och sjukvård