A presente dissertação é composta por dois estudos. O primeiro corresponde à uma revisão sistemática da literatura científica nacional, na área de Ciências da Saúde, que trata da análise de registros de violência contra crianças e adolescentes do período entre 1990 e 2014. Os resultados apontaram que o documento mais utilizado foi a notificação de violência ao Conselho Tutelar. As características das vítimas e das situações de violência foram as mais frequentemente analisadas. Os dados observados informaram sobre a evolução das políticas de vigilância epidemiológica da violência. Foram também observados elevados índices de informações ausentes, bem como desconhecimento de variáveis psicossociais anteriores às situações de violência que interferem na testagem dos dados a partir de modelos teóricos atuais. O segundo estudo consiste em um artigo empírico que visou a caracterização das notificações de violência contra crianças no Rio Grande do Sul entre 2010 e agosto de 2014 realizadas junto ao SINAN. As vítimas foram predominantemente do sexo feminino e os agressores do sexo masculino. A negligência foi significativamente prevalente na 1ª infância, enquanto a violência psicológica, física e sexual na 3ª infância. Diferenças entre tipologia de violência e sexo de vítimas e agressores foram observadas dentro de períodos desenvolvimentais específicos. Foram discutidas como as interações dessas características operam nos níveis microssistêmico, exossistêmico e macrossistêmico. / The present dissertation is composed of two studies. The first if a systematic review of the Health Sciences literature on the analysis of child maltreatment occurrences. Results showed that the document most used for analysis was the Guardian Council child maltreatment notification. Victim’s characteristcs and aspects of maltreatment situations were the categories most frequently analysed. The data was informative on the evolution of the policies for epidemiological surveillance of child maltreatment. High rates of absent information and lack of approach of psychossocial aspects previous to the maltreatment cases were also observed, which limits the testage of theoretical models through empirical data. The second study consists of an empirial analysis aiming to characterize notifications of child maltreatment in Rio Grande do Sul between 2010 and August of 2014. Victims were majorly females and perpetrators, males. Neglect was significantly prevalent in infancy, as psychological, physical and sexual abuse were higher amongst older children. Differences on the maltrament type and victims and perpetrators gender were observed within specific developmental periods. Discussion is presented on the interaction between these characteristics whithin the microsystem, exosystem, and macrosystem.

O desenvolvimento saudável do adolescente é favorecido por interações que envolvam reciprocidade e equilíbrio de poder, no entanto, relações negligentes ou abusivas podem ser encontradas em práticas educativas na família ou escola sendo a violência psicológica a mais recorrente e associada com frequência a outros tipos de abuso. Nesse tipo de abuso o adolescente é desqualificado em suas capacidades, desejos e emoções. Este trabalho objetivou investigar a exposição de adolescentes à violência psicológica, assim como identificar sua associação com outros tipos de maus-tratos (físico, sexual e negligência), o perpetrador e o contexto de ocorrência. Procuramos também verificar a relação dos diferentes tipos de violência estudadas e as variáveis sócio-demográficas dos participantes da pesquisa. Para tanto foi realizado um estudo transversal com uma população de 218 adolescentes (entre 14-18 anos) de uma instituição escolar pública. Os estudantes responderam a um questionário e à Escala de Violência Psicológica (EVP), cujos dados obtidos foram analisados por meio de estatística descritiva. O estudo demonstrou que 96,3% dos estudantes sofreram violência psicológica, seguido da violência física (34,9%), sexual (7,3%) e negligência (2,8%). Mais de 90% dos adolescentes que sofreram violência física, sexual e negligência sofreram violência psicológica na modalidade leve e moderada o que demonstra a coocorrência da vitimização. Observamos que 94,5% dos alunos foram expostos a esse tipo de violência na sua forma leve e moderada e 1,8% na forma severa e apenas 3,7% dos adolescentes responderam nunca aos 18 itens de violência psicológica indagados na pesquisa. Esses dados mostram que a violência psicológica, mesmo que vivenciada com intensidade leve e moderada, é um comportamento presente na relação com pessoas significativas na vida da maioria dos adolescentes deste estudo / The healthy development of adolescents is favored by interactions involving reciprocity and balance of power, however, neglectful or abusive relationships can be found in educational practices in family or school psychological violence being the most recurrent and often associated with other types of abuse. In this type of abuse the teenager is disqualified in their abilities, desires and emotions. This study aimed to investigate the exposure of adolescents to psychological violence, as well as identify its association with other types of abuse (physical, sexual, and neglect), the perpetrator and the context of occurrence. We also sought to investigate the relationship between different types of violence studied and socio-demographic variables of the respondents. Therefore we performed a cross-sectional study with a population of 218 adolescents (aged 14-18 years) of a public educational institution. These students completed a questionnaire and Psychological Violence Scale (EVP), whose data were analyzed using descriptive statistics. The study showed that 96,3% of students suffered psychological violence, followed by fisical violence (34,9%), sexual (7,3%) and neglect (2,8%). Over 90% of adolescents who suffered physical, sexual and psychological violence suffered neglect in mild and moderate form which shows the co-occurrence of victimization. We observed that 94,5% of students were exposed to such violence in its mild and moderate and 1,8% severe form, and only 3,7% of adolescents never responded to the 18 items asked of psychological research. These data show that psychological violence, even if experienced with mild to moderate behavior is present in the relationship with significant people in the lives of most adolescents in this study

Muitas crianças e adolescentes são vítimas de maus-tratos infantis, no Brasil e no Peru, e estas práticas constituem-se em uma violação aos seus direitos. Em ambas as sociedades, tais direitos são preconizados e garantidos por dispositivos legais, tendo em vista sua proteção integral, sendo que um destes dispositivos prevê a suspensão temporária do direito de guarda pelos pais/responsáveis. A presente investigação propõe-se a conhecer melhor as famílias brasileiras e peruanas nessa situação, em termos de exposição a fatores de risco maleáveis, específicos para os maus-tratos, situados no micro e no exosistema. O referencial é o da Teoria Bioecológica e o Modelo Transacional. Trabalhou-se com amostras de conveniência no Brasil, na cidade de Ribeirão Preto - SP (n=30) e no Peru, na cidade de Arequipa (n=30), formadas por adultos mãe/pai ou cuidador, responsável legal. Os instrumentos utilizados para a coleta de dados foram: um Roteiro de Entrevista de Caracterização Sociodemográfica da Família; o Inventário de Potencial de Maus-Tratos Infantis (CAP); a Escala de Avaliação da Coesão e Adaptabilidade Familiar Versão IV (FACES IV); o Inventário de Estilos Parentais - Práticas Educativas Maternas/Paternas (IEP) ou, a depender da idade da criança, o Roteiro de Entrevista de Habilidades Sociais Educativas Parentais (RE-HSE-P); e o Questionário de Apoio Social (QAS). Cada instrumento foi corrigido segundo seus próprios critérios técnicos, sendo que os dados obtidos puderam ser categorizados e comparados estatisticamente. Os resultados indicaram que as famílias investigadas, em ambas as sociedades, seriam vulneráveis em termos socioeconômicos. No Brasil, embora padecendo menos do ponto de vista econômico, devido ao fato de serem, em sua maioria, beneficiárias de ajuda governamental, as famílias teriam baixo status social, tendo em conta o baixo nível de escolaridade dos pais/cuidadores e a situação de desemprego. No Peru, as famílias também teriam baixo status social, embora tendo em média uma escolaridade mais alta que as brasileiras. Essas, contudo, viveriam em condições mais precárias, com baixa renda, advinda de trabalho informal, e em moradias mais precárias, em regiões da cidade caracterizadas por escasso acesso aos serviços básicos. Nos dois países, as famílias perceberiam seus bairros como violentos ou perigosos: no Brasil, devido à venda de drogas; no Peru, devido à venda de álcool, aos roubos e ao pouco policiamento. Elas também se assemelhariam no tocante a aspectos de configuração: a maioria seria desconstituída e, por vezes, reconstituída, denotando-se histórico de violência entre os parceiros íntimos, para a maioria. Com relação às características pessoais dos pais/cuidadores, destaca-se que no Brasil estes seriam, em sua maioria, usuários de substâncias psicoativas e teriam familiares com envolvimento criminal. Em relação aos instrumentos padronizados, sublinha-se que, de modo geral, nas duas amostras, os dados indicaram a existência de problemáticas consideradas fatores de risco específicos para os maus-tratos. Focalizando as diferenças estatisticamente significativas (p<0,05) entre as amostras, destaca-se que no CAP os participantes brasileiros pontuaram mais alto na subescala rigidez, indicando uma problemática maior nesse plano. No FACES, as amostras apresentaram diferenças nas escalas Coesão, Flexibilidade, Comunicação e Satisfação Familiar, denotando maior disfuncionalidade na amostra brasileira. O IEP diferenciou as amostras somente na dimensão de Punição inconsistente, denotando que a amostra peruana empregaria com maior frequência esta prática negativa. Em síntese, os dados sugerem que as famílias no sistema de proteção infantil efetivamente vivem problemas associados à ocorrência dos maus-tratos. Novas pesquisas na área devem se dedicar a conhecer e a analisar se os serviços que lidam com essas famílias e com seus filhos têm contemplado suas necessidades. / Many children and adolescents are victims of child abuse in Brazil and Peru; these practices constitute a violation of their rights. In both societies such rights are recommended and guaranteed by the law, in view of its full protection, with one of these law disposition standing a temporary suspension of guard by parents / guardians. This research proposes to better understand Brazilian and Peruvian families in this context in terms of exposure to manageable risk factors specific to ill-treatment, located in the micro and exosistema. The theoretical framework is the bio-ecological theory and the transactional model. We worked with convenience samples in Brazil, in the city of Ribeirão Preto - SP (n = 30), and Peru, in the city of Arequipa (n = 30) were composed, formed by adults - mother / parent or caregiver, guardian. The instruments used for data collection were: A Sociodemographic Family characterization Interview; the Child Abuse Potential (CAP); the Family Adaptability and Cohesion Evaluation Scale- IV (FACES IV); Inventory of Parenting Styles - Educational Practices Maternal / paternal (IEP) or, depending on the age of the child, the Interview Script Education Social Skills Parental (RE-HSE-P); and the Social Support Questionnaire (SAQ). Each instrument has been analysed according to their own technical criteria, and data could be categorized and compared statistically. The results indicated that the families investigated in both countrys would be vulnerable in socioeconomic terms. In Brazil, although suffering less from the economic point of view, due to the fact that they are mostly beneficiaries of government aid programms, families have low social status, due to the low level of parents / caregivers`s education and the unemployment situation. In Peru, families also have low social status, while having on average higher education scores than the Brazilian. These, however, would live in precarious conditions, with low income, related to informal work ones and in precarious houses, in city regions characterized by poor access to basic services. In both countries, families perceive their neighborhoods as violent or dangerous: in Brazil, due to the sale of drugs; in Peru, due to the sale of alcohol, theft and little policing. They also would resemble regarding the configuration aspects: most would broked and sometimes reconstituted, showing up history of intimate partners violence, for most. With regard to parents/caregivers`s personal characteristics, in Brazil they would be, mostly psychoactive substances users and have family members with criminal envolvement. Regarding standardized instruments, it is emphasized that, in general, in both samples, the data indicate the presence of problematics considered specific risk factors for maltreatment. Focusing on statistically significant differences (p <0.05) between samples is emphasized that, in the CAP, , Brazilian participants scored higher in subscale Rigidity, indicating a larger problem here. In FACES, the samples showed differences in cohesion scales, flexibility, communication and family satisfaction, showing increased dysfunctionality in the Brazilian sample. The IEP differentiated samples only in the size of inconsistent punishment, indicating that the Peruvian sample used more often this negative practice. In summary, the data suggest that families in the child protection system effectively face problems associated with the occurrence of maltreatment in significant levels. New research in the area should be devoted to know and consider whether the services dealing with these families and their children contemplate their needs.

Esta dissertação se refere à pesquisa clínica realizada com adolescentes gestantes ou mães, que vivenciaram experiências de violência doméstica e encontravam-se acolhidas institucionalmente. Estudos apontam que a maternidade na adolescência pode decorrer de sentimentos de abandono, depressivos e/ou comportamento delinquente. Apesar de a maternidade na adolescência ter sido amplamente pesquisada, estudos sobre essa no contexto institucional são escassos. Aventou-se a hipótese de que a construção da identidade, personalidade e adaptação social dessas adolescentes apresenta prejuízos decorrentes das vivências de violências e exclusão social. Assim, visou-se o estudo de casos múltiplos de cinco mães adolescentes a partir da realização do Psicodiagnóstico Interventivo que permitiu a compreensão psicodinâmica e a proposição de medidas interventivas ao longo desse processo. A partir do conhecimento construído, pode-se também elaborar estratégias de trabalho junto às jovens. O método clínico qualitativo foi empregado, embasado no método psicanalítico. O psicodiagnóstico se deu por meio de entrevistas e aplicação do TAT. Os dados coletados foram analisados a partir da livre inspeção do material e discutidos visando ao entrelaçamento de aspectos clínicos e teóricos sob a perspectiva psicodinâmica. Observou-se que as adolescentes apresentaram dificuldades na aquisição de autonomia, exercício do papel materno, sentimentos de solidão e depressão frente à maternidade e à vida. Os achados apontam para um desenvolvimento emocional prejudicado. Aventou-se que a maternidade é uma forma de possuir um lugar no mundo e, inconscientemente, pode ser uma tentativa de estabelecer a dupla mãe-bebê que não fora vivenciada satisfatoriamente na primeira infância. Intervenções foram realizadas, como apontamentos, acolhimentos e encaminhamentos. Conclui-se pela necessidade de intervir nessa realidade, por meio de uma proposta psicoterapêutica / This dissertation consists of the clinical research done with pregnant adolescents or mothers, who have experienced abuse and found themselves in shelter. Studies point that teenage motherhood may be due to abandonment, depression feelings and/or delinquent behavior. While adolescent motherhood have been widely researched, studies about this one are scarce in the institutional context. It was suggested that the construction of identity, personality and social adjustment of these adolescents presents losses resulting from experiences of violence and social exclusion. Therefore, it was aimed the multiple case study of five teenage mothers from the completion of the Psychodynamic and Interventive Diagnosis, which allowed the psychodynamic comprehension as well as the proposal of interventive measures along this process. From the constructed knowledge, one can also develop strategies to work with the youth. The qualitative clinical method was used, based on the psychoanalytic method. The psychodiagnosis was given through interviews and application of TAT. The collected data were analized based on the free inspetion of the material and discusses aiming the interlacing of clinical and theorical aspects under the psychodynamic perspective. It was observed that the adolescents presented difficulty acquiring autonomy, exercising the maternal role, feelings of solitude and depression facing motherhood and life. The findings point to an impaired emotional development. Hypothetically, it was said that the motherhood is a way of owning a place in the world, and, unconsciously, it may be an attempt to establish the relation mother-baby which had not been lived satisfactorily in early childhood. Interventions were carried out, as notes, holding and referrals. In conclusion, theres the need to intervene in this reality, through a psychotherapeutic proposal

Barnavårdscentralen (BVC) är en frivillig men väl socialt accepterad del av barnhälsovården i Sverige. Behovet av stöd på BVC har förändrats över tid och nu dominerar de psykosociala behoven. Barn är beroende av vuxnas omsorg. Eftersom en stor andel av förskolebarnen träffar en BVC-sjuksköterska har hon en viktig roll i att identifiera och hjälpa barn som är utsatta för omsorgssvikt. Syftet med studien är att undersöka BVC-sjuksköterskors erfarenheter av att möta familjer där de misstänker att barn kan vara utsatta för omsorgssvikt och hur de upplever de resurser de har till sitt förfogande för att hjälpa barn och familj.En kvalitativ metod med induktiv ansats valdes och åtta BVC-sjuksköterskor intervjuades. Intervjuerna är analyserades med kvalitativ innehållsanalys. I resultatet framkommer att känslan av utsatthet och ensamhet i beslut och bedömning kring utsatta barn är tydlig, likaså frustration och maktlöshet i förhållande till samarbetet med socialtjänsten. Reflektion och tankeutbyte får BVC-sjuksköterskorna med sina kollegor, men också med barnhälsovårdspsykolog och socionom på familjecentral, där sådan finns. Den egna kunskapen och intuitiva känslan används i mötet med familjerna. Det svåraste är att formulera sin oro för familjerna. Mycket energi och kraft går åt till processen att fundera kring utsatta barn.De som arbetar i någon typ av team, upplever att de har bäst stöd och störst möjlighet att hjälpa familjer. Familjecentraler, eller liknande på fler platser, handledning och utbildning i samtalsmetodik är önskvärda förbättringar som författarna föreslår. I framtida forskning är det intressant att undersöka familjers upplevelse av stöd på BVC med eller utan familjecentral. Mer kunskap behövs om hur BVC-sjuksköterskans utsatthet påverkar henne. / Program: Fristående kurs

Child maltreatment is a prevalent and pernicious problem in the United States. In 2013, nearly 680,000 children were found to be victims of maltreatment, with actual instances of maltreatment likely significantly higher. Exposure to maltreatment has negative short and long-term impacts on child wellbeing and development. Poverty and single parenthood have long been shown to be primary determinants in the etiology of child maltreatment. Changes in family structure over the last 50 years have resulted in dramatic declines in the number of children who grow up in a two parent married household. Indeed, recent research indicates that large numbers of children will experience living with a single mother as well as experiencing multiple parental relationships throughout their childhoods. At the same time that non-marital relationships have become increasingly common, ideas about the role of fathers in parenting have changed as well. Traditional normative views of fathers as breadwinners have given way to an increased focus on the ways in which father involvement in parenting can influence positive child development. In contrast, research on child maltreatment has largely left the possible role of fathers in protecting against child maltreatment unaddressed. To date, little research has investigated the ways in which mothers’ relationship transitions, as opposed to static measures of marital status, might be associated with the risk for child maltreatment or how fathers’ involvement in parenting may buffer the risk for maternal child maltreatment.

Background: In high-income countries, parenting programmes have been shown to be effective in reducing the risk of child maltreatment. However, there is limited evidence of their effectiveness in low- and middle-income countries. This thesis focuses on the development and pilot randomised controlled trial (RCT) of a parenting programme to reduce the risk of child maltreatment in low-income families with young children in Cape Town, South Africa. Methods: This thesis is comprised of three studies submitted as papers for publication. The first study focused on the development of an evidence-informed, locally relevant parenting programme for families with children aged three to eight years in Cape Town, South Africa. Intervention development took place over three stages: (a) identification of core intervention components common in evidence-based parenting programmes; (b) formative evaluation using qualitative in-depth interviews and semi-structured focus groups with South African practitioners and low-income parents; and (c) integration of evidence-based approaches and local contextual issues to develop the intervention structure, protocols, and manual. The second study used a pilot RCT (N = 68 parent-child dyads) to examine the evaluation feasibility and initial effects of the parenting programme developed during the first study in Cape Town - the Sinovuyo Caring Families Programme. Parents of children aged three to eight years with clinical levels of parent-reported child behaviour problems were randomly allocated to either a 12-session, group-based parenting programme or a wait-list control group. Primary outcomes included parent-report and observational assessments of positive parenting, harsh parenting, and child behaviour problems; secondary outcomes included parent-report of parent depression, parenting stress, and social support. Assessments occurred at baseline and immediate post-test (i.e., 3-months after baseline). The third study was a mixed-methods process evaluation assessing the feasibility of the parenting programme based on three theoretical dimensions: participation, implementation, and acceptability. Quantitative data included attendance registers, fidelity checklists, satisfaction surveys, and parent-report of engagement in home practice activities. Qualitative data included post-programme focus groups with community facilitators (n = 8), individual interviews with a randomly selected group of parents (n = 15), transcripts from parenting sessions, and minutes from supervision sessions with facilitators. Results: In the first study, the formative evaluation suggested that many evidence-based parenting programme components and approaches were compatible with the local cultural context. These included managing child behaviour problems, learning effective discipline strategies, building positive parent-child relationships, and reducing parenting stress. Findings also suggested that programmes may benefit from including additional content on keeping children safe in violent communities, communicating about HIV/AIDS and poverty, involving fathers and alternative caregivers, and incorporating cultural values of social responsibility and respect. The pilot RCT in the second study showed high levels of study recruitment and retention, outcome measurement reliability and response rates, and a minimal effect of clustering due to delivering the intervention in groups of parents. Analyses showed moderate intervention effects for parent-report of increased positive parenting and observations of improved child-led play. However, observational assessments also found reduced frequency of positive child behaviour in the treatment group in comparison to controls. In the third study, quantitative results showed high levels of programme acceptability, implementation, and participation. Thematic analysis of qualitative data identified seven themes related to feasibility: (a) receptivity to strengthening existing parenting practices, (b) initial resistance to new parenting skills, (c) contextualising content within a cultural framework, (d) reinforcing implementation fidelity and improving quality of delivery, (e) challenges delivering content on nonviolent discipline, (f) supporting participant involvement, and (g) engagement in a collaborative learning approach. Conclusion: This thesis is the first in sub-Saharan Africa to use a systematic approach to develop and rigorously pilot a parenting programme to reduce the risk of maltreatment against young children in low-resource settings. Initial results indicate that a parenting programme derived from evidence-based approaches is feasible, culturally acceptable, and has the potential to reduce the risk of child maltreatment by improving positive parenting behaviour. Further intervention development and testing is necessary to strengthen core programme components and determine programme effectiveness.

Background: Child maltreatment has since 1979 been a punishable crime according to Swedish law but is still occurring in society today. All sorts of physical, psychological, sexual violence, neglect and exploitation of an individual under 18 years old was qualified as child maltreatment. Previous research has found an insecurity among nurses when they met children exposed to maltreatment. Nurses can encounter these children and are obligated through duty to notify and report when they suspect child maltreatment. Aim: The aim of this study was to illustrate nurses´ experiences of suspected child maltreatment or child maltreatment. Method: A literature review was conducted with a qualitative approach. Ten qualitative studies from Cinahl and Pubmed was reviewed for quality assurance and analyzed by Friberg's five-step analysis. Result: The analyze of the study resulted in three themes and eight subthemes. The first theme, Complex meetings, was about experiences in being a professional and challenges in the meeting. The second theme, Complicated assignments, described how nurse's experienced to assess the child's situation, to make a report and the cooperation with authorities. The third and last theme, Inhibitory and promotional activities, exposed the nurse's view on receiving support and education and the support for children and parents. Conclusion: Nurses experienced that it was important to be available and to build a relation with the child so the child could feel safe to tell about the mistreatment. It has also been shown that the nurse experienced complex emotions in the meeting with both the child and the parents and that it was not always clear to the nurse when to report child maltreatment. There was a need for more information and education for the nurse within the topic of child maltreatment. Also, the nurse experienced a need for better cooperation with the authorities that oversees cases of child maltreatment. / Att komma i kontakt med barn som far illa är något som alla sjuksköterskor kan komma att göra. Detta är en litteraturbaserad studie med analys av kvalitativa artiklar som visar att det utifrån flera perspektiv är både svårt och komplext. Denna studies resultat visar att sjuksköterskor upplever att det finns både viktiga och svåra delar i mötet och att det kan vara svårt att vara professionell, även om det eftersträvas. Det upplevs som att det finns faktorer som både kan underlätta och försvåra en bedömning och likaså som påverkar om sjuksköterskan utfärdar en anmälan. Att göra en anmälan har en känslomässig påverkan på sjuksköterskan och samverkan med myndigheter upplevs som svår och bristande. Sjuksköterskan har erfarenheter av att stödet är otillräckligt och upplever att de vill ha mer support från både kollegor och professionellt stöd. För att kunna känna sig mer trygga inför dessa situationer önskar de få mer utbildning kring barn som far illa. Sjuksköterskan ser också att det finns ett stödbehov hos familjerna och barnen. Att kunna ge stöd upplevs viktigt men ibland svårt om familjen inte vill ta emot det eller när åtgärder riskerade att bryta barnets förtroende för sjuksköterskan. Verksamheter och supportgrupper upplevs vara ett bra stöd och att samarbete med skola kan underlätta för barnet.

Background: The number of children abused in Sweden has increased in last years. All children have the right to live a safe life and receive a good development during their upbringing. It is important that the child's basic needs are met for the child to have a good development. Being a victim of child abuse can lead to enormous consequences in the future for the child's physical and mental health. Aim: This study aimed to illuminate the nurse's experiences in suspected child maltreatment Method: A literature study based on analysis of qualitative studies according to Friberg´s five step model. Results: The results of the studies showed that responding and helping children who live in child abuse was a difficult task for the nurses to perform. The nurses were aware of their obligation to maintain the child's safety. The nurses described the basis of their experience that they encountered personal and work-related obstacles to be able to identify, remedy and report when children were suspected of being abused. The result is presented under three themes. The first theme highlights how nurses are emotionally affected. The second theme is about experiences about collaboration with other authorities. The third theme describes the nurses' need for professional development. Conclusion: The nurses should be able to give the child the right care to ensure the safety of the child and be able to give advice to the child's family. A prerequisite for providing adequate nursing needs nurses have good health science knowledge. / Antalet barn som far illa i Sverige ökar. Sjuksköterskor har skyldighet att anmäla vid misstanke om barn som far illa. Forskning visar att barn som far illa väljer att inte berätta för en vuxen eller en professionell person om misshandeln. Forskning visar även att sjuksköterskans beteende kan hindra eller stimulera patientens delaktighet samt att vårdkultur kan bidra till ett vårdlidande. Konsekvensen av att leva med utsatthet som barn kan resultera i fysisk och psykisk ohälsa senare i livet. Resultat av denna litteraturstudie baseras på sammanställning av nio kvalitativa studier. Resultatet visar att sjuksköterskornas emotionella påverkan har sin inflytande på arbetet. Sjuksköterskorna förstår sitt ansvar att reagera och hjälpa det utsatta barnet, för att sjuksköterskorna ska kunna utöva sitt ansvar krävs det en fungerande samverkan med andra verksamheter. Sjuksköterskorna upplever frustration över bristande samverkan med andra vårdenheter och myndigheter. Sjuksköterskorna uttrycker även ett behov av mer kunskap och professionell utveckling samt tydliga rutiner för att kunna upptäcka varningstecken och därefter kunna vidta relevanta åtgärder i syfte att barnets säkerhet säkerställas i god tid. Slutsatsen av detta examensarbete är att sjuksköterskorna stöter på hinder under processen att hjälpa barn och deras familj. För att sjuksköterskorna ska kunna tidigt upptäcka och vidta rätta åtgärder vid misstanke om barn som far illa krävs det förutsättningar för sjuksköterskorna att utveckla sin kunskap, en fungerande samverkan med alla berörda, samt rätt stöd för att bearbeta den emotionella påverkan som uppstår.

Bakgrund: Barnmisshandel är ett stort globalt problem, i Sverige är trenden för anmälningar av misshandelsbrott mot barn stigande. Svenska lagen rättfärdigar hälso- och sjukvårdspersonal med anmälningsplikt att anmäla misstanke om barnmisshandel till socialtjänsten. Det finns dock forskning att anmälningar inte sker på grund av exempelvis okunskap kring upptäckt av misshandel samt anmälningsprocessen. Det finns oklarhet över de känslomässiga upplevelserna av att vara involverade i barnmisshandelsfall. Syfte: Att beskriva hur sjuksköterskor upplever att vara involverade i barnmisshandelsfall samt att beskriva en metodologisk aspekt i de inkluderande artiklarna. Metod: Beskrivande litteraturstudie utifrån tolv kvalitativa studier. Resultat: Det framkom att sjuksköterskorna upplevde att deras misstanke om barnmisshandel oftast baserades på en magkänsla vilket skapade osäkerhet och frustration. Känslan av osäkerhet är konstant genom hela processen från misstanke till utredning. De upplevdes svårt att upprätthålla ett professionellt förhållningssätt. Flera studier visar att många av deltagarna var rädda för sin egen säkerhet. Sjuksköterskorna kände att dessa fall lämnade djupa spår. Både oro och tillfredsställelse kunde uppstå i samband med anmälan. Under utredningsprocessen visar studier att uppgivenhet och frustration dominerade i samarbetet med Soc, exempelvis på grund av brist i statusuppdatering över fallen. De flesta sjuksköterskorna upplevde att kollegorna var ett stort stöd i processen, dock hade inte alla tillgång till det. Det var totalt 222 deltagare i de inkluderade artiklarna varav 161 sjuksköterskor, mellan 25 - 64 år gamla. Majoriteten var kvinnor och arbetslivserfarenhet som sjuksköterska låg mellan två och 38 år. Slutsats: De olika stegen i ett barnmisshandelsfall sätter framförallt negativa spår på sjuksköterskan. Osäkerhet spelar den största rollen och går som en röd tråd genom alla olika steg. Även om socialt stöd upplevdes som en bra resurs för att kunna hantera dessa situationer finns det många utmaningar kvar att hitta mer lösningsorienterade ansatser. Det behövs en mer salutogen synvinkel i forskning, sjuksköterskeutbildning och i verksamheter, för att förbättra förutsättningar för sjuksköterskor att kunna hantera dessa upplevelser. / Background: Child abuse is a huge global problem and the trend in Sweden in reporting child abuse is increasing. Swedish law obligates health care personnel to report any suspicion of child abuse to child protection services. However, research shows that reports are not happening to the extent they should. Lack in knowledge on how to identify abuse and which process to follow when reporting are the main factors. It is unclear how nurses are emotionally involved when handling a child abuse case. Aim: To describe how nurses experience to be involved in child abuse cases and to describe one methodological aspect of the articles this study is based on. Method: Descriptive literature review based on twelve qualitative studies. Result: Nurses felt that the initial suspicion about a child being abused was often based on gut feeling only, causing both insecurity and frustration. The feeling of insecurity followed most nurses throughout the whole case, from suspicion until investigation. Research showed that most nurses felt it was difficult to maintain a professional attitude. Moreover, nurses were scared for their own lives when dealing with child abuse. The negative emotions were often long lasting. When reporting such a case to the authorities nurses could experience both feelings of anxiety and satisfaction. Throughout the investigation resignation and frustration dominated the nurses' cooperation with child protection services due to lack of status updates, for example. One successful way to deal with insecurity was social support from colleagues, but not everyone had access to such a support network. In total, the included studies comprised 222 participants, 161 of whom were nurses, between 25-64 years old. The majority were women and the participants had work experience as a nurse between two and 38 years Conclusion: Dealing with child abuse cases as a nurse is mostly characterized by negative impressions. The feeling of insecurity is predominant and runs lika a red thread from suspicion to investigation. Social support is perceived as a vital resource in order to deal with child abuse cases. However many challenges remain to find more solution focused approaches. A more salutogenic view is needed in research, nursing education and on the work floor in order to improve the conditions for nurses to be able to cope with these experiences.