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Sammanfattning  Bakgrund:Att fara illa som barn leder till negativa konsekvenser både på kort och lång sikt. Därför måste dessa barn tillkännages socialtjänsen av anmälningsskyldiga. Specialistsjuksköterskor inom barnhälsovården och elevhälsan har denna skyldighet men forskning visar att en anmälan inte alltid görs trots oro för barnet.  Syfte: Syftet var att beskriva specialistsjuksköterskans upplevelse av att arbeta med barn som far illa eller misstänks fara illa inom barnhälsovården och elevhälsan.  Metod:En kvalitativ intervjustudie genomfördes med 12 specialistsjuksköterskor inom barnhälsovården och elevhälsan. Data analyserades med konventionell innehållsanalys.  Resultat:Arbetet med barn som far illa beskrevs som komplext. Anmälningsskyldigheten var en viktig men svår uppgift. Att bedöma var gränsen går för när ett barn far illa samt bristande samarbete med socialtjänsten var svårigheter som framkom, en anmälan kunde av den anledningen ibland dröja eller utebli. Flera strategier användes i arbetet där relationen med barnet och familjen var av stor betydelse.  Konklusion: Ämnet är komplext. Specialistsjuksköterskor beskriver att de saknar metoder och arbetssätt för att på bästa sätt hantera arbetet med barn som far illa. Specialistsjuksköterskorna har utarbetat egna strategier för att hjälpa barnet eller familjen på andra sätt först, innan en anmälan skrivs. / Abstract Background:Child maltreatment can have negative consequences in both the short and long term. Therefore, these children must be reported to the social services by persons liable to report. Specialist nurses in child health care and student health have this obligation, but research shows that a report is not always made despite concerns for the child.  Aim:The aim of the study was to describe the specialist nurse's experience of working with children who are maltreated or suspected of being maltreated in child health care and school.  Method:A qualitative interview study was conducted with 12 specialist nurses in child health care and school. Data were analyzed using conventional content analysis.  Results:The work with maltreated children was described as complex. The reporting obligation was an important but difficult task. Assessing where the limit is for when a child becomes maltreated as well as a lack of cooperation with social services were difficulties that emerged, for which reason a report could sometimes be delayed or absent. Several strategies were used in the work where the relationship with the child and the family was of great importance.  Conclusion:The subject is complex. The specialist nurses describe a lack of methods and working methods to best manage work with maltreated children. The specialist nurses have developed their own strategies to help the child or the family in other ways first, before a report is written.

Bakgrund: Barn som far illa är ett ökande samhällsproblem som kan ge konsekvenser för barns hälsa. BHV-sjuksköterskan har möjlighet att upptäcka barn som far illa. Enligt socialtjänstlagen finns en skyldighet att anmäla, trots det visar tidigare forskning att det kan upplevas svårt och att riktlinjer kan behöva förtydligas. Syfte: Syftet med studien var att belysa BHV-sjuksköterskans erfarenheter av orosanmälningar vid misstanke om att barn far illa. Metod: Semistrukturerade intervjuer genomfördes med nio BHV-sjuksköterskor i Halland. Dataanalysen utgick från Kvalitativ innehållsanalys enligt Graneheim och Lundman (2017). Resultat: BHV-sjuksköterskornas erfarenheter kategoriserades i tre huvudkategorier; Att ta beslutet, Organisatorisk påverkan, Föräldrarnas påverkan. Konklusion: Studien belyser beslutet kring en orosanmälan som komplext och känsloladdat. Rutiner, riktlinjer, teamarbete och stöd från chefen beskrevs vara viktigt. Förbättrade rutiner skulle kunna leda till att fler barn som far illa upptäcks. Brister i samarbetet med socialtjänsten framkom som försvårande. Bemötandet av föräldrarna var viktigt för relationen och negativa reaktioner från föräldrarna kunde försvåra att göra orosanmälningar. Vidare forskning från föräldrarnas perspektiv samt djupare undersökning av samverkan med socialtjänsten skulle behövas. / Background: Children who are victims of maltreatment is an increasing society problem, which can have consequences for children’s health. Pediatric primary nurses have an opportunity to detect these children. According to the law there is an obligation to report when maltreatment is suspected. Research has shown that it can be difficult and that improved guidelines is needed. Aim: The aim of this study was to describe pediatric primary nurses’ experience of mandatory reports if children are suspected to be victims of maltreatment. Method: Semi-structured interviews have been conducted with nine pediatric primary nurses in Halland. The data analysis was based on Qualitative content analysis (Graneheim and Lundman, 2017). Results: Three main categories were identified; To make the decision, Organisational involvement, The parents’ involvement. Conclusion: The study highlights the decision regarding a mandatory report as complex and emotional. Routines, guidelines, teamwork and support from the employer are described as important. Improved routines could make it easier discovering child maltreatment. Shortcomings in the cooperation with social services emerged as obstructing. The reception of the parents was important and negative reactions could make mandatory reports difficult. Research of the parent’s perspective, and investigation into the cooperation with the social services, is needed.

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Postpartum psychopathology is a well-documented risk factor for impaired mother-infant bonding and thus child development. Increasingly, the focus of research in this area lies on maternal adverse childhood experiences that mothers bring into the relationship with their own baby, especially regarding the possible intergenerational transmission of traumatic experiences. Several studies showed that there is no direct link between child maltreatment and mother-infant bonding as one part of mother-child relationship, but that this link is mediated by postpartum psychopathology. To date, few studies examined differential effects between sexual, physical, and emotional abuse, and physical and emotional neglect, especially in a clinical sample. The aim of this study is to investigate whether the relationship between child maltreatment, psychopathology, and mother-infant bonding can be found for different forms of child maltreatment in patients of a mother-baby unit. Our sample consisted of 330 mothers of a mother-baby-unit in a psychosomatic clinic, who filled out self-report measures at time of admission. Mothers reported on maternal child maltreatment history with the Childhood Trauma Questionnaire, on current psychopathology with the Brief Symptom Inventory, and on mother-infant bonding with the Postpartum Bonding Questionnaire. Mediation analyses were performed with psychopathology as mediator, child maltreatment history as independent, and mother-infant bonding as dependent variable. There was no total effect of child maltreatment on mother-infant bonding. However, there were significant indirect effects of child maltreatment in general (ab = 0.09) and of the various forms of child maltreatment on mother-infant bonding via psychopathology (0.16 ≤ ab ≤ 0.34). The strongest effect was found for emotional abuse. After controlling for psychopathology, the direct effect of physical abuse on mother-infant bonding presented as a negative significant effect. This indicates that the more severe the physical abuse experienced, the better the self-reported bonding. A similar, but non-significant trend was found for sexual abuse. Our findings highlight the importance of assessing neglect forms of child maltreatment as well as abuse in women during the perinatal period. It further supports initial findings that different forms of child maltreatment can have differential effects on mother-infant bonding as one aspect of the mother-child relationship. Further research should include observational data to compare with self-report measures.

This study aimed to investigate primary school teachers' experiences of mandatory reporting and the need for support in the reporting situation. The study was based on semi-structured interviews with seven professional primary school teachers which were qualitatively analyzed using thematic analysis. The results showed that primary school teachers experienced mandatory reporting as a self-evident legal obligation, but which in practice was perceived to have an unclear application. Furthermore, the primary school teachers experienced a lack of cooperation with the social service, which negatively affected the work with mandatory reporting, while solidarity in the workplace had a positive impact. The results were discussed based on developmental ecological systems theory and highlighted the importance of the interaction between different system levels for teachers' experiences and handling of mandatory reporting. / Studiens syfte var att undersöka lågstadielärares upplevelser av anmälningsplikten och stödbehov i anmälningssituationen. Studien baserades på semistrukturerade intervjuer med sju yrkesverksamma lågstadielärare som analyserades kvalitativt med tematisk analysmetod. Resultaten visade att lågstadielärare upplevde anmälningsplikten som en självklar legal skyldighet men att dess tillämpning i praktiken upplevdes oklar. Vidare framkom att lågstadielärare upplevde en bristfällig samverkan med socialtjänsten som påverkade arbetet med anmälningsplikten negativt, medan stöd och gemenskap på den egna arbetsplatsen upplevdes viktig för förmågan att hantera anmälningsplikten. Resultaten diskuterades utifrån utvecklingsekologisk systemteori och belyste betydelsen av samspelet mellan olika systemnivåer för lärares upplevelser och hantering av anmälningsplikten.

Bakgrund: Barn har rätt till en trygg uppväxt. Att befinna sig i en utsatt miljö som barn kan innebära både fysiska och psykiska konsekvenser i framtiden. Det finns en möjlighet att specialistsjuksköterskan kan upptäcka dessa barn. Syfte: Var att beskriva specialistsjuksköterskans erfarenheter av att möta familjer inom barnhälsovården där barnet misstänks befinna sig i en utsatt miljö.   Metod: En kvalitativ metod med induktiv ansats tillämpades. Individuella semistrukturerade intervjuer genomfördes med specialistsjuksköterskor som arbetat inom barnhälsovården i minst ett år. Kvalitativ manifest innehållsanalys enligt Graneheim och Lundman (2004) användes i analysen. Resultat: Analysen genererade tre huvudkategorier: Betydelsen av kompetens och erfarenhet, Möjligheten att både ge och få stöd samt En känslomässig påfrestning. Erfarenheter beskrevs av att identifiera tecken på barnet, att vara uppmärksam på föräldrarna samt att vara observant i familjens hemmiljö. Det var viktigt att erbjuda stöd till familjen samt att erhålla stöd i sin yrkesroll. Att bli emotionellt berörd i mötet med barnet, att kunna härbärgera olika slags känsloyttringar samt att det fanns en önskan om återkoppling. Slutsats: Det är svårt att identifiera tecken på utsatthet. Stöd till familjen ansågs viktigt i förebyggande syfte, men även stöd till specialistsjuksköterskan för att bidra till att fler orosanmälningar genomförs. / Background: Children have the right to a safe childhood. Being in a vulnerable environment as a child can have both physical and psychological consequences in the future. There is an opportunity for the specialist nurse to recognise these children.  Purpose: The aim was to describe the specialist nurse's experiences of meeting families in child health care where the child is suspected of being in a vulnerable environment.  Method: A qualitative method with an inductive approach was applied. Individual semi-structured interviews were conducted with specialist nurses who had worked in child health care for at least one year. Qualitative manifest content analysis according to Graneheim and Lundman (2004) was used in the analysis.  Results: The analysis generated three main categories: The importance of skills and experience, The ability to both give and receive support, and An emotional strain. Experiences of recognising signs of the child, being attentive to the parents and being observant in the family home environment were described. It was important to offer support to the family and to receive support in their professional role. Being emotionally involved in the meeting with the child, being able to harbour different kinds of emotional expressions and a desire for feedback.  Conclusion: It is difficult to identify signs of vulnerability. Support for the family was seen as important for prevention, but also support for the specialist nurse to help ensure that more concerns are reported.