The purpose of the study is to examine what effects the law has on principals’ approaches to mandatory reporting of child maltreatment (Social Services Act 14:1§). Moreover, the aim is to study if the regulation gets the impact intended. To respond to the purpose, legal science methods in the form of sociology of law were employed aided by qualitative semi-structured research interviews. The interviews comprised six principals in six different schools in the Stockholm area. The interviews were analyzed based on sociology of law theory, earlier research and relevant regulations in social law. The outcome indicates that principals’ understanding of the intentions behind mandatory reporting of child maltreatment is limited in some aspects. There is a difference between the interviewed principals’ official approaches and how they answer that they apply mandatory reporting in practice. When deciding how to apply the mandatory reporting, the child’s best interest is weighed against the parents’ right not to be reported to the authorities unless there is a real concern in the child. The principals suggest that in situations when a report does not lead to action, the reporting creates a bad relationship between the parents and the school. According to the principals, these situations affect the children and their wellbeing

Bakgrund: Sjuksköterskor som arbetar på barnavårdcentral (BVC-sjuksköterskor) träffar 99,2 procent av alla barn. De har därför en viktig funktion när det gäller att upptäcka och rapportera barn som far illa. Trots anmälningsplikt är anmälningsfrekvensen låg. Det råder brist på studier kring hur det blir för BVC-sjuksköterskor efter att de har gjort en anmälan. Syfte: Att ur ett etiskt perspektiv undersöka BVC-sjuksköterskors upplevelser och erfarenheter efter att de har anmält till socialtjänsten att barn far illa. Metod: Semistrukturerade intervjuer genomfördes med sex BVC-sjuksköterskor. Intervjuerna analyserades med kvalitativ innehållsanalys på manifest nivå enligt Graneheim och Lundman. Resultat: BVC-sjuksköterskornas erfarenheter av samarbetet med socialtjänsten varierade. Alla informanterna menade dock att bristen på återkoppling var ett stort hinder. Relationen till föräldrarna kunde ibland bevaras eller fördjupas efter anmälan. Ibland skadades relationen och då ansågs byte av BVC-sjuksköterska som bra. Efter beslutet om anmälan fanns många känslor. Bland annat kände sig informanterna utsatta och var rädda för hot. Det fanns även en stor oro för barnet och moralisk stress förekom. Att anmäla upplevdes som att göra sin plikt. Stöd var viktigt och kunde göra tröskeln till ny anmälan mindre. Slutsats: BVC-sjuksköterskor upplever många svårigheter efter anmälan, vilket kan påverka anmälningsfrekvensen. Ett gott samarbete med socialtjänsten, handledning och tillräckligt med stöd efter anmälan, skulle kunna leda till fler anmälningar till socialtjänsten när barn far illa. / Background: Nurses working in primary child healthcare meet 99,2 percent of the children in Sweden. Therefore they have an important role in finding and reporting child abuse and neglect. Despite mandatory reporting according to the law, the rate of reports is low. There is a lack of research about experiences from nurses after they have made a report to the social welfare board. Aim: To, from an ethical perspective, explore the experiences from nurses working in primary child healthcare after they have made a report to the social welfare board about child abuse or neglect. Method: Semistructured interviews were conducted with six nurses working in primary childhealth care. The interviews were analysed using qualitative content analysis on a manifest level according to Graneheim and Lundman. Results: Nurses working in primary child healthcare had a varying experience of the contact with the social welfare board. All respondents however, thought that the lack of feedback from the social welfare board was a major obstacle. The relation to the parents were sometimes preserved or even deeper after the report. The relation could also be harmed and then a replacement of the nurse was considered to be good. After decision to report, there were a lot of emotions and some felt that they were in an exposed situation some feared threats. Further on there was a major concern for the child and some respondents perceived moral distress. To report was considered to do ones duty. To get support was important and could lower the threshold for making another report. Conclusion: Nurses working in primary child healthcare experience many difficulties after reporting to the social welfare board, which may influence the amounts of made reports. Good cooperation with the social welfare board, mentoring and sufficient support after reporting, may result in more reports to the social welfare board about child abuse or neglect.

Background: The proportion of older individuals in the driving population is predicted to increase in the next 50 years. This has important implications for driving safety as abilities which are important for safe driving, such as vision (which accounts for the majority of the sensory input required for driving), processing ability and cognition have been shown to decline with age. The current methods employed for screening older drivers upon re-licensure are also vision based. This study, which investigated social, behavioural and professional aspects involved with older drivers, aimed to determine: (i) if the current visual standards in place for testing upon re-licensure are effective in reducing the older driver fatality rate in Australia; (ii) if the recommended visual standards are actually implemented as part of the testing procedures by Australian optometrists; and (iii) if there are other non-standardised tests which may be better at predicting the on-road incident-risk (including near misses and minor incidents) in older drivers than those tests recommended in the standards. Methods: For the first phase of the study, state-based age- and gender-stratified numbers of older driver fatalities for 2000-2003 were obtained from the Australian Transportation Safety Bureau database. Poisson regression analyses of fatality rates were considered by renewal frequency and jurisdiction (as separate models), adjusting for possible confounding variables of age, gender and year. For the second phase, all practising optometrists in Australia were surveyed on the vision tests they conduct in consultations relating to driving and their knowledge of vision requirements for older drivers. Finally, for the third phase of the study to investigate determinants of on-road incident risk, a stratified random sample of 600 Brisbane residents aged 60 years and were selected and invited to participate using an introductory letter explaining the project requirements. In order to capture the number and type of road incidents which occurred for each participant over 12 months (including near misses and minor incidents), an important component of the prospective research study was the development and validation of a driving diary. The diary was a tool in which incidents that occurred could be logged at that time (or very close in time to which they occurred) and thus, in comparison with relying on participant memory over time, recall bias of incident occurrence was minimised. Association between all visual tests, cognition and scores obtained for non-standard functional tests with retrospective and prospective incident occurrence was investigated. Results: In the first phase,rivers aged 60-69 years had a 33% lower fatality risk (Rate Ratio [RR] = 0.75, 95% CI 0.32-1.77) in states with vision testing upon re-licensure compared with states with no vision testing upon re-licensure, however, because the CIs are wide, crossing 1.00, this result should be regarded with caution. However, overall fatality rates and fatality rates for those aged 70 years and older (RR=1.17, CI 0.64-2.13) did not differ between states with and without license renewal procedures, indicating no apparent benefit in vision testing legislation. For the second phase of the study, nearly all optometrists measured visual acuity (VA) as part of a vision assessment for re-licensing, however, 20% of optometrists did not perform any visual field (VF) testing and only 20% routinely performed automated VF on older drivers, despite the standards for licensing advocating automated VF as part of the vision standard. This demonstrates the need for more effective communication between the policy makers and those responsible for carrying out the standards. It may also indicate that the overall higher driver fatality rate in jurisdictions with vision testing requirements is resultant as the tests recommended by the standards are only partially being conducted by optometrists. Hence a standardised protocol for the screening of older drivers for re-licensure across the nation must be established. The opinions of Australian optometrists with regard to the responsibility of reporting older drivers who fail to meet the licensing standards highlighted the conflict between maintaining patient confidentiality or upholding public safety. Mandatory reporting requirements of those drivers who fail to reach the standards necessary for driving would minimise potential conflict between the patient and their practitioner, and help maintain patient trust and goodwill. The final phase of the PhD program investigated the efficacy of vision, functional and cognitive tests to discriminate between at-risk and safe older drivers. Nearly 80% of the participants experienced an incident of some form over the prospective 12 months, with the total incident rate being 4.65/10 000 km. Sixty-three percent reported having a near miss and 28% had a minor incident. The results from the prospective diary study indicate that the current vision screening tests (VA and VF) used for re-licensure do not accurately predict older drivers who are at increased odds of having an on-road incident. However, the variation in visual measurements of the cohort was narrow, also affecting the results seen with the visual functon questionnaires. Hence a larger cohort with greater variability should be considered for a future study. A slightly lower cognitive level (as measured with the Mini-Mental State Examination [MMSE]) did show an association with incident involvement as did slower reaction time (RT), however the Useful-Field-of-View (UFOV) provided the most compelling results of the study. Cut-off values of UFOV processing (>23.3ms), divided attention (>113ms), selective attention (>258ms) and overall score (moderate/ high/ very high risk) were effective in determining older drivers at increased odds of having any on-road incident and the occurrence of minor incidents. Discussion: The results have shown that for the 60-69 year age-group, there is a potential benefit in testing vision upon licence renewal. However, overall fatality rates and fatality rates for those aged 70 years and older indicated no benefit in vision testing legislation and suggests a need for inclusion of screening tests which better predict on-road incidents. Although VA is routinely performed by Australian optometrists on older drivers renewing their licence, VF is not. Therefore there is a need for a protocol to be developed and administered which would result in standardised methods conducted throughout the nation for the screening of older drivers upon re-licensure. Communication between the community, policy makers and those conducting the protocol should be maximised. By implementing a standardised screening protocol which incorporates a level of mandatory reporting by the practitioner, the ethical dilemma of breaching patient confidentiality would also be resolved. The tests which should be included in this screening protocol, however, cannot solely be ones which have been implemented in the past. In this investigation, RT, MMSE and UFOV were shown to be better determinants of on-road incidents in older drivers than VA and VF, however, as previously mentioned, there was a lack of variability in visual status within the cohort. Nevertheless, it is the recommendation from this investigation, that subject to appropriate sensitivity and specificity being demonstrated in the future using a cohort with wider variation in vision, functional performance and cognition, these tests of cognition and information processing should be added to the current protocol for the screening of older drivers which may be conducted at licensing centres across the nation.

Made available in DSpace on 2015-07-22T20:49:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-30 / O presente trabalho pretende, por meio da abordagem qualitativa e do estudo de caso, analisar as narrativas de pediatras da atenção básica básica de saúde do município do Embu e de um ambulatório de especialidades do município de São Paulo, com o objetivo de apreender como esses profissionais lidam com a questão do abuso sexual infantil. Para a coleta de dados, foram utilizadas as técnicas de observação não participante, entrevistas gravadas com roteiro semiestruturado e registro em diário de campo. A partir das entrevistas gravadas, foram construídas narrativas, analisadas segundo a orientação de Pope (2009), o que resultou na construção dos eixos empíricos, a saber: a) os pediatras frente à situação de abuso sexual; b) ambiguidade ante a notificação; c) necessidade de encontrar marcas físicas e d) a questão do vínculo com o paciente e com a instituição. Os resultados mostraram que o abuso sexual infantil provoca nos profissionais reações emocionais que prejudicam a objetividade diagnóstica. Por outro lado, apontam que o vínculo com o paciente ajuda a conhecê-lo melhor, permitindo suspeitar de maus-tratos, apesar de a maioria insistir na necessidade de encontrar sinais físicos de abuso. Em que pese o treinamento em matéria do abuso sexual, pelo qual a maioria dos profissionais passa, persiste o entendimento de que a notificação de suspeita de abuso poderá gerar problemas, tanto pessoais quanto profissionais. Resta apontar, enquanto perdurar a ineficácia da lei, e considerando os cuidados demandados quando a criança entra no serviço de saúde, a importância para a sensibilização do papel protetivo exercido por esses profissionais, no momento em que não perdem a oportunidade de notificação dos casos suspeitos ou diagnosticados, considerando sua co-responsabilidade pela continuidade ou não da violência sofrida pela criança. / This research intends to analyze, through a qualitative approach and a case study, the narratives of Pediatricians from the basic health care service of Embu County and one specialized clinic in Sao Paulo County, with the purpose of learning how these professionals deal with the question of child sexual abuse. The data collection was made through non-participative observation techniques, semi-structured recorded interviews and registrations in a field notebook. The data were presented through the construction of narratives from the analysis of the recorded interviews following the orientation of Pope et al. (2009), which resulted in the construction of empiric axels, to be noted: a) the pediatricians facing the sexual abuse situation; b) ambiguity upon the notification; c) the necessity for finding physical signs and d) the question of ties with the patient and with the institution. The results show that sexual child abuse brings out emotional reactions in the professionals which harm the diagnostic objectiveness. On the other hand, they point out that bonding with patients helps better knowing them, thus allowing the detection of foul play, outthought most insist in finding evidence of physical signs of abuse. Despite all the training on sexual abuse which the majority of professionals go through, a common notion persists that when one notifies the suspicion of a case of abuse, it may cause not only personal, but also professional problems. We still point out that while the inefficiency of the law exists and considering the care demanded when a child enters the health care service, the importance of the sensitivity of the protective role exercised by these professionals at the moment they elect not to miss the opportunity of notification of suspicious or detected abuse cases, taking into consideration their co-responsibility for the continuation or not of the violence suffered by such child. / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Erika Demachki (erikademachki@gmail.com) on 2014-12-16T19:01:50Z No. of bitstreams: 2 Dissertação - Elza Gomes Finotti Nogueira - 2013.pdf: 1436172 bytes, checksum: b8b55cc595fb175da393ca1fe1706f7b (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Erika Demachki (erikademachki@gmail.com) on 2014-12-16T19:02:16Z (GMT) No. of bitstreams: 2 Dissertação - Elza Gomes Finotti Nogueira - 2013.pdf: 1436172 bytes, checksum: b8b55cc595fb175da393ca1fe1706f7b (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2014-12-16T19:02:17Z (GMT). No. of bitstreams: 2 Dissertação - Elza Gomes Finotti Nogueira - 2013.pdf: 1436172 bytes, checksum: b8b55cc595fb175da393ca1fe1706f7b (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-11-27 / Violence is a phenomenon that has always been part of human experience and has been emphasizing between the main causes of morbidity and mortality worldwide. Since 1993 the World Health Organization recognizes in violence a public health problem. In 2010, the Ministry of Health of Brazil recorded 27,176 notifications of cases of domestic violence, sexual and/or other violence. According to the data, the characteristics of victims of violence against women are: young adult, married or in a consensual union, resident of urban zone, higher education and white color. In relation to the likely perpetrator of the assault, mostly committed by a male person and that have closed relationship with the victim, provided that spouse or ex-spouse. Therefore, it should be noted the importance of the Brazilian public policies to combat violence against women and the institution of compulsory notification within the Health System in Brazil. The present study aimed to analyze the knowledge of professionals about the notification of cases of violence against women in the Municipal Health Secretariat of Goiânia-Goiás/Brazil. A qualitative study of exploratory type, whose study population consisted of professionals involved with attention to women in situation of violence and/or epidemiological surveillance of violence in three hierarchical levels of the Secretariat. It was used for data collection the interview and documentary research in written records and fingerprints of trainings addressing the subject of notification of violence against women. Considering the manifestations of the professionals interviewed in relation to the understanding of the role of the professional in the attention to women in situation of violence, one realizes that some procedures reported go beyond purely technical questions of assistance, especially to motivate to get support, receive, listen and observe, offer support and inspire confidence. Most professionals understand that the notification is mandatory, have epidemiological and purpose must be carried out by who does the attendance, even anonymously, evidencing compliance with what the law calls for the notification. As for the professionals ' knowledge about the reference flows and opposite-reference and existence of Protocol, it can be observed that there is a consensus, especially on the existence of the Protocol. Some understand the role of Network of Care for Children, Adolescents and Women in Situations of Violence, emphasizing the articulation of institutions, training of professionals and the support service of the Health Unit. Regarding training for the notification of cases of violence against women, professionals recognize the need of updates. With the documentary research found a significant quantitative educational events or courses, however, without subsidies to verify that meet National Policy for Continuing Education in Health (PNEPS), in force since 2004. In this way, it is considered that the training of professionals must fit the guidelines of PNEPS, and their records need to be qualified. Regarding the Network of Care for Children, Adolescents and Women in Situations of Violence is considered necessary a continuous, comprehensive disclosure of their actions to the professionals. / A violência, mesmo sem ser natural, é um fenômeno que sempre fez parte da experiência humana e vem se destacando entre as principais causas de morbimortalidade em todo o mundo. Desde 1993 a Organização Mundial da Saúde reconhece na violência um problema de saúde pública. Em 2010, o Ministério da Saúde registrou 27.176 notificações de casos de violência doméstica, sexual e/ou outras violências. Segundo os dados, as características das vítimas de violência contra a mulher são: adulta jovem, casada ou em união consensual, residente da zona urbana, escolaridade mais elevada e da cor branca. Em relação ao provável autor da agressão, a maior parte foi cometida por indivíduo do sexo masculino e que matinha relação próxima com a vítima, na condição de cônjuge ou ex-cônjuge. Portanto, ressalta-se a importância das políticas públicas brasileiras de combate à violência contra a mulher e a instituição da notificação compulsória dentro do Sistema Único de Saúde. O presente estudo teve como objetivo analisar o conhecimento dos profissionais sobre a notificação dos casos de violência contra a mulher na Secretaria Municipal de Saúde de Goiânia-Goiás. Realizou-se um estudo qualitativo do tipo exploratório, cuja população de estudo constou de profissionais envolvidos com a atenção à mulher em situação de violência e/ou vigilância epidemiológica das violências, nos três níveis hierárquicos da Secretaria. Utilizou-se para coleta de dados a entrevista e a pesquisa documental em registros escritos e digitais de capacitações que abordaram o tema da notificação da violência contra a mulher. Considerando-se as manifestações dos profissionais entrevistados em relação ao entendimento sobre o papel do profissional na atenção à mulher em situação de violência, percebe-se que alguns procedimentos relatados vão além das questões meramente técnicas da assistência, especialmente ao motivar a buscar apoio, acolher, ouvir e observar, oferecer apoio e inspirar confiança. A maioria dos profissionais entende que a notificação é obrigatória, tem finalidade epidemiológica e deve ser realizada por quem faz o atendimento, evidenciando conformidade com o que preconiza a legislação sobre a notificação. Quanto ao conhecimento dos profissionais sobre os fluxos de referência e contrarreferência e protocolo assistencial, pode-se observar que não há um consenso, especialmente, sobre a existência do protocolo. Alguns compreendem o papel da Rede de Atenção a Crianças, Adolescentes e Mulheres, enfatizando a articulação das Instituições, capacitação de profissionais e a retaguarda ao atendimento da Unidade de Saúde. Quanto à capacitação para a notificação dos casos de violência contra a mulher, os profissionais reconhecem a necessidade de atualizações. Com a pesquisa documental verificou-se um quantitativo significativo de eventos educativos ou cursos, porém, sem subsídios para verificar se atendem a Política Nacional e Educação Permanente em Saúde (PNEPS), em vigor desde 2004. Desta forma, considera-se que as capacitações de profissionais devem se adequar às diretrizes da PNEPS, e seus registros precisam ser qualificados. Em relação à Rede de Atenção a Crianças, Adolescentes e Mulheres em Situação Violência considera-se necessária uma ampla e contínua divulgação de suas ações aos profissionais.

Estudo de abordagem qualitativa que teve como objetivos conhecer e analisar a percepção dos profissionais de saúde e dos usuários do SUS, sobre a violência de gênero e a compreensão da notificação compulsória de violência contra a mulher no conjunto das ações de enfrentamento, a fim de elencar subsídios para elaboração de um projeto conjunto de intervenção na realidade. O estudo foi realizado com profissionais de saúde representantes das doze unidades da Estratégia de Saúde da Família do Distrito do Capão Redondo, profissionais da Coordenadoria Regional de Saúde Sul e usuários do SUS da mesma região. Os dados foram coletados durante a realização de três sessões de uma Oficina de Trabalho em que os discursos grupais foram gravados, transcritos e submetidos à análise de conteúdo. Os resultados foram analisados segundo as categorias analíticas de gênero e violência de gênero. Os resultados mostram que os grupos possuem uma visão conservadora acerca da construção da masculinidade e feminilidade, evidente pela confirmação de papéis idealizados para o homem e para a mulher, revelando estereótipos próprios do senso comum: homem - provedor e mulher - cuidadora. O grupo reconhece a violência de gênero como violação dos direitos humanos e a interface que ela possui com a saúde. As dificuldades de enfrentamento encontram-se no despreparo dos profissionais de saúde quanto ao reconhecimento e atendimento às mulheres em situação de violência. Associado a isso, está o desconhecimento dos caminhos utilizados para o enfrentamento do problema. Quanto à notificação compulsória da violência, constatou-se que reconhecem a inexistência da utilização do serviço, a despeito da sua importância para conferir visibilidade aos casos de violência. Consideram importante a elaboração de políticas públicas a partir da realidade constatada. No entanto, não diferenciam a notificação compulsória da denúncia por meio de Boletim de Ocorrência. O desconhecimento de todo o processo que envolve a notificação de violência gera desconforto e medo tanto nos profissionais quanto nos usuários. As propostas de intervenção discutidas pelo grupo incluem a capacitação dos profissionais de saúde para o atendimento e a realização da notificação, associada à definição de fluxos e à construção de uma rede de atenção às mulheres em situação de violência. / Qualitative approach study with the objective of knowing and analyzing the perceptions of health professionals and SUS users about violence of gender and their understanding of the mandatory report of violence against women in the set of actions for facing the problem, in order to recruit subsidy for the elaboration of a combined project of intervention in that reality. The study was performed with health professionals representing the twelve units of Family Health Strategy of the District of Capao Redondo, professionals from the Southern Regional Health Coordination and SUS users from that same region. Data was collected during three sessions of a Workshop when the group discussions were recorded, transcribed and submitted for content analysis. The results were analyzed according to the analytical categories of gender and gender violence. The end results reveal that the groups possess a conservative vision about the construction of masculinity and femininity. This was evidenced by the confirmation of roles idealized for man and woman, which revealed common sense stereotypes: man provider and woman keeper. The group recognizes that violence of gender is a violation of human rights and that it interferes with health. Setbacks in facing the situation reside in the health professionals lack of preparation regarding the recognition and service to women in violence situations. Associated with that, is the lack of knowledge regarding the ways to face the problem. As for the mandatory report of violence, it was found that they recognize this service is not used, despite its importance to confer visibility to violence cases. They consider important the elaboration of public politics based on the reality found out. However, they do not differentiate the report [notification] and the accusation (Police Report). The lack of knowledge about the entire process involving the report of violence generates discomfort and fear both in professionals and users. The intervention proposals discussed by the group include enabling health professionals to serve and to use the report associated with the definition of flow and the development of an attention network to serve women in violence situations.

Stakeholders have for the past few years been interested in organizations' impact on sustainability, where economic, environmental, and social issues are prioritized. In 2017, the Annual Reports Act was amended. It now requires companies that meet the criteria to report their CSR activities and impact on sustainability-related issues annually. There is a growing demand and expectation for companies to take responsibility for actions that may negatively impact the society in which they operate. However, critics point out that sustainability reports could be used as a marketing tool for corporations to construct a beautified image of themselves. A corporation's social responsibility is a significant challenge for the business, as it requires them to adapt to society's expectations, which is why the amendment was implemented. Hence, the purpose of this thesis is to contribute to theory on CSR and sustainability reporting by evaluating how mandated reporting has affected the content of Swedish companies' sustainability reports. The thesis includes two different content analyses, one quantitative and one qualitative. The quantitative content analysis showcases the change in the frequency of sustainability-related keywords in sustainability reports, while the qualitative content analysis focuses on more in-depth content developments. The study concludes that there is a strong correlation between the amendment taking legal force and the improvement of all selected companies' sustainability reports. There has been a significant increase in the social and environmental dimensions, while the economic dimension is consistent throughout the period. Lastly, the study also concludes that mandatory reporting improves the information and content communicated in the sustainability reports to relevant stakeholders.

Yrkesverksamma inom hälso- och sjukvården är skyldiga att göra en anmälan till socialtjänsten genast då de i sin verksamhet fattar misstanke om eller får kännedom om att ett barn far illa. Det är känt att trots att det finns misstanke om att ett barn far illa så är det vanligt att det inte anmäls till socialtjänsten. Syftet med studien var att beskriva erfarenheter hos sjuksköterskor inom barnhälsovården av att göra orosanmälan vid misstanke om att ett barn far illa. Deltagarna bestod av nio sjuksköterskor verksamma vid barnhälsovården i norra och mellersta Sverige. Studien genomfördes med en kvalitativ ansats och med semistrukturerade intervjuer som datainsamlingsmetod. Intervjuerna analyserades genom kvalitativ innehållsanalys och resulterade i fem kategorier. Resultatet visade att sjuksköterskor verksamma inom barnhälsovården upplevde svårigheter att identifiera att ett barn far illa och att de vanligtvis använde stödjande åtgärder i första hand. De uppgav att en god relation med familjen var mycket betydelsefull och viktig för samarbetet med familjen. Sjuksköterskor försökte arbeta familjecentrerat, men brist på tid gjorde att de inte alltid kände att de gjorde ett tillräckligt arbete. Samtliga sjuksköterskor önskade ett bättre samarbete med socialtjänsten. Studien visar på brister i sjuksköterskornas stöd för att kunna ta beslut om anmälan och brister i kommunikation mellan sjuksköterskor och socialtjänsten.

Bakgrund: Barn som far illa är ett omfattande samhällsproblem. Mörkertalet är stort och undersökningar visar på en underrapportering. Specialistsjuksköterskan besitter en central roll i att identifiera dessa barn. Det är därför av stor vikt att undersöka bakomliggande faktorer som påverkar upprättandet av en orosanmälan i specialistsjuksköterskans dagliga arbete inom BHV.   Syfte: Syftet var att undersöka specialistsjuksköterskors upplevelser av att upprätta en orosanmälan inom BHV. Metod: Studien genomfördes med en kvalitativ metod och induktiv ansats. Totalt 10 specialistsjuksköterskor från sju Barnhälsovårdscentraler i Götaland inkluderades. Deras erfarenheter inom BHV varierade mellan 1 och 31 yrkesverksamma år. Datainsamlingen utfördes genom semistrukturerade intervjuer via Zoom och analyserades genom manifest innehållsanalys enligt Graneheim och Lundman. Resultat: Studien resulterade i fyra kategorier: Barnets bästa i första hand, vilken betonade vikten av att vara barnets röst. Vikten av ett familjeperspektiv, där betydelsen av att involvera hela familjen belystes. Vikten av ett kollegialt stöd, där kollegornas betydelse i samband med upprättad orosanmälan beskrevs och Betydelsen av ett samarbete med Socialtjänsten, vilken belyste vikten av ett välfungerande tvärprofessionellt samarbete. Slutsats: Barnperspektivet, samarbetet med hela familjen samt ett kollegialt stöd är av stor betydelse för upprättandet av en orosanmälan. Ett välfungerande samarbete med Socialtjänsten upplevdes centralt för det fortsatta arbetet samt för att upptäcka fler utsatta barn. / Background: Child maltreatment are a major social problem. The hidden statistics are large and surveys proven underreporting. The specialist nurse plays a central role in identifying these children. It is therefore of great importance to investigate underlying factors that influence the establishment of a report of concern in the specialist nurse's daily work within Child Health Care.  Aim: The purpose was to investigate specialist nurses' experiences of setting up a report of concern within Child Health Services.  Method: The study was made using a qualitative method and an inductive approach. A total of 10 specialist nurses from seven Child Health Centers in Götaland were included. Their experiences varied between 1 and 31 professional years within Child Health Care. The data collection was carried out through semi-structured interviews via Zoom and analyzed with a manifest content analysis according to Graneheim and Lundman.  Result: The study resulted in four categories: The best interests of the child first, which emphasized the importance of being the child's voice. The importance of a family perspective, where the importance of involving the whole family was highlighted. The importance of collegial support, where the importance of colleagues in connection with a complaint report was described and The importance of a collaboration with Social Services, which highlighted the importance of a well-functioning interprofessional collaboration.  Conclusion: The child's perspective, cooperation with the whole family and collegial support are of great importance for the establishment of a report of concern. A well-functioning collaboration with Social Services was felt to be central to the continued work and to discovering more vulnerable children.

Syftet med studien är att bidra till kunskap om hur förskolepedagoger beskriver sina förutsättningar att identifiera och agera i situationer där barn misstänks fara illa. Att lyfta pedagogers uppfattningar och erfarenheter av deras förutsättningar att hantera situationer där barn misstänks fara illa är centralt i och med att förskolan spelar en viktig roll i att rapportera misstankar om att barn far illa till socialtjänsten. Med anmälningsplikten (SFS 2001:453) som utgångspunkt är det grundläggande att pedagoger känner sig förberedda och rustade med de rätta förutsättningarna för att kunna identifiera och agera kring barn som misstänks fara illa. Studien utgår från en fenomenologisk ansats, där fokus ligger på att förstå hur människor uppfattar världen genom att studera deras levda erfarenheter. I föreliggande studie lyfts förskolepedagogers uppfattningar och erfarenheter kring fenomenet förutsättningar i förskolans verksamhet. Metoden i studien utgår från både kvantitativa och kvalitativa aspekter för att ge en helhetsbild av ämnet. För datainsamling används en webbaserad enkät som består av öppna och slutna frågor. I resultatet framkommer att en majoritet av pedagogerna uppger att de fått tillräcklig information för att identifiera barn som misstänks fara illa, men en betydande andel av pedagogerna upplever att de endast delvis eller inte alls har fått denna nödvändiga information. Resultatet lyfter även fram förutsättningar som pedagogerna beskriver som viktiga för att kunna hantera svåra situationer där barn misstänks fara illa, vilka bland annat är kontinuerlig kompetensutveckling, tid att dokumentera misstankar och samtala med kollegor samt rutiner och handlingsplaner för att agera effektivt och säkert. / The purpose of this study is to contribute to the understanding of howpreschool educators describe their prerequisties for identifying and acting insituations where children are suspected of being harmed. Highlightingeducators' perceptions and experiences of their prerequisties to handlesituations where children are suspected of being harmed is crucial, aspreschools play an important role in reporting suspicions of childendangerment to social services. Given the mandatory reporting requirement(SFS 2001:453), it is essential that educators feel prepared and equipped withthe necessary conditions to identify and act upon such suspicions. This studyadopts a phenomenological approach, focusing on understanding howindividuals perceive the world through their lived experiences. The studyemphasizes preschool educators' perceptions and experiences regarding thephenomenon of prerequisites in preschool operations. The methodologyincorporates both quantitative and qualitative aspects to provide acomprehensive view of the subject. Data collection is carried out using aweb-based survey comprising both open-ended and closed-ended questions.The results indicate that the majority of educators report having receivedsufficient information to identify children suspected of being harmed, but asignificant proportion of educators feel they have only partially or not at allreceived this essential information. The findings also highlight the conditionsthat educators describe as important for managing challenging situationswhere children are suspected of being harmed, including continuousprofessional development, time to document suspicions and discuss withcolleagues, and established routines and action plans to act effectively andsafely.