Public Health Nurses' Work in Detecting Violence in Child and Family Health Clinics: A Qualitative Study

Violence against children is a major public health concern, yet detecting it, particularly in young children, can be difficult due to subtle signs and limited communication. In Norway, child and family health clinics provide universal services for children aged 0-5, with public health nurses in a key position to identify concerns. Despite frequent contact and a legal duty to report, few cases of violence are detected. Research highlights barriers such as uncertainty, lack of training, time pressure and unclear procedures, but little is known about public health nurses' own experiences with these challenges and what they perceive as supportive in their work.

The purpose of the study is to explore what public health nurses experience as barriers and facilitators in their work to detect violence at child and family health clinics for children aged 0-5 years.

Fourteen qualitative semi-structured interviews were conducted with public health nurses at eleven different child and family health clinics. We used qualitative content analysis with manifest and latent content to analyse the transcripts.

An overarching theme identified in the data was 'Navigating the unspoken: Public Health nurses' conscious and subconscious effort to detect violence in everyday practice.' This theme was supported by five categories: (1) comprehensive assessment and observation, (2) flexibility as both opportunity and obstacle, (3) the value of experience and knowledge, (4) the need for procedures and tools and (5) the role of relationships in detection.

The study highlights the complexity of public health nurses' work in detecting violence, emphasising challenges such as limited time and flexibility, as well as the importance of building trust with families. The findings underscore the demand for practical tools and continuous training to support early identification of violence against children. The study contributes to knowledge on how public health nurses work with violence against children, providing a basis for future research, improved collaboration across services, and the development of policies and training to support prevention in primary care.