School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee, Scotland, UK.
BMC Public Health. 2013 Apr 19;13:370. doi: 10.1186/1471-2458-13-370.
Child neglect is a pernicious child protection issue with adverse consequences that extend to adulthood. Simultaneously, though it remains prevalent, childhood dental caries is a preventable disease. Public health nurses play a pivotal role in assessing oral health in children as part of general health surveillance. However, little is known about how they assess dental neglect or what their thresholds are for initiating targeted support or instigating child protection measures. Understanding these factors is important to allow improvements to be made in care pathways.
We investigated public health nurses' assessment of oral health in preschool children in relation to dental neglect and any associations they make with child neglect more broadly. A qualitative study was conducted in Scotland during 2011/12. Sixteen public health nurses were recruited purposively from one health region. Individual, semi-structured interviews were undertaken and data were analyzed inductively using a framework approach. Categories were subsequently mapped to the research questions.
Public health nurses assess oral health through proxy measures, opportunistic observation and through discussion with parents. Dental neglect is rarely an isolated issue that leads on its own to child protection referral. It tends to be other presenting issues that initiate a response. Threshold levels for targeted support were based on two broad indicators: social issues and concerns about child (and parental) dental health. Thresholds for child protection intervention were untreated dental caries or significant dental pain. Barriers to intervention are that dental neglect may be 'unseen' and 'unspoken'. The study revealed a communication gap in the care pathway for children where a significant dental problem is identified.
Public health nurses take their child protection role seriously, but rarely make a link between dental caries and child neglect. Clear guidance on oral health assessment is required for public health nurses. Establishing formal communication pathways between child dental care providers and public health nurses may help close gaps in care pathways. However, further research is required into how these communication mechanisms can be improved.
儿童忽视是一种具有不良后果的严重儿童保护问题，这些后果会延伸到成年期。与此同时，尽管儿童龋齿仍然普遍存在，但它是一种可预防的疾病。公共卫生护士在评估儿童口腔健康方面发挥着至关重要的作用，这是一般健康监测的一部分。然而，对于他们如何评估牙齿忽视，或者他们启动有针对性的支持或启动儿童保护措施的阈值是什么，我们知之甚少。了解这些因素对于改进护理途径至关重要。
我们调查了公共卫生护士在评估学龄前儿童口腔健康时与牙齿忽视的关系，以及他们与更广泛的儿童忽视的任何关联。这项定性研究于 2011/12 年在苏格兰进行。从一个卫生区域有目的地招募了 16 名公共卫生护士。进行了单独的半结构化访谈，使用框架方法对数据进行了归纳分析。随后将类别映射到研究问题上。
公共卫生护士通过代理措施、机会观察和与父母讨论来评估口腔健康。牙齿忽视很少是一个孤立的问题，它本身不会导致儿童保护转介。通常是其他出现的问题引发了反应。有针对性支持的阈值水平基于两个广泛的指标：社会问题和对儿童（和父母）口腔健康的关注。儿童保护干预的阈值是未经治疗的龋齿或严重的牙痛。干预的障碍是牙齿忽视可能是“看不见的”和“未说出口的”。该研究揭示了儿童护理途径中的一个沟通差距，在这个差距中发现了一个重大的牙科问题。
公共卫生护士认真对待他们的儿童保护角色，但很少将龋齿和儿童忽视联系起来。公共卫生护士需要明确的口腔健康评估指南。在儿童牙科护理提供者和公共卫生护士之间建立正式的沟通途径可能有助于缩小护理途径中的差距。然而，需要进一步研究如何改进这些沟通机制。
