L’obligation de signalement aux services de protection de l’enfance : analyse situationnelle de sa mise en oeuvre dans les pratiques de soins primaires

Abstract

Introduction: International studies suggest that a lack of forensic knowledge, clinical skills and organizational support may hinder nurses' implementation of the duty to report suspected cases of maltreatment to child welfare services. No studies to date have documented how the duty to report is integrated into primary care nursing practice. Objectives: To describe primary care nurses' perceived role in preventing child maltreatment and to explore the process of implementing mandatory reporting to child welfare services. Methods: A situational analysis was conducted using 14 semi-structured interviews with primary care nurses in Quebec, Canada. These interviews were qualitatively mapped and analyzed using inductive coding. Results: Clinical vigilance is an important dimension of nursing practice, which is influenced by external constraints. The implementation of the duty to report relies on clinical intuition, the exercise of discretionary power and organizational work that can be preventive, targeted or symbolic in scope. The determining factor in the implementation of the duty to report is the exercise of control over the situation and its anticipated consequences. Discussion and conclusion: These findings provide insight into the process of implementing mandatory reporting practices to child welfare services in terms of factors that may influence the exercise of nurses’ discretionary power.