Tensions in the therapeutic relationship: emotional labour in the response to child abuse and neglect in primary healthcare

Abstract

Background Child abuse and neglect (child abuse) is a prevalent public health issue linked to survivors experiencing a higher risk of health issues such as obesity, heart disease and major depression. Given the significant impact of child abuse on health, general practitioners (GPs) and primary care nurses (nurses) are well-placed to respond to child abuse. However, research shows that responding to child abuse is difficult for health practitioners, especially the act of reporting child abuse. The present study aimed to understand how GPs and nurses experience the response to child abuse in primary healthcare. Methods This study employed qualitative methods. Twenty-six in-depth individual and group interviews were conducted with 30 GPs and nurses. The interviews were audio recorded with consent, transcribed verbatim and thematically analysed. Results The participants were mostly metropolitan-based female GPs. Participants were sampled from two settings: private general practice and community health; and Doctors in Secondary Schools, a program that places GPs and nurses in high schools. Thematic analysis generated four themes: blowing trust out of the water; riding the reaction wave; opening a hornet’s nest; and battling emotions. Participants felt that, in considering child abuse, they were betraying the trust of the therapeutic relationship and thus, had to manage their patients’ reactions to preserve the therapeutic relationship. They used strategies that created shifts in perception in both themselves and their patients to help maintain the therapeutic relationship. Participants often felt that they had to compromise their professional code of ethics to fulfil their mandatory reporting obligations. Thus, they experienced internal emotional battles when responding which led to some experiencing burnout or vicarious trauma and others resilience. This complex interplay of relationship and emotional management was placed in the context of emotional labour theory. We contend that our participants undertook emotional labour across three levels: internal, organisational and systemic. Conclusions We conclude that the emotional labour exerted in the response to child abuse can be diminished by: developing strategies for therapeutic relationship management; undertaking an internal, organisational and systemic values assessment; and facilitating communication between health professionals and the child protection system.

Engagement and Retention of Families in Universal Australian Nurse-Home-Visiting Services: A Mixed-Methods Study

“…The emotional toll associated with working with families was found to have implications in all phases of parent involvement, including when engagement was fractured. Similar to another study [37] the current study found when the working relationship between nurse and family ends without warning the emotional impact on the nurse is evident. The critical importance placed on honesty in the early formation of the relationship has been emphasised and must remain equally important across all phases of intervention.…”

“…In an Australian study of primary health care providers [37] the health professionals regarded making a child protection report as an act of betrayal, rather than a sign of trust. However, recent research interest in this field, including this study herein, indicates that relationships are preserved, and that trust can be extended when honesty is prioritised during the enrolment phase [13].…”

“…Critical analysis of research on reporting behaviours [10,13,37,38] has provided further insight into this complex area of nursing practice. We sought to address issues identified in the literature through a detailed description of practices used when managing the complex needs of a family, beyond that of reporting risk.…”

Exploring social media adoption by nurses for nursing practice in rural Volta, Ghana

“…This patients' charter specifies the privacy, rights and expectations that patients have as part of their human basic rights (Kalyuzhny et al, 2020 ). When their privacy is compromised, even if accidentally, patients may feel they have lost their dignity, destroying the therapeutic relationship that exists between nurses and patients (Kuruppu et al, 2022 ).…”