title: Latvian community nurses practising in a time of turmoil: a thin line of defence for children at risk.
abstract: Recent World Health Organization (WHO) statistics rank Latvia below average on a number of health indicators, compared to other European Union (EU) candidate countries. Nurses who visit children in the home see a close-up view of the decline in health. This exploratory study was designed to understand the day-to-day experience of a representative sample of 17 Latvian nurses visiting infants and children in 1999, almost 10 years after the collapse of the Soviet Union. Analysis of practice reports from group and individual interviews, using interpretive phenomenologic methods, revealed three consistently emerging themes: the negative impact of societal change and dislocation on clients and nurses; clinical reasoning concerning degree of risk to children and priorities for intervention; and the physical and emotional burden of caring for increasingly vulnerable children. Risk assessment was expressed in the classification of families as 'good little family, a family that was 'simply poor, or a family that was a 'social risk.' With the first two types of families, concern about children was balanced with concern about the family as a whole. With 'social risk' families, the primary concern of the nurses was safeguarding the child. The findings cannot be generalized, but may imbue family health and welfare statistics with a human face, and suggest directions for education, practice and further research.
authors.affiliation: Saint Louis University School of Nursing, MO 63104, USA. kalninsis@slu.edu
authors.forename: I
authors.initials: I
authors.lastname: Kalnins
mesh_terms: D002648:Child; D002654:Child Care / Q000592:standards; D006801:Humans; D007844:Latvia; D010371:Pediatric Nursing / Q000592:standards*; D011203:Poverty; D012924:Social Conditions