How do Pediatric Nurses Differentiate Physical Discipline from Abuse? Preliminary Findings from a Q-study

Ho, Grace W.K.

Monday, 18 November 2013

Grace W.K. Ho, BSN, RN
Johns Hopkins University School of Nursing, Baltimore, MD

Learning Objective 1: The learner will be able to understand the procedures and applications of Q-methodology in nursing research.

Learning Objective 2: The learner will be able to identify pediatric nurses’ viewpoints on differentiating physical discipline from child physical abuse.

Nurses are mandated to report any “reasonable suspicion” of child maltreatment. However, 49 of the 50 States lack mandatory training on child abuse and neglect, and it is unclear how pediatric nurses decide what constitutes abuse. Research demonstrates that suspicion and reporting of child abuse are influenced by patient factors, including minority race/ ethnicity (Flaherty, Sege, Mattson, & Binns, 2002; Land & Barclay, 2008), and healthcare providers’ attitudes toward physical discipline (PD; Ashton, 2000). It is crucial to examine how nurses define various forms of child maltreatment, including child physical abuse (CPA) and its differentiation from PD, in order to enhance our services to different families.

The preliminary findings are based on a larger study that used Q-methodology to examine how pediatric nurses and Chinese American mothers differ in their PD and CPA differentiations. Q-methodology uses a combination of qualitative and quantitative techniques to explore and analyze subjective viewpoints (Akhtar-Danesh, Baumann, & Cordingley, 2008). It allows participants to create their own meanings through the operational medium of a Q-sort (McKeown & Thomas, 1988), and was deemed the most appropriate method for the study given that discipline and abuse are highly sensitive topics. A Q-study is traditionally performed in two sequential phases: (1) Creating a Q-sample (i.e. a list of relevant statements), and (2) Q-sorting.

Using discipline and abuse statements drawn from interviews with 1^st and 2^nd generation Chinese American mothers, 40 pediatric nurses performed individual Q-sorts using the internet application, Q-Assessor. By-person factor analysis was used to elicit the nurses’ different viewpoints, which were compared and contrasted by examining their viewpoint structures. An overview on the different viewpoints will be presented, and a detailed example of how to conduct a Q-study and the utility of Q-methodology in nursing research will also be discussed.

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