Peer-reviewed article
Navigating structural demands and relational care: a qualitative study of public health nurses' experiences and handling of online screening tools.
Holm T, Thygesen E, Hausvik GI, Westergren T ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study explores how public health nurses experience and use online screening tools in well-child visits and school health services. The research, based on observations and interviews with 13 nurses, found that nurses experienced tension between the structural requirements of standardized screening tools and their values around relational care with families. The study highlights that while tools can support assessment and dialogue, they sometimes create uncertainty and distract from building trust and relationships, which nurses see as central to their role.
Key points
- Nurses experienced tension between structural requirements of online screening tools and their relational values
- Relationship with families was considered the cornerstone of nurses' work, shaping trust, continuity, and holistic understanding
- Tools offered opportunities for structured assessment but introduced uncertainty about interpretation, follow-up, and professional responsibility
- Time and attention were sometimes diverted away from nurturing relationships when using the tools
- Successful integration requires safeguarding both structural requirements and relational needs
Limitations
This is a qualitative study focused on nurses' experiences and perspectives rather than child outcomes or effectiveness of screening. The study does not evaluate whether online screening tools actually improve early detection or child well-being.
Abstract
Background Online screening tools are recommended in well-child visits to support early detection and standardized assessment, while also facilitating meaningful dialogue and collaboration with parents. However, little is known about how public health nurses experience and handle these tools in practice. The aim of this study was to explore public health nurses' experiences with, and handling of, online screening tools in their work practices in well-child clinics and school health services. Method We used observations and semi-structured interviews to capture public health nurses' experiences and practices after integration of online screening tools. Public health nurses were observed during well-child visits, and when possible, also before and after visits to provide a broader understanding of their practice. In total, eight public health nurses were observed in connection to well-child visits with families of children aged 0-7 years. Interviews were conducted over an extended time-period, with a total of 13 public health nurses participating individually or in groups. Data was analyzed using reflexive thematic analysis of verbatim transcripts and field notes. Findings The findings from this study illustrate how public health nurses experienced tension between structural requirements and relational values when online screening tools were implemented into their practice. The relationship with families was considered the cornerstone of their work, shaping trust, continuity, and holistic understanding. While the tools offered opportunities for structured assessment and dialogue, they also introduced uncertainty about interpretation, follow-up, and professional responsibility, often diverting time and attention away from nurturing relationships. The experienced tension between standardized procedures and relational care reflected a deeper struggle to balance professional obligations with the relational connection that public health nurses regarded as foundational to their role. These dynamics are explored through three themes: When the Structures Comes Between Us, When We Get Trapped Within the Structures, and When the Structures Supports Our Practice. Conclusion To realize the potential benefits of online screening tools, integration must safeguard both structural requirements and relational needs, ensuring that structures do not come at the expense of trust, relationship, and presence. Trial registration Not applicable.