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Table 2 Summary themes derived from CIT

From: How public health nurses’ deal with sexting among young people: a qualitative inquiry using the critical incident technique

Participant # Antecedents Context Consequences
3 Young people not realising the consequences
Young people thinking sexting is ‘a bit of a laugh’
Lack of knowledge about sexting – only heard of it ‘in the news’.
Never talked about sexting in role.
Public health nurse lacked knowledge
Critical incident linked to media reports
Media report of sexting.
PHN shocked.
Perceived need to avoid normalisation
Perceived need for education
Public health nurse more aware as a result of taking part in the study
PHN has thought about sexting more as a result.
5 Thinking that the relationship is a trusting one
Being let down
Ongoing relationship with client.
Already talking about trust.
Young girl being able to discuss matters with the public health nurse
Client thought she was in a trusting relationship. Photos were shared.
One of PHNs least complicated clients.
PHN took no further action as client did not want to take it further but left it open to talk about again in the future.
Being informed in how to respond, rather than ‘blagging’
Educating on power and control within relationships
PHN would not do anything differently now but would like more information on how to respond, rather than ‘blagging’
6 Genuine relationship ‘gone wrong’
Young people not realising the consequences
Experience of sexting as part of child protection cases where involving 15 and 16 year olds.
Sexting as a feature of contemporary culture
15 year old has ended up on a child protection plan
Practice experience of legal consequence i.e. criminality – Sexting can ruin lives
PHN has reflected on need for messages to be clear and direct, informing young people that the legal consequences can ‘ruin your life’
9 Beginning the conversational process in the first place
PHN has experienced sexting in professional role a number of times.
It’s a normal practice for some young people
Used opportunity to discuss risks of sexting and how to stay safe. Client thinks differently about how she uses pictures as a result. Learning also shared with friends.
Don’t have images in the first place
Sexting can be dangerous
PHN demonstrates confidence in using sexting issues as an opportunity for health promotion and harm reduction.
14 Girl has learning difficulties
Client known to PHN as known child protection case due to neglect. Probable learning disabilities.
Parents not able to protect her on line.
Family on social services radar
Paradox of children already being at risk being less of a concern
Client sharing pictures of self in underwear over Facebook.
Family ‘on the radar’ and known to school therefore this was identified and dealt with.
What happens when a child is not ‘on the radar’?
Educating on what is appropriate to share
PHN involved teaching her how to protect herself on line.
PHN has ongoing worries for children ‘not on the radar’.
17 Girl has learning difficulties (risk factor//vulnerability)
One girl disclosed to a (teacher) that she had shared explicit images of herself.
Second girl with learning disabilities involved in on-line grooming involving sexting.
Public health nurse is confident in discussing sexual health
PHN ‘surprised’ despite being used to young people discussing sex ‘vividly’ with her.
Both cases were dealt with as child protection cases (my wording might not be very good here)
The young girl hadn’t ‘learnt’
Vulnerability
Absconding
Second girl ‘disappeared’ and met up with a man she met on line when she was 17.
7 Grooming retrospectively identified
Blackmail
Girl has learning disability
PHN feels she doesn’t know a lot about sexting and hasn’t had a lot of experience.
12/13 year old girl blackmailed into sending explicit photograph of herself to him via Facebook. Led to her then being blackmailed in to having sexual intercourse with a 15/16 year old.
Friend of girl ‘took it into her own hands’ and involved teachers and parents.
PHN identifies it as grooming but also states that the girl ‘allowed’ herself to be blackmailed.
Girl still didn’t seem to be worried about the situation.
PHN expresses feeling helpless, and cross and that there ‘must be something we can do to protect them from this and I don’t know what that is’.
10 Grooming retrospectively identified
PHN involved in case through safeguarding meeting that a girl with identified as involved in CSE (child sexual exploitation) was sending images and being videoed.
Debates about consent and abuse
Legal issues - Police don’t know whether prosecution possible as in she is giving implied consent in some videos and not others.
PHN identifies child as victim of grooming.
What happens when a relationship breaks down?
PHN worked with girl to explore her understanding of sexting and safety, and to think about what may happen if a relationship breaks down.
13 PHN identifies a 14 / 15 year old girl with a learning disability who was exploited by a paedophile who was grooming her, and she sent explicit images.
PHN states that the girl has a high sex drive and uses telephone sex lines.
Grooming suspected
Predatory Paedophile (retrospectively identified)
Girl has learning disability
Girl has high sex drive
Girl craves attention
Girl was wrong
No discussion of actual actions in relation to this case.
Long term mental health problems
Pregnancy
Violent relationships
PHN reflects on possible long term health consequences: depression, anxiety, suicidal thoughts, and potential for pregnancy and violent relationships.