Abstract
Safeguarding for healthcare involves working together to protect adults, children, and young people at risk of harm. Despite global research and national guidance outlining health professionals’ roles in this regard, there is limited knowledge about the type of strategies used to mobilise safeguarding research to practitioners in England. Our critical interpretive synthesis (CIS) sought to explore how safeguarding knowledge is mobilised to enable practitioners to use research effectively. This synthesis aimed to bridge the theory-practice gap in mobilising safeguarding knowledge to practitioners. Knowledge mobilisation (KMb) is an emerging discipline concerned with moving knowledge across communities to catalyse change. This review aimed to build understanding about how safeguarding knowledge is mobilised for healthcare in England and to synthesise the type of approaches undertaken to protect adults and children from harms, including abuse. A critical interpretive synthesis was undertaken using KMb theory and computer-assisted modelling technologies for secondary thematic analysis of complex literature of relevance, including qualitative research, reviews, and reports. Few papers informed how safeguarding knowledge is mobilised for healthcare in England. Learning from experience dominated the literature in three ways: (i) crisis response, (ii) practice engagement, and (iii) influencing actions (for “best” practice). Embedding safeguarding knowledge and skills in healthcare settings usually followed a crisis response. Learning from experience showed movement between practice engagement and influencing actions for adult and/or child protection. KMb might be useful in supporting the implementation of evidence-based safeguarding for practice. CIS identified a gap in how safeguarding research is mobilised to practitioners for healthcare. KMb theory provided an analytical bridge to computer-assisted modelling of factors associated with moving learning from experience to learning in practice. Future research could build on hybrid synthesising of safeguarding functions and impacts for healthcare, to enable practitioners to protect adults and children from multiple harms, including violence and abuse.
1. Introduction
Safeguarding adults, children, and young people from harms is a legal priority in England [1]. The National Health Service (NHS) [2] describes safeguarding as a broad function “a means of protecting a citizen’s health, wellbeing, and human rights, enabling them to live free from harm, abuse, and neglect. It is an integral part of providing high-quality health care. Safeguarding children, young people, and adults is a collective responsibility.” Recent updates to the Health and Care Act [1] emphasise systems working in partnership with people to improve health in communities.
Six principles derived from the Care Act (2014) show a value-based approach to safeguarding adults: (i) empowerment, (ii) prevention, (iii) proportionality, (iv) protection, (v) partnership, and (vi) accountability [3–5].
Legislation that drives child safeguarding implementation in England is influenced by the international United Nations Convention on the Rights of the Child [6]. This is ratified by the UK government although not all aspects apply to England. The Human Rights Act [7] and the European Convention on Human Rights of the Child Joint Committee on Human Rights emphasise chidren’s rights to education and essential healthcare [8]. In England, the Children’s Act (1989) [9] and Children’s Act (2004) [10] provide the legal framework for safeguarding children from abuse.
Working together to safeguard children [11] is the guidance for interagency working for children in England which defined safeguarding and promoting the welfare of children as follows: (i) protecting children from maltreatment, (ii) preventing impairment of children’s mental and physical health or development, (iii) ensuring that children grow up in circumstances consistent with the provision of safe and effective care, and (iv) taking action to enable all children to have the best outcomes.
The coronavirus pandemic heightened the need to protect adults and children from harms associated with social restrictions and poor infection control [12–14]. Real world challenges for professionals included failure to identify or act to protect adults and children at suspected or known risk of harm (broadly defined) during this time. There is, therefore, a need to effectively mobilise knowledge to improve healthcare practice in safeguarding adults and children from harms including violence and abuse.
Knowledge mobilisation (KMb) is an emerging discipline in healthcare which is intended to bridge the well-recognised theory-practice gap [15]. In KMb theory, evidence is conceptualised in accordance with the notion of evidence-based practice (EBP), that is, a blending of best research evidence, professional expertise, and service user values and preferences [16]. In contrast to some interpretations of EBP, KMb does not propose a hierarchy of evidence but rather acknowledges the value of contextual and timely knowledge [17]. In essence, knowledge mobilisation (KMb) is about sharing knowledge across communities to catalyse change [18]. KMb tends to be used as an umbrella term which includes activities relating to the production and use of research results, knowledge synthesis, dissemination, transfer, exchange, and coworking by researchers and knowledge users [19]. It involves concerted efforts to create, share, and use research and other forms of knowledge [20, 21]. Many knowledge mobilisers recognise that knowledge sharing is relational [22], constructed from social interaction [23], and context specific [24]. The purpose of KMb is to change practice and achieve positive clinical, population, or other outcomes. To achieve this potential, knowledge must be mobilised for the benefit of different stakeholders across the boundaries that otherwise exist between these groups [25]. Knowledge needs to be made rich, relevant, and real to end users if it is to change practice [26].
To date, there are 71 published reviews and 47 models of KM [21]. Derived from an extensive review of extant models, Ward [21] offered a framework of four questions: (i) why is knowledge being mobilised? (ii) whose knowledge is being mobilised? (iii) what type of knowledge is being mobilised? and (iv) how is the knowledge being mobilised? Although these questions and associated categories are primarily intended to help knowledge mobilisers reflect on, communicate, and evaluate their work, they offer a useful structure to review evidence of KMb activity in the current practice. Our review focuses on England for pragmatic reasons. We are conversant with the surrounding health and social care landscape, for example,(i)National safeguarding priorities which embed the Mental Capacity Act [27], updated 2007, the Children’s Act [9], updated 2004, the Care Act (2014), the Children and Family Act [28]; Health and Social Care (Safety and Quality) Act (2015), the Serious Crime Act (2015) [3, 4, 27, 29], and Liberty Protection Safeguards (LPS) (Mental Capacity Act (2005), (updated 2007) cited in [30] and associated NHS England updates(ii)The National Health Service (NHS) England Safeguarding Community of Practice which produces rapid evidence reviews on priority topics and cascades information nationally (NHS England)(iii)Royal College of Nursing (RCN) [31] intercollegiate document “Adult Safeguarding: Roles and Competencies for Health Care Staff”(iv)Royal College of Nursing (RCN) [32] intercollegiate document “Safeguarding Children and Young People: Role and Competencies for Health Care Staff”(v)The National Insitute for Health and Care Excellence (NICE) produces guidance and standards on creating a safeguarding culture [33–37](vi)Local Government Association [38] “Making Safeguarding Personal” approach incorporating outcome-focused collaborations with the Care and Health Improvement Programme and the Association of Directors of Adult Social Care (ADASS) to develop resources to keep people safe
This familiarity has allowed us to identify a broad base of literature from areas that may otherwise have been overlooked. We are mindful that safeguarding intersects across multiple professions; both local child safeguarding and adult arrangements are led by three statutory safeguarding partners: (i) The local authority (ii). Integrated care boards. (iii) Policing, with the local authority being the lead agency for adult/child protection enquiries in England. Here, we start with healthcare, recognising the intersection between hospital and community settings and the need to broaden the scope of health and social care applications over time.
Critical interpretive synthesis (CIS) is an established qualitative review method [39] congruent with our practical aim to critically analyse a complex array of literature. We were not concerned to answer questions about the effectiveness of safeguarding strategies or interventions, or the methodological rigour or quality of studies. We aimed for a practical synthesis of the type and level of safeguarding knowledge mobilised for (and by) different disciplines and groups at the point of healthcare. The primary aim of this review is to build an understanding about how safeguarding knowledge is mobilised, first and foremost for healthcare, and from this derive practical guidance on novel approaches to KM which we anticipate being potentially transferrable across geographic and professional boundaries.
2. Method
2.1. Research Question
How is safeguarding knowledge mobilised for healthcare?
Generations of our research questions emerged from discussions about the gap in research utilisation to protect adults, children, and young people from maltreatment or abuse. The problem requires theorization of the evidence, through critique of the safeguarding literature. Co-authors’ experiences of KMb and safeguarding practice were applied to the review question over a two-year period (2019–2021). CIS is a qualitative systematic review method based on the premise that traditional systematic reviews are inadequate to generate theories about complex human process [39, 40]. The method aims to derive new concepts and theories by inductive critical interpretation of qualitative and quantitative data from a range of sources. We followed Dixon-Woods et al.’s [39] framework by focusing on KMb features evident in the safeguarding literature, exploring how such resources were mobilised for healthcare. We interpretively reviewed a range of sources and produced categorical ontological constructs on how safeguarding knowledge for protecting both adults and children is mobilised for healthcare in England. In keeping with the method, bioscientific critical appraisal of the literature was not undertaken.
2.2. Search Strategy
2.2.1. Literature Searching
The initial search strategy involved the identification of relevant sources through electronic database searching, ASSIA, CINHAL, APA, PsycInfo, and Medline, between 01/01/2010 and 16/10/2020, with an updated search in 2021. Initial searches used leads for safeguarding adult and children alerts, online forums, and reference lists using keywords and Boolean operators: keywords for the second iteration (update) of the search leading to current results were “Safeguarding” AND “Knowledge Mobilisation” AND “Healthcare.”
Inclusion criteria:(i)Safeguarding literature in the past 10 years(ii)English language(iii)All healthcare professions(iv)Involving healthcare settings(v)Knowledge mobilisation theory practice(vi)England only
To gain a broader perspective, we included all keyword and abstract references to safeguarding-related activities and to KMb, recognising the overlap with terms such as adult and child protection, knowledge utilisation, knowledge brokering, and knowledge transfer. Harms were broadly conceptualised and included violence and abuse against adults and children, but harms were not exclusively focused on abuse. However, KMb had to be evident in an applied sense and papers that only implicitly alluded to the practices and methods of KMb were reserved for background information but excluded from the CIS. Papers reviewed included opinion articles and peer-reviewed primary and secondary studies, both qualitative and quantitative, adults and children, and all involving healthcare. Excluded papers were unrelated to safeguarding KMb in healthcare contexts in England. All papers published were in English. One article included translations in different languages.
An abstract screen was conducted independently by two authors (FC and KB) and then reviewed (by MC), and 141 were included in the second stage of the selection process. Each of the 141 papers was independently appraised by two team members and the final inclusion decision was made by a third researcher. 76 articles met the KMb criteria, but of these, only 51 included healthcare in England. These 51 papers were included and progressed to the final data extraction stage, which utilised a discursive strategy to develop an agreed data extraction framework. To achieve this, we initially applied KMb theory [21] to concurrent data extraction mapped to our research objectives. Differences in opinion were few, reflected on, and discussed. We reached the final number of papers included by consensus, reflecting a complex body of literature published in peer-reviewed professional journals, comprising qualitative research, reviews, and reports.
2.3. Analysis
2.3.1. A Priori Assumptions
In constructing our synthesis, we reflexively bracketed our prior assumptions relating to safeguarding roles and functions in healthcare in England. As an authorial team, we carried out different assumptions about the level and type of knowledge mobilised, agreeing that a lack of evidence-based approaches might conversely show high tacit based practice. From the outset, we were keen to collate any KMb approach that constituted adult and child protection. We acknowledged that both digitised and integrated care agendas were likely to impact upon safeguarding across health and social care. We expected both formal and informal processes to be reflected in the literature, including discursive or managerial supervisory approaches to healthcare staff training and education.
2.3.2. Crucial Conversations about KMb
The first stage of data extraction involved detailed conversations about the range and scope of the papers included. To enable a consistent approach, we pilot “the tested” and adapted the original data extraction template, each using three papers for discussion. We noted early on that most articles were from a limited range of journals (e.g., professions, child, or adult safeguarding). This has implications for safeguarding work; knowledge pertaining to shared care across adult or child boundaries is relevant to effective safeguarding [12]. Through the initial review, we refined our key words and parameters, developing our data extraction framework, as informed by Dixon-Woods et al’s [39] prompts:(i)Are the aims and objectives of the research clearly stated?(ii)Is the research design clearly specified and appropriate for the aims and objectives of the research?(iii)Do the researchers provide a clear account of the process by which their findings reproduced?(iv)Do the researchers display enough data to support their interpretations and conclusions?(v)Is the method of analysis appropriate and adequately explicated?
This iterative process involved peer check of data, conversations about inclusion criteria, development of a data extraction framework, hybrid data analysis modelling, and the synthesising statement. The second stage of data analysis involved a discursive refinement of the data extraction framework with a deeper focus on the change processes reported in the 51 included papers. Textual content was analysed for evidence of changes relating to safeguarding KMb for healthcare. We then presented our preliminary findings to the “Knowledge to Care” (K2C) research group at Birmingham City University (BCU), inviting healthcare and academic stakeholders to voice their thoughts about the CIS strategies that constituted our preliminary synthesising statement. Through this mechanism, we generated and extended our interdisciplinary authorial team. Our critical analysis was subsequently enhanced by one team member using computer sciences knowledge modelling (EV) to generate textual maps of the key messages arising from the second stage analysis.
We did not hold expectations about which type of professions would be represented. The literature presented here represents healthcare professions from nursing, medicine, learning disabilities, and midwifery including both adult and child safeguarding. Papers focusing on policing and/or social care were included as they involved healthcare professions or settings.
Our computer-assisted safeguarding contributions modelling of the results was enabled by Protégé and reflected five iterative stages of synthesising narrative:(1)Collating a priori assumptions using Ward’s [21] guide to KMb(2)Identification of assorted KMb strategies in data extraction -(3)Primary findings indicate “best practices” research strategies undertaken closer to or allied to healthcare for both adult and child safeguarding(4)Secondary/tertiary level findings showing movement between (i) crisis and response, (ii) learning initiatives, and (iii) influencing actions for practice.(5)Synthesising statements regarding some evidence of change/future directions
2.3.3. Thematic Analysis Using Knowledge Modelling Software
Ward’s [21] KMb theory was used as an a priori framework to inform the design of our data extraction framework and first stage synthesis, focusing on how safeguarding knowledge was mobilised in healthcare contexts. Following the background review, we subsequently used a computer-assisted ontology-driven data mining approach (Protégé). This computer-assisted knowledge modelling framework has been applied in Alzheimer’s research [41]. Here, it helped to objectively assess and develop an ontology of safeguarding KMb literature derived from or for healthcare. Our modelling framework involved four analytical features:(i)Actor (who)(ii)Function (what) (what for)(iii)Impact (where, who, what, and how (combination of above))(iv)Setting (where occurred/population)
Data mining used these four features to explore hitherto “hidden” relationships extracted from the papers, including safeguarding-specific ontological measures or outcomes that aimed to achieve safeguarding in or for people accessing healthcare. Through this means, we were able to identify the intended function and impact of actions to improve safeguarding knowledge and skills at the point of care.
3. Results
The initial database search returned 1505 sources; however, these sources were often not relevant to the subject of this review. The second search returned 541 sources, filtered to 141 after ambiguous papers and duplicates removed. 1 paper was irretrievable (professional membership access only). Of the 141 papers retrieved, 51 papers met the inclusion criteria (see Figure 1).
Included papers reflected how safeguarding knowledge was mobilised in healthcare, predominantly learning from experience involving (i) crisis response aligned to (ii) practice engagement (most frequently following adverse events). Knowledge brokering involves multiprofessional actors, namely, healthcare professionals, who set out to improve or increase practitioner and/or organisational confidence in detecting child and/or adult presentations of abuse or harm in healthcare settings. Influencing actions reported by the authors included simulated (scenario or case-based) learning and teaching, suggesting impacts on organisational or practitioner’s level of confidence in applying new safeguarding knowledge to healthcare.
The articles we found varied in how or whether they aimed to or succeeded in moving safeguarding research closer to practitioners. Many authors focused on educational leadership and training interventions to help healthcare professionals protect people at risk from harm. These involved local safeguarding boards and specialist safeguarding initiatives in the NHS, as well as academic literature reviews, interprofessional learning evaluations, safeguarding simulation learning, and staff supervision interventions. All contributions aimed towards improving the safeguarding of adults and children for healthcare purposes and often involved partnership working with social care and policing.
A summary of the included papers is provided in Table 1.
Our analysis identified purposeful safeguarding roles and actions in healthcare or healthcare-related settings (hospitals, community, and health or social care education). Few studies suggested how safeguarding knowledge impact was measured or assessed to improve practitioners’ decision making, excepting those that focused on this [76, 91, 93].
Applied learning tools and techniques (some tested and some not) were used to mobilise safeguarding-related activities close to practice. A turning point in learning about safeguarding was influenced by changes to legislature following the Mid Staffordshire public inquiry and the Care Act [3], involving new regulatory arrangements for health and social care professionals [94]. Change management in healthcare involved service audit and evaluation of mortality reviews, serious case reviews (children), safeguarding adult reviews, and adverse safety events. Some practitioners mobilised multiagency communities of practice for improving public or patient safety [45]. Another showed “bystander interventions” approach to critical decision making [53]. Social work and social policy featured some multiagency working for healthcare, highlighting the lack of evidence for the effectiveness of serious case reviews and adult safeguarding boards (safeguarding adult reviews) in areas such as adult self-neglect, harmful behaviours and/or preparing for court [78, 80].
Knowledge and skills modelling demonstrated intended change management strategies to improve how professionals identify abuse to better protect adults and/or children in safeguarding contexts, signposting to poor staff adherence to national, legislature, or local policies [54, 56]. Evaluating safeguarding training or education was evident [70], often following a crisis such as premature deaths [55, 59, 95] or domestic abuse [61]. Preregistration preparation for nursing practice featured [62, 85] and there was some strategic (local board) mobilisation of evidence about child sexual exploitation and neglect [68, 69].
Authors mainly focused on healthcare staff training and education (including supervision) [47–49, 96]. Some practitioner research studies showed whether (and how) learning strategies (including learning from case reviews) were successful in enabling change for practice [50, 79].
4. Themes
Principal findings are presented as narrative themes, suggesting a safeguarding-specific ontological framework, representing assorted “best practices” strategies for both adult and child safeguarding. We have not separated out the adult and child safeguarding in the presentation of results here because we aimed to find the patterns common to both functions for healthcare in England. Our safeguarding contribution modelling uses Protégé computer-assisted figures to illustrate how the authors presented a movement between firstly learning from experience and secondly learning from practice through influencing actions for adult and/or child safeguarding functions. Illustrating the relationship between the four domains (actor-function-impact-setting) adds to our understanding of how some evidence of change is demonstrated in safeguarding KMb for healthcare.
4.1. Safeguarding Contributions Modelling
4.1.1. Learning from Experience: A Crisis Response (Adult and Child Safeguarding)
Learning from experience was an overarching theme in both adult and child safeguarding, showing “what was done” and “by whom” following the reporting of a safeguarding crisis event and organisational response. This was a common pattern of reporting when referring to adult safeguarding procedures/practice and child safeguarding. The movement between learning from experience to learning from practice usually indicated failure to protect a child or adult from serious harm or death, triggering an investigation or local multiagency response. For example, Crawford and L’Hoiry [45] showed how to build and evaluate a multiagency community of practice to enable cultural transformation in how professions might better work together to share information across healthcare, policing, and youth services for child protection, highlighting colocated “boundary work” as a new form of knowledge brokering across previously fragmented “silo” spaces.
Wyllie and Batley [91] provided a good example of evidencing change through qualitative research evaluation of simulated case learning for children’s nursing, demonstrating how the fidelity of simulation design can incorporate student feedback to show their increased confidence in safeguarding practice, including enhanced communicative capacity to challenge and question senior colleagues and staff about their decision making. Some authors focused on better partnership working as a mechanism for change improvement. Lewis et al. [60] showcased best practice case studies that demonstrated how effective collaborative working between social work and acute healthcare enables earlier identification of child maltreatment.
Few papers explicitly addressed how to evidence change. For example, Thacker et al. [88] advocated professional curiosity in learning from safeguarding adult reviews and did not attempt to evaluate how to move this evidence closer to practice or practitioners. Some training updates showed a bridging function, disseminating local practice innovations for tackling child sexual exploitation [90], [46]. In adult safeguarding, Preston-Shoot [78] advanced a critical analysis of safeguarding adult reviews using systemic theory to suggest how practitioners of social care who work with healthcare professions and adults who self-neglect simultaneously shape (and are shaped by) that relational work.
These examples from both adult and child safeguarding added to our understanding of how interpersonal organisational dynamics informs and reflects the evidence base in our four domains (actor-setting-function-impact). Preston-Shoot [78] demonstrated KMb by example, through moving evidence from safeguarding adult reviews closer to practitioners working across both health and social care.
4.1.2. Practice Engagement: What Is the Desired or Intended Change?
Practice engagement shows how knowledge is shared in and across healthcare boundaries, sometimes involving health and social care, and academic, educational, or service user stakeholders. The desired or intended change focused on a range of safeguarding functions closely allied to learning for practice. Learning from experience is applied to practice engagement for healthcare practitioners, intending to mobilise safeguarding failures into proactive learning functions for practice. The type of knowledge shared suggests how it is intended to be mobilised for healthcare, yet necessarily involves working across professional boundaries to share information with other professional and lay populations. For example, simulated training and educational interventions showcased role-playing opportunities to improve students and practitioners’ assessment and decision-making capacity for safeguarding adults and children from maltreatment and harm [48, 64, 65, 70, 91].
Drewitt et al. [48] showed a good example of the use of virtual reality for training healthcare practitioners (actors) to recognise child protection issues (functions) in public health practice (settings) drawing on GP responses to training which showed how training enabled them to be better aware of missed safeguarding cues encountered in consultations (impact). The authors also advanced a discussion about ethical issues related to engaging children in role play in safeguarding training, suggesting some promise for future practical research in this field.
Purposely designed scenarios highlight presentations and features of child or adult maltreatment and abuse in health and social care settings. Wherever the point of contact, the function is an assessment, showing the intersection between KMb (such as knowledge transfer or knowledge to action) [43] and the role of simulated scenario learning from experience. Creative arts-based pedagogy explored safeguarding policy change in one case, to examine how different professional and lay actors understand, interpret, and relate to the Care Act (2014) when tasked with safeguarding of adults [92]. Not all four domains of KMb are fully addressed, although each is incorporated into a linked intention.
For example, Yeoli et al. [96] demonstrated how various actors might relate to the Care Act (2014) in a shared learning setting, yet the function and impact of the desired change might be contested by individuals or organisations. Learning about the Care Act (2014) moved from learning from experience to learning from practice. The change impact is not formally evaluated. Instead, practice impact is inferred by how well the theatre intervention simulates, engages, and elicits common and differing participant responses to performative prompts and cues. Illustrating how organisational power differentials and interpersonal dynamics might alter how safeguarding professionals and learners by experience might engender or attribute harms differently and, therefore, problematise ideas or notions about change impacts.
4.1.3. Influencing Actions for Healthcare
The relationship between safeguarding function and healthcare impact was not well articulated or shown in most research papers. However, some authors demonstrated evidence of the movement between learning from experience to learning from practice, through “closer to practice” KMb. Each of these papers addressed the KMb question “what is the change?” by more critically examining the evidence for adult safeguarding interventions designed to implement, improve, or assist such changes. Two cases show how the authors at once present their influencing actions for practice [80] and simultaneously build a case for knowledge transfer as an influencing action for practice [43]. In each case, the authors show who is doing the KMb and why, describing their practitioner and research roles in influencing safeguarding function and impact. Evidence of change is not always evaluated, or even possible, yet the authors show good examples of real-world practical attempts to move safeguarding knowledge beyond operational rhetoric.
Bellman et al. [93] (Figure 5) called for knowledge transfer partnerships for systematic reuse of KT frameworks for utilising evidence closer to practice in adult safeguarding in hospitals, using the example of infection control. Similar to Preston-Shoot [80], the authorial voice (actors) is academic-linked research for practice engagement at the interface between health and social care (setting). The knowledge transfer partnership is enabled by a knowledge action framework showing an evidenced movement from learning from experience to learning from practice. The desired outcome (change impact) showed the considered integration of educational interventions for nurses (actors) through influencing safeguarding actions for infection control (function) at the point of care.
4.2. Summary
Our critical interpretive synthesis revealed few papers focusing on KMb theory in safeguarding adults and children for healthcare. This is perhaps not surprising given it is an emerging discipline. Nonetheless, our a priori assumptions about wide-ranging KMb theory suggested to us that safeguarding crises might reasonably trigger change movements for multiagency information sharing for best practice. While the crisis response was evident, published patterns showed specialist population approaches to the problem of adult or child protection, which might in turn limit how safeguarding research is integrated or disseminated in healthcare in profession specific communities. Computer-assisted modelling helps identify multiprofessional actors (who), functions (how), and impacts (what) of safeguarding research in healthcare settings, sometimes involving health and social care and policing. Safeguarding learning and education occurred in several practice settings, often supported or allied to academic functions. Influencing actions included a blend of practitioner-research learning for healthcare, some involving pre and post evaluation of safeguarding interventions with predetermined outcomes.
5. Discussion
Our CIS showed that few papers directly inform or reflect how safeguarding knowledge for adults and children at risk of harm is mobilised for healthcare in England. Bridging the theory-practice gap is evidently a challenge, reflected in the crisis triggers prompting the movement of safeguarding knowledge and skills for healthcare. Educational interventions showed promise, particularly those designed, delivered, and evaluated closer to practitioners in the healthcare setting. Influencing actions are weakly demonstrated in the literature, suggesting a research need to identify and strengthen safeguarding functions for adult and child health protection, for health improvement in acute and community healthcare settings. CIS aligned safeguarding actors, functions, settings, and impacts for healthcare, showing the challenges encountered in enabling recognition of adverse determinants of health, including missed opportunities to identify serious crime, modern slavery, domestic abuse, gender-based violence, and child abuse.
5.1. Strengths and Limitations
The CIS answered the review question, generating a useful computer-assisted model to think about how to mobilise safeguarding knowledge for healthcare in England. While the aim was geographically specific, we believe the process and results might be considered for wider transferability of the KMb method and concept. The relevance of the papers to our research question was informed by our collective research question, search strategy, and matrix data analysis; bioscientific critical methods appraisal was not undertaken, and we privileged key word content descriptors mapped to our KMb framework for data extraction as quality indicators.
Included papers were retrieved from peer-reviewed journals only, including professional opinion articles and primary and secondary research. While this suggests some formal methodological quality indicators, the heterogeneity of the papers might be considered a limitation of our CIS. Due to the resource limitations of this small-scale review, we also reviewed the keywords and search strategy only to increase accuracy. We acknowledge that rich safeguarding functions are referred to in national policy and practice guidance provided by professional healthcare disciplines and organisations, including the National Institute of Clinical Excellence (NICE) and NHS Safeguarding Futures Fora.
5.2. Implications for Policy, Practice, and Research
In the context of the wider KMb literature, there is ample theory to support new applications to safeguarding research and practice for adults and children in healthcare. Computer-assisted modelling (Figures 1–5) shows promise in bridging the contribution gap in a hitherto not so ripe field, showing the interrelationship between safeguarding actor-function-setting-impact representations in the healthcare-related literature. This digital modelling revealed “hidden” relationships between themes and showed how nursing and medical education dominates the literature landscape, while allied health professions are not so well represented (Table 1). Our CIS signposts to these patterns but cannot offer explanations. Further discipline-specific research is required to help bridge the gap in safeguarding KMb for healthcare. Contemporary safeguarding policy issues are represented in the literature, but there is scant attention to preventive strategies. Safeguarding literature is focused on the crisis response. While this is vital, the type and level of KMb applied to safeguarding practice is restricted. There is a need for harnessing integrated whole system information sharing for meaningful healthcare improvement. Our search strategy privileged “safeguarding” as a key word. Excluded literature did not use safeguarding as a key word or indicate the word in the abstracts, although the safeguarding stakeholder focus is evident in those papers that combined words; for example, safeguarding and DVA, child abuse, and adult abuse. This could be considered a limitation of our review, as ample research in specific related fields such as DVA and child abuse is not wholly represented. However, we contend that we researchers could perhaps consider publishing strategies that enable the movement of research closer to practice-including the use of safeguarding as a functional word for healthcare research, building evidence-informed pathways to healthcare impact.
6. Conclusion (Synthesising Statement)
Our CIS builds a processual understanding about how safeguarding knowledge is mobilised for healthcare in England, demonstrating assortative learning approaches to protecting adults and children from harms. KMb theory and computer-assisted modelling showed the “learning from experience” in three rudimentary ways: crisis response, practice engagement, and influencing actions (for best practice). The relationship between these three features showed how safeguarding knowledge is mobilised in a limited way for healthcare in England. The inter-relationship between safeguarding actor-function-setting impacts is represented, suggesting some evidence of the movement between learning from experience to learning from practice. Our hybrid synthesis of safeguarding research for and allied to healthcare settings was enabled by CIS design using KMb theory and computer-assisted modelling. Future directions could explore hybrid frameworks for embedding KMb theory in safeguarding for healthcare, perhaps focusing on preventive as well as crisis learning actions, closer to practitioners protecting children and adults from harms including those associated with violence and abuse.
Data Availability
The search strategy extraction data and computer modelling frameworks used to support the findings of this study are included within the article.
Additional Points
What is known about this topic? (i) Safeguarding adults and children is a global function in hospital and community settings. In England, it is described as an integral part of high-quality healthcare and a means of protecting a citizen’s health, wellbeing, and human rights, enabling them to live free from harm, abuse, and neglect. (ii) Despite global research in adult and child health protection, there is ample evidence to suggest that healthcare professionals lack confidence in undertaking safeguarding at the point of care. Failure to effectively safeguard adults and children from harms suspected, identified, and associated with violence or abuse can result in further maltreatment, abuse, or even death. (iii) Remarkably, little is known about the type or level of strategies employed to mobilise safeguarding research closer to healthcare practitioners. What this paper adds? (i) Few publications have focused on how safeguarding research is mobilised for healthcare in England. Our critical interpretive synthesis bridges a gap in safeguarding knowledge mobilisation for adults and children in healthcare. (ii) Safeguarding adults and children revealed several functions involving recognition of serious crimes, modern slavery, domestic abuse, gender-based violence, and adult and child abuse. Infection control and multiagency partnership working also featured. Learning from experience dominated the literature on safeguarding for healthcare, involving multiprofessionals in (i) crisis response, (ii) practice engagement, and (iii) influencing actions for best practice in England. (iii) KMb theory enabled computer-assisted modelling to illustrate how the authors presented a movement between firstly learning from experience and secondly learning from practice through a range of influencing actions. Further research might benefit from the hybrid synthesis of safeguarding-specific functions, impacts, and healthcare outcomes for building safer communities.
Conflicts of Interest
The authors declare that they have no conflicts of interest.