Battling boundaries and conscience : a grounded theory of paediatric diabetes healthcare professionals’ experiences of safeguarding and child protection
Introduction: Managing diabetes in children is complex, and in some families, overwhelming life circumstances hinder their capacity to meet diabetes care recommendations leading to safeguarding concerns for healthcare professionals. This study explores how healthcare professionals navigate safeguarding and child protection within paediatric diabetes services in England and Wales. Objectives: The study investigated how paediatric diabetes-specific safeguarding or child protection concerns are experienced, interpreted, and acted upon in clinical practice. Methods: A sample of 20 multidisciplinary participants was purposefully recruited through a professional network. Data from semi-structured interviews was analysed using a constructivist grounded theory methodology to develop a substantive theory. Results: Battling boundaries and Conscience is a grounded theory substantive to the area of paediatric diabetes in England and Wales. It is presented in the form of a conceptual model that presents the two interconnected conceptual categories and the relationships between them. It provides an understanding of how diabetes healthcare professionals navigate safeguarding or child protection concerns. Informing the ‘Battling Boundaries’ category. Participants described challenges in deciphering need, determining what constitutes “good enough care” when families appear unable, ambivalent, or overwhelmed in managing their child’s diabetes. However, systemic challenges, associated with institutional referral thresholds and a lack of diabetes literacy within children’s services, creates a divide between services, which hinders professionals enabling protective change for children and families often leaving professionals ‘filling the gap’, operating in a grey area “under the threshold.” The second category ‘Reconciling Professional Insecurity’, represents the battle of conscience. Participants revealed moral distress arising from personal doubt, fear of damaging therapeutic alliances, striving to protect the child and concern over systemic inaction. The emotional toll of safeguarding leading professionals to question their role, feel isolated, and experience professional anxiety. Conclusion: Diabetes is one of a few conditions that pose a high safeguarding risk if not properly managed. However, this is not well understood by children’s services. This study is the first to highlight professionals’ experiences of navigating safeguarding and child protection specifically in the context of paediatric diabetes. The grounded theory ‘Battling Boundaries and Conscience’ conceptualises the dual struggle faced by paediatric diabetes professionals: navigating systemic and relational boundaries while managing the ethical and emotional impact on their conscience. This study reveals the hidden emotional labour and moral complexity inherent in safeguarding work, identifying critical gaps in current safeguarding training and practice. It offers actionable recommendations for clearer guidelines; enhanced safeguarding training tailored to medical neglect and improved interagency collaboration to support both professionals and families.
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