A survey of school nursing provision in the UK

Students', parents' and teachers' views about the resources required by school nurses in Perth, Western Australia

BACKGROUND

Nurses play a significant role in promoting health in schools; however, they are often poorly resourced to do so.

AIMS

The aim of the study was to identify the perceptions of students, parents and teachers regarding the resources school nurses require in order to practise effectively in the secondary school environment in Perth, Western Australia.

METHODS

One-on-one interviews were conducted with parents, teachers, nurses, school principals and school counsellors. Focus groups were conducted at three schools with students in years 10, 11 and 12, parents and teachers. Interviews and focus group data were analysed using thematic analysis.

RESULTS

It was acknowledged that nurses in all schools were under-resourced, with large student numbers contributing to high workloads. The importance of privacy during a visit to the school nurse was highlighted by students. All stakeholders discussed the advantages of nurses completing extra qualifications, in addition to an undergraduate degree. Appropriate support and supervision were also highlighted.

CONCLUSIONS

School nurses need to thoroughly document and describe the work that they do and collaborate within the school community to advocate for increased resources. There is a great need for further research regarding the school nurse role involving the whole school community, and most importantly the students.

Flying by the seat of their pants: A grounded theory of school nurse case management

AIMS

To develop a theory describing the processes and actions involved with school nurse case management for school-aged children with chronic conditions in the K12 system.

DESIGN

Case management is an essential practice for the school nurse. Little is known about actual case management practice in real-world settings. Grounded theory methodology following a literature-based conceptual model of school nurse case management.

METHODS

A purposive maximum variation sampling was used for data collection and analysis. Semi-structured interviews conducted in-person and via conferencing software from January to March 2017 with school nurses practicing in Washington State until data saturation was achieved. A condition lasting at least 6 months was also used to define a chronic condition.

RESULTS

In all, 14 school nurses with an average of 12 years of experience were interviewed. Analysis revealed that the core strategy used by participating nurses for case management involved navigating through ambiguity; balancing multiple roles; seeking guidance and training; acknowledging imperfect functioning and navigating poor system supports.

CONCLUSION

The findings suggest that actual school nurse case management practice differs from best practice recommendations. Participants did not discuss health promotion or environmental management and did not act to set goals or prioritize care as suggested in the literature.

IMPACT

This article informs nursing leadership of the real-world challenges faced by nurses performing case management in the school setting. These findings indicate that improvements in system supports and training, together with tolerance for the challenges nurses face in providing such care, might improve case management practice in the schools.

Sustaining secondary school nursing practice in Australia: a qualitative study

This interpretive descriptive, qualitative study explored secondary school nurses' perceptions of factors that impact on their role and their views on how their role can be best supported. Nine secondary school nurses from four Department of Human Services regions in Victoria, Australia, participated in semistructured, in-depth interviews. Purposive sampling was used, with participants required to have a minimum of 2 years' experience as secondary school nurses. Data were thematically analyzed, revealing a complex and challenging role. The findings identified key factors necessary to support quality practice. All stakeholders need a shared understanding of the purpose and principles underpinning the secondary school nurse role and the nurse's professional obligations. Knowledge and experience are required that recognize the breadth and depth necessary for secondary school nurses to work effectively within their scope of practice. The adoption of a model of critical companionship is recommended to provide facilitated reflection on practice as a support mechanism for the role.

School nursing in New Zealand: a study of services

There are universal concerns about youth health and recognition of the potential of school health services but little consensus internationally as to how these are best configured. Limited information about nursing services in New Zealand secondary schools, changing patterns of youth health needs and expanding roles for nurses in primary health care indicated a need to research school nursing services. This study found that within New Zealand schools there was wide variation in the types of health services and their funding; that nurses are well qualified and highly experienced, although some lack clinical supervision; that students present most commonly for sexual health and injuries or sickness; and that they choose school health services for accessibility and confidentiality. It concludes that one way forward would be to develop a national-level policy for nurse-led school health centers, with appropriate funding, that allows for local flexibility and includes a career pathway for school nurses.

The role of school nurses in delivering accessible health services for primary and secondary school students in Hong Kong

AIMS

To explore and describe the distinctive role of nurses in delivering school health services for primary and secondary school students in Hong Kong.

BACKGROUND

The practical responsibility of nurses in delivering school health services has not been established. There is no literature on this topic and, in particular, nothing has been written from the perspective of the practitioner in communities in Hong Kong.

DESIGN

A qualitative design using semi-structured interviews was employed.

METHODS

Thirteen school nurses were recruited and interviewed in 2006. The narratives were analysed using content analysis steps to identify categories.

RESULTS

Seven categories were formulated. School nurses described their roles as providers, counsellors, leaders, promoters, collaborators, referrers and administrators and housekeepers. The school nurses also reported that they needed to maintain a diverse range of skills and knowledge, such as effective communication skills and clinical updated knowledge, to cope with the demands and the diversity of their roles and to support the health and educational needs of the students and their local communities.

CONCLUSION

The future development of the 'one school, one nurse' policy envisaged by the current government for ordinary schools in Hong Kong will not occur unless the role of school nurses is clearly delineated and valued by society as reducing school children's and adolescents' risk-taking behaviours and promoting the health and well-being of school children and adolescents.

RELEVANCE TO CLINICAL PRACTICE

The findings provide relevant information for school nurse leaders and school nurse policy makers to understand how school nurses are practicing and promoting child and adolescent health services, which can inform regional and national policy and practice.

Determinants of the intention of elementary school nurses to adopt a redefined role in health promotion at school

Background

The quest for greater efficiency in the provision of primary healthcare services and the implementation of a "health-promoting school" approach encourage the optimal redefinition of the role of school nurses. School nurses are viewed as professionals who might be significant actors in the promotion of youth health. The aim of this study was to identify the determinants of the intention of elementary school nurses to adopt a new health-promotion role as a strategic option for the health-promoting school.

Methods

This study was based on an extended version of the theory of planned behaviour (TPB). A total of 251 respondents (response rate of 70%) from 42 school health programs across the Province of Québec completed a mail survey regarding their intention to adopt the proposed health-promotion role. Multiple hierarchical linear regression analyses were performed to assess the relationship between key independent variables and intention. A discriminant analysis of the beliefs was performed to identify the main targets of action.

Results

A total of 73% of respondents expressed a positive intention to accept to play the proposed role. The main predictors were perceived behavioural control (β = 0.36), moral norm (β = 0.27), attitude (β = 0.24), and subjective norm (β = 0.21) (ps < .0001), explaining 83% of the variance. The underlying beliefs distinguishing nurses who had a high intention from those who had a low intention referred to their feelings of being valued, their capacity to overcome the nursing shortage, the approval of the school nurses' community and parents of the students, their leadership skills, and their gaining of a better understanding of school needs.

Conclusions

Results suggest that leadership is a skill that should be addressed to increase the ability of school nurses to assume the proposed role. Findings also indicate that public health administrators need to ensure adequate nurse staffing in the schools in order to increase the proportion of nurses willing to play such a role and avoid burnout among these human resources.

The lifestyle behaviours and psychosocial well-being of primary school students in Hong Kong

AIMS

To examine the lifestyle behaviours and psychosocial well-being of primary school students in Hong Kong.

BACKGROUND

The establishment of healthy lifestyle habits and maintenance of psychosocial well-being during early adolescence can prevent the morbidity and mortality caused by unhealthy practices.

DESIGN

A cross-sectional study.

METHODS

A questionnaire was used to solicit information on primary school students' lifestyle behaviours and psychosocial well-being using the Chinese version of the Adolescent Lifestyle Questionnaire (C-ALQ).

RESULTS

Out of 249 primary school students, 241 returned their questionnaires (a response rate of 96.8%). Results on the lifestyle behaviours of students indicated that nearly half of them 'play sports at least three times a week' (n = 111, 46.1%), 'try not to eat foods high in fats/salt' (n = 112, 46.5%), 'report unusual bodily changes to nurses, parents, friends or physician' (n = 136, 56.4%) and 'avoid doing drugs' (n = 186, 77.2%). Results for the psychosocial well-being of students showed that nearly half 'use helpful strategies to deal with stress' (n = 104, 43.2%), are 'confident about [their] own beliefs and values in life' (n = 143, 59.3%) and 'enjoy spending time with friends' (n = 169, 70.1%). Male students were found less likely than females to demonstrate 'health awareness' (t = 4.87, p = 0.028) and 'social support'(t = 4.17, p = 0.042) and to have better overall psychosocial well-being (t = 5.43, p = 0.021).

CONCLUSIONS

Primary school students have various health education needs related to lifestyle behavioural choices and the maintenance of psychosocial well-being. Lifestyle choices are formed in early adolescence; therefore, health education must begin as early as possible to influence healthy behaviours.

RELEVANCE TO CLINICAL PRACTICE

School nurses should assess health needs across the school-age population and develop programmes to address these overall needs. School nurses are needed to cater for the needs of students, particularly boys, to establish health programmes for lifelong healthy lifestyles and psychosocial well-being and to monitor their health status.