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

WhatsApp-based intervention for people with type 2 diabetes: A randomized controlled trial

Diabetes mellitus is a metabolic disease characterized by prolonged elevated blood glucose levels. Diabetes self-management education and support programs are widely used in western countries. The impact of social media education and support interventions such as a WhatsApp-based program and the nurses' role in supporting and implementing this self-management program unclear. Using a WhatsApp-based program, we evaluated the effects of a 6-week program in improving self-efficacy and education among people with type 2 diabetes mellitus in Saudi Arabia. Eligible participants (n = 80) were recruited with the support of nurses into a randomized controlled trial and randomly assigned into self-management intervention and control groups. The intervention group (n = 40) received the self-management program support and the usual care. The control group (n = 40) received only the usual care with nurses' support. Results from generalized estimating equation analysis showed a significant increase in self-efficacy, self-management, and education in the WhatsApp-based intervention support group compared with the control group at 6 and 12 weeks (follow-up). Implementing the program via social media improves self-efficacy. The use of social media platforms should be promoted for global diabetes management.

Effects of school nurse-led health education to reduce malnutrition among primary school children in Bangladesh: Cluster nonrandomized controlled trial

Background

Malnutrition is a major health concern among children especially in low and middle-income countries. However, there are limited studies on school health in Bangladesh. This study aimed to reduce malnutrition among primary school children in Bangladesh by increasing awareness and knowledge through school nurse-led health education.

Methods and Materials

A prospective, open-label, parallel-group (1:1), cluster nonrandomized controlled trial on primary school children conducted in rural Bangladesh. The study lasted 13 months between September 2021 and September 2022. Four schools were selected and assigned to the intervention and control groups (CGs). Next, school nurses provided evidence-based health education to the children in the intervention group (IG) for 9 months to improve awareness and knowledge of malnutrition. Data were collected at baseline, midline, and endline.

Results

Overall, 604 children were enrolled at the baseline; among them, 455 (CG, n = 220; IG, n = 235) completed the study. Changes in the malnutrition rate-the primary outcome-were not significant (P = 0.225). However, after adjusting the endline data with baseline and sociodemographic data, the children's body mass index improved significantly in the IG than in the CG (P < 0.05). Changes in eating behavior, and awareness and knowledge of malnutrition-the secondary outcomes-significantly differed between the groups (P < 0.001).

Conclusion

The school nurse-led health education program significantly improved primary school children's awareness and knowledge of malnutrition. This study revealed the effectiveness of school nurses in reducing malnutrition among children, which may decrease future morbidity and mortality rates in children.

Nutritional status and prevalence of helminthic infection among primary school children in Bangladesh: A cross-sectional study

AIM

Malnutrition and infectious diseases, such as helminthic infections, are widespread among primary school children, especially in low- and middle-income countries. However, there are limited studies on school health in Bangladesh, particularly in rural settings. This study aimed to explore the nutritional status and prevalence of helminthic infections in relation to associated health behavior, awareness, and knowledge regarding malnutrition and helminthic infections which were evaluated by school nurses among primary school children in Bangladesh.

METHODS

This was a descriptive, cross-sectional survey study with a total duration of 1 month, from September to October, 2021. This study formed part of a school nurse project as a cluster non-randomized clinical trial in Bangladesh. Selected variables from that clinical trial were analyzed and reported in the results section. The study participants were primary school children from four schools in rural Bangladesh.

RESULTS

In total, 604 children participated in the baseline survey and health checkups. Among them, 163 (27.0%) children were classified as malnourished according to the World Health Organization growth reference standard 2007. The prevalence of helminthic infections was 53 (8.8%). Approximately >50% of the children responded that they never/rarely practiced hygiene-related behaviors and had no awareness and knowledge regarding malnutrition and helminthic infections. However, differences between the variables were not statistically significant.

CONCLUSION

Children's nutritional status and prevalence of helminthic infections with related deprived health behaviors, and minimal awareness and knowledge, reinforce the importance of implementing educational interventions in the future.

A Mixed-Methods Study to Evaluate Elementary School Staff's Acceptability, Delivery Challenges, and Communication Regarding the Implementation of School-Located Influenza Vaccination Program in Hong Kong

This was a mixed-methods study comprising a questionnaire-based survey, a qualitative study, and analysis of school newsletters to evaluate elementary school staff's acceptability, delivery challenges and communication about school-located influenza vaccination program (SIVP) in Hong Kong. We found that school staff with lower intention to implement SIVP perceived greater logistical difficulties in arranging SIVP. Challenges regarding program delivery included schools' limited infrastructure, the burden of paperwork, the fear of being overwhelmed by multiple school-based vaccination schedules, lacking confidence in communicating with parents about influenza vaccines, and the difficulties in managing vaccination-related anxiety among children with intellectual disability. School staff were generally passive in communicating with parents and students about influenza vaccines. We also found that schools may use the school newsletters as a substitute of the formal informed consent forms. Good partnerships among government, service providers and schools should be established to minimize the burden of paperwork for school staff, facilitate early planning of SIVP, and support schools with limited infrastructure and the vaccination of children with intellectual disabilities. Training is needed to enhance school staff's confidence in communicating with parents and students about influenza vaccines and improve information delivery to support parents' informed decisions for children's vaccination.

Development of emergency nursing care competency scale for school nurses

BACKGROUND

School nurses perform vital student emergency services at school, and assessing their emergency nursing care competency is critical to the safety and quality of care students receive. The purpose of the study was to develop a scale for measuring school nurses' competency.

METHODS

This was an instrument development and validation study. It was conducted according to the revised DeVellis scale development process coupled with the application of the International Council of Nurses' Nursing Care Continuum Competencies Framework. Eight experts specializing in school health and emergency care evaluated the content validity, while 386 school nurses evaluated the scale. The validity evaluation comprised factor analysis, discriminative validity analysis according to differences in school nurse experience, and criterion validity analysis. Scale internal consistency was analyzed using Cronbach's α value.

RESULTS

The final scale comprises a self-reported 5-point Likert scale with 30 items based on three factors and three sub-factors. Both the convergent validity of the items by factor and the discriminative validity were both confirmed. The criterion validity was also found to be positively correlated with the Triage Competency Scale.

CONCLUSION

The scale may be used to identify factors influencing school nurses' competency in emergency nursing care and contribute to research in competency-based education programs.

A qualitative exploration of the experiences of school nurses during COVID-19 pandemic as the frontline primary health care professionals

Background

It is widely acknowledged that the experiences of frontline primary health care professionals during COVID-19 are important to understand how they respond and act under situations of pandemic as the gatekeepers in primary health care system. School nurses are primary health care professionals who lead health care in schools and practice in a holistic manner to address the needs of schoolchildren and school personnel. There are rising mental health concerns of frontline health care professionals with anxiety and panic disorders, somatic symptoms, and feeling isolated. No studies use a qualitative study approach to document community frontline school nursing professionals’ experiences and challenges during the COVID-19 pandemic. Hence, understanding the school nurses’ experiences and challenges to fight against COVID-19 in the communities is important.

Purpose

This study aims to explore the experiences of school nurses during the COVID-19 pandemic in Hong Kong.

Methods

A qualitative study design adopted the principles of thematic analysis. Nineteen school nurses were recruited to participate in individual semistructured interviews and shared their roles and responsibilities during the COVID-19 pandemic.

Findings

Three themes indicated the school nurses’ expand professional responsibilities to fight against COVID-19 emerged from the data analysis. These were “Managing Stress,” “Navigating the School Through the Pandemic,” and “Raising the Profile of the School Nurse Professional,”

Discussion

Findings reveal the important role of school nursing professionals in minimizing the community-wide risk posed by pandemics and the need to integrate them into planning and implementation of school health policies and guidelines in the primary health care system. This essential role in schools is necessary to assess, implement, monitor, prevent, and reduce the spread of virus in school communities and to minimize the burden to and extra health care resources utilized in the acute care setting during COVID-19 pandemic.

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.

Acceptability and feasibility of a school-based contraceptive clinic in a low-income community in South Africa

Aim

To investigate how acceptable and feasible a school-based contraceptive clinic (SBCC) would be in a low-income South African community.

Background

Teenage pregnancy is an important issue in South Africa, with significant health and social consequences. Issues regarding lack of confidentiality in an intimate community, unwelcoming health workers, long distances to clinics and perceptions of contraceptive side effects may all inhibit contraceptive use by adolescents. Although SBCC has been initiated and investigated in other countries, this approach is inadequately researched in South Africa.

Methods

A mixed method study was conducted to assess the attitudes of one community towards establishment of an SBCC in their area. Methods of data collection included: focus group discussions (FGDs) with teenage girls from a local high school; a key informant interview with the school principal; a structured survey, including open-ended questionnaires with randomly selected parents of teenage girls from the same community; and a documentary analysis to explore relevant legal and policy considerations.

Findings

Teenage girls, the school principal and parents with teenage daughters largely supported the idea of an SBCC, but with concerns about confidentiality, the possibility of increased promiscuity and contraceptive side effects. While legal statutes and policies in South Africa do not pose any barriers to the establishment of an SBCC, some logistical barriers remain.

Supporting the health and well-being of school-aged children through a school nurse programme: a realist evaluation

BACKGROUND

The school nurse's role varies across countries. In Scotland, the Chief Nursing Officer recommended that the role should be refocused. The refocused programme emphasises nine care pathways with a view to improve pupils' health and wellbeing. Two sites were identified to test this new programme. Our aim was to assess how, for whom and under what circumstances the programme works in order to provide learning to support school nurse training and intended national roll-out.

METHODS

This study was a mixed methods study, using a realist evaluation approach, and conducted in three phases. In phase one, six nurse managers from both study sites took part in individual interviews or focus groups and this was complemented by programme documents to develop initial programme theory. In phase two, the programme theory was tested using qualitative data from 27 school nurses, and quantitative data from the first 6 months of the programme that captured patterns of referral. The programme theory was refined through analyses and interpretation of data in phase three.

RESULTS

The findings show that the programme enhanced opportunities for early and improved identification of health and wellbeing needs. The context of the nine pathways worked through the mechanism of streamlining referral of relevant cases to school nurses, and yielded positive outcomes by extending school nurses and thus children's engagement with wider services. The mental health and wellbeing pathway was the most frequently used, and nurses referred complex mental health cases to more specialist mental health services, but felt less equipped to deal with low to moderate cases.

CONCLUSIONS

The programme facilitated early identification of risk but was less successful at equipping school nurses to actually deliver specific interventions as intended. Capacity building strategies for school nurses should seek to enhance intervention delivery skills within the parameters of the pathways. Realist evaluation provided a useful framework in terms of identifying contextual and mechanistic influences that required strengthening prior to wider implementation.

Parents' and teachers' expectations of school nurse roles: A scale development study

OBJECTIVES

Many studies concerning the roles and functions of school nurses exist, however, such studies are very limited in Turkey and there is any research on a comprehensive measuring tool that can evaluate teachers' and parents' perceptions and expectations of school nurses roles. The purpose of this study is to develop a valid and reliable assessment tool that can be used to determine parents' and teachers' expectations of school nurse's roles.

METHODS

For the methodological research "Parents' and Teachers' Expectations of School Nurse's Roles" scale was designed and administered at primary and high schools in Turkey. To assess the data, assessment of item variability, internal consistency, factor analysis, correlations between the scale and subscales, and test-retest reliability were utilized.

RESULTS

The content validity index for the scale was 0.94. As a result of core components analysis varimax rotation, 7 factors were obtained from 54 items. Cronbach's α coefficient for the factors ranged from 0.82 to 0.92. The intra-class correlation coefficient for the test-retest reliability was 0.859, P < 0.001.

CONCLUSIONS

The scale was a rather valid and reliable assessment tool in determining the parents' and teachers' expectations of school nurses' roles.

Adolescents' evaluations of the quality of lifestyle counselling in school-based health care

BACKGROUND

Adolescents need effective lifestyle counselling precisely because health problems are so common. Good-quality lifestyle counselling can prevent the problems from becoming worse and decrease the costs of health care. Nurse practitioners in schools are well positioned to promote adolescent health.

AIM

This study describes adolescents' evaluations of the quality of lifestyle counselling and factors related to it in school-based health care.

METHODS

The data were collected from seventh- to ninth-grade adolescents (n = 846) using the Counselling Quality Instrument, from two junior high schools in northern Finland. The study employed a web-based survey. Response rate was 67% (n = 563). The data were analysed via descriptive statistics.

RESULTS

Most adolescents (84%) reported that the counselling resources related to school-based health care are quite good. Most of them reported that nutrition (70%) and physical activity (63%) related to lifestyle counselling are sufficient. Approximately half of adolescents (51%) considered the counselling related to substance abuse as being sufficient. Most (80%) felt that the level of interaction during counselling is good. Overall, the majority of adolescents reported that goal-oriented lifestyle counselling (67%) and adolescent-centred counselling (69%) are good. Finally, most adolescents (72%) reported that they have benefitted from lifestyle counselling. Gender and health status were significantly related to resources, interaction and benefits of lifestyle counselling. Girls evaluated that counselling were more adolescent-centred than boys. Adolescents with very good health status evaluated content of lifestyle counselling better than adolescents with poorer health status.

CONCLUSION

The adolescents evaluated the quality of lifestyle counselling in school-based health care as mainly being good. School nurses should pay particular attention when providing counselling to boys and those who are in poorer health.

School Nurses’ Experiences of Managing Young People With Mental Health Problems

Prevalence of mental health disorder is increasing among young people. It is recognized that early intervention is essential in supporting young people, and care provided within schools to support emotional well-being is recommended as part of this process. A scoping review was undertaken examining school nurses’ experiences of supporting the mental health of schoolchildren. Findings suggest that school nurses have a central role in supporting young peoples’ mental health, although a number of barriers exist which impact on school nurses’ preparedness for this aspect of their role. While there are inconsistencies in the provision of mental health training available to support school nurses, when training is implemented it has positive outcomes for service provision and quality of care. A number of challenges for school nurses were also identified, and recommendations for practice are suggested in the article.

Health promotion interventions to prevent early childhood human influenza at the household level: a realist review to identify implications for programmes in Hong Kong

AIMS AND OBJECTIVES

To identify factors affecting the delivery of health promotion interventions to prevent early childhood human influenza at the household level.

BACKGROUND

Yearly, influenza epidemics seriously affect all age groups, particularly those with weakened immune systems, including children. Influenza is transmitted easily from person to person through droplet and direct contact. Maintaining personal hygiene, avoiding close contact with the infected person and proper hand washing are recommended as the most effective means of preventing the transmission of influenza. However, it is not clear what programme-related mechanisms and contexts are crucial to the successful delivery of interventions in the home. This study systematically reviewed published research studies to identify factors influencing the effective delivery of health promotion programmes targeting influenza in a household.

DESIGN

Realist review.

METHODS

A realist review methodology was selected to examine what interventions are effective in preventing and managing influenza at the household level and in what circumstances. A structured search of the peer-reviewed primary research literature was undertaken using a defined search protocol.

RESULTS

Eight studies were retrieved for the analysis. Mechanisms impacting on intervention delivery were identified, including timing of implementation, programme reach, organisational and healthcare worker involvement, mode and place of delivery, contact with infected person, health practice compliance and sustainability at home.

CONCLUSION

These findings suggest contextual factors that could be identified through ecological approaches to health promotion that are crucial for policymakers to consider when designing interventions.

RELEVANCE TO CLINICAL PRACTICE

The active involvement of community nurses through an integrated household visiting programme may help to better deliver family-based health promotion interventions to prevent illnesses such as influenza in children.

Implications for school nursing through interprofessional education and practice

AIMS AND OBJECTIVES

To explore the interprofessional collaboration between nursing and social work professionals in their delivery of health services for schoolchildren.

BACKGROUND

Interprofessional education has long been recommended as a way to meet the need for effective collaboration in school health service with a view to improving the quality of health care. No local study in Hong Kong has looked specifically at how nursing and social work professionals carry out school health services through interprofessional education and practice. Therefore, an examination was conducted of collaboration on a community-based school caring project.

DESIGN

A qualitative design was employed, using semi-structured interviews, field observation and field debriefing.

METHODS

Seven nursing students and five social work students were recruited and interviewed in 2011. The transcripts were analysed using qualitative content analysis.

RESULTS

Three themes were identified: (1) early identification of children's needs through interprofessional collaboration for health promotion, (2) prompt referral for schoolchildren in need, and (3) comprehensive planning and implementation of school health service.

CONCLUSION

The strength of collaborative work between nursing and social work professionals is that it helps to identify and address these complex health needs of children. Healthcare providers are hence able to develop a fuller understanding of children's problems, which in turn enables them to provide appropriate and effective health promotion interventions.

RELEVANCE TO CLINICAL PRACTICE

The development of interprofessional education for school health services should be envisaged by the local higher educational institute and policy makers to reduce children's risk-taking behaviours and promote their health and well-being. Health educators and health policy makers can better understand how interprofessional education and collaboration can promote children health service for regional and national policy and practice.