Adolescents' and school nurses' perceptions of using a health and lifestyle tool in health dialogues

School children's perceptions about being offered the HPV vaccination - A focus group study

AIM

There is limited knowledge about the perceptions of HPV vaccination in middle-school children. This qualitative study aimed to explore their views.

METHODS

We conducted focus group interviews with children, 10-11 years of age, who had been offered HPV vaccination through the school health services in mid-north Sweden in spring of 2023. Data were analysed with qualitative content analysis.

RESULTS

This study included six focus group interviews with 49 children (boys n = 29; girls n = 20), mean of 11 years of age. Participating children expressed the need to feel safe to be of utmost importance and the means to do so was to be prepared and informed by someone the child trusted. The school nurse was perceived as the expert, best suited to provide factual information, support and motivation, both to children and their parents.

CONCLUSION

We confirm that healthcare providers' recommendations are crucial for HPV vaccine acceptance also from the child's perspective. Improved information about HPV vaccination to children is necessary. Children's right to participate on their own terms is not fulfilled today. Vaccine promotion, both to children and parents, should be actively managed by the school nurse.

Healthcare professionals' experiences of targeted health dialogues in primary health care

BACKGROUND

In Sweden, population-based targeted health dialogues are an important part of health promotion and disease prevention in primary health care. Targeted health dialogues are performed with a pedagogical approach to allow individuals to reflect over their resources, situation and motivation to change lifestyle habits together with a healthcare professional.

AIM

The aim of this study was to explore healthcare professionals' experiences of targeted health dialogues in primary health care.

METHODS

Three focus group interviews were conducted with 20 healthcare professionals. The interviews were analysed using qualitative content analysis.

RESULTS

The main category A possibility to promote healthy behaviours and prevent disease describes how the targeted health dialogues were experienced as a valuable opportunity to promote health among inhabitants. The significance of the primary healthcare centre's health promotion and prevention strategies was emphasised to enable the targeted health dialogues as a part of the assignment to promote health. These strategies were expressed as shared focus and organisational space and support making it possible for example to reach all socioeconomic groups. The work with targeted health dialogue was described as a complex task requiring extensive competence. Furthermore, the pedagogical tool including the visual health profile was experienced to have an important impact on the dialogue offering direction for actions to promote health and prevent disease.

CONCLUSIONS

Targeted health dialogues can be a valuable opportunity for healthcare professionals in primary health care to promote a healthy lifestyle among inhabitants. Certain preconditions at both the meso- and the micro level is however required for this to come about.

Exploring Screening Practices for Child Sexual Abuse in School Settings: An Integrative Review

Child sexual abuse (CSA) is a pervasive public health problem. If left undetected, CSA can result in immediate and long-term health problems, which can be mitigated through early identification. Schools are an ideal environment to implement screening measures, and school nurses (SN) are uniquely poised to intervene and respond early. The aim of this review was to systematically examine and synthesize the international evidence related to screening for early identification of CSA in schools. Themes emerging from the analysis were SN behaviors relative to screening, potential instruments or approaches for screening, and SN and school professionals' beliefs about CSA screening practices. This review found little evidence that CSA screening is occurring in schools. However, SNs are aware that screening falls within their scope of practice and many SNs feel they should be screening for it. A constant proactive approach by SNs is necessary to improve early identification and subsequent intervention.

Health care professionals' experiences and perceptions of health promotion through the health dialogue intervention in the scania region, Sweden: a qualitative interview study

BACKGROUND

Cardiovascular disease and type 2 diabetes are among the largest public health challenges in Sweden. Research indicates that a healthy lifestyle can prevent most cases. The health dialogue is an evidence-based public health programme for primary care with positive results in several regions of Sweden. This study aimed to describe health care professionals' experiences and perceptions of health promotion through the health dialogue intervention during the pilot phase in the Scania region of Sweden.

METHODS

The study consists of 12 individual interviews with health care professionals educated in the health dialogue method, implementing the intervention in Scania. Qualitative content analysis with an inductive approach was used.

RESULTS

The analysis resulted in 10 sub-categories and the four main categories: A more health-promoting mindset would benefit primary care; Empower individuals; Facilitate sustainable lifestyle changes; Challenges, tools and support for the implementation of the health dialogue. One overarching theme emerged: "Health dialogue, a potential start of a paradigm shift in Swedish primary care".

CONCLUSIONS

Conclusions imply that the health dialogue is a well-structured method with tools to make health promotion and primary prevention an integrated part of primary care. A respectful and motivating approach during the health dialogue is recommended. It is important to have an ongoing discussion about the approach among the health care professionals. Incorporating the Health Belief Model in the health care professionals' education in the method could increase the focus on self-efficacy during counselling, which could favour the participants' change process.

In search of factors related to migration affecting children's health - an analysis of documents guiding health visits within the Swedish school health services

BACKGROUND

Migration affects the health of children worldwide. Therefore, school nurses who encounter these children as part of their everyday practice need support from guidelines on how to promote the health of children who have migrated or whose parents have migrated. Yet knowledge regarding such content in guidelines of school nursing practice is sparse. Therefore, this study aims to investigate how municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include factors related to migration that affect children's health.

METHODS

A document analysis of municipal and regional guidelines and health questionnaires guiding school nurses' practice in health visits was conducted during the autumn of 2020. In total, 687 guidelines and health questionnaires were analyzed using deductive content analysis.

RESULTS

The results show that municipal and regional guidelines and health questionnaires used in health visits in the Swedish school health services include content on many factors related to migration that affect children's health. Yet the content was limited, and none was found on factors related to discrimination based on ethnicity or origin.

CONCLUSION

Guidance related to promoting the health of children who have migrated or whose parents have migrated should include all factors affecting these children's health. Therefore, to strengthen school nurses' evidence-based practice, guideline development might be needed, although guidelines and health questionnaires exist and include content on many factors related to migration affecting the health of children in order to provide equitable healthcare for all children, regardless of country of origin.

Experiences of Stress - A Focus Group Interview Study Among Swedish Adolescents During the COVID-19 Pandemic

Adolescence can be a stressful period in life. The period contains challenges associated with the transition from childhood to adulthood (body changes, changes in interpersonal relationships, and identity changes). The aim was to investigate experiences of stress among adolescents in addition to stress related to the COVID-19 pandemic. Focus group interviews (n = 8) were conducted with girls (n = 22) and boys (n = 19) aged 13-15 in southern Sweden. The transcribed interviews were analyzed with qualitative content analysis. Analysis of the collected material resulted in two categories with four sub-categories each of which highlights adolescents' experiences of stress. The results show that adolescents' have a variety of experiences of stress, i.e., what they mean are the sources of stress and how stress is manifested. The adolescents experienced how stress was manifested both physically and emotionally. This affected both their sleep and performance. The adolescents reflected on both positive and negative manifestations of stress.

Associations between intakes of foods and their relations to overweight/obesity in 16-year-old adolescents

There is limited knowledge about the associations between intakes of different foods and inconsistency in the literature of the relation between the quality of food intake and bodyweight in adolescents. The aim of this study is to explore how healthy self-reported food intakes are associated with each other and with overweight/obesity in adolescents. This is a cross-sectional study of seven cohorts of adolescents (n 13 451) who turned sixteen from 2009/2010 up to 2015/2016 and responded to a health questionnaire used by the School Health Services in southeast Sweden. Associations between intakes of ten self-reported foods as well as between food intakes and weight groups based on the International Obesity Task Force standards (isoBMI) were explored by multivariable logistic regression. Healthy intakes of different foods were mostly associated with each other with the strongest association between a high intake of fruit and a high intake of vegetables (odds ratio (OR) = 25 (95 % confidence interval (CI) 20⋅0–33⋅1)). A low-frequency intake of sweets/snacks (OR = 2⋅35 (95 % CI 1⋅84–3⋅00)) was associated with overweight/obesity as well as a healthy choice of butter/margarine (≤40 % fat) (OR = 1⋅82 (95 % CI 1⋅39 to 2⋅41)), but a high-frequency intake of vegetables was negatively associated with overweight/obesity 0⋅77 (0⋅62–0⋅95). To promote health and achieve a healthy weight among adolescents, it is important to take both diet quality and total food amount into consideration.

Assessing sense of coherence as an element of primary-focused health services in schools for children and adolescents with complex health care needs

AIM

This study aimed to clarify if sense of coherence (SOC) could be used as an element of primary-focused health services in schools.

BACKGROUND

The United Arab Emirates (UAE) is striving to develop a high-quality, primary-focused health care system. School health care services are well established in the UAE but have not yet been fully used to play a key role in this development.

METHODS

This is a cross-sectional survey study to explore adolescents' SOC and their behavioural, psychosocial and clinical outcomes.

RESULTS

A total of 408 adolescents participated in this study. Compared with others, adolescents with higher SOC had better adherence to treatment, fewer visits to the school nurse, better self-efficacy, fewer hyperactivity problems, fewer emotional problems, more prosocial behaviours and fewer conduct problems.

CONCLUSION

Implementing interventions that improve SOC may support improved well-being among adolescents. The findings also support the use of SOC and salutogenesis as a framework to reinforce primary health care services for this population.

IMPLICATIONS FOR NURSING MANAGEMENT

Health service managers can utilize SOC as a framework to focus service on illness prevention and health promotion, they should collaborate with education authorities to include more health-related topics as part of school curricula to promote students' SOC and, finally, they should assess and build awareness of SOC and associated tools among school nurses and primary health care providers.

A Philosophical Review of School Nursing Framed by the Holistic Nursing Theory of Barbara Dossey

This article is a philosophical review of school nursing and its constructs framed by Barbara Dossey's holistic nursing theory. The author describes the application of holistic nursing theory within the school nurse's area of activity. The review suggests that holistic nursing theory can be applied in several areas of school nursing. School nurses have a multifaceted occupation that includes meetings with students, parents, and school staff. Barbara Dossey's holistic nursing theory offers the school nurse tools to deal with people's varied experiences, feelings, and needs.

How About the Psychological Pandemic? Perceptions of COVID-19 and Work-Life of Private Sector Employees-A Qualitative Study

COVID-19 had a devastating and profound impact worldwide. The business world has been turbulent, and countries' economic landscape has shown dismal performance. There have been massive downsizing of employees and deductions of pay in most organisations as the pandemic outbreak negatively impacted the business environment. The study aimed to analyse the impact of COVID-19 on the psychology of employees working in private organisations. A qualitative analysis was conducted with 22 middle-level Indian employees employed in private sector organisations. Content analysis was performed from the transcripts and themes; coding categories were developed. Participation in the study was voluntary and was carried out through informed consent. The results demonstrated that the participants experienced psychological stress, social disconnectedness, and a sense of loneliness over the lockdown period.

Furthermore, the semi-structured interviews also revealed the perceptions of the job, career prospects, and the fear of the imminent looming future ahead. The pandemic has raised serious questions on the employee’s mental health and engagement issues. Managerial implications have been discussed with suggestions to alleviate the current professional and psychological challenges.

Food intake in children and adolescents: a cross-sectional study from 2009/2010 to 2015/2016

The aim was to describe food intake over time in children and adolescents, with respect to age and gender. The present study was a repeated cross-sectional study using self-reported data from a health questionnaire. Data were collected from the School Health Services in south-east Sweden from 44 297 students, 10, 13–14 and 16 years of age, 48 % girls and 52 % boys from 2009/2010 to 2015/2016. Reported intakes for eight foods were analysed in relation to the Nordic Nutrition Recommendations. Seventeen per cent of the students reported an intake in line with the recommendations for at least six of the eight foods fish, vegetables, fruit, mealtime beverages, juice/chocolate drinks, sugar-sweetened beverages, sweets/snacks and pastries. Intake of at least two fruits a day was the recommendation that was followed by the lowest proportion of students (30 %), and this result was stable over the study period. There was a gradual increase over time in the proportion of students who reported an intake in line with the recommendations. Younger students compared to older students, as well as girls compared to boys, reported intakes in line with the recommendations to a statistically significant larger extent. Few students reported intakes in line with the recommendations, although the quality of food intake seems to improve over time. The present results indicate a deterioration in reported food intake in the early years of adolescence. Finding methods to support all children and especially older adolescents to eat healthier, including eating more fruit, is of great importance to public health.

The development of the clinical assessment tool "Health and Everyday Functioning in Young Children with Cancer"

BACKGROUND

Young children's experiences of everyday life with cancer are vital in guiding care. The universal and interdisciplinary language of the International Classification of Functioning (ICF) and the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY) has wide reaching effects for the care of young children in need. The aim of this study was to select and validate the content of a clinical assessment tool (CAT) for health and everyday functioning in young children with cancer.

METHODS

A comprehensive set of ICF-CY codes (n = 70) mapping everyday function and health was previously identified from the transcripts of 12 interviews with young children with cancer and their parents at a paediatric oncology centre in the west of Sweden. Three transcripts were from data collected shortly after diagnosis, three transcripts from 6 months after diagnosis, three transcripts from 12 months after diagnosis, and three transcripts from 18 months after diagnosis. The present study involved the development of items based on the ICF-CY codes.

RESULTS

The CAT consists of 52 items grouped in four dimensions: "the child herself/himself," "the child's everyday life," "the child's need for support," and "the child's contacts with health care."

CONCLUSION

The questions correlate well with known research results and highlight areas that are important for health and everyday life for young children with cancer. This tool, based on children's experiences, can be used by both parents and health care personnel such as nurses to highlight aspects of health and function in everyday life for the young child with cancer that otherwise might be missed. This novel approach using the ICF-CY could be used to guide the delivery of care towards living an everyday life with a long-term illness.

Positive self-reported health might be an important determinant of student's experiences of high school in northern Sweden

There is a need for more knowledge about positive health determinants in the school setting. The overall aim of this study was to analyse if positive self-reported health is associated with experiences of school among high-school students. Data originated from the health dialogue questionnaire answered by students in grade 1 of high school. A total of 5035 students participated from the academic years 2013 to 2016. Logistic regression with positive odds ratio (POR) was used to analyse associations between positive self-reported health and school experiences. There was an association between positive self-reported health and school experiences among students. Positive mental health was the strongest predictor for positive school experiences. To frequently participate in Physical Education, have a positive body image and satisfactory sleep nearly doubled the students' odds for positive school experiences. The results also revealed gender differences; boys more often reported positive experiences of school and positive health than girls. Positive self-reported health is associated with positive experiences of school, particularly mental health. Moreover, these findings have significant implications for how students experience school and demonstrate the importance of including health-promoting interventions in systemic school improvement, meeting both girls' and boys' needs.

Dealing with adolescents' recurrent pain problems in school health care-Swedish school nurses' view

Aim

To explore school nurses' strategies for supporting adolescents with recurrent pain.

Design

An explorative inductive qualitative design.

Method

Twenty-one Swedish school nurses were interviewed, and the interviews were subjected to content analysis.

Results

The findings show that the nurses are aware that recurrent pain problems are common among the adolescents. In their attempt to support these adolescents, the nurses describe how they are striving in attempts to acquire an understanding of the adolescents' situation, to understand the cause of the pain problem and to devise strategies that can be used to help the adolescents handle the situation.

A Person-Centred Approach When Encountering Students With Recurrent Pain: School Nurses' Experiences

Stress has a negative impact on students' daily lives and can be associated with recurrent pain. School nurses play a key role in supporting young people with stress-related pain. The purpose of this qualitative interview study was to elucidate school nurses' experiences of encountering students with recurrent pain when practicing person-centred care. The school nurses were based at public and private schools and worked with students aged 12-19. Data were collected through interviews with 18 school nurses and analyzed with deductive content analysis. The school nurses felt that actively listening to the students' narratives about daily life with recurrent pain, and co-creation of a health plan, encouraged the students to participate as partners in their own care and strengthened their relation with the students. The application of a person-centred approach in school health care meant that traditional knowledge transfer was replaced with a dialogue that reflects both the student's and school nurse's perspective.

How school nurses experience and understand everyday pain among adolescents

Background

Pain problems are a rapidly growing health problem found among both children and adolescent, and about 15–30% have reported chronic pain problems. School nurses in Norway meet adolescents with various ailments, including pain. Yet research on how school nurses perceive the pain experienced by adolescents is limited. The aim of the present study was to explore how school nurses explain and experience the everyday pain of adolescents.

Method

A qualitative study with an explorative design comprising five focus group interviews. Each group consisted of three to five school nurses. Seventeen female school nurses in five junior high schools in Norway, age range 29–65 years participated. To cover the issues a semi structured interview guide was used. The transcribed text was analysed with qualitative content analysis.

Results

The experience of school nurses with adolescents’ pain in everyday life is mainly that pain is a social, physical, and psychological phenomenon. School nurses experienced that everyday pain is reflecting: 1) high expectations, 2) difficult relationships and traumatic experiences and 3) an unhealthy lifestyle. School nurses have ambivalent attitudes to medicalisation of pain.

Conclusion

Despite of a biopsychosocial understanding of pain, the school nurses maintained referral practice of medical examinations, with the results that many adolescents became shuttlecocks in the health system. Although the school nurses´ were sceptical of the tendency towards medicalization in society, it appears that they actually help maintain this tendency.

Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study

Background

Despite experiencing a high prevalence and co-occurrence of mental health disorders and health-compromising behaviors, young people tend not to seek professional help for these concerns. However, they do regularly attend primary care, making primary care providers ideally situated to identify and discuss mental health and lifestyle issues as part of young people’s routine health care.

Objective

The aim was to investigate whether using a codesigned health and lifestyle-screening app, Check Up GP, in general practice influenced young people’s assessment of the quality of their care (measures of patient-centered care and youth friendliness), and their disclosure of sensitive issues. In addition, this study aimed to explore young people’s acceptance and experience of using a screening app during regular health care.

Methods

This was a mixed methods implementation study of Check Up GP with young people aged 14 to 25 years attending a general practice clinic in urban Melbourne, Australia. A 1-month treatment-as-usual group was compared to a 2-month intervention group in which young people and their general practitioners (GPs) used Check Up GP. Young people in both groups completed an exit survey immediately after their consultation about disclosure, patient-centered and youth-friendly care, and judgment. In addition, participants in the intervention group were surveyed about app acceptability and usability and their willingness to use it again. Semistructured interviews with participants in the intervention group expanded on themes covered in the survey.

Results

The exit survey was completed by 30 young people in the treatment-as-usual group and 85 young people in the intervention group. Young people using Check Up GP reported greater disclosure of health issues (P<.001), and rated their GP higher in patient-centered care: communication and partnership (P=.01), personal relationship (P=.01), health promotion (P=.03), and interest in effect on life (P<.001). No differences were found on core indicators of youth-friendly care: trust, level of comfort, expectations met, and time to ask questions. In all, 86% (73/85) of young people felt the app was a “good idea” and only 1% (1/85) thought it a “bad idea.” Thematic analysis of qualitative interviews with 14 participants found that Check Up GP created scope to address unmet health needs and increased sense of preparedness, with use moderated by honesty, motivation, app content and functionality, and app administration.

Conclusions

Integrating a health and lifestyle-screening app into face-to-face care can enrich young people’s experience of seeing their GP, create scope to identify and address unmet health needs, and increase patient-centered care. Further research is needed to investigate the effect of using a health and lifestyle-screening app in a diverse range of clinic types and settings, and with a diverse range of GPs and youth.

Nurses' use of pliable and directed strategies when encountering children in child and school healthcare

Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3-16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.

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.

Gender-based generalisations in school nurses' appraisals of and interventions addressing students' mental health

Background

There has been an increase of reports describing mental health problems in adolescents, especially girls. School nurses play an important role in supporting young people with health problems. Few studies have considered how the nurses’ gender norms may influence their discussions.

Methods

To investigate this issue, semi-structured interviews focusing on school nurses’ work with students who have mental health problems were conducted. Transcripts of interviews with Swedish school nurses (n = 15) from the Help overcoming pain early project (HOPE) were analysed using theories on gender as a theoretical framework and then organised into themes related to the school nurses’ provision of contact and intervention. The interviewees were all women, aged between 42–63 years, who had worked as nurses for 13–45 years, and as school nurses for 2–28 years. Five worked in upper secondary schools (for students aged 16–19) and 10 in secondary schools (for students aged 12–16).

Results

The results show that school nurses more commonly associated mental health problems with girls. When the school nurses discussed students that were difficult to reach, boys in particular were mentioned. However, very few nurses mentioned specific intervention to address students’ mental health problems, and all of the mentioned interventions were focused on girls. Some of the school nurses reported that it was more difficult to initiate a health dialogue with boys, yet none of the nurses had organized interventions for the boys.

Conclusions

We conclude that generalisations can sometimes be analytically helpful, facilitating, for instance, the identification of problems in school nurses’ work methods and interventions. However, the most important conclusion from our research, which applied a design that is not commonly used, is that more varied approaches, as well as a greater awareness of potential gender stereotype pitfalls, are necessary to meet the needs of diverse student groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1710-1) contains supplementary material, which is available to authorized users.

School nurses’ health dialogues with pupils regarding food habits

The aim of this study was to describe the content of school nurses’ health dialogues with pupils regarding food habits. A qualitative content analysis of 24 recorded health dialogues resulted in five categories describing the content of the dialogues, regarding food habits. Current food habits covered food, mealtimes and food related to physical activity. Social context and food habits showed that social groups in the pupils’ surroundings affected their food habits . Society and food habits included external factors that affected food habits, such as school and laws . School nurses’ advice and support regarding food habits described how nurses offered advice, support and information. Pupils’ understanding of health in connection to food habits comprised the pupils’ knowledge, participation and willingness to change. The results showed a variety of interacting factors which affected the pupils’ food habits, upon which health-promotional work can be based.

Psychometric properties of self-sufficiency assessment tools in adolescents in vocational education

Background

Self-sufficiency is the realisation of an acceptable level of functioning either by the person him/herself or through the adequate organisation of help from informal or formal care providers. Assessment of self-sufficiency for determining an individual’s functional strengths and areas for improvement is increasingly being applied among adolescents in vocational education, a group considered vulnerable with high school dropout rates and often characterised by an accumulation of problems. This study examined the psychometric properties of two instruments, i.e. a self-report questionnaire assessing self-sufficiency and the Self-Sufficiency Matrix for professionals (SSM-D) conducted among adolescents in vocational education.

Methods

The self-report questionnaire used to assess self-sufficiency was completed by 581 adolescents. Professionals completed the SSM-D for 224 of the 581 adolescents. Furthermore, constructs related to the domains of self-sufficiency were assessed with self-report questionnaires and information about school absenteeism was monitored via the school registration system.

Results

For both self-report and professional-report ratings, the internal consistency was satisfactory (Cronbach’α > 0.70) and various minor to strong correlations were found between the domains of self-sufficiency and related constructs. For most of the domains, there was little or no agreement between professionals and adolescents.

Conclusions

Both the self-report questionnaire assessing self-sufficiency and the SSM-D applied in this study seem to possess adequate psychometric properties. The results indicated that adolescents and professionals provide different views of adolescents’ self-sufficiency, which merits further study. In the meantime, we recommend assessment of adolescents’ self-sufficiency by using both the self-report questionnaire and the SSM-D to get a comprehensive measure of adolescents’ self-sufficiency.

Trial registration

Netherlands Trial Register: NTR3545; 30 July 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s40359-015-0091-2) contains supplementary material, which is available to authorized users.

Your health, an intervention at senior vocational schools to promote adolescents' health and health behaviors

This study evaluates the appreciation, application and effects of an intervention (Your Health), in which adolescents received a consultation with the school nurse. A cluster randomized controlled trial with an intervention and control group (care-as-usual) was conducted among first-grade senior vocational students. Adolescents (n = 418) completed a questionnaire at baseline and 6-month follow-up assessing health and health behaviors. School absenteeism was monitored via the school registration system. After the consultation, adolescents and nurses evaluated the consultation by questionnaire. Adolescents appreciated being invited for the consultation and gave the consultation a positive mean rating of 8.78 on a 10-point scale. Adolescents rated the other nine items on the appreciation of the consultation also high. In 36.8% of the adolescents, nurses suspected problems. Most often these adolescents were given tailored advice (59.3%) or they were referred to another professional (40.7%). No statistically significant effects of the intervention were found on the health and health behaviors of adolescents. This study supports the use of Your Health as a promising intervention to reach senior vocational students. Future research is needed to evaluate long-term effects and the effects and appreciation of the subsequent help that is offered.

TRIAL REGISTRATION

www.trialregister.nl, NTR3545.

The School Nurse's Ability to Detect and Support Abused Children: A Trust-Creating Process

Child abuse has negative health consequences. Early detection and preventive measures lead to avoidance of prolonged and more complex problems. School nurses have a child protection role and should pay attention to vulnerable children. Through health dialogues and other interactions with pupils, school nurses have the opportunity to detect child abuse. The aim of the study was to explore how school nurses detect child abuse and initiate support measures. Focus group interviews were conducted with 23 school nurses. The data were analyzed using a grounded theory approach. Results showed that the main concern of the school nurses was support and assistance to children who are abused which was preceded by a trust-creating and trust-strengthening process. Trust contains self-confidence and confidence in the system and trust can be strengthened or undermined. Building trustful relations is time consuming and is facilitated by networking, refined assessment instruments, and collaboration.

Nurses' encounters with children in child and school health care: negotiated guidance within a given frame

BACKGROUND

Throughout childhood, children take part in health visits according to a health-monitoring programme. The visits are aimed to promote the children's development and health and to strengthen them to take own responsibility for their health. Nurses' actions when encountering children at these visits are not explored to any great extent. Exploring nurses' actions can facilitate their reflections on their actions towards children and thereby promote children's involvement in such visits.

AIM

The aim of this study was to explore nurses' actions when encountering children at health visits.

METHOD

A qualitative explorative design, based on 30 video recordings of health visits in child and school health care, was used in this study. These visits were ordinary real-life health visits. The data were subjected to qualitative content analysis. The right to conduct video recordings during health visits was approved by appropriate research ethics committees.

RESULTS

The findings show that nurses, in order to carry out the health visits, encounter children through negotiated guidance. This guidance is understood as the process through which the nurses reach agreement with the children, and is comprised of directed and pliable strategies. At one moment, the nurse can use a directed strategy to inform the child and at the next moment a pliable strategy to provide the child space within the given frame, the health-monitoring programme. By using these strategies intertwined, the nurse can provide the child space within the given frame and, at the same time, fulfil his/her responsibility to promote children's health and development.

CONCLUSION

The results highlight nurses' challenging and complex assignment of guiding children to promote their engagement in the health visits, thereby enabling the nurses to promote the children's health and development according to the national health-monitoring programme.

Striving to Make a Positive Difference

In Sweden, school nurses are part of the School Health Service with the main objective of health promotion to support students’ health and attainment of educational goals. The aim in this phenomenological study was to illuminate the experiences of school nurses in promoting the health and well-being of adolescent girls. Seventeen school nurses were interviewed, both in groups and individually, to facilitate personal disclosure and expressions from their lived experiences. To achieve their goal of improving the health of adolescent girls, school nurses require flexibility in their approach and in endeavoring to make a positive difference they experience many challenges. This study concluded that school nurses can tactfully provide adolescent girls with knowledge and health guidance adjusted to individual needs and empowering the individual girl to participate in her own health process.

The influence of living conditions on adolescent girls' health

Adolescence is described by the Swedish National Board of Health and Welfare as the healthiest period in life. However, adolescent girls differ in that they self-report that their health decreases with age. The aim of this hermeneutical study was to describe the meaning of living conditions in relation to adolescent girls' health. Guided by principles of reflective lifeworld research, 15 interviews with adolescent girls were analysed. The result section consists of four narratives with their existential interpretations illustrating different ways of approaching living conditions and their meaning for health and well-being. The narratives are: Approaching everyday life in a balanced way--feeling harmonious; approaching everyday life with ambiguity--feeling confused; approaching everyday life as an intellectual project--striving for control; approaching everyday life as a struggle--feeling forlorn. In addition, a comprehensive understanding was developed by using the lifeworld dimensions: lived body, lived room, lived time, and lived relations. These dimensions may deepen the understanding of important parts of those living conditions which are meaningful for the girls' health and well-being. By using the dimensions, complex living conditions have been explored and the meaning of different parts clarified. The girls' thoughts and feelings are often ambiguous and sometimes contradictory, depending on the situation. The health of adolescent girls needs to be understood against the background of their experiences of living conditions. One way to support their health and well-being seems to be to supply them with forums where they can talk about their living conditions.

Health dialogues between pupils and school nurses: a description of the verbal interaction

OBJECTIVE

The purpose of this study was to explore and describe the content of and the verbal interaction in health dialogues between pupils and school nurses.

METHODS

Twenty-four health dialogues were recorded using a video camera and the conversations were analysed using the paediatric version of the Roter Interaction analysis system.

RESULTS

The results showed that the age appropriate topics suggested by national recommendations were brought up in most of the health dialogues. The nurses were the ones who talked most, in terms of utterances. The pupils most frequently gave information about their lifestyle and agreed with the nurses' statements. The nurses summarised and checked that they had understood the pupils, asked closed-ended questions about lifestyle and gave information about lifestyle. Strategies aimed to make the pupil more active and participatory in the dialogues were the most widely used verbal interaction approaches by the nurses.

CONCLUSION

The nurses' use of verbal interaction approaches to promote pupils' activity and participation, trying to build a partnership in the dialogue, could indicate an attempt to build patient-centred health dialogues.

PRACTICE IMPLICATIONS

The nurses' great use of questions and being the ones leading the dialogues in terms of utterances point at the necessity for a nurses to have an openness to the pupils own narratives and an attentiveness to what he or she wants to talk about.