School nurses' perceived capability, opportunity, and motivation to provide health promotion: A convergent mixed-methods study.

BackgroundFinnish schools are forerunners in promoting health for children, adolescents, and families, offering a range of dedicated services in schools to support this mission. Since services offered in schools can play a crucial role in promoting health amongst students and their families, it's essential to evaluate and improve these health promotion services to better meet the needs of users. School nurses are a vital part of the health promotive and preventive work, governed by law, offered to all students in Finnish compulsory schools. However, scarce research exists in a European context regarding the school nurses’ work in health promotion, especially focusing on their own experiences regarding health promotion actions.MethodsThis study investigates school nurses’ own views on their health promotive role, responsibility, and work in compulsory schools through qualitative interviews with school nurses (n = 13) in Finland, using qualitative content analysis guided by Granheim and Lundman.ResultsPreliminary results highlight the complexity of the school nurses’ work in Finnish compulsory schools. The tasks performed by the nurses vary from care assessments and health check-ups, to complex case solving in collaboration with different stakeholders. The school nurses highlight the importance of adopting a health promotive approach in every individual interaction, striving to provide children, adolescents and families with a low threshold contact available at school. They express the need to see and care for the students in a holistic way, including improving health and wellbeing at a general level in schools.ConclusionsThe study provides insight into the school nurses’ experiences regarding their role in providing health promotion in compulsory school settings. School nurses strive to have a health promotive approach in every encounter, wishing for more resources and time to get involved in health promotion on a general level in the school environment.Key messages• School nurses experience being a vital part of efforts aimed at improving health and well-being within the school environment, but request more time and resources for general health promoting actions.• By examining nurses’ views of their contribution to the students’ health promoting services, development opportunities can be located and examined to support nurses’ health promoting work in schools.

OF DISSERTATION THE ROLE AND IMPACT OF SCHOOL NURSES AND INTENTIONS TO DELEGATE DIABETES-RELATED TASKS AMIDST BUDGET CUTS AND LEGISLATIVE CHANGES As the percentage of school children with chronic conditions such as diabetes continues to rise, funding for school nurses to keep those students healthy and safe is decreasing. This dissertation includes three studies: (1) a systematic review of the literature on the role and impact of American elementary school nurses, (2) a focus group study that further examined the role of Kentucky school nurses and described their reaction to a new regulation that necessitates delegation of diabetes-related nursing tasks to unlicensed assistive personnel (UAP), and (3) a quantitative study that examined Kentucky school nurses’ past behaviors and future intentions regarding the delegation of diabetes-related tasks. A systematic review of the literature revealed that activities of school nurses can be conceptualized into four major areas: (a) health promotion and disease prevention; (b) triage and treatment of acute issues (e.g., injuries and infectious diseases); (c) management of chronic conditions; and (d) psychosocial support. School nursing activities are associated with increased attendance, higher quality schools, and cost savings. Focus groups in three regions of Kentucky found that Kentucky school nurses fulfill the same major roles as their counterparts across the nation, and face similar challenges such as lack of time, limited resources, language barriers, and communication issues with families. School nurse participants described their biggest impact on students as identifying and addressing students’ physical and psychosocial barriers to learning. While recent legislation was passed in Kentucky necessitating the delegation of insulin administration to UAP, school nurses had not experienced many changes at the time of the focus groups. However, some nurses said that their districts were not planning to delegate insulin administration and intended to keep a nurse in every school. Others appreciated the prospect of having more trained staff in schools to recognize signs of distress in chronically ill students. A statewide survey of 111 Kentucky school nurses indicated that nurses’ past delegation behaviors and future intentions related to delegation are rooted in the level of skilled decision-making that must occur and the risk to the student if the wrong decision is made. Unfortunately, school nurses’ intentions to delegate higher-stakes tasks (e.g. carbohydrate counting, insulin dose verification, and insulin administration) were significantly stronger than their support for (attitude related to) delegation of those tasks, which is disconcerting both for the safety of students as well as for the liability retained by delegating nurses. This disparity between support and intentions indicated that school nurses anticipate that they will have to delegate certain tasks to UAP despite their discomfort with delegating them, most likely due to high workload and lack of resources. Additional studies should be undertaken to determine the impact of legislative changes on the delivery of school health services in Kentucky and other states, particularly once school districts and nurses have had adequate time to adjust to new laws. Such studies should investigate to whom nurses are delegating health services, what tasks are being delegated, and the extent and process of training that UAP receive. Future surveys should utilize perceived behavioral control items that assess situational control (e.g. policy, workload) over delegation rather than, or in addition to, efficacy of individual skills required for delegation of nursing tasks. Researchers must further explore the discrepancies between attitude and intentions; that is, why are nurses planning to delegate tasks to UAP if they do not support the delegation of those tasks? Kentucky school nurses are champions of health promotion for children, not only in their provision of health services and health education, but also in the area of school health policy. School nurses should train UAP so that more school staff can recognize signs of distress in students with diabetes, but at the same time should continue to advocate and seek funding for a nurse in every school with the help of the Every Student Succeeds Act.

To identify new and accelerated modes of practice used by school nurses during the COVID pandemic. To create a quick reference infographic bringing together experiential evidence on the range and considerations regarding different modes of practice for use by the school nursing community of practice. A descriptive qualitative secondary data analysis of open-ended questions in a survey, and focus groups with school nurses. The pragmatic aim was to focus on changes in school nurse modes of practice to ensure continued engagement with children and young people, and school nurses' experience of the benefits and challenges of these modes of practice. Data were collected from 98 school nurse participants across a United Kingdom-wide survey (n78) in April to May 2022, and focus groups (n20) in June to July 2022, within the School Nursing in the Time of COVID project. Data from the seven open-ended questions in the survey and four questions from the focus group were analysed using the framework approach. Modes of practice fell into two categories: individual assessment and support (video-calling platforms, telephone contact, virtual messaging, walk-and-talks and home visits) and group support (wellbeing approaches, social media). Considerations for these modes rooted in school nurses' experience are described. Interpretations were used to create the summarising evidence-based infographic as a quick reference resource for school nurses. There was no 'one size fits all' approach. The modes used by school nurses were adopted or developed out of necessity or resource availability and in response to the specific needs of individuals or groups. The developed infographic provides a quick reference guide to deliver the expressed need for knowledge exchange within the school nursing community by participants in the original studies and can be used to inform current school nurse practice. The developed evidence-based infographic has stand-alone value. It has the potential to raise awareness of the range of different strategies that can be used to facilitate and/or enhance engagement with children and young people, equip school nurses with knowledge to foster innovative and responsive practice and aid critical reflection in a complex post-pandemic landscape. The infographic is a unique resource and is a first step in knowledge exchange based on experiential learning. The resource will be used as the foundation for future work to develop a co-created training resource for school nurse students (undertaking the Specialist Community Public Health Nurses course) and/or continuing professional development resource for established school nurses. This study has been conducted and reported in accordance with COREQ guidelines for qualitative research. A consultation group was closely involved with the planning, conduct and analysis of the original studies. This group consisted of representatives from professional organisations SAPHNA (School and Public Health Nurses Association) and the CPHVA (Community Practitioners' and Health Visitors' Association), a school nurse and a member of the public. SAPHNA have continued in their consultative role for this study and has provided content and usability feedback regarding the infographic. Early findings have been presented to the SN community of practice, and feedback invited, through presentation separately at the CPHVA and SAPHNA annual conference.

Background All children in Sweden are invited to health visits to the school nurse to talk about their health. However, health visits with children of foreign origin might involve challenges when the child and school nurse do not share language and or culture. Such challenges might hinder the child's participation as e.g. sharing needs and experiences important for their health. Hence, school nurses' promotion of participation for these children need to be clarified to develop knowledge on how to promote health. The aim was to investigate school nurses' descriptions of promoting participation for children of foreign origin in health visits. Methods A cross-sectional study was conducted, using a web-based questionnaire distributed to all school nurses in Sweden. It contained eight open-ended questions regarding promotion of participation for children of foreign origin. Answers were provided by 673 Swedish school nurses and analyzed using qualitative content analysis. Results The preliminary result shows that school nurses use three approaches to promote participation: 1) adjusting according to the child's proficiency in Swedish and/or cultural or national background, 2) adjusting according to the child's individual needs, and 3) doing the same for all children regardless of their origin. These approaches are used throughout the health visit, although the most commonly was number 1. Such adjustments included the school nurse considering cultural aspects, simplifying their way of talking, or asking the child about their culture or background. Conclusions Adjustment according to the child's proficiency in Swedish and/or cultural or national background are warranted to promote participation in health visits with children of foreign origin. These will strengthen the opportunities for children to share their experiences as well as the encounter between school nurses and children. Key messages School nurses adjust promotion of participation when encountering children of foreign origin. Adjusting promotion of participation in health visits will enable children to share their health needs.

Background: Over the last few decades, there has been an increase in mental health problems among adolescents, manifested as physical symptoms, such as stomach pain, headaches, feelings of anxiety, worry, stress and sleeping problems. Surveys among school nurses’ have revealed that mental health work now forms a key part of their role. Although an increasing number of adolescents are suffering from mental health problems in upper-secondary schools (16-19 years), there are few studies focusing on this matter. Therefore we wanted to explore the matter from the school nurses’ point of view. The aim of this study was to explore Swedish school nurses’ experiences of caring for and promoting the health of students suffering from mental health problems.Methods: The present study had a descriptive design and a qualitative approach. A purposeful sample of eight (n = 8) school nurses was interviewed. Their working experience varied between 4 and 29 years. The data were analysed using content analysis. The ethical principles stipulated by the Swedish Research Council were carefully followed throughout the study.Results: Three main themes with sub-themes were found: A caring relationship as the foundation for health promotion, organizing health-promoting work and interprofessional cooperation as a prerequisite for good caring.Conclusions: The findings strengthen the evidence of the importance of the health dialogue as a tool for the school nurses to identify students with mental health problems. Creating a caring relationship with the students is a prerequisite for caring and health promotion. Further education concerning mental health and evidence-based-practice should be arranged on regular basis. More research and cooperation between different stakeholders is needed.

In this convergent mixed-methods study, the aim was to explore how objective and subjective quality ratings of school nurses’ motivational interviewing (MI) correlate whilst also considering the perceptions of delivering and participating in the same MI sessions. Quantitative and qualitative data were derived from seven intervention schools participating in the Healthy School Start Plus parenting support intervention. School nurses were trained in MI and conducted an MI session with parents of 6–7-year-old children to discuss children’s physical health and development. Quantitative data comprised objective ratings of school nurses’ MI competence using the Motivational Interviewing Treatment Integrity 4.2 [MITI-4] protocol, as well as parents’ and school nurses’ subjective ratings of the MI sessions. Qualitative data comprised semi-structured interviews with parents and school nurses about their perceptions of the MI sessions. First, quantitative data were analysed using Spearman’s rank correlation, and qualitative data were analysed using content analysis. Next, quantitative and qualitative findings were merged. Our findings suggest that school nurses’ MI performances were rated and perceived as valuable and family-centred by both school nurses and parents who had left the meeting feeling motivated and empowered to promote their children’s healthy behaviours. Nonetheless, school nurses were critical to their own MI technical performance, and they found that reflections were easier to deliver and to self-rate. Overall, MITI ratings were the lowest and parents’ ratings were the highest. Future studies should focus on relating clients’ subjective ratings of MI with clients’ behavioural outcomes.

To use school nurses' knowledge and experience for a better understanding of schoolchildren's health problems and their association to socioeconomic background and gender. Mail questionnaires were sent to a nationally representative, random sample of Swedish school nurses (n=129). The questionnaire included structured and open-ended questions asking for school nurses' judgement of schoolchildren's health status; changes over the previous two years; estimation of schoolchildren's most common reasons for consulting the school nurse; and estimation of factors influencing schoolchildren's health. Swedish school nurses judged schoolchildren's mental health to have deteriorated during the previous two years with increasing health complaints, especially among girls and in disadvantaged housing areas. Disturbed family relations were considered as one important explanatory factor. Girls were more inclined to consult school nurses with subjective health complaints. Boys more often consulted the nurses with physical injuries. School nurses work closely with the children and meet them continuously during the school age period. They have a genuine knowledge of schoolchildren's health, which should be used even more, both in research and practice. The results may be applicable in other countries with similarly organized school health systems.

Traditionally, health protection and health promotion activities have operated independently of each other in the workplace. Health protection has usually been viewed as encompassing the activities that protect workers from occupational injury and illness ranging from basic safety training to the us

PurposeThis study aims to evaluate the participation and satisfaction of learners with the brief “Mental health promotion in school health care” e-learning course, and to describe factors related to their participation and satisfaction.Design/methodology/approachA convergent mixed-method study with a descriptive, posttest-only design was conducted in Finland. Quantitative data was collected from the learning portal data and via an electronic feedback questionnaire and qualitative data in four focus group discussions.FindingsThe three modules of the course were opened altogether 12,922 times during the 21 months period. The identified factors influencing participation within the course were: favorite methods attracting attention, the relevance of additional information and postprocessing boosting diligence. The learners’ satisfaction with the course was high. The factors identified for improving satisfaction were: filling gaps in earlier education, clear and concise structure and content, inspiring and interesting design and suitability for clinical use. In addition to the primary target group (school nurses), the course was well-participated and evaluated as satisfying among other health and social care professionals as well as undergraduate students.Originality/valueThis study demonstrates demand for brief, fully online mental health trainings among school nurses, but also among other health and social care professionals and students. The results indicate that learners perceive such training as beneficial. This paper also presents a novel training intervention and its pedagogical base.

Most adolescents are insufficiently physically active and technology use has become a crucial part of people's lives. School nurses have a key role in health promotion. The purpose of this study was to determine the associations between school nurses’ lifestyle counseling competence (specifically, their competence in counseling students on physical activity and technology use) and various potentially related factors (including the background of the nurses, the time spent on counseling during a working day, and the nurse’s education on physical activity and technology use). To our best knowledge, there is no up-to-date information about school nurses’ counseling concerning physical activity and technology use. A cross-sectional study design was used. Data were gathered by surveying nurses working in school or student healthcare (n = 116) in Finland during the autumn of 2017. The data were analyzed using descriptive statistics, non-parametric tests, and logistic regression analysis. The survey included one open-ended question which was analyzed by performing inductive content analysis. Over half (58.6%) of respondents assessed that the competence in physical activity and technology use counseling is overall good. 85.3% of the respondents evaluated their physical activity counseling skills and 62.9% technology use counseling skills to be good. Only 33% of the nurses knew how to identify adolescents needing counseling concerning technology use. Education on physical activity and recreational technology use was more relevant than age in explaining nurses' counseling knowledge and skills. School nurses reported that there is a need to develop skills and tools for counseling adolescents about the recreational use of technology. The results highlighted three factors which limited the development of couseling; a lack of resources; a need for more education; and a lack of clear, consistent policies and tools for adolescents’ lifestyle counseling. There is also a need for more multi-professional cooperation and time for counseling. The results presented herein could be used in designing targeted interventions and education in school and student healthcare and with it to improve the lifestyle counseling offered by school nurses.

Aim: The purpose of this research is to examine School Based Youth Health Nurses experience of health promotion. Background: The School Based Youth Health Nurse Program is a state-wide school nursing initiative in Queensland, Australia. The program employs more than 100 fulltime and fractional school nurses who provide health services in state high schools. The role incorporates two primary components: individual health consultations and health promotion strategies. Design/Methods: This study is a retrospective inquiry generated from a larger qualitative research project about the experience of school based youth health nursing. The original methodology was phenomenography. In-depth interviews were conducted with sixteen school nurses recruited through purposeful and snowball sampling. This study accesses a specific set of raw data about School Based Youth Health Nurses experience of health promotion. The Ottawa Charter for Health Promotion (1986) is used as a deductive framework for analysis. Results: The findings indicate school nurses have neither an adverse or affirmative conceptual experience of health promotion and an adverse operational experience of health promotion based on the action areas of the Ottawa Charter. Conclusions: The findings of this research are important because they challenge the notion that school nurses are the most appropriate health professionals to do school health promotion. If school nurses are the most appropriate health professionals to do school health promotion, there are implications for recruitment and training and qualifications. If school nurses are not, who are the most appropriate health professionals to do school health promotion ? Implications for Practice: These findings can be applied to other models of school nursing because they relate specifically to school nurses’ experience of health promotion.

Highlights From the Creating Healthy Work Environments Conference

Health promotion, as defined by the Ottawa Charter (1) is the ‘process of enabling people to increase control over, and to improve their health’. Four life style risk factors: smoking, alcohol, obesity and physical activity are recognised as leading to health inequalities. These factors have implications at an individual, community and national level and the burden of disease has large cost implications for the NHS and country as a whole. Therefore the assessment of these risk factors, and the provision of good health promotion assist to address these problems. A pilot and initial audit demonstrated that assessment for the key life style risk factors and the provision of health promotion was poor. This quality improvement audit developed an easy to use, checklist based, amended clerking document. This improved both assessment and provision of health promotion and will be carried forward to influence the designing of a new clerking document.

To examine competencies, attitudes, barriers and factors that influence the provision of mental health services by nurses in schools and higher education institutions in the post COVID-19 era in Taiwan. This cross-sectional study used nationwide proportionate stratified random sampling to recruit nurses from K-12 schools and higher education institutions. Data were collected through an online survey administered between July and December 2024, with 305 responses received (response rate = 46.4%). Among the respondents, 55.1% provided advanced mental health services, while 38.3% delivered basic mental health services. The main barriers to the delivery of mental health services were lack of mental health-screening training (63.3%), insufficient brief screening tools (46.2%) and time constraints (42.6%). Nurses in junior and senior high schools were 5.78 and 3.07 times more likely, respectively, to provide advanced mental health services compared to those in universities. Furthermore, significant predictors of the provision of advanced mental health services included working in junior or senior high school, higher competence, and more positive attitudes; perceiving time constraints was a significant barrier. Working in junior and senior high school settings was the most significant predictor of delivering advanced mental health services. These results underscore the need for targeted professional training, enhanced resources, and inter-professional collaboration to improve the quality of school-based mental health services. Enhancing the attitudes and competencies of nurses in schools and higher education institutions towards mental health care is essential. Training should target nurses working in junior and senior high schools. Administrators must improve workflows, provide better tools and address barriers such as time constraints and limited referrals to support students' mental well-being. This study adhered to the relevant cross-sectional EQUATOR STROBE guidelines. No Patient or Public Contribution. This study examined the barriers to mental health service delivery among nurses in schools and higher education institutions and identified key determinants influencing their provision of such services. Nurses in schools and higher education institutions face challenges in providing mental health services due to a lack of mental health training, insufficient brief screening tools and time constraints. Advanced services were more common in junior and senior high schools, with competence and attitude being key predictors of their delivery.

IntroductionThe World Health Organization has reported that one fifth of all children in the world suffer from poor mental health regardless of cultural differences. Previous studies have shown that working with mental health is an important part of the duties of school nurses in Sweden.ObjectiveThe aim of the present study was to describe the experiences of school nurses regarding the identification of mental illness among pupils in primary school.MethodsIn this inductive qualitative study, interviews were conducted with 11 school nurses in southern Sweden and analyzed using content analysis.ResultsThe results indicate three major themes: (1) the need for shared responsibility, (2) feelings of uncertainty and inadequacy in school nurses, and (3) the importance of establishing relationships.ConclusionThis study indicates that school nurses feel responsible for their pupils’ well-being, but also feel that they need support. A lack of guidance in identifying mental illness emerged from the interviews.