Abstract
BackgroundThe 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.MethodsThis 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.ResultsThe 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.ConclusionsThe 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.
Highlights
The school nurse’s role varies across countries
The re-organisation was intended to refocus the role in order to deliver consistent and more efficient services across Scotland to address some of the fundamental causes of poor health and expressed need of school children and young people aged, 5–19 years by delivering safe, effective and person-centred care based on the national practice model of Getting It Right For Every Child (GIRFEC) [8]
The new role focuses on nine priority areas or pathways: mental health and well-being, substance abuse, child protection, domestic abuse, homelessness, looked after children, youth justice, young carers and transitions
Summary
The school nurse’s role varies across countries. In Scotland, the Chief Nursing Officer recommended that the role should be refocused. Within Scotland, the school nurse role forms part of the NHS school health service – a universally accessible service provided to children and young people, aged 5–19 years and their families. Operation of the school health service, including the school nurse role has varied greatly across Scotland These have comprised roles and interventions focused in schools, including a remit to vaccinate all school aged children, as well as those with a wider public health and community function. The re-organisation was intended to refocus the role in order to deliver consistent and more efficient services across Scotland to address some of the fundamental causes of poor health and expressed need of school children and young people aged, 5–19 years by delivering safe, effective and person-centred care based on the national practice model of Getting It Right For Every Child (GIRFEC) [8]. As part of the NHS, school nurses have access to a child’s clinical record and will record all referrals and their outcomes into the primary care database as well as into a specially developed national core minimum dataset for school nursing
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