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SCHOOL HEALTH NURSING: Perceiving, recording and improving schoolchildren’s health
Nordic Council of Ministers, Nordic School of Public Health NHV.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of schoolchildren’s health and to analyse factors influencing the recording of school-children’s health in the School Health Record (SHR). An additional aim is to evaluate fam-ily nursing interventions as a tool for the school nurses in the School Health Service (SHS). Methods: The thesis comprises four papers. A combination of qualitative and quantita-tive methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early ad-olescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separate-ly. Qualitative content analyses were used to analyze the interview text with the school nurs-es and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically. Findings: The findings showed that nurses judged the schoolchildren’s mental health as dete-riorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environ-ment and family relations. The latter seemed to be the most important factor affecting school-children’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the im-proper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families ex-perienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was sup-ported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families. Conclusions: The results indicate that school nurses have a deep knowledge about schoolchil-dren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would de-mand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level.

Place, publisher, year, edition, pages
Nordic School of Public Health NHV Göteborg, Sweden , 2008. , 66 p.
Series
Master of Science in Public Health, MScPH, ISSN 1404-904X ; NHV Report 2008:4
Keyword [en]
Schoolchildren’s health, school health service, school nurse, school health record, ethic, family, intervention, SDQ, Bronfenbrenner
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3479ISBN: 978-91-85721-35-1 (print)OAI: oai:DiVA.org:norden-3479DiVA: diva2:757633
Public defence
2008-05-08, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-10-23 Created: 2014-10-23 Last updated: 2014-10-23Bibliographically approved
List of papers
1. Family intervention sessions: one useful way to improve schoolchildren's mental health.
Open this publication in new window or tab >>Family intervention sessions: one useful way to improve schoolchildren's mental health.
2008 (English)In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 14, no 3, 289-313 p.Article in journal (Refereed) Published
Abstract [en]

This study examines the effectiveness of therapeutic conversations with families (through family sessions) in alleviating health complaints among adolescent girls in a school setting. Four girls with recurrent, subjective health complaints and their families were included in the study. Three sessions were held with each family, using genograms, ecomaps, interventive questions, and other family nursing interventions; practicing school nurses were also present. A therapeutic letter was sent to each family at the end of the sessions. The Strengths and Difficulties Questionnaire was used as a pre- and posttest measure. Evaluative interviews were carried out with the families and with school nurses. The families reported feeling relief and described positive affective, behavioral, and cognitive changes as a consequence of the interventions. The school nurses experienced the family sessions as time-saving and easy-to-use tools in their work. Involving the family when schoolchildren's recurrent mental health problems are addressed may reduce future suffering.

Keyword
Intervention research, family nursing, family intervention, school nursing, Calgary Family Assessment Model, Calgary Family Intervention Model, Illness Beliefs Model, therapeutic conversation, Swedish families
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3478 (URN)10.1177/1074840708322758 (DOI)18780887 (PubMedID)
Available from: 2014-10-22 Created: 2014-10-22 Last updated: 2014-10-23Bibliographically approved
2. Schoolchildren's health as judged by Swedish school nurses: a national survey.
Open this publication in new window or tab >>Schoolchildren's health as judged by Swedish school nurses: a national survey.
2008 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 7, 690-7 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: To use school nurses' knowledge and experience for a better understanding of schoolchildren's health problems and their association to socioeconomic background and gender.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Keyword
Family, gender, health complaints, mental health, schoolchildren, school health service, school nurse, socioeconomics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3476 (URN)10.1177/1403494808090671 (DOI)18684783 (PubMedID)
Available from: 2014-10-22 Created: 2014-10-22 Last updated: 2014-10-23Bibliographically approved
3. Ethical challenges for school nurses in documenting schoolchildren's health.
Open this publication in new window or tab >>Ethical challenges for school nurses in documenting schoolchildren's health.
2008 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 15, no 1, 40-51 p.Article in journal (Refereed) Published
Abstract [en]

This study explored Swedish school nurses' experiences of school health record documentation. Fifty per cent of a representative sample of Swedish school nurses (n = 129) reported difficulties with documenting mental and social health problems in family relationships, schoolchildren's behaviour, and school situations. Ethical considerations concerning fears of misinterpretation and practical barriers to documentation were expressed as reasons for their worries. Mental and social ill health is an increasing and often dominating problem among schoolchildren, thus proper documentation is a basic issue, both for individuals and for the population as a whole. School nurses obviously need professional guidance regarding documentation and ethical challenges. Systematic effort should be directed towards recognition and support of these nurses' unique opportunities to consider, follow and promote all aspects of schoolchildren's health.

Keyword
documentation, ethics, schoolchildren’s health, school nurses
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3477 (URN)10.1177/0969733007083933 (DOI)18096580 (PubMedID)
Available from: 2014-10-22 Created: 2014-10-22 Last updated: 2014-10-23Bibliographically approved
4. School nurses' view of schoolchildren's health and their attitudes to document it in the school health record--a pilot study.
Open this publication in new window or tab >>School nurses' view of schoolchildren's health and their attitudes to document it in the school health record--a pilot study.
2003 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 4, 392-8 p.Article in journal (Refereed) Published
Abstract [en]

This study highlights school nurses' view of schoolchildren's health and their attitude to document it in the school health records. A strategic sample of 12 school nurses was interviewed. The interviews were semistructured and analysed with qualitative content analysis. The findings showed that the school nurses' viewed schoolchildren as physical healthy although they called attention to growing problems related to a changed lifestyle. Psychosocial ill-health was however increasing and the most common reason for visiting the school nurse was psychosomatic expressions. According to the nurses' descriptions, health was related to the individual, the school and the family situation. The family situation was mentioned as one of the most important factors of schoolchildren's health. The nurses described no problem to document schoolchildren's physical health. Ethical consideration, tradition, lack of time and the structure of the record were however factors that were said to hinder the documentation of the psychosocial health. In order to promote, protect and recover schoolchildren's health, more research is needed about how beliefs, experience, ethical consideration and resources influence the school nurse's daily work with schoolchildren's health.

Keyword
School nursing, School Nurses’ Experience, Schoolchildren's Health, School Health Records, Family, Interview, Qualitative Content Analysis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3475 (URN)14629642 (PubMedID)
Available from: 2014-10-21 Created: 2014-10-21 Last updated: 2014-10-23Bibliographically approved

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