School Nurses’ perspectives on the role of the school nurse in health education and health promotion in England: a qualitative study

Background

The role of the school nurse is complex with many possible elements identified by previous research. The aim of this study is to understand perceptions of the role of the school nurse in order to support school nurses in the delivery of health education.

Methods

The study used an inductive, qualitative research design involving semi-structured interviews and focus groups. Participants were recruited from four NHS trusts across England and final sample size was thirty one school nurses. Three focus groups and two interviews took place in person, and three interviews were over the phone. Data was thematically analysed.

Results

School nurses described six main themes. Four themes directly related to the school nurse role: the main roles of a school nurse, school nurses' role in health education, prioritisation of workload and activities, and community work. A further two other themes related to the delivery of health education: the school nursing system and educational resources.

Conclusions

The role of the school nurse in England is very diverse and the school nurse role in health education is primarily to advise and support schools, rather than to directly deliver education. The study identified that tailored public health educational resources are needed to support school nurses.

     

What are the needs of frail older patients in the emergency department? A qualitative study

BackgroundThere is an increase in the number of frail elderly patients presenting to the emergency department. Diagnosis and treatment for this patient group is challenging due to multimorbidity, a-typical presentation and polypharmacy and requires specialised knowledge and competencies from healthcare professionals. We aim to explore the needs and preferences regarding emergency care in frail older patients based on their experiences with received care during Emergency Department admission.MethodA qualitative study design was used, and semi-structured interviews were conducted after discharge with twelve frail older patients admitted to emergency departments in the Netherlands. Data collection and analysis were performed iteratively, and data were thematically analysed.ResultsThe analysis enfolded the following themes; feeling disrupted, expecting to be cared for, suppressing their needs and wanting to be seen. These themes indicated a need for situational awareness by healthcare professionals when taking care of the participants and were influenced by the participants' life experiences.ConclusionFrail older patients feel disrupted when admitted to the emergency department. Because of this, they expect to be cared for, lessen their own needs and want to be seen as human beings. The impact of the admission is influenced by the extent to which healthcare professionals show situational awareness.     

Do universal school‐based mental health promotion programmes improve the mental health and emotional wellbeing of young people? A literature review

Aims and objectives

To examine evidence—using a range of outcomes—for the effectiveness of school‐based mental health and emotional well‐being programmes.

Background

It is estimated that 20% of young people experience mental health difficulties every year. Schools have been identified as an appropriate setting for providing mental health and emotional well‐being promotion prompting the need to determine whether current school‐based programmes are effective in improving the mental health and emotional well‐being of young people.

Methods

A systematic search was conducted using the health and education databases, which identified 29 studies that measured the effectiveness of school‐based universal interventions. Prisma guidelines were used during the literature review process.

Results

Thematic analysis generated three key themes: (i) help seeking and coping; (ii) social and emotional well‐being; and (iii) psycho‐educational effectiveness.

Conclusion

It is concluded that whilst these studies show promising results, there is a need for further robust evaluative studies to guide future practice.

Relevance to clinical practice

All available opportunities should be taken to provide mental health promotion interventions to young people in the school environment, with a requirement for educational professionals to be provided the necessary skills and knowledge to ensure that the school setting continues to be a beneficial environment for conducting mental health promotion.

     

Do Thai parents really know about the sexual risk taking of their children? A qualitative study in Bangkok

This qualitative study explores the perceptions of parents and adolescents toward sexual risk‐taking behaviors. In‐depth interviews were conducted with 30 parents and 30 adolescents (aged 13–14 years) in Bangkok, and were analyzed by using coding and thematic analysis. The results showed that although parents generally believed that Thai teens begin to have sex at an early age and engage in sexual risk‐taking behaviors , they trusted that their teens would follow parental guidance and rules and not engage in sexual activity at this age. Most of the Thai teens reported that their parents were not really aware of their sexual behaviors because of their tendency to keep their sexual stories secret for fear of being scolded, blamed, and punished. The teens also reported that they wanted their parents to listen, give them warmth and more freedom, and be more in touch with their activities. Parents expressed their need for knowledge and skills so that they could help guide their adolescent children to avoid sexual risk‐taking behaviors. A family intervention specifically aimed at empowering Thai urban parents is needed.     

An exploration of best practice in multi‐agency working and the experiences of families of children with complex health needs. What works well and what needs to be done to improve practice for the future?

Aims and objectives. This Appreciative Inquiry study aimed to explore appreciatively examples of best multi‐agency working practice with families (mothers, n = 20; fathers, n = 7; children, n = 1) and people working with children with complex needs (n = 41), to determine what works well, why it has worked well and what best practice in the future could be. Background. The term ‘children with complex health needs’ encompasses a diverse group of children and this population is increasing. This diverse group of children often requires high levels of physiological, psychological and social care which brings them and their families into therapeutic contact with a wide range of health, social and education professionals and people from other agencies. Design. The study used appreciative interviews, nominal group workshops and consensus workshops to develop a set of 10 ‘best practice’ guidelines that reflected the views of all participants. Two of these are discussed in detail in this article. All participants were seen as co‐researchers whose expert contributions were vital to understanding of what works well and what needs to be done in multi‐agency working practice. Results. The study resulted in ‘best practice’ statements that illuminated ‘what works well’ in multi‐agency working practice that spanned issues including information, decision making, communication, accessibility, collaboration, respect and sharing a common vision. Conclusions. The guidance that results from this study suggests that parents need the opportunity to share and receive support from other parents who understand the lived reality of caring for a child with complex needs. Parents and people from across various agencies need to work together to ensure that the most appropriate person acts in the role of a long‐term coordinator, where the family wants this aspect of support. This study adds a multi‐disciplinary and appreciatively oriented focus on what works well in complex care. It contributes to an understanding of the value of an Appreciative Inquiry approach within health‐care research. Relevance to clinical practice. The guidelines arose from and are grounded in practice and as such they provide clear, workable directions for enhancing practice and for considering what already does work well.     

Australian nurses in general practice,enabling the provision of cervical screening and well women’s health care services: a qualitative study

Background

The role of Australian general practice nurses (PNs) has developed exponentially since the introduction of service based funding in 2005. In particular, their role has expanded to include cervical screening and well women’s health care services provided under the supervision of a general practitioner (GP). While previous research identifies barriers to the provision of these services, this study sought to investigate enablers for nurse led care in this area.

Methods

A number of grounded theory methods including constantly comparing data, concurrent data collection and analysis and theoretical sampling are utilised in this qualitative, exploratory study. A purposive sample of PNs who completed the required program of education in order to provide cervical screening and well women’s health care services was recruited to the study. Data is presented in categories, however a limitation of the study is that a fully integrated grounded theory was unable to be produced due to sampling constraints.

Results

Four enablers for the implementation of a change in the PN role to include cervical screening and well women’s health checks are identified in this study. These enablers are: GPs being willing to relinquish the role of cervical screener and well women’s health service provider; PNs being willing to expand their role to include cervical screening and well women’s health services; clients preferring a female practice nurse to meet their cervical screening and well women’s health needs; and the presence of a culture that fosters interprofessional teamwork. Seven strategies for successfully implementing change from the perspective of PNs are also constructed from the data. This study additionally highlights the lack of feedback on smear quality provided to PNs cervical screeners and well women’s health service providers.

Conclusions

The influence of consumers on the landscape of primary care service delivery in Australia is of particular note in this study. Developing interprofessional teams that maximise each health care provider’s role will be fundamental to comprehensive service delivery in the future.

     

A question of competence? Re‐evaluating the roles of the nursing auxiliary and health care assistant in the NHS

This article draws from the first national sample survey evidence and detailed case studies of both the long-standing grade of Nursing Auxiliary/Assistant and of the new grade of 'Health Care Assistant/Support Worker' in the NHS. It argues for a fundamental re-evaluation of the real competencies of non-registered caregivers, and of their potential to progress into registered nurse training. The study demonstrates their real maturity, experience, competencies, roles and responsibilities, along with the extent to which they perceive themselves as 'substituting' for registered nursing staff. It is shown that many have been blocked from entering registered nurse training due to domestic and financial constraints. The rise of NVQ accreditation has now provided both the potential for a formal recognition of their experimental learning and also the means by which they might progress into registered nurse training or even along parallel--and more practice-orientated--lines. It is argued that registered nurses should welcome a more fluid and progressive role for these team members, since, failing such a welcome, managers will otherwise continue to 'undercut' registered staff with their 'cheaper' non-registered caregiving colleagues.     

Review of small rural health services in Victoria: how does the nursing‐medical division of labour affect access to emergency care?

Aims. This paper is based on a review of the Australian and International literature relating to the nursing‐medical division of labour. It also explores how the division of labour affects patient access to emergency care in small rural health services in Victoria, Australia. Background. The paper describes the future Australian health workforce and the implications for rural Victoria. The concept of division of labour and how it relates to nursing and medicine is critically reviewed. Two forms of division of labour emerge – traditional and negotiated division of labour. Key themes are drawn from the literature that describes the impact of a traditional form of division of labour in a rural context. Methods. This paper is based on a review of the Australian and international literature, including grey literature, on the subject of rural emergency services, professional boundaries and roles, division of labour, professional relationships and power and the Australian health workforce. Results. In Australia, the contracting workforce means that traditional divisions of labour between health professionals cannot be sustained without reducing access to emergency care in rural Victoria. A traditional division of labour results in rural health services that are vulnerable to slight shifts in the medical workforce, unsafe services and recruitment and retention problems. A negotiated form of division of labour provides a practical alternative. Conclusion. A division of labour that is negotiated between doctors and nurses and supported by a legal and clinical governance framework, is needed to support rural emergency services. The published evidence suggests that this situation currently does not exist in Victoria. Strategies are offered for creating and supporting a negotiated division of labour. Relevance to clinical practice. This paper offers some strategies for establishing a negotiated division of labour between doctors and nurses in rural emergency care.     

‘Do you have a future when you are 93?’ Frail older person’s perceptions about the future and end of life – a qualitative interview study in primary care

ObjectiveTo explore frail older persons’ perceptions of the future and the end of life.DesignQualitative content analysis of individual semi-structured interviews.SettingNine primary health care centres in both small and middle-sized municipalities in Sweden that participated in the intervention project Proactive healthcare for frail elderly persons.Subjects/PatientsThe study includes 20 older persons (eight women and 12 men, aged 76–93 years).Main outcome measuresFrail older persons’ perceptions of the future and end of life.ResultsThe analysis uncovered two main categories: Dealing with the future and Approaching the end of life. Dealing with the future includes two subcategories: Plans and reflections and Distrust and delay. Approaching the end of life includes three subcategories: Practical issues, Worries and realism, and Keeping it away.ConclusionThis study highlights the diverse ways older people perceive future and the end of life. The results make it possible to further understand the complex phenomenon of frail older persons’ perceptions on the future and the end of life.

KEY POINTS

• The study found that older persons described their future as contradictory- with a broad spectrum of approaches, where some wanted to deal with these subjects and others wanted to ignore them.
• •Older persons that consciously planned for the future had tactics that often were related to goals that functioned as motivators to live longer.
• •Those who adopted a more passive approach did not think about what the future might hold in terms of losing autonomy and deteriorating health.
• •Older persons that approached end of life in a more proactive way wanted to plan practical arrangements around death but often found it hard to address this issue with relatives.
• •Those older persons that had a more passive approach to end of life preferred not to think about those issues, and some explicitly stated that they did not want to address the final period of life.