Health education: an important role for school nurses.

Health education is an important, yet challenging and time-consuming, nursing intervention. It is one of the most important tools school nurses have in teaching students, families, and staff about health. To be effective health educators, nurses need skills in planning and implementing attractive and effective programs to students. They also need to develop skills in evaluating the effectiveness of their efforts to emphasize the impact school nursing can have on the health of children. This editorial highlights the school nurse's role in health education in schools and gives a brief overview of the health education process. Health education provides many opportunities for school nurses to reach out in new and creative ways to students in their quest to promote health and success in the school environment.     

A qualitative study of nurses' attitudes and practices regarding brief alcohol intervention in primary health care

BACKGROUND: Excessive alcohol consumption causes significant mortality, morbidity, economic and social problems in the United Kingdom (UK). Despite strong evidence for the effectiveness of brief intervention to reduce excessive drinking in primary health care, there is little indication that such intervention routinely occurs. AIMS: This study aimed to explore primary health care nurses' attitudes and practices regarding brief alcohol intervention in order to understand why it is underexploited. METHODS: The study design was qualitative, using a grounded theory approach to data collection and analysis. Semi-structured in-depth interviews were conducted with 24 nurses from practices that had previously been involved in a General Practitioner (GP) led brief alcohol intervention trial in the North-east of England. A combination of convenience and purposive sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. RESULTS: It was clear that although primary health care nurses have many opportunities to engage in alcohol intervention, most have received little or no preparation for this work. This has left nurses at a disadvantage as alcohol consumption is a confusing and emotive area for both health professionals and patients. An analysis of factors influencing nurse involvement in alcohol intervention outlined a requirement for clear health messages about alcohol, training in intervention skills, facilitation to enhance confidence regarding intervention and support to help deal with negative patient reactions. CONCLUSIONS: As current health policy is to encourage, sustain and extend the health promotion and public health role of primary care nurses, more attention should be given to providing them with better preparation and support to carry out such work.     

What are the criteria that mentors use to make judgements on the clinical performance of student mental health nurses? An exploratory study of the formal written communication at the end of clinical nursing practice modules

Issues concerning the assessment of student nurse performance in clinical practice have pre-occupied nurse educationalists for some time and continue to pose problems. The debate in the nursing literature tends to revolve around two seemingly mutually exclusive positions related to competence vs. learning outcomes. These are views that seem to be held by academics with little reference to clinical nurses who have responsibility for the assessment of student performance in clinical practice. This paper adds to the wider debate on clinical assessment by reporting on a small research study that explored the written comments that 150 mentors made in relation to the performance of student mental health nurses following periods of clinical practice. An extensive literature review is provided in order to place the debate in context, followed by a brief outline of the research study, its findings, discussion and conclusion. This analysis of findings demonstrates that student learning is of major concern to mentors, and that the assessment of student performance in clinical practice is not restricted by pre-determined behavioural learning outcomes. Personal characteristics of students exert a great influence on judgements about clinical performance. This paper does not offer solutions to the search for the perfect clinical assessment, but it does call for an increased dialogue between educationalists and mentors to discuss the implications of this research for the development of an appropriate clinical assessment tool.     

The impact of school nursing on school performance: a research synthesis.

School nurses work in an educational setting. Due to budget cuts, different goals, and confusion between educators and nurses regarding the school nurse role, school nurses are being asked to demonstrate their effectiveness and justify their presence in elementary and secondary schools. Although school nursing was first initiated 100 years ago, a review of the literature published since 1965 indicates that 15 studies have been conducted that examine the impact of school nurses on academic performance. However, today many articles have recommended more research linking school nursing to educational outcomes. This article synthesizes the results of 15 research articles. Findings from these studies indicate that nursing interventions targeted at specific populations, including parents, have had significant effects. A relationship between school nurses' interventions and absenteeism is also suggested. Limitations of these studies are discussed, along with suggestions for future research.     

Brief reports for disseminating systematic reviews to nurses

Much has been written about the importance of using research findings to guide nursing practice. How to best disseminate those findings to nurses remains a challenge. In many clinical settings, nurses interested in research utilization and evidence-based practice retrieve, review, and integrate knowledge from research reports to guide decisions about best practices. Major barriers to this approach, however, are staff nurses' lack of time, expertise, and resources for this process. One approach to overcoming these barriers is to disseminate the results of systematic research reviews directly to nurses in the form of brief reports, written in an easy-to-understand style, and sent via e-mail. This article describes the development of brief reports as a strategy for disseminating the results of systematic reviews to staff nurses. To demonstrate the use of brief reports for this purpose, we chose a systematic review published in the Cochrane Database of Systematic Reviews.     

Research utilization and attitudes towards research among psychiatric nurses in Northern Ireland

Evidence-based practice depends on a number of factors including practitioners' attitudes towards, and knowledge of, research, the availability and access to relevant research, adequate resources and managers' support. Yet little is known about these issues with regard to psychiatric nurses. The aim of this study was to survey psychiatric nurses on their attitudes to research, their perceptions of their use of research and other research-related activities. This paper reports data collected from a convenience sample of 236 nurses from the six main psychiatric hospitals and from the psychiatric wards of six general hospitals. The results show that, while they report positive attitudes towards research, their perception of their use of research in practice indicates that evidence-based practice is far from being realized. There is also some evidence to suggest that psychiatric nurses' reported extent of research utilization and frequency of reading research literature in this study are lower than those of general nurses. The implications of these and other findings are discussed.     

Knowledge of school nurses in the u.k. Regarding sexual health education.

In the U.K., a current government health strategy indicates that school nurses should be key contributors to sexual health education because they have access to the school-age population. However, there appears to be little research that investigates whether school nurses are the most appropriate health care professionals or indeed have sufficient knowledge to contribute to this topic in the schools. The purpose of this study was to examine the sexual health knowledge of school nurses, using a survey to assess school nurses employed in a large central region of the U.K. The results suggest that although their general knowledge of the topic was adequate, school nurses have insufficient knowledge to effectively teach about sexually transmitted infections or emergency contraception. This has implications for school nursing because it appears that school nurses may have inadequate knowledge about sexual health to contribute to sex education in schools.     

Talking about sex as part of our role: Making and sustaining practice change

Sexual issues are common for consumers of mental health services and have many adverse consequences for quality of life as well as impacting negatively on the mental illness itself. Nurses in mental health settings are well placed to assess for the presence of and provide interventions for sexual concerns. To date, little research has been undertaken to explore nurses' attitudes and whether sexual issues would be accepted as part of their care. This paper presents findings from the third stage of a qualitative, exploratory research study with mental health nurses working in an Australian mental health service. The findings from the first two stages suggested that the participants had tended to avoid discussion of sexual issues, but a brief education intervention had produced a greater willingness to address sexual issues as part of care. The aim of the third stage was to determine the degree to which changes in practice had continued over time. Two main themes that emerged from this data were: (i) holism, from rhetoric to reality; and (ii) part of what I do. Addressing sexual issues became part of practice, a change sustained 2 years following the intervention, because participants recognized its importance for holistic nursing care.     

How prevalent is violence towards nurses working in general hospitals in the UK?

BACKGROUND: Violence in nursing is not a new phenomenon but in recent years much greater emphasis has been placed on the problem in the United Kingdom (UK). A number of official reports, media stories and national initiatives have focused attention on the problem in this country. However, it is not clear whether violence and abuse have in fact become more prevalent. At present little is known about the scale of the problem for general nurses working in general hospitals in the UK. AIM OF THE STUDY: A realistic assessment of the scale of this problem should facilitate a meaningful debate about the interventions needed to counter it and support the requests for funding that will be required. This study aimed to establish the utility of existing research findings, to include relevant but previously unused sources and to synthesize the results. METHOD: A systematic search of the literature pertinent to the aim of the study was followed by a critical review. The focus was on research originating in the UK, including some general research on occupational violence which included data on nurses. FINDINGS: Overall, the research findings are limited. The best available evidence suggests nurses as a whole do face a high level of risk compared with all workers and this excess risk holds for general nurses. The data support a figure of more than 9.5% of general nurses working in general hospitals assaulted (with or without injury) in any 1 year. Trends over time are impossible to identify at present. CONCLUSIONS: Efforts to combat the problem should include greater emphasis on the problem outside accident and emergency departments, prioritizing preregistration training in the management of aggression, and further research. Better reporting should also be a priority.     

The aspects school health nurses find important for successful health promotion

Scand J Caring Sci; 2010; 24; 156–163
The aspects school health nurses find important for successful health promotion
Background:  The work of school health nurses has changed over time; today they focus on health promotion, i.e. encouraging and protecting pupils' health.
Aim:  The aim of this study was to explore school health nurses' conditions for health promotion work with pupils aged 13–15 years.
Methods:  Eight school health nurses from eight different municipalities in Sweden were interviewed. Since the focus was on describing school health nurses' own experiences of their conditions for health promotion work, the research method used was based on Graneheim and Lundman's qualitative content analysis.
Results:  The results showed that conditions for school health nurses' work with health promotion varied between the different municipalities. This had an influence on what they did and the extent to which they worked in this way. The school health nurses described three important aspects that were essential in order to enable successful health promotion work in schools: organisation, support and knowledge. Organisation : It was important to understand the role of school health nurses and the conditions for health promotion work. Without this, they could only work on an individual level. Support : A network of other professions, working in close collaboration for the health of the pupils, created an understanding of ill health and what could be done to promote health. Knowledge : Most school health nurses recognized a lack of general theories and methods, leading to different empirical working methods in the municipalities.
Conclusion:  In an organisation where the need for health promotion work was understood, and school health nurses had support and knowledge, health promotion could be performed not only on an individual- but also on a general level.     

Factors influencing the effectiveness of clinical supervision

Clinical supervision is widely accepted as an essential prerequisite for high quality nursing care. This paper reports findings from a study that aims to identify the factors that may influence the effectiveness of clinical supervision for community mental health nurses (CMHNs) in Wales, UK. Two hundred and sixty (32%) CMHNs from an estimated total population of 817 completed the Manchester Clinical Supervision Scale (MCCS) and a demographic questionnaire. The MCCS is a 36-item questionnaire measuring the quality and effectiveness of the supervision received. Three-quarters of CMHNs reported having participated in six or more sessions of supervision in their current posts. Clinical supervision was more positively evaluated where sessions lasted for over one hour, and took place on at least a once-monthly basis. Perceived quality of supervision was also higher for those nurses who had chosen their supervisors, and where sessions took place away from the workplace. These findings have important implications for the organization and delivery of mental health nursing services.     

Effectiveness of nurse-led brief alcohol intervention: a cluster randomized controlled trial

AIM: This paper reports an evaluation of the effectiveness and cost-effectiveness of nurse-led screening and brief intervention in reducing excessive alcohol consumption among patients in primary health care. BACKGROUND: Excessive alcohol consumption is a major source of social, economic and health problems. However, such consumption is responsive to brief alcohol intervention. To date, brief intervention research in primary health care has focused on general practitioner-led interventions, and there is only circumstantial evidence of effectiveness in nurse-led interventions. However, nurses are increasingly taking a lead in health promotion work in primary care. METHODS: A pragmatic cluster-randomized controlled trial was carried out between August 2000 and June 2003 to evaluate the effects of a brief intervention compared with standard advice (control condition). A total of 40 general practice clusters (intervention = 21 and control = 19) recruited 127 patients (intervention = 67 and control = 60) to the trial. Excessive consumption was identified opportunistically via the Alcohol Use Disorders Identification Test. After baseline assessment, patients received either a 5-10 minutes brief intervention using the 'Drink-Less' protocol or standard advice (control condition). Follow-up occurred at 6 and 12 months postintervention. RESULTS: Analysis of variance weighted for cluster size revealed no statistically significant differences between intervention and control patients at follow up. A majority of patients in both conditions reduced their alcohol consumption between assessment and subsequent measurement. Economic analysis suggested that the brief intervention led to no statistically significant changes in subsequent health service resource use relative to standard treatment. CONCLUSION: The brief intervention evaluated in this trial had no effect over standard advice delivered by nurses in primary health care. However, there was a reduction in excessive drinking across both arms of the trial over time. Due to nurse drop-out, this trial was significantly underpowered. Future research should explore barriers to nurses' involvement in research trials, particularly with an alcohol focus. A larger trial is required to evaluate the effectiveness of nurse-led screening and brief alcohol intervention in primary care.     

Influencing mental health nursing practice through the teaching of research and theory: a personal critical review

This paper will critically review the factors that influence the teaching of theory and research to mental health nurses. Following a brief historical review it is asserted that current educational approaches fail to address the complexity and context-dependent nature of mental health nursing practice. The author then argues for a radical approach to education which will enable students and practitioners to engage critically in deconstructing and developing theories that illuminate and help us understand the multiple realities of our post-modern professional world. In conclusion, the author provides an example of a casework-based curriculum that emphasizes the ways in which clinical experience with clients in a range of contexts should be the main focus of knowledge and skill development for the emerging profession of mental health nursing.     

Adolescent smoking cessation: development of a school nurse intervention.

The purpose of this study was to examine the feasibility of a range of strategies to engage and to enhance secondary school nurse involvement in teenage smoking prevention and cessation. School nurses were willing to assist students to quit smoking, but they felt unprepared. Information provided by nurses involved in a three-stage review, pilot-testing, and trial design resulted in the development of a resource for nurses. This resource comprised individual student approaches (brief intervention based on motivational interviewing and written activities designed to help students examine their smoking behavior), approaches to assist parents (letter of support for parents of students who smoke), and school newsletter items. Each component of the resource was found by school nurses to be appropriate, useful, and complementary to their other school- wide approaches to assist adolescents to quit smoking. Nurses also reported an interest to expand or to enhance their smoking cessation role in the school.     

A multi-factor analysis of job satisfaction among school nurses.

Although job satisfaction has been widely studied among registered nurses working in traditional health care settings, little is known about the job-related values and perceptions of nurses working in school systems. Job satisfaction is linked to lower levels of job-related stress, burnout, and career abandonment among nurses. This study evaluated the level of job satisfaction among a convenience sample of school nurses practicing in California. The Index of Work Satisfaction (IWS) was the instrument used. Although the sampled school nurses rated autonomy and interaction as the most important and satisfying factors contributing to job satisfaction, the overall findings indicated that school nurses are relatively dissatisfied with their jobs.     

Addressing the issue of e-learning and online genetics for health professionals

Health-care professionals need an appropriate genetics knowledge base to care for patients and their families. However, studies have indicated that nurses and midwives lack the requisite genetics knowledge to practice effectively and safely, with a paucity of resources to address their educational needs. This paper describes an action research study aimed at developing an online genetics resource for students and practitioners in a range of health professions. A literature review of current health-care genetics education was undertaken. In the first phase of the action cycle, a sample of nurses and midwives were surveyed using a questionnaire to discover their perceived learning needs and the acceptability of an e-learning approach. Using the findings, an online resource for health professionals was developed, by means of a life stage structure to expedite accessibility. The developmental process leading to the construction of clinical case studies in this resource (including theory, ethical, and practical issues) and the evaluation strategy are discussed.