Background
Previous role | Current role |
---|---|
Responsible for immunisation of all school age children | Immunisation progressively delegated to specialist teams |
Support for whole school curriculum | Individual interventions based on pupil need |
Support for school children with chronic physical health conditions | Chronic physical health conditions delegated to Community Children’s Nurses |
Children ‘referred’ to service via ad hoc requests e.g. being stopped in corridor by teachers | Children referred formally to service from a variety of sources including education staff, GPs, social workers etc |
School nurse role ill-defined but incorporates children with almost any need | School nurses prioritise children who are referred into service on one or more of the 10 pathways. |
Does not lead team | Leads a school health team possibly including health care assistants and staff grade nurses |
Infrequent and ad hoc home visiting | Role includes family assessment and home visits |
Limited holistic assessment of family and environment outside school | GIRFEC and wider family assessment |
Unfocused and unclear contribution to outcomes such as improved mental health | Focused role with agreed definition and referral mechanisms |
No nationally collected data on school nurse role | Contributes to national dataset on health of school age children |
Methods
Evaluation design
Settings
Total area population | Area | Primary Schools | Secondary Schools | |
---|---|---|---|---|
Site A | 149,670 | 6426 km2 | 99 | 16 |
Site B | 149,930 | 5286 km2 | 69 | 11 |
Participants
Sampling, recruitment and data collection
Phase 1. Identifying the programme theory
Phase 2. Testing and refining the programme theory
Analysis
Phase 1
Phase 2
Phase 3
Results
Initial programme theory
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The nine pathways (C) lead to streamlining of referrals (M), which could improve children’s outcomes, especially for those who need the service the most (O).
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Standardisation of service and clarity of role (C) adds credibility to the school nursing role (M), and could result in enhanced professional status (O) and promote interagency working (O).
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Regarding engagement and accessibility of the school nursing role (C), opportunities to be more accessible to the wider school population have reduced, as has the perceived visibility of school nurses within school settings (M) but engagement with partner agencies and ‘high risk’ children has improved, which is important in terms of building trusting relationships (O).
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Training and support (C) could facilitate the adoption of the programme and would provide opportunity for role development (M), which would empower nurses to deliver, identify and provide appropriate support within the pathways (O).
Testing the programme theory
Characteristics of cases referred to school nurses
Item | Description | Site A (n = 299) | Site B (n = 107) |
---|---|---|---|
Gender (% of cases) | Boys | 36.3 | 46.7 |
Girls | 63.7 | 53.3 | |
School level (% of cases) | Nursery | 0 | 2 |
Primary | 29 | 58 | |
Secondary | 72 | 38 | |
Deprivationa (Scottish Index of Multiple deprivation (SIMD) (% of cases) | SIMD 1 (most deprived) | 26 | 11 |
SIMD 2 | 21 | 23 | |
SIMD 3 | 34 | 19 | |
SIMD 4 | 16 | 35 | |
SIMD 5 (least deprived) | 3 | 12 |
Components
“You’ve got a team of school nurses here, who are hugely experienced, good at their job, and we all felt that we just weren’t giving it enough time, and enough, you know, effort. Because we just couldn’t, because, since October, we’ve basically been immunising, from October to June” (PK3, Site B).
“I think the referral process is really good, because it gives the education staff a clearer focus on the children that we should be working with, rather than just a wee word in the corridor as you pass, which is what happened previously. I think the referral process is really good for education and for us as well, because we can have a much more, almost like a streamlined caseload that, you know, we’re working with children that really need to be worked with” (PK4, Site B).
“To me it’s too big, there are too many priority areas, you know, it needs to be more defined, maybe more structured. It’s a bit wordy as well, there is quite lot in it, there’s quite a lot in it, you know” (D5, Site A).
“I squeeze in children that are quite overweight and obviously need that managed and you can say it will affect their self-esteem and their confidence so you can fit it under the mental health and wellbeing pathway but actually you’re not recognising the problem” (PK7, Site B).
“Do you know, I just think it’s crazy that sexual health isn’t one on its own” (D9, Site A).
Site A (%)a | Site B (%)a | |
---|---|---|
Mental Health and Well-Being | 68 | 68 |
Substance Misuse | 0.3 | 0 |
Child Protection | 4 | 0 |
Domestic Abuse | 2 | 3 |
Looked After Children | 12 | 0 |
Homelessness | 1 | 5 |
Youth Justice | 0 | 3 |
Young Carers | 0.3 | 5 |
Transitions | 4 | 0 |
Unknown/Discharged | 9 | 32 |
“For those of us who are not mental health trained we noticed a real gap in our training there and we sort of passed that on to relevant people, but more and more the children that were coming to see us and that were asking for our help were falling into that pathway and that was an area where we all felt we lacked somewhat” (PK16, Site B).
“In the past people in a community, other professionals were never quite sure what we’ve done and it’s always been a, you know, yes, we’ve been needed and appreciated but I think we’ve been appreciated more, especially now we have got the referral form, it can show that, you know, we’ve got proof that we are getting referred and why they are getting referred and I think our profile has been greatly raised with the pilot” (D1, Site A).
“We’ve dropped a lot, we don’t do health promotion and things like that anymore, but it’s been taken up, the time that we gained by not doing that has been taken up with immunisations…I’ve not been given the opportunity to take on any of this (pilot)” (PK10, Site B).
“I would say that it definitely strengthens relationships with children and families because we’ve got more focus on what we are doing” (D1, Site A).
“Well, when they had the drop-in they didn’t have to speak to anybody. They could have just dropped in confidentially. Now it’s not a confidential service because you’d have to go to pupil support and what happens is they may go to pupil support and say I’d quite like to see the school nurse when she’s in and pupil support may say, oh, what’s wrong, can I help at all and in the right way but that’s not...that means that you’re taking something away from that service because it’s not then as accessible as a confidential service” (D8, Site A).
“…and with the training we’re able to maybe identify the kind of early indicators of risk within maybe if it’s risk-taking behaviours or if it’s potential issues at home, we’re better” (D3, Site A).
“You’ve got the skills on maybe assessing anxiety or assessing self-harm, but what can we use to try and do a bit of work with that person? We don’t have the resources to actually implement the work there. We’ve got the knowledge of what maybe the risk factors and things are but we’ve got nothing to make any interventions with” (D3, Site A).
“I think it is when the young people or children’s come to us, and it’s a mental health issue they’ve got, I feel confident enough to know if I need to move it on quickly. Because I can recognise that, you know, if they are in a stage where I have to move it onto my mental health colleagues quickly I know that. But it’s with the ones who are just a wee bit, you know, sort of a wee bit of anxiety, a wee bit of they are feeling a bit low mood. It’s just to have more support on, you know, where we are taking them” (PK12, Site B).