How Do School Nurses Perceive Their Public Health Role - Literature review Example

Literature Review: How do School Nurses perceive their Public Health Role? Modern Role of School Nurses School is a place where health related work is part of the system just as academic learning is. According to the National Healthy School Standard, a school nurse is an individual who is a registered nurse who has additional skills, training and knowledge that enables him/her to work efficiently with school-age children (Department of Health, 2002). School nurses have to be qualified and may have post registration training which specifically touches of children’s health needs (Kiddy, 2002). The general role of school nurses is to provide a variety of medical related services. These services can include: provision of health and sex education to students, developmental screening activities, and administering immunization (Burns and Grove, 2003). School nurses are normally employed by schools directly, or they can be employed by the primary care trust, community trust or the local health authority. For most o the roles of school nurses, some prior experience in healthcare is required. DeBell (2006) acknowledges the service has shifted to a Public Health focus. She decided to conduct a ‘scope review’ to identify how this shift affects the school nurse service, particularly in relation to training needs. Public health principles, which have a strong preventive emphasis, have always played an important role in school nursing (Department of Health, 2002). The new child centered public health approach to school nursing makes it possible for school nurses to work within their public health roles, while at the same time, providing an environment to ensure that they make a maximum impact in their child or student-based work. Goodman-Brown and Appleton (2004) established that nursing practitioners working in the school environment perceived their role in different ways and evidence suggests this is mainly influenced by their understanding of Public Health. For many nurses, public health is a different concept from school nursing. They do not see any connection between the services offered by school nurses and the general wellbeing of society (Wood and Ross-Kerr, 2010). McMurray and Cheater (2004) revealed that School Nurses believed that their Public Health role was misunderstood and unrecognized. According to the researchers, nurses thought that the public still perceived them as the ‘nit nurse’ (Burns and Grove, 2003). Most people do not realize the important role that school nurses play in the development of children and young people. Nurses feel that their work normally goes unnoticed since people do not appreciate that their work is important. DeBell (2006) suggests that nurses feel that their school nursing roles are hampered by the ‘school’. Most school systems do not recognize the importance of school nurses, and they normally end up frustrating or not supporting the work of nurses. DeBell also suggests that people make reference to a service provided to a school rather that a service to the child based on age. Most of the specialized health services provided by nurses normally goes unnoticed as their roles are defined as school activities. The radical shift of child centered Public Health role envisaged by the Government needs to be promoted and perhaps the introduction of a new title may also clarify their role. There are programs being implemented in most schools in the UK which have redefined the role of the school nurse (Kiddy, 2002). These programmes were rolled out in a bid to make people aware of the important role that nurse played in the overall growth and well being of children and also to promote healthier learning institutions for children and young people. DeBell (2006) suggests that the idea of child centered public health in schools may be difficult to implement without proper identification of what is expected from the service. Members of the public are not the only ones who are in the dark when it comes to understanding the roles of school nurses, there are several school nurses who have no idea of why or how their roles may be important to society. Debell also believes that the absence of protocols and outcome measures weakens the ability to strengthen School Nursing Practice.  One of the key roles of school nurses is to provide direct medical care to students. When students get injured or develop acute illnesses, it is the work of school nurses to ensure that they get the best medical care they can. The nurses are also responsible for the long-term management and care of those students who require special health care (Acheson, 1998). The school nurse has the duty to assess the status of the student’s health and in so doing; he identifies the health problems that may hinder the student’s educational development. At this point, the nurse develops an individualized health plan for the student that should also be a part of his individualized education plan. The nurses assess and make treatments within the scope of their professional training, practice. This scope also covers communication with parents, physician referrals and prescribed nursing care. In case there are students with chronic health conditions, it is up to the school nurse to develop an appropriate healthcare plan. During emergency situations, the nurse is also responsible for the creation of appropriate emergency plans (Goodman-Brown and Appleton, 2004). Another role of the school nurse is to provide leadership related to health services provision. The school nurse is regarded as the holder of the highest medical expertise within the school environment (Department of Health, 2002). This makes them responsible for assessing the overall system of school health care and creates a health plan to ensure that all healthcare needs are met. The school nurse is also responsible for providing screening services and referral for certain health conditions. When a nurse realizes that a student may be suffering from a serious illness, it is her duty to refer him or her to a medical expert who can help the student (Goodman-Brown and Appleton, 2004). This early identification of health conditions and their referral to qualified physicians is key to promoting optimal outcomes within the school health environment. It is the duty of the school nurse to ensure that a healthy school environment is maintained at all times. He or she provides for both the physical and emotional wellbeing of the school community in which he is working. The school nurse also ensures that the school environment is safe for both the students and staff (Kiddy, 2002). In doing their work, nurses are encouraged to appreciate the culture pressures and development of the organizations in which they work (Croghan, Johnson, and Aveyard, 2004). This enables them to better understand their roles and how to effectively carry out their duties as they aim to promote healthy living in their places of work. This understanding also helps them to facilitate the achievement of quality health in society. School nurses are highly valued in schools as they offer professional services which are trusted by both the young and the old alike (Department of Health, 2002). Key Policy Drivers School nursing has recently been the focus of policy change in the UK. This is as a result of the increasing recognition of pivotal role played by school nurses in the practice of child-centered public health. In the past, the role that school nurses played on the overall wellbeing of children and the community at large normally used to go unnoticed. DeBell (2006), who has written extensively on School Nurse practice clearly identifies the urgency needed in the clarification and understanding of the services delivered and expected from School Nurses. Her view is supported by Croghan, Johnson and Aveyard (2004) who recognize that evidence on the role of School Nurses and the service they deliver is limited and it is particularly weak from a practitioner perspective.  According to a new white paper published by the government of U.K in 2010, nurses were expected to play bigger roles in the public health sector. The white paper sought to shift nursing responsibility form primary care trusts to various local authorities. These measures were part of the move by government o improve children’s health. According to the white paper, the school nursing system would be expected to develop medical reviews for students at the entry level and at the same time promote the well being and medical condition needs of students. According to the Department of health, a new vision for school nurses is being developed, and it reflects the entire public health role of nurses in the school community (Wood and Ross-Kerr, 2010). There are a few government guidelines that exist which outline the role of school nurses. However, in many instances, the knowledge and even interpretation of these guidelines do differ. This creates a mixed perception of nursing roles among the public and also among the nurses themselves. Government policies such as the CNO Review redefined the role of school nurses in delivering healthcare services to children and young people (Debell and Everett, 1997). It also defined he role of school nurses in promoting the health of teaching staff, carers and parents. Another government legislation referred to Choosing Life identifies new approaches that are required by individuals to help them become more engaged in improving their health. The role of the school nurse in this case is to ensure that people are empowered in terms of health knowledge in such a way that they can make informed decisions regarding their health (Debell and Everett, 1997). The Healthy Schools program is a government initiative that aims to further clarify the roles of nurses who work in the school setting (Wood and Ross-Kerr, 2010). The roles of school nurses as outlined in this policy include: Supporting and helping school going children develop healthy behavior Supporting pupil achievement Reducing inequalities in terms of provision of health services among school going children Promotion of social inclusion in the creation of healthy schools and communities Most government policies that touch on the roles of school nurses have a common concern: the coordination of services around the health needs of children and young people. The policies emphasize on the need for school nurses to view their roles as encompassing and entwining with the provision of health services in the larger community, and not to focus only on school children. In order for nurses to work optimally and realize their objectives as their roles require of them. The nurses have to work within local and national frameworks, thereby maximizing on the ideals and expectations of child centered public health service (Debell and Everett, 1997). Public Health Role Public health is a concept that views health with the general population as a starting point. Therefore public health nursing involves providing quality health services to individuals, groups and communities within society (Hawksley, Carnwell and Callwood, 2003). School nurses are well placed to work within the public as they offer services not just to school going children, but also to their families, youth workers, teaching and non-teaching staff and other members of the community. The School Nursing Services in the U.K. is part and parcel of the National Health Service whose main focus is on public health. According to Wood and Kerr (2010), the public health role of school nurses is focused on: 1. Individual children 2. The school community 3. The children’s families and 4. The local community Public health is a principle of healthcare the looks at the kind of health that focuses of the general population as a starting point. The public role of school nurses involves promoting health in these institutions. They also give advice regarding health issues of children, school staff, parents and he education authority. Croghan, Johnson and Aveyard (2004) recognize the changing influences on School Nurse practice and their study acknowledges, this leaves some nurses feeling demoralized and undervalued. This literature also highlights that there is little understanding of their role and responsibilities by people outside the service. The average person does not fully understand the role of the school nurse. To most people, a school nurse is part of the larger school society and their roles are not very different from the roles played by other staff members within the learning institution (Wood and Ross-Kerr, 2010). In many cases, nurses are also involved in this misconception which often leads to ambiguity on service provision (Green and Reffel, 2009). The roles that nurses play in the well being of children and young people can be improved and made easier to comprehended by developing children’s trusts in the school setting. This is especially relevant for nurses who work among children and young people who have specialized health needs (Wilson, 2006). Such government-sponsored trusts can go a long way in offering more opportunities for the integration of multi-agency services within the school nursing program, a step that would benefit children with additional health needs, and help make the roles of school nurses less ambiguous (Green and Reffel, 2009). Child-Centered Public Health Approach School nurses play an important role in ensuring that the health needs of school going children are well taken care of. Nurses in the UK are encouraged to adopt the public health approach when assessing the needs of their young patients. This means that they are expected to change from a school only focus to a more generalized approach which encompasses the population around the school community (Stockman, 2010). Some of the child-centered health roles that nurses play include: ensuring that schools remain healthy, looking after children, preventing and taking care of childhood obesity, immunization and teenage pregnancies (Kiddy, 2002). In this approach, nurses also help the teaching staff in a particular school in the delivery of effective personal and social health education. This education normally covers topics such as sexuality, smoking, contraception, oral health, puberty issues, hygiene, accident prevention, healthy eating and any other topic that is meant to help young people make healthy choices (Molloy and Caraher, 2000). The child centered public health approach also requires nurses working in schools to create as well as monitor various health policies whose focus can vary from dental, asthma, sex and relationships education and bullying (Hawksley, Carnwell and Callwood, 2003). The nurses can also offer their professional services by giving advice on how medicines can be safely stored. Another key role of nurses working under the child centered approach is to take care of the needs of vulnerable children. These are the children who require special medical care, or those who have specialized needs. School nurses have the required clinical knowledge and skills for responding to the complex needs of these children (Molloy and Caraher, 2000). The child-centered public health approach focuses of the assessed needs of the general population as a point to start in the provision of healthcare to children and young people in schools. This approach recognizes the relevance of the roles of school nurses in the provision of health services to the whole community (Stockman, 2010). Most nurses, who work in the school setting, unfortunately do not fully grasp the implication of their roles as public health workers. To most of them, school nursing is all about taking care of sick children while the responsibility of taking care of other members of society is left to other categories of nurses (Wilson, 2006). School nurses need to work differently in order to effectively improve the health of those children and young people with whom they work. A change in role description for nurses is not enough to make them fully understand and appreciate their roles. There is need for relevant training for school nurses so as to empower them understand the ever changing and wide varied needs of children and society at large. In order to fully realize their public health roles while working in the school setting, school nurses should combine effort with other external care givers who may offer more specialized health services if and when they are needed (Kiddy, 2002). How do School Nurses perceive their Public Health Role? Many nurses working in schools understand their roles in terms of providing quality health care services to students. They also consider themselves to be counselors, promoters, leaders, referrers, administrators and collaborators in the healthcare system. This means that they work at all levels within the school hierarchy to ensure that the health of students is protected at all times (Stockman, 2010). There are a few instances when nurses working in school situations also offer their services to the community, including the families of children who attend the school where the nurses work. Such cases are rare as school nurses mostly believe that their work should be confined within the school boundary (Wood and Ross-Kerr, 2010). For most nurses their prime focus is on children and young people in schools. They do not consider their public health role of family support to be of much importance since most of them think that there are other nurses who can take care of families’ health needs (Acheson, 1998). In any case, not many nurses are usually ready to offer family health services since they do not have the training needed to offer such services. Some nurses also have a problem reconciling their roles with health needs assessments (Kiddy, 2002). Researchers have found a gap in the strategic focus of health workers as they offer health services to children. This gap has been attributed to among other things, limited prescriptive guidance on the national level, service development hat is hugely fragmented and a seemingly low priority on national policy (Wilson, 2006). Due to these problems, most school nurses do not understand fully their role in assessing needs of children. Researchers point out that other client groups report higher needs assessment rates than school age children (Molloy and Caraher, 2000). The issue of role ambiguity cannot be generalized among all school nurses. Some nurses understand certain aspects of their roles better than others (Reutersward and Lagerstrom, 2010). However, most of them concede that they are not sure about how their roles should be developed with high level efficiency. This is in respect to their roles as public health professionals working in a school environment (Green and Reffel, 2009). According to research, nurses do not consider that the existence of well structured school nurse programs adequately captures the essence of their roles (Acheson, 1998). Most nurses think that the current nursing programmes for school nurses do not incorporate the changing health needs of children and young people. For instance, most nurses do not know how to manage the health needs of children with mental illnesses since their training on this is quite shallow. Taking care of mental illnesses requires specialized training which most school nurses do not get (Reutersward and Lagerstrom, 2010). Role ambiguity is further complicated by the fact that school nurses have to perform more duties than they are supposed to (Reutersward and Lagerstrom, 2010). The small size of the school nurse population means that nurses have a heavy workload, which sometimes includes duties that they are not meant to carry out. This makes their roles hard to understand, not only among themselves, but also among children, teachers and parents (Stockman, 2010). Role ambiguity among the school nursing population can be minimized if proper policies are put into place stating the roles and duties of the school nurse under the new child centered approach to public health (Green and Reffel, 2009). Reference List: Acheson, D. (1998) Independent Inquiry into Inequalities in Health. London: Stationary  Office.  Burns, N. and Grove, S. (2003) Understanding Nursing Research, 3rd ed. Pennsylvania: W.B Saunders Company.  Croghan, E., Johnson, C. and Aveyard, P. (2004) School Nurses: policies, working practices, roles and value perceptions. Journal of Advanced Nursing, 47(4) pp.377-385.  DeBell, D. (2006) School Nurse practice: a decade of change. Community Practitioner, 79(10) pp. 324-327.  DeBell, D. and Everett, G. (1997) In a class apart: A study of School Nursing. Norwich: East Norfolk Health Authority.  Department of Health (2002) School Nurse practice development resource pack. London: Department of Health.  Goodman-Brown, J. and Appleton, J. V. (2004) How do Health Visitors perceive their Public Health role? Community Practitioner, 77(9) pp.333-337.  Green, R. and Reffel, J. 2009. Comparison of Administrators and School Nurses Perception of the School Nurse Role. Journal of School Nursing, v25 n1 p62-71 Hawksley, B., Carnwell, R. and Callwood, I. A. (2003) A literature review of the Public Health roles of Health Visitors and School Nurses. British Journal of Community Nursing, 8(10) pp.447-454.  Kiddy, M. (2002) From Chrysalis to butterfly the School Nurse role. Community Practitioner, 75(6) pp.293-208.  McMurray, R. and Cheater, F. (2004) Vision, permission and action: a bottom up perspective on the management of Public health nursing. Journal of Nursing Management, 12(43) pp.43-50.  Molloy, J. and Caraher, M. (2000) Public Health and the role of the nurse: the need for greater clarity. British Journal of Community Nursing, 5(9) pp.431-435.  Reutersward, M. and Lagerstrom, M. 2010. The aspects school health nurses find important for successful health promotion. Scandinavian Journal of Caring Sciences; Mar2010, Vol. 24 Issue 1, p156-163. Stockman, T. 2010. Role of the School Nurse. Accessed 31 August, 2011: http://www.sec-ed.co.uk/cgi-bin/go.pl/article/article.html?uid=77967;type_uid=1 Wilson, S. (2006) Health Visitor or Public Health Nurse? A Scottish study. Community Practitioner, 79(9) pp.289-292.  Wood, M.J. and Ross-Kerr, J.C. (2010) Basic steps in planning and nursing research: from question to proposal. 7th ed., Boston: Jones and Bartlett.  Read More