COBERTURA DEL PROGRAMA

Leighton, Worraker and Nolan (2003a) used non probability convenience sampling in a small study comprising 25 school nurses (total population) working within one NHS Trust, to identify the reasons why young people required support. A questionnaire using a 5 point Likert Scale was distributed. Despite the dangers of defaulting to a neutral response in 5-point scales (Demspey and Demspey, 2000), the respondents listed the most common types of problems that require support. These included family problems (such as domestic violence, parental separation) self-harm, and emotional difficulties including self-esteem (Leighton, Worraker and Nolan, 2003b).

Similarly Wilson et al. (2008) conducted a quantitative study in Scotland to explore the types of problems that young people presented with requiring support from the school nurse. Questionnaires were distributed to a larger sample of 230 school nurses although only 100 were returned (43% response rate), these were then analysed using descriptive statistics (Bryman, 2008). Although largely pre- determined, some questions did allow for free text responses to be given. Data were analysed using computer software packages however; the categories were continually developed and revised by the team of inter-professional researchers at team meetings, thus aiding the inter-rater reliability of the coding (Polit and Hungler, 1993). The findings indicated that school nurses spent most of their time supporting young people who self-harmed, had emotional difficulties, family problems and eating disorders. They spent much less time supporting those who had medical conditions or complex long term health needs. Conversely, it could be

30 surmised that those with diagnosed medical conditions were already receiving support from other health professionals. But those presenting with emotional problems and self-harm may have only sought support from the school nurse (Spratt et al., 2010). Despite these two studies being carried out in different countries within the UK, the findings are similar which adds strength to their reliability (Leighton, Worraker and Nolan, 2003a; 2003b; Wilson et al., 2008).

Krause-Parello (2008) suggests that the possible root cause of some young people’s emotional problems may be loneliness, stemming from emotional or social isolation. Emotional isolation results from a lack of close attachments to a significant adult, and therefore young people may present themselves frequently to see the school nurse. Alternatively, social loneliness can result from lack of friendships, which may occur at times of transition such as changing school. Nonetheless, whatever the cause Krause-Parello (2008) highlights that school nurses can play an important role in listening, increasing young people’s contacts with others, and helping them develop coping strategies in order to reduce their sense of loneliness.

The importance of listening or being listened to was also a main finding in a two- stage mixed methods study conducted by Madge and Franklin (2003). Semi structured interviews were conducted with groups of school nurses (n=12) in two different areas of the UK. Secondly a survey of pupils (n= 2988) attending six schools in the same two research areas was conducted. Mixed methodology is becoming increasing popular within health research (Parahoo, 2006). Although it is often used as an attempt to increase validity, in this study its prime purpose was

31 to collect data from two different sources rather than to compare findings between the two groups. The school nurses reported that much of the work conducted at school drop in clinics was listening to young people. They felt they needed more time and resources to be able to extend their availability in order to do this more effectively. Pryjmachuk et al. (2011) conducted a study in which the findings appear to support Madge and Franklin’s results, finding that school nurses had very good listening and communication skills. Within Madge and Franklin’s (2003) study the pupil survey showed that, although the vast majority of them did not access the school nurse as they did not know who she was, they felt that having someone to talk to and listen to them if they did have problems was important. The views of young people about the support provided will be addressed later in this review.

A study carried out in Norway using grounded theory, also reported that active listening or ‘intentional attentiveness’, helped to provide structured support to young people (Langaard and Toverud, 2010). Intentional attentiveness was defined as listening carefully and connecting to what people say and offering a space for neutral reflection (ibid). Thirteen school nurses were observed working one to one with young people, with informed consent being gained from both nurses and young people (Abbott and Sapsford, 1998). The findings from the study showed that active listening and attentiveness was an important factor when providing emotional support to young people. Encouraging them to talk about their problems and providing time and space to do this, helped a number of young people in the study to remain in school and continue their education. Being able to adapt to the uniqueness of each case and supporting the young people to

32 develop strategies to handle their own difficulties was also seen as fundamental (Langaard and Toverud, 2010). Yet this approach is time consuming and often problems are complex requiring referral to specialist mental health services.

In Queensland, Australia Barnes et al. (2004) examined the accessibility of school nurses to young people living in rural communities. This study used a descriptive cross sectional design, in the form of a self-report questionnaire, to identify the role of the school nurse in supporting young people. A total population was used as the sample size was small and 62% (n=44) nurses responded. Descriptive statistics were generated to assist in data analysis (Bryman, 2008). Although care should be exercised in interpreting these findings as the use of percentages can skew data when using small numbers (Polit and Hungler, 1993; Parahoo, 2006), psychological and emotion health concerns were identified as the main reason for pupils accessing school nurse support. The nurses considered it appropriate to deal with these issues, but as identified by Langaard and Toverud (2010) they also found it to be very time consuming. In addition if referral to more specialist services was required then there were often long waiting lists or no services available in rural and remote areas. This limited the effectiveness of service provision, and sometimes meant school nurses working outside of their scope of practice as they attempted to bridge the gap and provide the support needed. Ensuring nurses are able to practice at an advanced level and cater for a wide range of health needs was clearly highlighted.

To identify the views of school nurses concerning supporting the mental health needs of young people Haddad, Butler and Tylee, (2010) sent questionnaires to

33 700 school nurses across the UK and 258 responded (37%). Overwhelming 93% of the respondents indicated that supporting the emotional and mental health needs of young people was an integral aspect of their role, with 55% suggesting that providing emotional support occupied over 25% of their time. However, only 54% of the sample appeared to have received any specific training in mental health. Managing self-harm, recognising depression and delivering brief interventions were identified as areas that school nurses’ wanted more training on. The need for enhanced training to increase the school nurses confidence and skills, to enable them to provide more specialist interventions, was also reported in a number of studies (Madge and Franklin, 2003; Leighton, Worraker and Nolan, 2003b; Lohan, 2006; Wilson et al., 2008; Pryjmachuk et al., 2011). However, if practitioners are asked if they require more training then the responses will often be affirmative.