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Raising the visibility of school nursing services

03 June 2017

Laura Sanders, Charlie Pratten, Laura Pretty, Shiela Roberts and Jenny Robinson examine the voices of young people in secondary educational provisions, in a bid to raise the visibility of school nursing services.

Volunteers

Laura Sanders BSc (Hons) Specialist Community Public Health Nurse, School Nurse, Central London Community Healthcare NHS Trust

Charlie Pratten BSc (Hons) Adult Nursing, School Nurse, Central London Community Healthcare NHS Trust

Laura Pretty Dip HE Adult Nursing, BSc (Hons) Specialist Community Public Health Nurse in School Nursing, Central London Community Healthcare NHS Trust

Shiela Roberts RSCN, Immunisation Lead, Hounslow and Richmond Community Healthcare NHS Trust

Jenny Robinson BEd (Hons), RGN, School Nurse Cert, School Nurse Manager, Central London Community Healthcare NHS Trust

 

Key points:

  • Utilising technology through websites and apps can increase accessibility and improve visibility of the school nursing service
  • The majority of the focus group participants (99 per cent) had access to a device that they can download apps onto
  • Only a small percentage of young people from the focus groups would talk to someone face to face at school about a health problem
  • Young people in Hounslow and Richmond stated in focus groups that accessing health information through an interactive app would be useful.

Abstract

In an attempt to raise the visibility and profile of the school nursing service in the London boroughs of Hounslow and Richmond, school nurses sought to hear from the voices of the young people with whom they work. Ten focus groups in secondary educational provisions were held in a bid to look at young people’s accessibility to technological devices, where they would go if they had a health problem and which health topics they would like more information on. This paper examines both national and local data and demographics and discusses findings from the focus groups run with local young people. The results collected from the focus groups emphasised that technology is a fundamental aspect of many young people’s lives and that a large number of young people access the internet to source information about their personal health and wellbeing. The data suggests that the school nursing service could use technologies, such as an interactive app, to support the physical and emotional health of young people.

Keywords: Visibility, accessibility, technology, focus groups, young people

 


Introduction

The Department of Health (DH) (2012) document Getting it right for children and young people has a vision for school nurses as the frontline staff supporting and identifying mental health problems in young people, as leaders in public health, champions for young carers and supporting the delivery of personal, social and health education in schools. School nurses are in a pivotal position to support children, young people and families by identifying
problems early, which is proven to prevent family breakdown, reduce accident and emergency attendances and hospital admissions (Munro, 2011; DH, 2012).

In recent years school nursing services have suffered financial cutbacks nationally and locally, resulting in many services being stretched to capacity. The Royal College of Nursing (2015) warned school nurse numbers had decreased since 2010 despite a rise in the number of school pupils, identifying more than
8.4 million pupils attending 24,317 schools and the numbers of school nurses employed by the NHS at 3,053.

The school nurses within Hounslow and Richmond were conscious that they were not always able to work with young people preventatively. There was a concern that the school nursing service was reactive due to underinvestment and that the views of local young service users had not been sought. It was decided that, in order to revitalise the school nursing service and raise its visibility and profile it was important to seek and engage the voice of young people. The idea that the school nurse should be more visible was echoed in a consultation service, the ability to directly contact the school nurse using text, email or telephone was stressed as important. Confidentiality was also emphasised as a very important factor when contacting the school nurse: almost 40 per cent of young people were not sure if they would receive a confidential service from their school nurse (BYC, 2011).


Local Issues

Although culturally and diversely different the London boroughs of Hounslow and Richmond were jointly under the same NHS Trust, with the school nursing service covering a collective total of 98 primary schools, 24 secondary schools and seven special schools. With two small teams and more than 20,000 young people in the secondary education system, the battle for increased face-to-face visibility of the school nurses within schools could be a struggle.

According to the 2015 child health profile of Hounslow (Public Health England, 2015a) the areas of concern where the borough is significantly worse than the
national average is poor oral health, child poverty, high conception rate among under-18s, childhood obesity and high A&E attendances for the under-fours. Richmond borough health profile (Public Health England, 2015b) reports on high hospital admissions of young people aged 10 to 24 years with self-harm and young people aged 15 to 25 years with substance misuse.

Nationally there has been an increase in the severity of self-harming trends and patterns of risky behaviour among young people (National Society for Prevention of Cruelty to Children (NSPCC), 2014a). This was mirrored at a local level with reports of an increase in the number of young people attending the A&E department with deliberate self-harm or overdose.

The Office of the Children’s Commissioner (2013) reports that at least 16,500 children in England were identified as being at risk of child sexual exploitation (CSE), including growing incidents of gang-related and sexual violence. The Department of Health (2014) reinforces the knowledge that it is likely that these young people would have already disengaged with statutory services, including schools. Disengagement with school limits the accessibility of these extremely vulnerable young people to current school nursing services including access to physical, social and emotional health education.

As culturally diverse London boroughs we recognised that some young females could be at risk of harmful cultural practices. The NSPCC (2014b) estimates 23,000 girls under the age of 15 are at risk of female genital mutilation in the UK each year. Often these girls will not know where to go for help further highlighting the need for better visibility and opportunity for confidential advice and support.

Local data from a school nursing service audit in 2013 found that only 45 per cent of young people knew how to contact their school nurse or who their school nurse was (Hounslow and Richmond Community Healthcare, 2013). Hounslow and Richmond were not alone in our invisibility but were part of a national problem. This anonymity was echoed across the country: the BYC (2011) found similar statistics and alarmingly reported 69 per cent of young people did not have information about how to contact their school nurse.

The question was raised as to whether some of the local issues, such as CSE, self-harming, obesity and risky behaviours could have been reduced or prevented by an increased access to local information and front line services, especially for young people who are harder to reach, such as young males, children in care, young carers and children with special needs.

Research has highlighted the challenges of engaging young people in health services, indicating that you have to go to them, rather than wait for them to come to you. The Department of Health’s (2011) You’re Welcome quality criteria recommend increasing the visibility and confidentiality of school nursing in an attempt to engage young people.

Young people are already sharing large amounts of information about themselves on their phones, be it their social life, their photographs and even their troubles. The Office of National Statistics (2014) identifies that 75 per cent of five- to 15-year-olds have access to a smartphone within the home; a figure increasing from 52 per cent in the previous two years. Meanwhile 96 per cent of young people aged 16 to 24 have access to the internet on the go. Concerns have been raised about the safety and reliability of the information young people are accessing on line.

In response to the information available on the use of technology the school nursing service contemplated how it could capitalise on the information and utilise it to enhance communications with young people. The idea of creating a school nursing interactive app that offered the ability to access evidence-based health information and contact the school nurse anonymously and discreetly using text, email or phone and that signposted to local services was raised. When the project started it was clear that other school nursing services were enhancing their communication through websites, text message services and downloadable school nursing apps. Schuller and Thaker (2015) also recognise the need to develop and enhance young people’s access to support and services outside of traditional boundaries with an instant messaging service.


Focus Group

To identify what young people want in terms of accessibility to information about their personal, physical, social and emotional health, school nurses invited young people from 30 secondary education provisions across Hounslow and Richmond boroughs to be involved in focus groups. The focus groups were designed to listen to young people’s views on the accessibility, visibility and confidentiality of health information and the school nursing service and to explore how the service could meet their needs. Dunn (2009) advocates the use of focus groups when the knowledge about the target market is limited.

According to Hennessy and Heary (2005) focus groups are an effective way of gathering data on young people’s views and perspectives, they encourage openness as people feel more confident within a peer group environment where the responsibility is on the group not the individual. However, there are limitations to data collected from focus groups in that if there is one opinionated spokesperson the group may be swayed. The samples for the focus groups were not randomised; however, the school nurses tried to ensure they were of mixed demographics and all-inclusive.

A response from 10 secondary education providers was received following the invitation to participate in focus groups. Schools that reflected the cultural diversity and social economic status of the local population, as well as mixed year groups, were included. Service providers, such as the looked after children’s nurse, young carers’ key workers and pupil referral units were contacted directly to ensure young people from vulnerable and harder to reach groups were included. Evidence suggests that such children have poorer health outcomes than the rest of the population (Marmot, 2010; Davies, 2013).

Participation in the focus groups was voluntary and in order to ensure confidentiality the results were anonymised. Ten focus groups across Hounslow and Richmond were conducted, each comprised of an average of 10 to 15 young people aged 11 to 18 years. Figure 1 shows the number of participants for each year group.

To ensure the data collected from each focus group was consistent and the same questions were being asked a question sheet was devised using a mix of 10 closed and open-ended questions. The groups were conducted in schools by their respective named nurse and a school nursing colleague following the same set format of questions and ground rules. At the majority of the focus groups, teachers were not present to enable students to talk openly and freely about their ideas and answer questions honestly. The school nurse facilitated and took notes of the responses. The results were entered into a spreadsheet and analysed quantitatively.


Key Messages 

Out of the 152 young people involved in the focus groups 130 had access to a smartphone, 98 had a tablet and only one student stated that they did not have a device which you can download apps onto (see Figure 2).

Discussions with looked after children highlighted problems with accessibility since some young people are not allowed phones due to identified safeguarding
needs and would need access to technology within a safe local place.

A fundamental question was where the young people go or who do they initially turn to when they have a health problem. Figure 3 illustrates that the majority talked to a family member, a friend or looked online. It appeared that only a small percentage of young people would talk to someone at school. Since none of the children or young people reported that they would visit a health centre, the question was raised as to whether the current school nursing service would be able to support these young people in that initial stage of need if only a small percentage would speak to someone face to face.

The young people identified a range of topics and questions that they wanted information on regarding their health:

  • What is normal in puberty?
  • Self-confidence and body image
  • Depression, what is normal?
  • First aid
  • Friendships
  • Healthy eating
  • Muscles and exercise
  • Exam-related stress
  • Acne
  • Drugs and alcohol
  • Sexual health
  • Safety at parties and festivals.

The focus groups were positive and the young people enthused about the idea of an app that would be specifically designed to target their health needs. They liked the idea of being able to contact their school nurse confidentially, without face-to-face interaction and without having to approach a member of staff at school. They wanted their school nurse to be visible and they wanted to know when the nurse was available at their school.

Summary 

The results collected from the focus groups emphasised that the overwhelming majority of young people have access to the internet. In order to meet the health needs of young people today the health service in general needs to be flexible, innovative and have the ability to change. The data demonstrated technology is an intrinsic part of young people’s daily life. To reach young people and raise the visibility, and accessibility of the school nurse service technology is needed. The school nursing service needs to change and move forward. This project showed that young people were not always being reached and their health concerns were not always being addressed preventatively. In response to this the service needs to work smarter and be accessible at the first point of contact, when the solution to a problem is often less complex and more cost-effective.

It seems clear that young people want to contact their school nurse confidentially and instantly. This could be achieved via an interactive app offering the ability for anonymous, mobile and discreet contact with a school nurse using text, email or phone call. An app will help to address and identify some of the emotional and physical health needs of local young people in Hounslow and Richmond boroughs at early intervention, as emphasised by Schuller and Thaker (2015) in their research on instant messaging.


Future Directions

This project was undertaken while the school nursing service was commissioned by another NHS trust. Hounslow and Richmond school nurses have now joined with a new, larger NHS trust, and attempts to raise school nursing visibility are being pursued through a school nursing website. The website is an excellent resource for schools, professionals and families with up-to-date health information. To meet the needs of the discreet, highly accessible and confidential criteria that the young people voiced the current trust is considering the further development of the website being extended into an app.


References

British Youth Council (2011). Our School Nurse: young people’s views on the role of the school nurse. London: Department of Health.

Davies, S. (2013). Department of Health, Our Children Deserve Better: Prevention Pays. London: Department of Health.

Department of Health (2011). You’re Welcome - Quality criteria for young people friendly health services. London: Department of Health.

Department of Health (2012). Getting it right for children, young people and families: maximising the contribution of the school nursing team: Vision and Call to Action. London: Department of Health.

Department of Health (2014). Spotting the Signs: A national proforma for identifying risk of child sexual exploitation in sexual health services. London. Department of Health:

Dunn, T. (2009). Focus groups vs. usability testing - what, when and why? See: http://www.webcredible.com/blog/focusgroups- vs-usability-testing-what-when-and-why [Accessed 18 February 2016].

Hennessy, E and Heary, C. (2005).Exploring children’s views through focus groups. In: Greene, S and Hogan, D. (Eds). Researching children’s experience: Approaches and methods. London: Sage Publications.

Hounslow and Richmond Community Healthcare (2013). Service Audit of School Nursing in Hounslow and Richmond. Hounslow and Richmond Community Healthcare NHS Trust.

Marmot, M. (2010). Fairer Society, Healthy lives, The Marmot review. UCL Institute of Health Equity. See: www.ucl.ac.uk/gheg/marmotreview [Accessed: 18 February 2016].

Munro, E (2011). The Munro review of child Protection: Finial Report; a child centered system. Department for Education. London: The Stationary Office.

NSPCC (2014a). Female Genital Mutilation (FGM) factsheet. NSPCC. See: https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/female-genital-mutilation-fgm [Accessed: 18 June 2015].

NSPCC (2014b). On the edge: ChildLine spotlight: suicide. Child Spotlight Series. London: NSPCC.

Office for National Statistics (UK) (2014). Mobile Internet: Households and Individuals 2014. Office for National Statistics. See: http://www.ons.gov.uk/ons/rel/rdit2/internet-access---households-and-individuals/2014/stb-ia-2014.html#tab-Mobile-Internet [Accessed 15 July 2015)].

Office of the Children’s Commissioner (2013). Office of the Children’s Commissioner Annual Report and Financial Statements for 2012-2013. London: The
Stationary Office.

Public Health England (2015a). Child Health Profile Hounslow 2015. National Child and Maternal Health Intelligence Network. See: http://www.chimat.org.uk
[Accessed Jan 2016].

Public Health England (2015b) Child Health Profile Richmond 2015. National Child and Maternal Health Intelligence Network. See: http://www.chimat.org.uk
[Accessed Jan 2016].

Royal College of Nurses (2015). School nurses essential to solve child health crisis. Royal College Of Nursing. See: https://www.rcn.org.uk/news-and-events/news/schoolnurses-essential-to-solve-child-health-crisis [Accessed 9 Feb 2016].

Schuller, L. and Thaker, K. (2015). Instant messaging: The way to improve access for young people to their school nurse. Community Practitioner, 88(12): 34-38.

 

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