Dr Sarah Bekaert

Aim(s)

To identify new and accelerated modes of practice used by school nurses during the Covid pandemic. To create a quick reference infographic bringing together experiential evidence on the range and considerations regarding different modes of practice for use by the school nursing community of practice. 

Design

A descriptive qualitative secondary data analysis of open-ended questions in a survey, and focus groups with school nurses.  The pragmatic aim was to focus in on changes in school nurse modes of practice to ensure continued engagement with children and young people, and school nurses’ experience of the benefits and challenges of these modes of practice.

Methods

Data were collected from 98 school nurse participants across a United Kingdom-wide survey (n78) in April–May 2022, and focus groups (n20) in June-July 2022, within the School Nursing in the Time of Covid project. Data from the seven open-ended questions in the survey and four questions from the focus group were analysed using the framework approach. 

Results 

Modes of practice fell into two categories: individual assessment and support (video-calling platforms, telephone contact, virtual messaging, walk-and-talks, home visits); and group support (wellbeing approaches, social media).  Considerations for these modes rooted in school nurses’ experience are described. Interpretations were used to create the summarising evidence-based infographic as a quick reference resource for school nurses.

Conclusion

There was no ‘one size fits all’ approach. The modes used by school nurses were adopted or developed out of necessity or resource availability, and in response to the specific needs of individuals or groups.  The developed infographic provides a quick reference guide to deliver the expressed need for knowledge exchange within the school nursing community by participants in the original studies and can be used to inform current school nurse practice.

Sarah Bekaert shares some of the highlights from the recent school nursing congress in Sweden, including a collaborative effort towards growing the school nursing evidence base and discussion surrounding workforce.

Concerns for the long-term health and social well-being of teen mothers and their children arose in the 1970s as early childbearing was depicted as a public health problem. Early researchers identified the high-risk nature of teen mothering and a host of unfavorable maternal-child outcomes. The purpose of this study is to review the research published since 2010 on the outcomes for teen mothers’ offspring ≥ 6 years of age and to identify the strengths and limitations of this research.

Method:  We conducted a systematic search of 8 databases to identify studies that examined outcomes for offspring ≥ 6 years from high-income countries. We grouped studies by offspring age (child ≥ 6 years of age, adolescents, and adults) and outcomes in the domains of mental health, physical health, education, sexual activity, delinquency/crime, and substance use.  Child outcomes were examined in 16 studies, adolescent outcomes in 31, and adult outcomes in 14.

Findings: Of the 53 studies published between 2010 to November 2022, 32 originated in the U.S.; 9 in Sweden; 2 each in Canada and Taiwan; and 8 elsewhere. Since 2010, researchers have increasingly used national samples and sibling and cousin comparisons to control for selection into teen mothering. These studies have reduced, and in some cases, eliminated young maternal age as a predictor, suggesting that poor outcomes are largely due to factors related to teen mothers’ preexisting disadvantage.

Conclusions: The results of this scoping review echo a chorus of scholars who have long argued that the poor outcomes attributed to teen mothering disregard the systemic inequities that predispose youth to become teen parents. Because these upstream conditions are baked into the social worlds that most teen mothers and their children inherit, delaying childbearing in the absence of mitigating these conditions is unlikely to improve maternal-child outcomes. We urge researchers to adjust for selection into teen mothering; examine heterogeneity in samples; adjust for birth year when multiple birth cohorts are combined in a study; place findings in historical context; consider variables that align with the perspectives of teen mothers; and study the intergenerational effects of adverse childhood experiences. Doing so would improve our understanding not only of causal relationships but the context and temporality of maternal-child outcomes. ​​​​​​​

Research on masculinities has largely been influenced by Western countries and generalised as an understanding of global masculinities. This scoping review synthesises qualitative literature exploring dominant masculine ideals within the South Africa’s (SA) prisons and theorises how this reflects wider SA cultural norms. Arksey and O’Malley’s five steps of conducting a literature review were followed. Three databases were searched. Six studies were identified with the inclusion criteria of the SA prison setting, academic literature, English language and qualitative methodology. The analysis employed Malpass’s construct approach to qualitative synthesis. Four third-order constructs were identified: dominant masculine ideals; heteronormative adaptations; alternative identities; and factors enabling the violent status quo. The study recommended restorative justice programmes that promote the rights and voices of prison inmates; orientating new inmates with clear protocols to follow in abusive situations; and incentives for non-violent inmates. The study also stated that there is a need for more context-specific research to better understand dominant masculine ideals within prisons in SA.

The purpose of this study was to describe experiences of pain among students at upper secondary schools (adolescents aged 16–19 years) in Sweden. Focus group (n = 9) interviews with 41 adolescents were conducted in southern Sweden in 2021. The interviews were analyzed by qualitative content analysis, which identified four categories encompassing the theme how pain expressed itself: (1) a warning bell—the body’s way of saying that something is wrong; (2) school- and work-related pain; (3) interpersonal physical and emotional pain; and (4) heartache—a sign of humanity; and four categories describing the theme ways of dealing with pain: (1) turn your attention elsewhere; (2) “bite the bullet” and endure the pain; and (3) use painkillers or complementary treatments; and (4) ask for help from others. Findings are linked to the crucial role of school nurses in supporting students who experience pain.

Introduction

High-quality pre-registration student nurse training and development is integral to developing a sustainable and competent global nursing workforce. Internationally, student nurse recruitment rates have increased since the onset of the COVID-19 pandemic; however, attrition rates for student nurses are high. During the pandemic, many student nurses considered leaving the programme due to academic concerns, feeling overwhelmed, and doubting their clinical skills. Little was known about the extent to which nursing education prior to COVID-19 had prepared students for their role in managing the healthcare crisis or the impact on their resilience. Thus, this study aimed to explore how the COVID-19 pandemic impacted on the resilience levels of student nurses across the United Kingdom.

Methods

Data were collected as part of a multi-site qualitative study named ‘COV-ED Nurse’ and involved pre-placement surveys, placement diaries, and post-placement interviews with nursing students. Student nurse participants were recruited from across the United Kingdom, from all years of study, and from all four nursing branches: children, adult, mental health, and learning disabilities. Participants were asked to complete a pre-placement survey that collected demographic details and information about their placement expectations. They were also asked to record a weekly audio-visual or written diary to describe their placement experiences, and, on completion of their placements, students were interviewed to explore their experiences of this time. Data were thematically analysed using the Framework Approach. Ethical approvals were obtained.

Results

Two hundred and sixteen students took part in the wider study. The current study involved a subset of 59 students’ data. Four main themes were identified: ‘coping with increased levels of acuity’, ‘perceived risks of the pandemic’, ‘resilience when facing uncertainty and isolation’, and ‘the importance of coping mechanisms and support structures.’

Discussion

From this study, we have generated insights that can be applied to nursing research, education, policy, and practice and identified the wide-ranging impact that the COVID-19 pandemic had on student nurses and their abilities to remain resilient in an unstable environment. The value of communication and support networks from a wide range of sources was highlighted as key to navigating many uncertainties. In addition, the extent to which students were able to navigate their personal and professional roles and identities influenced their ability to cope with and continue along their training pathways.

Aims: To explore school nurses’ experiences during the Covid-19 pandemic, focusing on: methods enabling service delivery; factors affecting school nurses’ ability to support children; work with the interdisciplinary team; what pandemic-related practice changes should endure.

Design/method: The study took a pragmatic approach.  A purposive sample of 20 school nurses participated across ten virtual focus groups and one-to-one interviews.. Data were analysed using reflexive thematic analysis.

Results: Four overarching themes were identified: the impact and legacy of Covid-19 on children and families’ health; the rapid restructure of service delivery; workforce challenges; the school nurse profile before, during, and after the pandemic.

Conclusion: Recommendations are made for considered use of virtual modes to enhance rather than replace in-person practice; building a robust evidence base that can inform future commissioning; clear guidance regarding the boundaries of school nursing practice in the context of increasing workloads; investing in the school nurse workforce going forwards.

School nurses are public health specialists with an integral role in the safeguarding of children and young people. This study gathered information about school nurses’ approaches to overcome practice restrictions as a result of COVID-19. A cross-sectional survey was administered to school nurses across the United Kingdom. Quantitative data were analysed descriptively. Qualitative data (free-text responses to open-ended questions) were analysed using reflexive thematic analysis. Seventy-eight participant responses were included in the analysis. Quantitative data highlighted increased workloads; decreased contact with service users; and difficulties in identifying safeguarding needs and working with known vulnerable children. Through qualitative data analysis, five themes were identified: a move from preventive to reactive school nursing; professional challenges of safeguarding in the digital context; the changing nature of inter-professional working; an increasing workload; and reduced visibility and representation of the child. The findings call for advocacy by policymakers and professional organisations representing school nurses to enable this professional group to lead in the evolving public health landscape; for commissioning that recognises the school nurse as a specialist public health practitioner; and for sufficient numbers of school nurses to respond to the emergent and ongoing health needs of children and young people.

Aim: To examine how school nurse practice evolved as a result of the Covid-19 pandemic.

Design: A scoping review of international literature, conducted and reported in line with Arksey and O'Malley’s (2005) framework.

Data sources: Searches were conducted in September 2021. Ten databases were searched: The British Nursing Database, CINAHL, Cochrane Library, Consumer Health Database, Health and Medicine, Nursing and Allied Health, Public Health, PsycINFO, PubMed and Web of Science. Relevant grey literature was identified through hand searching.

Review methods: A minimum of three reviewers independently screened articles and two reviewers independently undertook data extraction, with any decisions made collaboratively with the wider team. Much of the literature was not empirical work and so it was not possible to apply a traditional quality appraisal framework.

Results: Searches identified 554 papers (after deduplication) which were screened against title and abstract. Following full-text review, 38 articles underwent data extraction and analysis. The review findings highlighted that school nurses adapted their practice to ensure they were able to continue providing their formal and informal school health offer to children, young people and their families, and continued working closely with the multidisciplinary team. In addition, the expanded public health role generated by Covid-19 for school nurses’ work was considerable, multi-layered and added to their routine workload. School nurses displayed resilience, adaptability and creativity in their response to delivering services during Covid-19.

Conclusion: School nurses took on a leading public health role during the Covid-19 pandemic. Some developments and practices were highlighted as beneficial to continue beyond the pandemic. However, formal evaluation is needed to identify which practices may merit integration into routine practice. Continued investment in staff and infrastructure will be essential to ensuring school nurses continue to expand their practice and influence as public health experts.

Introduction:

Child maltreatment has detrimental social and health effects for individuals, families and communities.  The ERICA project is a pan-European training programme that equips non-specialist threshold practitioners with knowledge and skills to prevent and detect child maltreatment. 

​​​​​​​Aim/objectives:

This paper describes and presents the findings of a rapid review of good practice examples across the seven participating countries including local services, programmes, and risk assessment tools used in the detection and prevention of child maltreatment in the family. Learning was applied to the development of the generic training project. 

Methodology/method:

A template for mapping the good practice examples was collaboratively developed by the seven participating partner countries. A descriptive data analysis was undertaken organised by an a priori analysis framework. Examples were organised into three areas:  

programmes tackling child abuse and neglect, local practices in assessment and referral, risk assessment tools. Key findings were identified using a thematic approach. 

Findings:

Seventy-two good practice examples were identified and categorised according to area, subcategory and number. A typology was developed as follows: legislative frameworks, child health promotion programmes, national guidance on child maltreatment, local practice guidance, risk assessment tools, local support services, early intervention programmes, telephone or internet-based support services, Covid-19 related good practices.

Discussion/recommendations

Improved integration of guidance into practice and for professional training in child development was highlighted as an overarching need. The impact of Covid-19 on safeguarding issues was apparent.  The ERICA training programme formally responded to the learning identified in this international good practice review.

As the Covid pandemic enveloped the globe there was a parallel increase in the incidence of domestic abuse (DA). This has been ascribed to the restrictions in movement and growing tensions during lockdown periods. The Domestic Abuse Act for England and Wales, was about to be passed prior to the Covid outbreak, but progress halted as attention focused on managing infection control and treatment nationally.  The unfolding DA ‘shadow pandemic’ led to pressure groups lobbying for specific changes to the DA Act which, in its revised form, became law in April 2021.  This commentary sets out the changes in definition, statutory response and prevention of DA and relates these to nursing practice.  Health education and promotion theory is considered and linked to nursing practice with those who are both victims/survivors and perpetrators of DA

The responsiveness of professionals working with children and families is of key importance for child maltreatment early identification. However, this might be undermined when multifaceted circumstances, such as the COVID-19 pandemic, reduce interdisciplinary educational activities. Thanks to technological developments, digital platforms seem promising in dealing with new challenges for professionals’ training. We examined a digital approach to child maltreatment training through the ERICA project experience (Stopping Child Maltreatment through Pan-European Multiprofessional Training Programme). ERICA has been piloted during the pandemic in seven European centers involving interconnected sectors of professionals working with children and families. The training consisted of interactive modules embedded in a digital learning framework. Different aspects (technology, interaction, and organization) were evaluated and trainers’ feedback on digital features was sought. Technical issues were the main barrier, however, these did not significantly disrupt the training. The trainers perceived reduced interaction between participants, although distinct factors were uncovered as potential favorable mediators. Based on participants’ subjective experiences and perspectives, digital learning frameworks for professionals working with children and families (such as the ERICA model nested in its indispensable adaptation to an e-learning mode) can represent a novel interactive approach to empower trainers and trainees to tackle child maltreatment during critical times such as a pandemic, and as an alternative to more traditional learning frameworks.

This metasynthesis brings together what is known about family members’ perspectives of their relationship with social care practitioners as a starting point for developing a pan-European training resource for practitioners. Four databases were searched for qualitative literature with search terms relating to family members and social care practitioners. After the application of inclusion and exclusion criteria, 35 studies were critically appraised and were included in the metasynthesis. Three broad themes were identified through a thematic analysis of the studies’ findings: family members’ perspectives of the system; perceptions of how they were viewed by their worker; and view of their worker. The following aspects are discussed: whether partnership between family and worker is possible within a legal framework; the detrimental effects of cultural bias; and practical foundations for building trust. Recommendations are made for practical support, reflection on cultural practice and broader service provision.

Objectives The first aim was to examine how the Covid-19 restrictions on movement impacted on teenagers’ access to a local sexual health service (SHS). The second aim was to audit whether safeguarding assessments were carried out for those accessing the service remotely.

Methods April –September 2020 consultation numbers for teenagers aged 17 years and under were compared to the 2019 equivalent.   Service safeguarding assessment standards were reviewed for teenagers receiving telephone consultations for the first six months of lockdown, April-September 2020.

Results There was a reduction in contact with the service of 100% for those aged 13 and younger, 48% for those aged 14 and 15 years, and 31% for those aged 16 and 17 years for the compared months. A safeguarding assessment was either carried out by the service or accounted for by a partner community practitioner for all contacts with the service by AHA 15 years or younger. 96% of safeguarding assessments were carried out for those aged 16-17 years. 

Conclusions There was a reduction in consultations for all age groups examined in the six months following lockdown. This adds to growing evidence restrictions during lockdown are barriers to young people accessing SHS.  For those who did have a consultation safeguarding assessments were consistently carried out. Nevertheless, due to reduced contact overall it is likely that some safeguarding issues remain undisclosed.   Multiagency safeguarding networks, and telephone consultations with a low threshold for promoting an in-person consultation facilitated access to SHS and a robust safeguarding pathway during the constraints of the Covid-19 pandemic.

This metasynthesis brings together what is known about family members’ perspectives of their relationship with social care practitioners as a starting point for developing a pan-European training resource for practitioners.  Four databases were searched for qualitative literature with search terms relating to family members and social care practitioners. After the application of inclusion and exclusion criteria, 35 studies were critically appraised and were included in the metasynthesis. Three broad themes were identified through a thematic analysis of the studies’ findings: family members’ perspectives of the system; perceptions of how they were viewed by their worker; and view of their worker.  The following aspects are discussed: whether partnership between family and worker is possible within a legal framework; the detrimental effects of cultural bias; and practical foundations for building trust.  Recommendations are made for practical support, reflection on cultural practice and broader service provision.

This paper reflexively considers the muted narratives of a desire for pregnancy and parenthood in teenaged women’s accounts of their journey to motherhood after deciding on abortion with their first, unexpected, pregnancy. By contrast their accounts were replete with good citizenship narratives that attested to pregnancy avoidance. Through the use of the Listening Guide, a feminist, layered, reflexive approach to data analysis, these accounts are considered in the wider social and cultural ‘narratives’ evident in the interview data, and the interviewee/interviewer relationship.  It is suggested that the young women draw on dominant cultural tropes of the good teenager and mother, shaped by the desire to present themselves to the interviewer as acceptable citizens. It is debated whether the young women choose relative silence regarding their growing desire for pregnancy to avoid judgment in a society that problematises young motherhood, or are silenced by the same dominant discourse.  Discussion considers what such a muted narrative might represent in a political and socio-cultural context. With narrow definitions of what is acceptable in the teenage years, and for motherhood, the young women’s desire to present as acceptable may eclipse valuable contextual considerations that are important to practitioners and policy makers in providing effective support.

Background: Electronic Health Records (EHR) provide an interesting potential data set for nursing research but can present challenges for data collection and data quality, as health care IT systems are often not designed with research in mind. 

Aim: To present an example of data collection using Electronic Health Records (EHR), conducted as part of a research study into the role of the school nurse in child protection.  

Methods: Descriptive analysis of quantitative, secondary data.

Discussion: Data were successfully obtained from Electronic Health Records (EHR) to understand school nursing caseloads and interventions with vulnerable children and young people. Major limitations included variances in record systems, such as different ‘labels’ used for interventions. These limitations were addressed during data collection by reviewing organisational record keeping guidance and a working knowledge of the different EHR systems. 

Conclusion: Conducting research using Electronic Health Records (EHR) has provided important learning about the potential of this type of data and the promise it holds for future research. 

Implications for Practice: Organisations who wish to engage in research using existing data might consider embedding pathways for data collection that are easy for potential researchers to navigate. Electronic Clinical Record (EHR) systems need to be sensitive for research, but not at the expense of efficiency in clinical practice. 

This case study presents the methodology and method for an exploratory study with eight young mothers regarding their pregnancy decision making. 

The study drew methodologically on feminist reflexivity and concepts of governmentality to attend to ways in which women’s sexuality is regulated through policy, clinical, and research practice, as well as framing how the young women speak of their own pregnancy decision making.  

The case study will critically consider issues relating to recruitment, sample size, the role of gatekeeper, children and consent,  anonymity  and confidentiality.  The Listening Guide method will be described drawing on examples from the research.  The four ‘reading’s within the Guide will be examined: firstly for ‘plot’ – eliciting the overall ‘story’ the participant wishes to tell before beginning the fragmentive process of data analysis.  Then for reader response to the participant’s words, building in a feminist reflexivity to the method.  The second reading is for the voice of I, and the third for relationships.  The fourth reading looks wider to social structures and cultural contexts.

This method highlighted how the young women interviewed offered stylized ‘good citizenship’ narratives as the participant may not feel free to fully voice their desires and opinions for fear of judgement. The readings highlighted quieter or less frequently mentioned narratives.  Using the Listening Guide leads the researcher to see the wider influences on the young women’s lives, which included poverty, gang culture and pervasive violence.  These fragile life circumstances had a significant bearing on the young women’s decisions to ‘get on with’ parenting in the teenage years.

This discussion piece arose from a conversation between the two authors, Sarah, a nurse researcher exploring teenage women’s pregnancy decisions and Joelle, researcher, ‘young mother’, activist and founder of @prymface a twitter feed that advocates for young mothers and anyone who was ever a young mother. We explore the concepts of teenage pregnancy within policy and popular discourse, and consider the extent to which this now applies to young mothers in their twenties.

Objectives. This review aims to describe the role of the school nurse in protecting children and young people from maltreatment by examining the international literature. Child maltreatment is a prevalent issue in global society today and includes physical, emotional and sexual abuse, neglect and exploitation. School nurses are ideally placed to identify and work with children and young people who are at risk of maltreatment through their regular contact with the school community. Design. Integrative literature review incorporating thematic analysis. Data Sources. Electronic databases British Nursing Database, Cumulative Index of Nursing and Allied Health Literature, Medline, PsycInfo, Cochrane Library Database for Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL). Search Terms: Role, School Nurse, Child Maltreatment. Review Methods. Initial title and abstract review of 444 studies resulted in 78 studies for full text review. Additional search strategies identified one relevant study. Inclusion and exclusion criteria were employed as follows; (1) study published in the English language, (2) peer-reviewed, (3) primary research, (4) inclusion of school nurses (or equivalent role internationally) in the study sample, and (5) a focus on the role of school nurses in preventing child maltreatment. Studies were appraised using the Critical Appraisal Skills Programme tool for qualitative studies and the Strengthening the Reporting of Observational Studies in Epidemiology checklist for mixed-methods and quantitative studies. Findings from the studies were identified, summarised and organised into a summary table, before being analysed thematically. Results. 21 studies met inclusion and quality criteria and were included in the review. Key themes that emerged from the analysis were; supporting the child and family, detective work, working with other professionals, training and supervision, barriers to protecting children and young people from maltreatment and trust. Conclusion. International literature highlights the variety of activities that school nurses may undertake in daily practice to protect children and young people from maltreatment. Several challenges to this role are identified, including time management and building relationships with children and young people. Recommendations for practice and further research are made.