Swedish school nurses’ perspectives on caring for and promoting the health of adolescents with mental health problems – A qualitative study the Health of Adolescents with Mental Health Problems – A Qualitative Study

Abstract

Background: Over the last few decades, there has been an increase in mental health problems among adolescents, manifested as physical symptoms, such as stomach pain, headaches, feelings of anxiety, worry, stress and sleeping problems. Surveys among school nurses' have revealed that mental health work now forms a key part of their role. Although an increasing number of adolescents are suffering from mental health problems in upper-secondary schools (16-19 years), there are few studies focusing on this matter. Therefore we wanted to explore the matter from the school nurses' point of view. The aim of this study was to explore Swedish school nurses' experiences of caring for and promoting the health of students suffering from mental health problems. Methods: The present study had a descriptive design and a qualitative approach. A purposeful sample of eight (n = 8) school nurses was interviewed. Their working experience varied between 4 and 29 years. The data were analysed using content analysis. The ethical principles stipulated by the Swedish Research Council were carefully followed throughout the study. Results: Three main themes with sub-themes were found: A caring relationship as the foundation for health promotion, organizing health-promoting work and interprofessional cooperation as a prerequisite for good caring. Conclusions: The findings strengthen the evidence of the importance of the health dialogue as a tool for the school nurses to identify students with mental health problems. Creating a caring relationship with the students is a prerequisite for caring and health promotion. Further education concerning mental health and evidence-based-practice should be arranged on regular basis. More research and cooperation between different stakeholders is needed.

Dealing with adolescents' recurrent pain problems in school health care—Swedish school nurses' view

“…The health dialogues, according to the national health monitoring programme, were mentioned as one important occasion for coming into contact with adolescents and a chance to listen to their narratives in line with a person‐centred approach (Ekman et al, ). These results are in line with Hilli and Wasshede (), describing school nurses' work when caring for adolescents with mental health problems.…”

“…The nurses in the present study also highlight the need of a relationship, where a mutual understanding can emerge, where the adolescent can receive support in line with a person‐centred approach (Ekman et al, ). The importance of creating trust to be able to build a forthcoming relationship to support adolescents with health problems in school is furthermore described by the nurses in Hilli and Wasshede (). The challenges in creating such relationships are discussed by adolescents and school nurses in Rosvall and Nilsson (), whereby the lack of opportunities to come into contact with each other without having prearranged these encounters was stressed.…”

“…The school nurses in this study tried to arrange the school situation for adolescents with recurrent pain problems, but it seems that the school nurses' collaboration in the school was more on an individual level for each adolescent, instead of working with an overall structure to provide a health‐promotive school environment as the national guidelines argue for (Socialstyrelsen, ). The challenge to work with an overall health‐promotive perspective and also meet the needs of each adolescent is also highlighted by school nurses in Rosvall and Nilsson () and Hilli and Wasshede () descriptions of how to develop the work in the school organization.…”

“…These results argue for the need to develop methods to support school nurses in working with a person‐centred approach in a long‐term perspective, based on the core concepts of listening to the narrative, establishing a partnership and a jointly agreed‐on health plan to understand each adolescent's individual situation (Ekman et al, ). In a trustful relationship, in which both adolescents (Golsäter et al, ; Nilsson et al, ) and school nurses (Hilli & Wasshede, ; Nilsson et al, ) argue for, it is possible to build a relationship allowing the adolescent to be an active partner and use his or her own resources in collaboration with the school nurse's professional knowledge, in line with a person‐centred approach (Ekman et al, ). To create opportunities to work using a person‐centred approach, school nurses need more knowledge, as well as time and structures, to work with adolescents with recurrent pain problems and to promote health in the school organization.…”

Overcoming barriers to reach for a helping hand: adolescent boys’ experience of visiting the public health nurse for mental health problems

“…The adolescent boys in this study revealed that the PHN was experienced as a helpful, kind, confident and trustworthy person with whom they were comfortable talking. Trusting relationships have previously been reported to be an essential basis for promoting health (Hilli & Wasshede, 2017;Larsson, Björk, Ekebergh, & Sundler, 2014). The PHN's approach is of importance in how the dialogue between adolescent boys and the school nurse was experienced in a Swedish setting (Golsater, Sidenvall, Lingfors, & Enskar, 2010).…”