Dataset Information

Supporting the health and well-being of school-aged children through a school nurse programme: a realist evaluation.

ABSTRACT:

Background

The school nurse's role varies across countries. In Scotland, the Chief Nursing Officer recommended that the role should be refocused. The refocused programme emphasises nine care pathways with a view to improve pupils' health and wellbeing. Two sites were identified to test this new programme. Our aim was to assess how, for whom and under what circumstances the programme works in order to provide learning to support school nurse training and intended national roll-out.

Methods

This study was a mixed methods study, using a realist evaluation approach, and conducted in three phases. In phase one, six nurse managers from both study sites took part in individual interviews or focus groups and this was complemented by programme documents to develop initial programme theory. In phase two, the programme theory was tested using qualitative data from 27 school nurses, and quantitative data from the first 6 months of the programme that captured patterns of referral. The programme theory was refined through analyses and interpretation of data in phase three.

Results

The findings show that the programme enhanced opportunities for early and improved identification of health and wellbeing needs. The context of the nine pathways worked through the mechanism of streamlining referral of relevant cases to school nurses, and yielded positive outcomes by extending school nurses and thus children's engagement with wider services. The mental health and wellbeing pathway was the most frequently used, and nurses referred complex mental health cases to more specialist mental health services, but felt less equipped to deal with low to moderate cases.

Conclusions

The programme facilitated early identification of risk but was less successful at equipping school nurses to actually deliver specific interventions as intended. Capacity building strategies for school nurses should seek to enhance intervention delivery skills within the parameters of the pathways. Realist evaluation provided a useful framework in terms of identifying contextual and mechanistic influences that required strengthening prior to wider implementation.

SUBMITTER: Doi L

PROVIDER: S-EPMC6114697 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Supporting the health and well-being of school-aged children through a school nurse programme: a realist evaluation.

Doi Lawrence L Wason Deborah D Malden Stephen S Jepson Ruth R

BMC health services research 20180828 1

<h4>Background</h4>The school nurse's role varies across countries. In Scotland, the Chief Nursing Officer recommended that the role should be refocused. The refocused programme emphasises nine care pathways with a view to improve pupils' health and wellbeing. Two sites were identified to test this new programme. Our aim was to assess how, for whom and under what circumstances the programme works in order to provide learning to support school nurse training and intended national roll-out.<h4>Met ...[more]

PMID: 30153849

Similar Datasets

Project description:BackgroundThe health visitors' role in many countries is changing. In Scotland, the role has undergone substantial changes through the introduction of an enhanced health visiting programme, which includes increased, structured home visits. This evaluation was conducted within NHS Ayrshire and Arran, one of the 14 Scottish Health Boards. Our aim was to understand and explain how, and why, the programme could contribute to improving health and wellbeing outcomes for children and families.MethodsWe used a realist evaluation approach, conducted in three phases. In phase one, eight managerial staff involved in developing and implementing the programme provided data, which were used to develop initial programme theories. In phase two, the programme theories were tested using qualitative data from 25 health visitors and 22 parents. The programme theories were refined through analyses and interpretation of data in phase three.ResultsThe home visiting context provided by the programme interacted with the mechanisms of the programme and produced outcomes such as early identification of health and wellbeing issues amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visits facilitated development of parent-health visitor relationships, and parents considered health visitors as their first point of contact on children's wellbeing and developmental-related issues. Moreover, the programme provided more clarity to health visitors' role, which in turn enhanced partnership working. However, there were aspects of the programme that may require further development. For instance, both parents and health visitors were concerned about the wide gaps between some home visits.ConclusionsThe enhanced health visiting programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These benefits need to be evaluated further in an effectiveness study.

Project description:This research is part of the last study Drugs and School IX developed in the Basque Country (Spain) by the Instituto Deusto de Drogodependencias (Deusto Institute of Drug Addiction) of the University of Deusto (The study had the support of the Public Health and Addictions Directorate of the Deputy Health Ministry from the Health Department of the Basque Country.) and the data gathered by means of cluster sampling in two stages. The sample is made up of N = 6,007 girls and boys ranging from 12 to 22 years of age in secondary education, and the aims, on the basis of those parameters, are as follows: (1) describe the reality of drug consumption and some psychosocial variables in this sample, as well as analyze several relations between variables; (2) analyze the role of school well-being (SWB), self-esteem, and self-concept regarding consumption; (3) take a close look at the moderating role of age and gender on the relationship of school well-being, self-concept, and self-esteem with consumption; and (4) understand the existing interaction between all these variables, by studying the moderating role of self-esteem and self-concept in the influence of school well-being on consumption. With the use of a correlation, hierarchical regression, and mediation analysis with SPSS (v. 26) and Amos (v. 26) applications, three main conclusions were reached. Firstly, educational and academic well-being, academic self-concept, and self-esteem seem to play the role of protecting factors in adolescence, whereas assertiveness is linked to a higher consumption level. Secondly, academic self-concept has a mediating effect between well-being and consumption. Some of these relations are moderated by the variables of gender and age. Thirdly, age and gender are very relevant sociodemographic variables that must be taken into account in order to understand this phenomenon. Age has shown its covariant effect, which is especially relevant in the influence of academic well-being measured as being held back years. It has also proved to be important in order to understand its experiential or experimental and transitory character. Moreover, significant differences in consumptions have been found based on gender.

Project description:Disrupted parental sleep, presenting as post-partum fatigue and perceived as problematic infant sleep, is related to increased symptoms of depression and anxiety among new mothers and fathers. Previous research indicates that UK parents would value an approach that facilitates meeting their infants' needs while supporting their own sleep-related well-being throughout their infant's first year. Six initial stakeholder meetings were held with 15 practitioners and 6 parents with an interest in supporting parent-infant sleep needs, to explore existing service provision and identify gaps. The Possums Sleep Program developed and delivered in Brisbane, Australia in a GP clinic setting, was chosen as an appropriate approach. Working collaboratively with a stakeholder group, we translated the Possums Sleep Program into an intervention that could be universally delivered in the UK via NHS antenatal and postnatal practitioners. Parent and practitioner views of the initial materials were obtained via feedback questionnaires and the tool was revised. The intervention was then field-tested by 164 practitioners who delivered it to at least 535 new parents and babies over 5 UK locations, to capture anonymous parent and practitioner views of the intervention concept, the materials, and their experiences with both. The intervention helps parents recalibrate their expectations of infant sleep development, encourages responsive parenting and experimentation to meet their infant's needs, offers parents strategies for supporting the development of their babies' biological sleep regulators and promote their own well-being, and teaches parents to manage negative thinking and anxiety that can impede sleep using the principles of Acceptance and Commitment Therapy. The 'Sleep, Baby & You' discussion tool, a 14 page illustrated booklet for parents, was field-tested and evaluated by practitioners and parents who offered enthusiastic feedback. Practitioners reported the 'Sleep, Baby & You' materials were easy for them to explain and for parents to understand, and were a good fit with the responsive parenting approaches they employed in other areas of their work. Parents who received the intervention postnatally understood the material and found the suggestions easy to follow. All parents who provided feedback had implemented one or more of the suggested changes, with the majority of changes (70%) being sustained for at least two weeks. Practitioners recommended development of digital and antenatal versions and offered feedback on circumstances that might challenge effective uptake of the intervention. 'Sleep, Baby & You' is a promising tool for promoting parental attitude and behaviour-change, that aims to adjust parental expectations and reduce negative thinking around infant sleep, promote responsive infant care in the face of infant-related sleep disruption and fatigue, and support parental well-being during the first year of parenthood. Initial field-testing provided insights useful for further development and subsequent testing via a randomised trial. Support exists for incorporating 'Sleep, Baby & You' into an anticipatory, universal intervention to support parents who may experience post-partum fatigue and infant sleep disruption.

Project description:BackgroundTo reduce social inequities in health, the World Health Organization's Commission on Social Determinants of Health recommends acting as soon as life begins. In this context, parenting support is promoted as a major lever. The objective of the present research was to develop an intervention theory establishing the conditions for the success of interventions, policies, and organizations supporting parenting in terms of reducing or preventing social inequalities in health for both mother and child in the perinatal period.MethodsTo meet these objectives, we conducted a realist evaluation based on a multiple-case study. The study evaluated two border towns in Europe. We collected data from three sources: documentary reviews, focus groups and interviews with professionals, and parental questionnaires.ResultsThe main results concerning the fight against social inequalities in health show a true willingness on the part of those involved to carry out universal actions, coordinated between professionals and institutions, in response to the demands of parents; however, the reality on the ground shows the complexity of their implementation and the multiplicity of results. Our middle-range theory showed that to be effective in tackling social inequalities in health, actions must address structural determinants at the macro-systemic level. However, the field of realist evaluation shows that it is first and foremost the actions focused on individual behavior that are implemented. While there is a general political desire to combat social inequalities in health in early childhood, the results show that the strategies in place are potentially not the most effective. Effective support actions would respond to individual strategies; however, current approaches target parents' behavior, aiming to empower them but without giving them the means to do so.ConclusionsThis research constitutes a body of knowledge gathered for reflection and action. In particular, any perinatal policy should clearly state among its objectives the intention to reduce social inequalities in health. The policy should also state that it will be evaluated according to the criteria of proportionate universalism, interprofessional coordination, and actions based on the diversity of parents' needs.

Dataset Information

Supporting the health and well-being of school-aged children through a school nurse programme: a realist evaluation.

Background

Methods

Results

Conclusions

Publications

Supporting the health and well-being of school-aged children through a school nurse programme: a realist evaluation.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure