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A scottish framework for nursing in schools
introduction
Purpose and context
The purpose of this framework is to set out in clear terms the nursing service that should be delivered to children and young people in Scottish schools. Whilst nurses already make a vital and valued contribution, the framework re-focuses this to ensure that the best use is made of their skills and expertise.
The framework has been developed within the context of a much wider commitment, across the Scottish Executive, to improve the health, well-being and aspirations of our children and young people. Nurses working in isolation can only have a limited impact, yet they have a major contribution to make as part of a wider, multi-disciplinary, multi-agency approach. It is within this context that the framework has been developed and should be used.
Nursing for Health
In 2001 the Scottish Executive Health Department published Nursing for Health the report of a review of the contribution of nurses, midwives and health visitors to improving the public's health. The review focused particularly on the roles of health visitors and school nurses.
The review process identified that the school nursing service had received little attention in policy terms over recent years and there was a lack of clarity over its role, with limited investment in the development of the service.
Nursing for Health made a number of recommendations about the school nursing service.
Firstly, it recommended that a new discipline of public health nursing should be developed, bringing together health visiting and school nursing into a single discipline with a shared educational preparation and a common focus on addressing the health needs of identified communities. In October 2001 the Health Improvement Fund funded the first 128 nurses on this programme, including 48 school nurses. The new public health nurses are now back in practice having completed the educational programme and ready to take a lead in developing practice.
Nursing for Health also recommended that a new model of practice should be developed for nurses working in schools, based on:
- Reduced commitment to surveillance
- Assessment of the health needs of each school and the development of school health plans
- Working with schools, children and parents to address identified needs
- Promoting healthy lifestyles and healthy schools
- Supporting children with chronic and complex health needs
- Supporting vulnerable children and young people
New Community Schools
The model draws heavily on the experience of the New Community Schools pilots. New Community Schools are founded on the twin principles of improving educational attainment and enhancing social inclusion, giving children the opportunity to realise their full potential so that they leave school with relevant skills, well motivated, with high self-esteem and better equipped for adult life. Since 1999, 62 three year pilots have been developed across all Local Authority areas, bringing together professionals from health, education and social work to take a holistic approach to improving opportunities for children.
Roll out of the concept commenced in April 2002. It is intended that by 2007, all schools will have adopted the New Community Schools concept. This will require a shift from testing out what works in a pilot, towards implementing the learning into mainstream practice across health, education and social work.
A key component of the development of each New Community School is a commitment to working towards becoming a Health Promoting School. All schools are to become Health Promoting Schools by 2007. The concept of the Health Promoting School underpins the entire framework. Many of the framework standards draw upon health promoting concepts. While there are specific sections in the framework on health promotion, highlighting key priority areas, the starting point is that the school nursing service focuses primarily on promoting health and well being as part of an integrated cross school approach, with a focus on the needs of each child as an individual.
The importance of the health and wellbeing of children and young people has been underlined by the Cabinet's commitment to take an Executive wide approach to improving the health of Scotland's people, with a particular emphasis on the needs of children and young people. The transition into teenage years is one of four priorities for multi-agency efforts to improve health. The school nursing service already makes a significant contribution to supporting children through this difficult transition when patterns of behaviour that can influence health for life are often established. The framework will ensure that this contribution is built upon and developed further.
Teamwork and Partnership
Some participants in the development of the framework have questioned the rationale of focusing purely on the contribution of nurses. Real improvements in the health of children and young people can only be achieved by many professionals, agencies working in partnership with one another and with children and young people and their families.
The framework takes as its starting point the principle that the school nursing service can not be effective without working in partnership with other professional colleagues in the child health service, primary health care teams, LHCCs and schools. However the need to refocus and develop the role of the school nursing service is such that a specific focus on the contribution of nurses is both necessary and appropriate.
Development of the Framework
In February 2002, two school nursing managers were seconded for nine months to the Nursing and Midwifery Practice Development Unit to job share the post of project officer, supporting the development of the framework. The first stage of the process was to investigate the current provision of school nursing services across Scotland.
The main element of this process included:
- A review of relevant literature and policies
- A questionnaire to the managers of school nursing services across Scotland, seeking quantitative and qualitative information on local services
- Focus group discussions in all mainland NHS Board areas (the island NHS Boards did not currently have dedicated school nursing services, although all were in the process of developing them). 262 nurses were involved in this process
The information gathered identified the strengths, weaknesses and aspirations of the service and formed the basis for the development of the framework.
A summary of the findings of this investigation is at Annex A.
The work of developing the framework was overseen by a steering group with wide representation from health and education services. The membership of the group is listed at Annex B.
Terminology
Throughout the framework, reference is made to the school nursing service and to nurses working in schools, rather than specifically referring to school nurses. The reason for this is an acknowledgement that the overall service needs to have a clear focus, but that elements of the service may be delivered by a variety of nurses, rather than just the group we currently think of as school nurses. This already happens in some more remote areas where the local nurse provides the local service. In future this may develop further with the introduction of more specialist roles such as paediatric nurses or mental health nurses to help deliver key parts of the service. It is important that the framework also incorporates their contribution.
In order to make the framework accessible to professionals from a variety of backgrounds a glossary of terms is included at Annex C.
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