År 2015 sökte 70 384 barn asyl i Sverige. Flyktingbarn löper större risk att drabbas av ohälsa än andra. Idag träffar skolsköterskor i Sverige dessa barn allt oftare. Syftet med denna studie var att belysa skolsköterskors upplevelse av att möta nyanlända flyktingbarn. Semistrukturerade intervjuer genomfördes med 11 skolsköterskor och analyserades med hjälp av kvalitativ innehållsanalys. Resultatet redovisas i fyra kategorier: språket, ett hinder för att kommunicera; där skolsköterskorna tar upp vikten och svårigheten av att ha en fungerande dialog. Påfrestande att stödja barnen; där skolsköterskorna beskrev det som betungande att höra barnens historier och att de upplevde en känsla av otillräcklighet. Att känna tillfredsställelse i mötet; skolsköterskorna beskrev sig vara fascinerade över barnens mentala styrka och deras positivitet. Svårighet att anpassa sig till olika kulturer; där skolsköterskorna beskrev att hälsoformulären inte var anpassade till barnens olika kulturer och skolsköterskorna upplevde själva en bristfällig kunskap om de olika kulturerna. Konklusionen av studien var att skolsköterskors möten med nyanlända flyktingbarn kan effektiviseras om skolsköterskor får ökad kunskap om olika kulturer och flyktingbarns psykiska, fysiska och emotionella hälsoproblem samt genom att optimera kommunikationen.

Forskning om stickrädda barn i elevhälsovården bedöms som otillräcklig, men betydelsefull då många vaccinationer sker i skolan. Syftet var att undersöka flickors upplevelser kring HPV- vaccination i elevhälsovården. Uppsatsstudien hade en mixad metod design och studien var baserad på enkätsvar från 14 flickor i årskurs fem och sex. Det kvantitativa resultatet visade att hälften av flickorna skattade sig som rädda i samband med HPV-vaccination och av dem skattade sig 42 % som livrädda. Upplevd smärta och rädslan för eventuell smärta var de faktorer flickorna uppgav skapade rädsla. Att ha en förälder och/eller en kompis med sig vid vaccinationen var enligt flickorna de viktigaste strategierna för att kunna minska deras rädsla. Det fanns en positiv korrelation mellan flickornas skattade rädsla och hur de upplevde att de inte kunde koncentrera sig på skolarbetet under hela veckan innan vaccination (r2=0,761; p=0,002). Det kvalitativa resultatet visade att flickorna upplevde starka fysiska och psykiska reaktioner såsom gråt, illamående, panik och stress, orsakade av rädsla inför, under och efter vaccinationen. Då elevhälsvårdens övergripande mål handlar om att förebygga både fysisk och psykisk ohälsa för barn och ungdomar är det viktigt att belysa problematiken med stickrädsla. Sammanfattningsvis behövs vidare forskning genomföras. Detta för att bättre kunna förstå hur omfattande stickrädsla är bland skolelever och för att sätta elevernas perspektiv i fokus. / Research on children with fear of needles in the student health service is estimated as inadequate but important because many vaccinations take place at school. The aim was to examine girls’ experiences of HPV-vaccination in student health services. The study had mixed method design and the study was based on survey responses from 14 girls in the fifth and sixth grade. The quantitative results showed that half of the girls estimated themselves as frightened during HPV-vaccination, and 42 % rated themselves as terrified. The percieved pain and fear of eventuall pain were the factors in the girls' experiences of HPV- vaccination that caused fear. Having a parent and/or a friend present as support are the two most common strategies for reducing the fear during the HPV-vaccination, according to the girls. There was a positive correlation between the girls' estimated fear and their percieved ability to not be able to concentrate on schoolwork during the week prior to vaccination (r2= 0.761; p = 0.002). The qualitative results showed that before, during and after vaccination, strong physical and psychological reactions such as crying, nausea, panic and stress were caused by fear. The student health services overall goal is about preventing both physical and mental health of children and adolescents and therefor it is important to highlight the problem of fear of needles. Further research is therefor needed to better understand the extent of fear of needles among schoolchildren and focus on their perspective.

Background: School health services of today focus on prevention and health promotion within the school. A collaboration between the school health services and the student care team from the guidelines with focus on the student, is expected. Purpose: The purpose was to illustrate School nurses  vocational experiences and what the role of school health services in the student care team at upper secondary schools of John Bauer in relationship to the vision of the school. Method: Qualitative content analysis with inductive approach was used (Lundman &Hällgren-Graneheim, 2008). Data was collected by interviewing  school nurses at  School of John Bauer. Result: From the results school nurse´s health enhancement-and promoting work, team cooperation, prioritizing, management and co-ordination were found. From the data eight categories were found such as teamwork, health promoting tools, follow-up of schoolenvironment, knowledge, accessibility, low prioritized student care team, inadequate management and co-ordination of the team. Conclusion: According to the study, time limits and lack of comprehension from school management makes it more difficult for school health service to reach its fully potential. Theresults can be used to improve school nurses´ situation through self-education and encourage education of other student care team members and quality assurance.

I Sverige finns idag cirka 7000 barn och ungdomar med den kroniska sjukdomen diabetes. Ungdomar med diabetes typ 1 har ibland tendens att experimentera och ta risker genom att testa gränser för att utveckla sin kunskap. Risktagandet vid en kronisk sjukdom kan innebära medicinska konsekvenser för ungdomarna. En god vård är därför av betydande vikt. En systematisk litteraturstudie med deduktiv ansats genomfördes där syftet var att beskriva skolsköterskans stödjande insatser ungdomar med diabetes typ 1, utifrån Orems teori omstödjande och undervisande omvårdnadssystem. De vetenskapliga artiklarna eftersöks i databaserna Cinahl och Pubmed och sammanlagt hittas 16 artiklar som svarade mot syftet. Databearbetningen utfördes i form av temaanalys. Resultatet visade fyra kategorier av stödjande insatser som ungdomar med diabetes typ 1 är i behov av från skolsköterskan. Utifrån Orems teori om stödjande och undervisande omvårdnadssystem delas de in i: stöd – fysiskt och psykiskt, vägledning, undervisning och skapa en utvecklande miljö. Det fysiska stödet bestod av att ha en fysiskt närvarande skolsköterska som befann sig på plats och gav stöd åt ungdomarna när diabetesrelaterade problem uppkom. Det psykiska stödet bestod av att ha en god lyssnare som en som förstod ungdomarnas livssituation och deras känslor. Det vägledande stödet bestod i att ha en skriftlig vårdplan för att kunna hantera ungdomarnas diabetes i skolan. Stöd i form av undervisning till ungdomarna med diabetes, lärarna och övrig skolpersonal ansågs viktigt. För att ungdomar med diabetes ska kunna hantera sin sjukdom och egenvård krävdes en anpassad miljö. I en stödjande miljö fanns behov, tid och tillgänglighet av mat. Det var viktigt för att fler personal på skolan skulle ha kunskap och handlingsberedskap vid eventuella akuta situationer som kunde uppstå. Kunskapen som framkommit är viktig i skolsköterskans kliniska arbete, för att kunna ge ungdomar med diabetes typ 1 en trygg tillvaro under sin skoltid. Vidare kvalitativ forskning behövs för att förbättra skolsköterskans stödjande insatser till ungdomar med kronisk sjukdom. Metoder för att skapa en anpassad och säker miljö för ungdomar med kroniska sjukdomar behöver utarbetas. / In Sweden there are currently 7000 children and young people with the chronic disease diabetes. Young people with type 1 diabetes have sometimes tended to experiment and take risks by testing limits to develop their knowledge. Risk-taking in a chronic disease may involve medical consequences for young people. A good health care is therefore of considerable importance. A systematic literature search with a deductive approach carried out where the purpose was to describe the school nurse support to young people with diabetes type1, based on Orem´s theory of supportive and educational care system. The research articles were searched for in database Cinahl and Pubmed and 16 articles were found who answered the purpose. Dataprocessing was carried out in the form of thematic analysis. The result showed 4 categories of support that young people with diabetes type 1 is in need of. Based on Orems theory of supportive and educational caresystem divided into: support -physically and mentally, guidance, education and create a developed environment. The physical support consisted of having a present school nurse who was situated at school and gave support to young people with diabetes related problems when they needed help. The mental support consisted of having a good listener who understood young people's life situation and feelings. The guidance support consisted in having a written care plan for young people to be able to manage diabetes in school. Educational support for young people with diabetes their teachers and other school staff was considered important. Young people with diabetes should be able to manage their disease and care required a developed environment. A supportive environment was necessary also time and availability of food. It was important that more staff at the school would have knowledge and preparedness in the event of any emergency situations that could arise. The knowledge that was found is important in a school nurse clinical work, to be able to give adolescents with diabetes type 1 safe environment during school time. Further qualitative research is needed to improve the school nurse´s supportive service for young people with chronic illness. Methods to create a customized and secure environment for young people with chronic illnesses need to be developed.

Sammanfattning   Bakgrund: Inom skolsköterskans arbetsfält ingår hälsofrämjande arbete med sexuell hälsa. I utbildningen till skolsköterska saknas antingen ämnet helt eller ges bristfälligt. Kunskap kring sexuell hälsa samt utformningen av det hälsofrämjande arbetet inhämtas istället via vidareutbildning som arbetsplatsen erbjuder. Tidigare studier har visat att utbildningsinterventioner inom arbetsområdet sexuell hälsa kan ge skolsköterskor ökad kompetens, liknande studier saknas i Sverige.   Syfte: Syftet var att beskriva om en utbildningsintervention om sexuell hälsa påverkat skolsköterskornas arbetssätt med det hälsofrämjande arbetet inom sexuell hälsa.   Metod: Studien var en enkätstudie bestående av slutna och öppna frågor och utgjordes av en jämförelse av svaren från två identiska enkäter som skickades ut före respektive efter en utbildningsintervention. De slutna frågorna i enkäten analyserades med hjälp av deskriptiv statistik och de öppna frågorna med hjälp av konventionell innehållsanalys.   Resultat: Utbildningsinterventionen bidrog dels till att skolsköterskorna fick ökad kunskap i olika områden inom sexuell hälsa samt dels en känsla av ökad trygghet i samtalet kring sexuell hälsa. Skolsköterskorna ansåg även att samverkan med andra professioner var betydelsefullt för ett framgångsrikt hälsofrämjande arbete med sexuell hälsa.   Slutsatser: Utbildningsinterventioner av liknande slag kan öka kompetensen och därmed öka tryggheten i arbetet kring sexuell hälsa.   Nyckelord: distriktsköterska, elevhälsa, kompetenshöjning, sexuell hälsa / Summary   The school nurse’s health promoting work with sexual health. A survey study.   Background: The school nurse's field of work includes health promotion work concerning sexual health. In school nurse education, either the subject is completely missing or given deficiently. Previous studies have shown that educational interventions in the area of sexual health can increase competence, similar studies are lacking in Sweden.   Objective: The aim was to describe how an educational intervention on sexual health effect school nurses´ work procedure in the health enhancing work in sexual health.   Method: The study was a questionnaire consisting of closed and open questions and consisted of a comparison of the answers from two identical questionnaires that were sent out before and after an educational intervention. The closed questions in the questionnaire were analyzed by using descriptive statistics while the open questions were analyzed using a qualitative, conventional content analysis.   Results: The educational intervention has helped the school nurses to gain increased knowledge in various areas of sexual health, as well as having created a sense of increased security in talking about sexual health. The school nurses also considered that a collaboration with other professions was important for successful health promoting work within sexual health.   Conclusions: Education interventions can increase competence and thus increase security in work on sexual health.   Keywords: district nurse, increase competency, school health service, sexual health

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of schoolchildren’s health and to analyse factors influencing the recording of school-children’s health in the School Health Record (SHR). An additional aim is to evaluate fam-ily nursing interventions as a tool for the school nurses in the School Health Service (SHS). Methods: The thesis comprises four papers. A combination of qualitative and quantita-tive methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early ad-olescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separate-ly. Qualitative content analyses were used to analyze the interview text with the school nurs-es and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically. Findings: The findings showed that nurses judged the schoolchildren’s mental health as dete-riorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environ-ment and family relations. The latter seemed to be the most important factor affecting school-children’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the im-proper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families ex-perienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was sup-ported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families. Conclusions: The results indicate that school nurses have a deep knowledge about schoolchil-dren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would de-mand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level.

Overvekt er et voksende folkehelseproblem blant barn og unge. Andelen overvektige barn utgjør mellom 15-20% av barnepopulasjonen i de nordiske landene. Fysisk aktivitet og kosthold er viktige innsatsområder for å snu denne trenden. Skolehelsetjenesten har en unik mulighet til å arbeide med dette inn i skolen. Mangel på tid og tilgjengelighet har vist seg å være den viktigste barrieren for å samarbeide med skolene om helsefremmende aktiviteter. Hensikten med dette studiet har vært å undersøke hvordan helsesøster i skolehelsetjenesten i Oslo opplever sin rolle, sine muligheter og begrensninger for å forebygge overvekt gjennom å fremme fysisk aktivitet og et sunt kosthold for barn og unge. Studien bygger på teori om helsefremmende arbeid, empowerment, salutogenese og samarbeid. Det er gjennomført kvalitative intervju med ni skolehelsesøstere i ulike bydeler i Oslo kommune. Materialet er analysert ved hjelp av Graneheims innholdsanalyse. Resultatene viser at opplevelsen av egen rolle samsvarte med opplevelsen av problemet på egen skole, og at dette hang sammen med sosiodemografiske faktorer. Det var ulik praksis på om dette arbeidet ble prioritert i de ulike bydelene. En årsplan med felles mål og innsatsområder var viktig for å sette disse tiltakene på dagsorden for den enkelte helsesøster. Mangel på tid var den viktigste årsaken til at dette arbeidet ble prioritert bort til fordel for andre oppgaver som er bedre spesifisert i ”Anbefalt program for skolehelsetjenesten 5-20 år”. Tverrfaglighet, spesielt med fysioterapeut fremsto som viktig fordi det å kunne dele på oppgaver ut fra kompetanse styrket kvaliteten i arbeidet, og fordi man hadde mulighet til å fordele oppgaver og derfor fikk tid til mer. Et godt samarbeid med skolens ledelse og forankring i skolen blant annet ved god tilgjengelighet av helsetjenesten og felles årsplanlegging var nødvendig for å kunne jobbe med tiltak på systemnivå. Vekt ble opplevd som et sensitivt tema, og flere av informantene i denne undersøkelsen hadde vanskelig med å finne en innfallsvinkel for de overvektige elevene. Nye nasjonale retningslinjer for vekt og høyde kan eliminere dette problemet i tillegg til å sikre viktige epidemiologiske data. / Since overweight currently affects 15-20% of all children in Nordic countries, overweight represents a growing public health problem among children and adolescents. Physical activity and healthy diet are important target areas for reversing this developing trend. Although school health services are uniquely positioned to address overweight within the school environment, time and availability present important barriers between schools and school health services. The purpose of this study was to explore how school health nurses in the Oslo area experience their roles, possibilities and limitations in preventing overweight by encouraging physical activity and healthy diet in children and adolescents. The present study is based on theories about health promotion, empowerment, salutogenesis and cooperation.We conducted qualitative interviews with nine school health nurses in different districts in the Oslo area and analyzed their response using the Graneheim method of content analysis. The results show that personal experience correlated with the level of the problem at the corresponding school. Both factors also related to socio-demographical factors. All participants viewed weight as a sensitive issue, and several encountered difficulty in identifying an approach toward overweight pupils. Different districts placed different priorities on preventing overweight. A year-plan that includes mutual goals and target areas figures importantly in adding these issues to the agenda of individual school health nurses. Lack of time was the foremost reason for sacrificing this work for other tasks specified in the “Recommended Program for School Health Services 5-20 yrs”. Since sharing tasks from different competencies strengthens work quality and since the opportunity to distribute tasks gives the individual more time, an interdisciplinary cooperation is particularly important with physiotherapists. We determined that adequate cooperation with the among school management and school based activities, among others with sufficient availability of health services and a coordinated year-planning, was necessary for shaping action-programs at a system level. Focus on weight and height was perceived as a sensitive topic and more informants in this study had difficulties finding an appropriate approach to overweight pupils. New national guidelines for weight / <p>ISBN 978-91-85721-97-9</p>

Bakgrund: Under Covid-19-pandemin använde skolsköterskor på gymnasiet videosamtal för att kommunicera med sina elever. Enligt kompetensbeskrivningen ska skolsköterskan kunna ta ny teknik i anspråk och använda informations- och kommunikationsteknik för att kommunicera. Syfte: Syftet med studien var att beskriva skolsköterskors upplevelser av videosamtal med gymnasieelever under Covid19-pandemin. Metod: En kvalitativ metod med induktiv ansats användes. Data samlades in genom en webbenkät med öppna frågor. Fritextsvar från totalt 24 respondenter analyserades genom kvalitativ innehållsanalys. Resultat: Analysen resulterade i två huvudkategorier: Videosamtal inverkar på kommunikationen mellan skolsköterska och elev; samt Olika praktiska aspekter av att erbjuda eleven videosamtal. I de två huvudkategorier framkom sex underkategorier. Konklusion: Videosamtal ökar tillgängligheten till elevhälsan och medverkar till att skolsköterskankan arbeta mer flexibelt. Elever som av olika anledningar inte kan vara i skolan kan speciellt främjas av videosamtal som mötesform. / Background: During the Covid-19 pandemic school nurses in high school used video calls to communicate with their students. According to the skills description, the school nurse must be able to use modern technology, information, and communication technology to communicate. Aim: The aim of the study was to describe school nurses' experiences of video calls with high school students during the Covid-19 pandemic. Method: The study uses a qualitative method with an inductive approach. Data were collected through an online survey with open-ended questions. Free text responses from a total of 24 respondents were analysed through qualitative content analysis. Results: The analysis resulted in two main categories: Video calls affect communication between school nurse and student; Several practical aspects of offering the student video calls. In the two main categories, six subcategories emerged. Conclusion: Video calls increase accessibility to student health and contribute to the school nurse being able to work more flexibly. Students who cannot attend school for various reasons can particularly benefit from video calls.

Aim: The overall aim of this thesis is to explore School health nursing through school nurses’ descriptions of school children’s health and to analyse factors influencing the recording of schoolchildren’s health in the School Health Record (SHR). An additional aim is to evaluate family nursing interventions as a tool for the school nurses in the School Health Service (SHS).Methods: The thesis comprises four papers. A combination of qualitative and quantitative methods was used through individual interviews with a strategic sample of school nurses (n=12) (PI), a national survey to a representative sample of school nurses (n=129) (PII, III) and the implementation of family nursing models developed in Canada with girls in their early adolescence with recurrent health complaints and their families (n=4) in co-operation with their school nurses (n=2) (PIV). The Strengths and Difficulties Questionnaire (SDQ) was used as pre and post test. Evaluation interviews were conducted with the families and the nurses separately. Qualitative content analyses were used to analyze the interview text with the school nurses and the families. Manifest content analysis was used to analyze the free text answers of the survey and the evaluation interview with the school nurses. Descriptive statistical analyses were used to describe demographic data in all four papers. The SDQ was hand-scored statistically.Findings: The findings showed that nurses judged the schoolchildren’s mental health as deteriorated, especially in socially disadvantaged areas and more generally among girls expressed as psychosomatic symptoms. Individual factors related to lifestyle affected the schoolchildren’s physical health, and the mental health was, to a large extent, affected by the school environment and family relations. The latter seemed to be the most important factor affecting schoolchildren’s mental health. The basis for the school nurses judgement of the physical health was health check-ups and the health dialogues. Spontaneous visits were more commonly used to judge the mental health. Recording schoolchildren’s mental health was a challenge for school nurses. Difficulties were related to ethical considerations, tradition, lack of time and the improper structure of the SHR. Fears of marking the schoolchild for life related to the schoolchild itself, the parents or to other authorities/successive caregivers were brought up as hinders for recording mental and social health. Family sessions may be useful within the profession when handling recurrent health complaints among adolescence girls. The girls and their families experienced relief, they felt confirmed and that their feelings and reactions were normal in that situation. The families became aware of their own strengths and possibilities and this was supported by the SDQ which showed an increased well-being. The school nurses valued this way of working and meant that the sessions seemed to start a changing process within the families.Conclusions: The results indicate that school nurses have a deep knowledge about schoolchildren’s health which is not used to its full potential in a public health perspective. However, the experienced difficulties recording schoolchildren’s mental health seem obvious, which would demand developing the SHR for the needs of today. Family sessions in SHS with the school nurse as a collaborator with the family seemed useful and may be transferable to other health problems expressed by the schoolchildren. Bronfenbrenner’s ecological systems theory and other models for health determinants are used to illustrate the school nurse as a mediator working on the bridge over different health streams with schoolchildren’s health on an individual and a population level. / Syfte: Avhandlingens övergripande syfte är att undersöka skolsköterskors uppfattning om skolbarns hälsa och att analysera faktorer som påverkar dokumentation av skolbarns hälsa i skolhälsovårdsjournalen. Ett ytterligare syfte är att utvärdera modeller för familjeinterventioner som redskap för skolsköterskor i skolhälsovård.Metoder: Avhandlingen består av fyra delarbeten. En kombination av kvalitativa och kvantitativa metoder användes. I delarbete I genomfördes intervjuer med ett strategiskt urval av skolsköterskor (n=12). Intervjuerna analyserades med kvalitativ innehållsanalys. I delarbeten II och III distribuerades en nationell enkät till ett representativt urval av Sveriges skolsköterskor (n=129). Manifest innehållsanalys användes vid analys av de öppna frågorna. I delarbete IV genomfördes en interventionsstudie med familjesamtal, inspirerad av modeller för familjefokuserad omvårdnad utvecklade i Kanada. Skolflickor i tidig adolescens med återkommande subjektiva hälsoproblem (n=4) och deras föräldrar i samarbete med deras verksamma skolsköterskor (n=2) ingick i studien. Separata utvärderingsintervjuer genomfördes med familjer och skolsköterskor. Intervjuerna analyserades med kvalitativ och manifest innehållsanalys respektive. The Strengths and Difficulties Questionnaire (SDQ) användes som före/efter test vid interventionen och resultatet bearbetades statistiskt manuellt. Deskriptiv statistik användes för analys av demografisk data i samtliga delarbeten.Resultat: Resultatet visade att skolsköterskorna bedömde skolbarnens mentala hälsa som försämrad särskilt bland flickor och i socioekonomiskt utsatta områden. Individuella livsstilsfaktorer påverkade skolbarnens fysiska hälsa och den mentala hälsan var i stor utsträckning påverkad av skolmiljö och familjerelationer. Det sistnämnda verkade vara den mest betydelsefulla påverkansfaktorn för skolbarnens mentala hälsa. Bedömningen av den fysiska hälsan baserades på hälsokontroller och hälsosamtal medan spontana besök var vanligare för bedömning av den mentala hälsan. Dokumentation av mentala hälsa var en utmaning för skolsköterskorna. Svårigheterna kunde relateras till etiska överväganden, tradition och tidsbrist samt till skolhälsovårdsjournalens struktur som inte ansågs uppfylla dagens krav. Skolsköterskorna uttryckte en rädsla för att journalanteckningarna skulle märka skolbarnet för livet. Framtida tolkningar relaterade till skolbarnet själv, föräldrar eller andra/påföljande vårdgivare uttrycktes som hinder för att dokumentera mental och social hälsa. Familjesamtal visade sig vara användbara i skolhälsovården. De medverkande flickorna och deras familjer kände sig bekräftade i att deras känslor och reaktioner var normala. De sade sig bli medvetna om egna styrkor och möjligheter vilket styrktes av SDQ som visade ett ökat välbefinnande efter sammankomsterna, både hos skolbarnen och hos föräldrarna. Skolsköterskorna var positiva till att arbeta med familjesamtal och upplevde sig mer som samverkanspartner än som expert. Samtalen ledde till att en förändringsprocess startade i familjerna enligt skolsköterskorna.Slutsatser: Resultatet indikerar att skolsköterskor har en djup kunskap om skolbarns hälsa som sannolikt kunde tas tillvara på ett bättre sätt ur ett folkhälsoperspektiv på såväl nationell som lokal nivå. Behovet av att utveckla skolhälsovårdsjournalen efter dagens behov och fördjupad kunskap om de upplevda svårigheterna att dokumentera skolbarns mentala hälsa är uppenbar. Familjesamtal, där skolsköterskan intar en roll som samverkanspartner, visade sig användbara och kan sannolikt överföras till andra hälsoproblem bland skolbarn. Bronfenbrenners utvecklingsekologiska systemteori och andra modeller för hälsodeterminanter används för att illustrera skolsköterskans arbete med skolbarns hälsa på såväl en individuell nivå som folkhälsonivå.

Bakgrund: I Sverige år 2015 fanns det ungefär 18 000 högstadieelever med ogiltig upprepad frånvaro. Det finns samband mellan skolfrånvaro och sämre självupplevd hälsa och inom elevhälsan har skolsköterskan kompetens att identifiera och förhindra ohälsa. Skolsköterskor har en viktig roll att stödja elever med ohälsa. Därför är det viktigt att beskriva skolsköterskors erfarenheter av arbetet med högstadieelever med omfattande skolfrånvaro.Syfte: Syftet var att beskriva skolsköterskors erfarenheter av arbetet med högstadieelever med omfattande skolfrånvaro.Metod: En kvalitativ induktiv design. Ett ändamålsenligt urval gjordes och nio skolsköterskor verksamma på nio olika skolor i Sverige deltog. Individuella semistrukturerade intervjuer genomfördes och intervjuernas manifesta innehåll analyserades med kvalitativ innehållsanalys. Resultat: Ett tidigt initierat teamarbete där eleven är en viktig del i teamet är betydelsefullt i arbetet med att stödja högstadieelever med omfattande skolfrånvaro. Att skolsköterskan är närvarande genom att vara fysiskt tillgänglig och genom att bry sig om eleven är viktigt för att stödja eleven. Slutsats: Ett fungerande teamarbete där elevens berättelse är central är betydelsefullt. Genom att arbeta personcentrerat och använda arbetsmodellen gemensam problemlösning erhålls en arbetsstruktur där teamarbete möjliggörs och där eleven blir en viktig medlem i teamet. / Background: In Sweden in 2015, there were approximately 18 000 high school students with repeated invalid absence. There is a connection between school absence and poorer self-perceived health and in student health, school nurses have competence in identifying and preventing illness. School nurses have an important role in supporting students with ill health. Therefore, it is important to describe school nurses' experiences of working with high school students with extensive school absence.Aim: The aim was to describe school nurses’ experiences of working with high school students with extensive school absenteeism.Method: Purposive sampling was made and nine school nurses working at nine different schools in Sweden participated. Individual semistructured interviews were conducted and the manifest content of the interviews was analyzed with qualitative content analysis. Result: An early initiated teamwork where the student is an important part of the team is important in the work of supporting high school students with extensive school absence. That the school nurse is present by being physically accessible and by caring for the student is important to support the student.Conclusion: A functioning team work where the student's story is central is important. By working person-centered and using the work model collaborative problem solving, a work structure is obtained where teamwork is made possible and where the student becomes an important member of the team.