Philosophiae Doctor - PhD / This study focused on developing an intervention programme for school health nurses on guiding adolescents in their decision-making on reproductive health. A review of literature shows that this role is necessary, as there is a great need to reduce adolescents' morbidity and mortality rates due to poor decision-making about their reproductive health. School health nurses are strategically positioned to perform this role in ensuring that adolescents are well guided in making responsible decisions about their reproductive health. However, available evidence shows that school health nurses have not been performing this role in the school health service, especially in Nigeria. The provision of guidance for adolescents, on making decisions about their reproductive health is an adaptive role of school health nurses. The literature further shows that school health nurses require adequate preparation before they can perform this role. The study was conducted in the secondary school environment of Ijebu Ode local government area of Nigeria. Work role performance theory, adult learning principles, and experiential learning constituted the theoretical point of departure for this study. The paradigmatic assumptions revolved around intrepretivism/constructionism using the qualitative methodological approach. Semi-structured interviews and focus groups were the means of obtaining information from study participants for the study. The Intervention Design and Development model of Rothman and Thomas (2013) was used to design the study. The participants for the study were eight school health nurses, five school teachers, thirty-six adolescents, and one school health coordinator. They were all purposively selected. The data collected was analysed manually using inductive content analysis. The main findings from the interviews show that school health nurses have a poor awareness of their role and responsibilities, a lack of knowledge on how adolescents make their decisions, a lack of adequate knowledge on how to guide adolescents in their decision-making. The findings also show that there is poor interpersonal communication between school health nurses, and adolescents, and between school health nurses and members of the teaching staff. The findings further show that there are insufficient continuous professional development programmes. Results from integrative reviews regarding the types of intervention programmes that had been developed for school health nurses at different times in the past focused on role orientation, knowledge and skills acquisition, and mutual interaction between school health nurses and adolescents, and members of the teaching staff. The findings reflect a gap in how school health nurses provide guidance to school adolescents in decision-making on their reproductive health, hence the need for a training programme that will assist them in discharging this function effectively. A training programme was designed and developed for school health nurses to assist them on guiding adolescents in their decision making about their reproductive health. The training programme was pilot tested with observational methods, an interview being used as a means of assessing the quality and outcomes of the training programme. The results of the pilot test show the participants' satisfaction with the organisation and the quality of the training workshop. Participants indicated that they had gained more knowledge and understanding of adolescent reproductive issues, and their decision-making processes. They also said that they had gained more interpersonal skills, and greater communication skills. Some expressed the conviction that they had gained more confidence in their ability to communicate with the teaching staff. Some also expressed their readiness to apply the skills obtained during the training to their practice area. It is recommended that the training programme be fully evaluated in phase five of the Intervention Design and Development model of Rothman and Thomas, which will enable full dissemination and implementation of the programme (Rothman and Thomas, 2013). It is further recommended that the training programme be disseminated to end users (school health nurses) by sensitizing the necessary stake-holders on the need to use the training programme for school health nurses in their respective school contexts.

Syfte: Att beskriva skolsköterskors sociala stöd till ungdomar med långvariga och kroniska sjukdomar.Bakgrund: Ungdomar med långvariga och kroniska sjukdomar hade behov av socialt stöd för att klara av sin skolgång på ett tillfredsställande sätt. Skolsköterskor ska arbeta förebyggande och främjande och genom hälsofrämjande omvårdnad stötta elever och vårdnadshavare vid sjukdom gentemot skolans miljö och krav. Eleverna värdesatte att skolsköterskorna lyssnade på dem aktivt och ställde motfrågor. Vidare ansåg eleverna att förtroende, uppmärksamhet, respekt, äkthet, tillgänglighet och kontinuitet var betydelsefullt i kontakten med skolsköterskorna.Design: Kvalitativ design med induktiv ansats.Metod: Individuella intervjuer utfördes med en semistrukturerad intervjuguide. Totalt nio skolsköterskor intervjuades och intervjuerna analyserades med kvalitativ innehållsanalys.Resultat: Analysen resulterade i sex kategorier och 16 underkategorier. Studien visade att skolsköterskors sociala stöd till elever med långvariga och kroniska sjukdomar utgjordes av att finnas tillhands, vara lyhörd och stötta föräldrar i kontakten med vården. Skolsköterskorna upplevde det positivt att involvera föräldrarna i elevernas skolsituation. I interaktionen med elever och föräldrar var samtal ett betydelsefullt verktyg för skolsköterskorna. Tidsbrist bidrog till att det sociala stödet påverkades negativt och tillgängligheten för eleverna försämrades.Slutsats: Skolsköterskornas arbete var mångfacetterat, ställde krav på kompetens, flexibilitet och samarbetsförmåga. De hade en betydelsefull roll när det gällde att ge socialt stöd till ungdomar med långvariga och kroniska sjukdomar.Nyckelord: socialt stöd, skolsköterskor, elever, ungdomar, långvarig sjukdom, kronisk sjukdom, omvårdnad / Aim: To describe school nurses social support to adolescents with long-term and chronic illness. Background: Adolescents with long-term and chronic illness needed social support in order to cope with their schooling in a satisfactory manner. School health nurses work with health prevention and health promotion and should support students and their parents during illness towards the school environment and demands. Students appreciated that the school health nurses listened to them actively and asked counter-questions. Furthermore, the students felt that trust, attention, respect, genuineness, availability and continuity of contact with the school nurses were significant. Design: Qualitative design with inductive approach. Method: Individual interviews were conducted using a semi-structured interview guide. Nine nurses were interviewed and the interviews were analyzed using qualitative content analysis. Findings: The analysis resulted in six categories and 16 subcategories. The study showed that school health nurses’ social support to students with long-term and chronic illness were to be available, be responsive and to support parents in their contact with healthcare. The school health nurses experienced it positively to involve parents in students' school situation. In the interaction with students and parents the dialogue was a meaningful tool for the school health nurses. Social support was negatively affected by lack of time, and the availability for the students was deteriorated. Conclusion: School health nurses work was multifaceted, required expertise, flexibility and teamwork skills. They had a meaningful role in providing social support to adolescents with long-term and chronic illness.Keywords: social support, school health nurses, students, adolescents, long-term illness, chronic illness, nursing

This study identifies the Integrated School Health Programme’s implementation constraints in (Ekurhuleni Metropolitan Municipality, Southern Region), and describes how these constraints have affected the implementation of school health services. This predominantly qualitative study employed the structured interview-based research design and focus group discussion approaches, with the target population consisting of school health nurses and educators working with them in Ekurhuleni Metropolitan Municipality, Southern Region. The criterion-referenced sampling strategy was opted for, because of the researcher’s knowledge of the research environment. The focus group discussions, structured interviews and participant observations complement the study’s data collection methods. The principal findings depicted the Integrated School Health Programme was not as effective as expected in its implementation. The main constraints were identified as lack of resources and knowledge; and poor teamwork of the Department of Health, the Department of Basic Education, and parents. Emanating from these findings, the study recommends innovative collaboration mechanisms between the two government departments, and that relevant and sufficient resources should be allocated for effectively implementing the Integrated School Health Programme. / Health Studies / M. P. H.