SUMMARY With changing public attitude to health and health care, health indicators and health care priorities are changing too. This situation is increasing special demands for health care system and for schoolchildren health care in schools too. Health care situation in schools has changed, because become popular to think that school was responsible for schoolchildren health education but not for their treatment (Vienonen, Springett, 1998/1999). Health indicators of children and young people are going lower (Juskelienė, Kalibatas, 2003). We have to pay a big attention to children and youth health service. Aim of study – to analyze school nurses view of schoolchildren health care and it‘s developing possibilities. Objectives: 1. To reveal schoolchildren health problems in a view or school nurses. 2. To analyze school nurses problems in a process of their work. 3. To present schoolchildren health care developing possibilities/ways. Methods. This research methodology consists of theoretical analysis (scientific literature and documents) and written questionnaire with quantitative data analysis. The questionnaire was answered by 202 school nurses from the biggest Lithuania cities (Vilnius, Kaunas, Klaipeda, Siauliai, Panevezys) schools. The written questionnaire was analyzed using descriptive statistics methods, counting average of respondents opinion, discriminantive analysis. The SPSS 12.0 (Statistical Package for Social Sciences) was using for data analysis. Results... [to full text]

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.

There is a new trend of shifting the provision of health care from hospitals to the patient?s natural environment. We are increasingly aware of the expensive and sometimes ineffective late hospital treatment; therefore, there are stronger efforts for early diagnosis, prevention and health education from an early age. It is necessary to keep the future generations focused on their health and the health of their family members who live in the community. The initiative must originate not only in families but also in the school environment in which children find themselves almost every day. A school nurse is an expert in the field of community care working in school environment. The work load of the school nurse rests in maintaining and improving physical and mental health. The school nurse supports pupils in their responsibility for their health and she creates a system of formalized school activities, prepares and implements the school?s educational program focused on prevention. The data in the research part of the thesis was obtained through quantitative and qualitative research survey. The quantitative research was carried out using the technique of an anonymous questionnaire. The questionnaire was intended for general practitioners for children and adolescents, as well as nurses working with general practitioners for children and adolescents. The qualitative research data was collected through semi-structured interviews with the head teachers of elementary and secondary schools on the basis of which casuistries were created resulting in categorized charts. The objective of this thesis was to find out about the position of general practitioners for children and adolescents, and paediatric nurses working with general practitioners for children and adolescents on introducing the function of school nurses in the healthcare system of the Czech Republic. The research in this thesis showed a low level of awareness about the position of school nurses. The primary controversies related to the introduction of school nurses can be described as follows: the method of financing, the issues of authority of such nurses, and the way of preparing for this occupation. The main positive aspect of school nurses can be seen by the respondents in comprehensive care for pupils, prevention and better public education. School head teachers, general practitioners and nurses believe that school nurses should be placed in schools according to the number of school pupils and school head teachers assume greater use school nurses in primary schools than in secondary ones. The method of financing school nurses should be, according to the respondents, from multiple sources. This thesis may be used as a basis for further research work focused on the position of school nurses, and also as a proposal of establishing the school nurse position in the healthcare system of the Czech Republic, or as informative material for professional as well as lay public.

Ohälsa bland nyanlända barn och segregation i mottagarlandet är ett folkhälsoproblem. Den stressfyllda situation som immigrerade barn lever i gör dem extra utsatt för en rad psykosociala problem och de har generellt sämre hälsa än barn som bor i landet. Barn som flyr ensamma har sämre hälsa än barn som har familjen med sig. Under år 2015 var flyktingströmmarna mot Sverige stor och de flesta barn som började i skolan var asylsökande från utomeuropeiska länder. Integrationen av nyanlända barn möter hinder i form av segregerade skolor, kulturella krockar och svenska språket. Många skolsjuksköterskor har erfarenhet av att arbeta med nyanlända barn men det fanns lite forskning i ämnet, och ingen forskning om skolsjuksköterskans perspektiv. Syftet med studien är att få kunskap om vad som främjar hälsa och integration för nyanlända barn i skolan utifrån skolsjuksköterskans perspektiv. Datainsamlingen genomfördes med en semistrukturerad intervju av sju skolsjuksköterskor i Mellansverige år 2015. Kvalitativ innehållsanalys valdes som metod. Analysen resulterade i tre huvudkategorier: 1. Vikten av ett bra mottagande. 2. Skolsjuksköterskan står för en helhetssyn. 3. Att kunna bli en del av svenska samhället. Skolsjuksköterskans arbete består till största delen av förebyggande arbete och då framförallt vaccinering av nyanlända barn. Jämlikhet i hälsa är framträdande i skolsjuksköterskornas arbete. Skolsjuksköterskan tycker det är viktigt att inge förtroende och ha bra relationer till nyanlända barn. Det som främjar integrationen i skolan är skolklasstillhörighet, kamrater, stöd av studiehandledare i modersmål och att barnet hamnar på rätt nivå i sin utbildning. Skolsjuksköterskans kunskap och kompetens är dåligt utnyttjad i skolan, trots att hennes kunskap om vad som främjar hälsa och integration för nyanlända barn stämmer överens med den forskning som finns. / Poor health among newly arrived children and segregation in the host country is a public health problem. The stressful situation that immigrant children live in makes them extra vulnerable to a range of psychosocial problems and they generally have worse health than children who already live in the country. Unaccompanied refugee minors have worse health than children who have family with them. In 2015 the flow of refugees to Sweden was large and most children who started school were asylum seekers from non-European countries. The integration of newly arrived children faces barriers in the form of segregated schools, cultural boundaries and Swedish language. Many school nurses have experience of working with newly arrived children, but there is little research done about the topic and no research from the school nurses perspective. The aim of this study is to get knowledge of what promotes health and the integration of newly arrived children in schools from the perspective of school nurses. Data collection was conducted using semi-structured interview with seven school nurses in the mid-region of Sweden year 2015. Qualitative content analysis was selected as the method. The analysis resulted in three main categories: 1. The importance of a good reception. 2. The school nurse stands for a holistic approach. 3. To be able to become a part of Swedish society. The school nurse's work was mainly preventive and especially focused on vaccinating newly arrived children. Health equity was the focus in the school nurses ‘work. The school nurse builds trustful relationship with the newly arrived children. The health promoting integration was school class belonging, peers, supported by educational culture brokers and the child ended up at the right level in its education. The school nurse's knowledge and expertise is poorly used in school even though her knowledge of what promotes health and integration of newly arrived children is consistent with the existing research.

Bakgrund: Skolsköterskans arbetsuppgifter har förändrats över tid, från medicinska insatser på individnivå till ett fokus på hälsofrämjande arbete på individ-, grupp- och organisationsnivå. Skollag, riktlinjer och kompetensbeskrivning beskriver att skolsköterskan ska arbeta hälsofrämjande och förebyggande på gruppnivå. Trots det sker skolsköterskans arbetsinsatser främst åtgärdande på individnivå. Syfte: Syftet med studien var att belysa skolsköterskors inställning till sitt uppdrag med fokus på hälsofrämjande arbete på gruppnivå. Metod: En kvalitativ metod med induktiv ansats valdes för att besvara studiens syfte. Semistrukturerade telefonintervjuer med tio skolsköterskor på väst- och östkusten i Sverige genomfördes. Datamaterialet analyserades med kvalitativ innehållsanalys på latent nivå. Resultat: Analysen resulterade i två kategorier; Skolsköterskans yrkesroll och rollförändring och Arbetsstruktur och organisation, med fem subkategorier; Fokus från åtgärdande insatser till hälsofrämjande arbete; Skolsköterskans breda hälsofrämjande potential; Inga tydliga arbetsbeskrivningar; Prioritering av arbetsuppgifter och Hela skolans ansvar. Konklusion: Skolsköterskan är en unik kompetens som den enda professionen i skolan som möter samtliga elever utifrån ett medicinskt-, omvårdnadsmässigt- och salutogent synsätt. Skolsköterskor vill arbeta mer hälsofrämjande på gruppnivå än vad som görs idag, men saknar tydliga strukturer och tillräckligt med tid och resurser för det arbetet. Med rätt förutsättningar kan skolsköterskan bli mer delaktig i det hälsofrämjande arbetet på gruppnivå. / Background: The school nurse’s duties have changed over time, from medical contributions at the individual level to a focus on promoting health at individual-, group- and organizational levels. Swedish school law, guidelines and competence description describes that school nurses’ work methods should be promoting health and be preventative at the group level. Nevertheless, today, the school nurse’s work is mainly done on an individual level. Purpose: The purpose of the study was to highlight school nurses’ attitude towards their assignment in focusing on health promoting work at the group level. Method: A qualitative method was used. Semi-structured telephone interviews with ten school nurses in Sweden were conducted. The data was analysed with a qualitative content analysis method and with an inductive approach, on a latent level. Result: The analysis resulted in two categories; The school nurse’s professional role and role change and Work Structure and Organization, with five subcategories; Focus from curative efforts to promote health promotion; School nurse's broad health promotion potential; No clear job descriptions; Priority of tasks and Responsibility of the whole school. Conclusion: The school nurses have unique skills being the only school profession that meets all students from a medical, care and salutogenic perspective. School nurses would like to work more health promotive at group level than what is currently done. With the right conditions, the school nurse would have a greater opportunity to work with health promotion at the group level.

Syfte: Att beskriva skolsköterskans upplevelser och erfarenheter av arbetet med att förebygga psykisk ohälsa samt deras upplevelser av den ökande psykiska ohälsan hos skolelever. Metod: Studien har en kvalitativ ansats med syfte att beskriva skolsköterskans upplevelser. Datainsamling gjordes genom semistrukturerade intervjuer med öppna frågor och informanterna var skolsköterskor. Intervjuerna transkriberades och genomgick en innehållsanalys. Resultat: Analysen utmynnade i fem kategorier; Betydelsen av hälsosamtalet, Samarbete, Tid och resurser, Organisationsmässiga aspekter samt Ett ökande problem. Skolsköterskor upplevde hälsosamtalet till stor hjälp i det förebyggande arbetet. Det underlättade även det förebyggande arbetet om det fanns ett gott samarbete, både inom den egna organisationen såväl som med andra. Det upplevdes som ett stort hinder när detta samarbete inte fungerade. Att ha tid till att kunna vara tillgänglig och ha möjlighet att vara i miljöer där eleverna vistas var något positivt, men skolsköterskorna upplevde att tid var en bristvara och att det var svårt att hinna med det förebyggande arbetet. Elever som redan mår dåligt tar mycket tid och skolsköterskorna upplevde att den psykiska ohälsan hos eleverna har ökat. Flera tyckte att det kom som en överraskning att det är så många barn som mår så dåligt i skolan. Många utav de barn som inte mår bra har någon neuropsykiatrisk funktionsnedsättning och skolsköterskorna trodde att om kunskaperna var bättre så skulle stor del av den psykiska ohälsan kunna förebyggas. Slutsats: Skolsköterskorna ansåg att den psykiska ohälsan är ett växande problem bland elever i högstadiet. Det var av vikt att arbeta förebyggande men det var även svårt att hinna med då de som redan lider av psykisk ohälsa tar så mycket tid, och tid var en bristvara. / Aim: The school nurse experiences of the work to prevent mental illness as well as their experiences of the increasing mental illness of pupils. Method: The study has a qualitative approach, with the purpose of describing the school nurse's experiences. Data collection was done using semi structured interviews with open questions. The interviews were transcribed and underwent a content analysis. Results: The analysis resulted in five categories; Importance of the health-dialouge, Cooperation, Time and resources, Organizational aspects and An increasing problem. School nurses experienced the health-dialouge to be very helpful in the preventive work. It also facilitated the preventive work if there was a good cooperation, both within their own organization as well as with others. It became a major obstacle in the school nurse's work when this cooperation did not work. To have time to be available and to be able to stay in environments where the students were staying was something positive, but the school nurses felt that time was a shortcoming and it was difficult to find the time for preventive work. Students who already feel bad take a lot of time and the school nurses felt that the mental illness of the students has increased. Several school nurses found it surprising that there are so many children who did not feel good at school. Many of the children who do not feel well have a neuropsychiatric disability and if the knowledge was better, much of the mental illness could be prevented. Conclusion: School nurses considered that mental illness is a growing problem among students in secondary school. It is important to work preventively but also difficult to cope with, as those who already suffers from mental illness need so much time, and time was a shortage.

Humant papillomvirus är ett mycket vanligt förekommande sexuellt överförbart virus som kan orsaka allvarliga sjukdomar såsom livmoderhalscancer. I Sverige vaccineras flickor i årskurs 5 – 6, vars vårdnadshavare har gett sitt skriftliga samtycke, mot humant papillomavirus via skolsköterskan. Vaccinet har minskat förekomsten av livmoderhalscancer. För att minska antalet dödsfall i denna sjukdom är det av stor vikt att uppnå hög vaccinationstäckning hos flickor före tonåren. Syftet med litteraturstudien var att belysa orsaker till att vårdnadshavare avböjer vaccination mot humant papillomvirus till sina döttrar. Studien genomfördes som en litteraturstudie med integrativ ansats. Resultatet baserades på 19 artiklar. Orsakerna till att vårdnadshavarna avböjer att vaccinera sina döttrar mot humant papillomvirus resulterade i sex teman: oro för vaccinets säkerhet; bristande kunskap; otillräcklig information; otydliga rekommendationer; värderingar och övertygelser; misstro gentemot myndigheter. Skolsköterskor bör utbildas och fördjupa sin kunskap om humant papillomvirus och om vaccinet för att förmå framföra korrekt och adekvat information. Detta kan minska vårdnadshavarnas oro, vilket i sin tur kan leda till att täckningsgraden ökar och folkhälsan förbättras. / Human papillomavirus is a very common sexually transmitted virus that can cause serious diseases such as cervical cancer. In Sweden, vaccination against human papillomavirus is administered by the school nurse to girls in grades 5 – 6 whose parents have given their written consent. The vaccine has shown to reduce the incidence of cervical cancer. In order to reduce the number of deaths in this disease it is very important to achieve high vaccination coverage in adolescent girls. The purpose of the literature study was to highlight the reasons why parents decline human papillomavirus vaccination for their daughters. The study was conducted as a literature study with an integrative approach. The result was based on 19 articles. The reasons why parents decline vaccination for their daughters resulted in six themes: concern about the safety of the vaccine; lack of knowledge; insufficient information; unclear recommendations; values and beliefs; distrust of authorities. School nurses should receive further education and improve their knowledge about human papillomavirus and the vaccination in order to provide accurate and adequate information. This can reduce parents’ concerns, which in turn can increase coverage and improve public health.

Syfte med studien var att belysa skolsköterskors erfarenheter av hälsosamtal med nyanlända elever som kommit till Sverige tillsammans med sina familjer. En kvalitativ design med induktiv ansats och semistrukturerade intervjuer tillämpades. Totalt inkluderades sju skolsköterskor från olika skolor i Västernorrlands län och i Stockholms län. Intervjumaterialet bearbetades genom innehållsanalys. Resultatet av studien visade på ett tema "Att vara mer än bara skolsköterska" med tre huvudkategorier; "Att utmanas i sin yrkesroll som skolsköterska i hälsosamtalet" "Att berikas i sin yrkesprofession i samband med hälsosamtalet" "Att inte räcka till i hälsosamtalet som skolsköterska" Vidare bildades 14 stycken subkategorier. Samtliga skolsköterskor betonade att mötet med nyanlända elever i samband med hälsosamtal innebar att vara mer än bara skolsköterska, baserat på både positiva och negativa faktorer. Hälsosamtal med nyanlända elever innebar olika typer av utmaningar som ofta var relaterade till avsaknad av riktlinjer, kunskapsbrist, tidsbrist och resursbrist. Trots de utmaningar som framkom i studien uppgav skolsköterskorna att de hankade sig fram. Vidare uppgav skolsköterskorna att de berikades i sin yrkesroll i samband med hälsosamtalet vilket skapade en känsla av tillfredsställelse och ett engagemang av att vilja hjälpa och finnas där för dessa elever på ett djupare plan. De beskrev också en känsla av att inte räcka till i hälsosamtalet med eleven, vilket väckte känslor som osäkerhet, frustration och maktlöshet hos skolsköterskorna samt påverkade deras professionella förhållningssätt. Alla deltagare i studien var överens om att det saknades riktlinjer för bemötande av nyanlända elever på gymnasienivå och att det fanns kunskapsluckor hos skolsköterskorna gällande kulturella skillnader. Deltagarna efterfrågade också handledning i arbetet med nyanlända elever. / The aim of this study was to investigate and disclose the experiences that school nurses encounter, in regard to health consultations, with newly arrived foreign students. The study had a qualitative design and was composed of semi structured interviews with an applied inductive approach. In total, seven interviews were performed with separate school nurses from the counties of Västernorrland and Stockholm. The interview material was processed through a content analysis. The results from the study indicated a theme of " being more than a school nurse" was composed of three main constituents; "To be challenged in one´s profession as a school nurse in health consultations" "To be enriched in one's profession in regard to health consultations" "To be inadequate in the health consultations as a school nurse" Based on both positive and negative factors, all school nurses affirmed that the meeting with the newly arrived foreign students, in regard to health consultations, resulted in being more than a school nurse. Health consultations with the students involved different types of challenges that consisted of inadequate guidelines, knowledge, time and resources. In spite of the challenges posed by the findings in this report, the school nurses asserted that they inched forward. The school nurses argued that they were enriched in their role in relation to the health consultations, which resulted in a sense of satisfaction and a commitment of wanting to help and be there for these students on a deeper level. The nurses reported a feeling of being inadequate during the consultations with the students, which brought forth feelings of insecurity, frustration and helplessness with the nurses. They reported that even their professional disposition had been affected. All participants in this study agreed that current high school health consultation guidelines were inadequate and confirmed that they lacked some knowledge in regard to cultural differences. The participants also requested guidance in their work involving newly arrived foreign students.

Background: Obesity is one of the most common causes of illness among children and adolescents. School nurses work includes health examination and health interviews including growth follow-up, prevention of illness and health framing. In health interviews the school nurse have possibility to support student to a more helthy lifestyle.                       Purpose: To study school nurses experiences of how they can affect overweight students to more healthy lifestyle.   Method: The study has been conducted with a qualitative method. School nurses have been interviewed by semi structured questions. The data from the interviews were analyzed by a qualitative content analysis with an inductive approach.   Results: In health interviews, the school nurse needs to establish a relationship that is built with a respectful approach in which recurring health interviews, the school nurse needs to establish a relationship that is built up by a respectful approach where autonomy is well preserved. Through encouragement and confirmation, the student can be motivated to reduce overweight if the family is involved too.   Conclusion: It is important to involve the whole family in health-framing nursing. School nurses experiences shows that it is important to focus on living habits instead of obesity.

Bakgrund: Elevhälsans organisation kan se olika ut utifrån lokala förutsättningar. En stor del av elevhälsans uppdrag är att arbeta hälsofrämjande. Hälsofrämjande arbete kräver samverkan inom elevhälsan. Skolsköterskan har en viktig roll i det hälsofrämjande arbetet, men upplever att mycket tid går till enskilda individärenden. Forskning visar att det finns en önskan från skolsköterskor om ökad tydlighet i hur det hälsofrämjande arbetet inom elevhälsan ska organiseras. Syfte: Syftet var att beskriva skolsköterskors erfarenhet av att inom elevhälsoteamet arbeta hälsofrämjande på olika nivåer. Metod: I studien användes kvalitativ innehållsanalys. Studien är en kvalitativ intervjustudie med induktiv ansats. Semistrukturerade intervjuer genomfördes med åtta skolsköterskor i Norrland. Resultat: I studiens resultat framkom temat, autonom roll som innebär både frihet och ansvar samt ensamhet i sin profession och två huvudkategorier, skolsköterskan intar rollen att skapa en hälsofrämjande lärmiljö samt organisationen är betydelsefull för elevhälsoteamets hälsofrämjande arbete samt sex underkategorier. Slutsats: För att lyckas med hälsofrämjande arbete krävs struktur och planering inom organisationen på olika nivåer. Planering, ansvarsfördelning och uppföljning är avgörande faktorer för att det hälsofrämjande arbetet ska bli framgångsrikt. Tydlig struktur och stöd från ledning och organisation, utökat samarbete inom elevhälsoteamet och övrig personal på skolan kan bidra till ökad hälsofrämjande lärmiljö för eleverna. / Background: The organization of the pupil health team differ with local preconditions. Health promotion is a major part of the teams commitments. Health promotion requires collaboration within the health pupil team. The school nurse has an important role to play in health promotion, but experience that a lot of time is spent on individual cases. Research shows that school nurses wishes for greater clarification in how health promotion should be organized within the pupil health team. Aim: To describe the school nurses experiences of health promoting work within the pupil health team in different levels. Method: The method used in the study was qualitative content analysis. The study is a qualitative interview study with inductive approach. Semi structured interviews was conducted with eight school nurse in the north of Sweden. Result: In the result a theme emerged: The school nurse has an autonomous role which lead to both liberty and great responsibility as well as seclusion in the profession, two categories The school nurse takes on the role of creating a health promoting environment and The health promoting work of the pupil health team is dependent of the organization and six subcategories. Conclusion: To succeed in health promotion structure and planning within the organization is needed. Planning, division of responsibilities and evaluation is important to succeed in the health promoting work. A distinct structure and support from the school leadership as well as expanded collaboration both within the pupil health team and with other school personnel can contribute to better health promotion in the pupils learning environment.