The purpose of this study was to understand what the professionals experiences are of stressed youth. We did a qualitative study with interviewing three school nurses, one welfare officer and two recreation leaders. Research is saying that stress is increasing among the youth and that girls are more stressed than boys. It also says that medium is a big consequent for that (ex. Brun M. Sundblad, 2006). In our study we found out that the professionals thought the same thing and they meant that Internet and mobile telephones was the biggest problem for being stressed. We analysed the results with the help of Giddens (2007), Frank (2009) and Marmot (2006) theories. Giddens (2007) is saying that our society is changing and that we are becoming more self-centred individuals. He also says that our society is moving very fast and that the communications and information is spreading fast all over our world. Frank (2009) means that people are always comparing them self’s with people around them. It is the rich groups that are increasing the consumption in our society, not medium. Marmot (2006) is saying that people’s health has a big deal to do with if you are living among the same kind of people, with the same amount of  material welfare or not. If you have a lot of money and lives on a street with the same kind of people, you’re health will be better, then if it would be big differences among you. These aspects was something that we found out during our study, which the professionals did not mention, they blamed the medium for allot of the stress.

Sammanfattning   Bakgrund Skolsköterskan träffar alla barn under skolgången vid minst tre planerade tillfällen för hälsobesök. Tillsammans med andra professioner i skolan har skolsköterskan möjlighet att identifiera barn som far illa och har lagstadgad anmälningsplikt. Vid misstanke om samt anmälan av barn som far illa finns det risk för att skolsköterskor utsätts för stress och kan uppleva olika etiska dilemman. Detta gör det angeläget att ta reda på deras erfarenheter inom området. Syfte Att beskriva skolsköterskors erfarenheter av etiska dilemman vid misstanke om att barn far illa samt anmälan därav. Metod Studien genomfördes i två kommuner i sydsverige. Materialet samlades in vid elva intervjuer med skolsköterskor och analyserades med kvalitativ manifest innehållsanalys. Resultat De etiska dilemman som skolsköterskorna upplevde kategoriserades i fyra kategorier och elva underkategorier. Att bygga upp och bevara förtroendefulla relationer med barnen och föräldrarna var viktigt för skolsköterskorna. Viljan att göra rätt upplevdes som en svår uppgift eftersom det innebar att identifiera barn som far illa, att göra sin plikt, men även att göra nytta och inte skada. Skolsköterskorna kunde känna sig ensamma och utsatta i sin profession samt i behov av stöd, både från kollegor men även från andra professioner. De saknade återkoppling från socialtjänsten och önskade att de hade ett bättre samarbete. Slutsats Skolsköterskorna upplevde etiska dilemman i mötet med barn som far illa samt vid lagstadgad anmälan. Handledning, stöd under hela processen samt bättre samarbete med socialtjänsten skulle kunna leda till fler anmälningar. Utbildning samt standardiserade bedömningsinstrument bör kunna medföra att fler barn som far illa identifieras.   Nyckelord Skolsköterskor, barn som far illa, etiska dilemman, anmälningsskyldighet / Abstract Background The school nurse sees all children at least three times during their school years in connection to planned health visits. Together with other school professionals the nurse has the possibility to identify maltreated children and is obligated by law to report it. Suspecting and reporting child maltreatment might implicate an exposure to stress and dealing with various ethical dilemmas. It is therefore important to investigate the school nurses’ experiences concerning this issue. Aim To describe the school nurses’ experiences of ethical dilemmas when suspecting and reporting child maltreatment. Method The study was conducted in two counties in southern Sweden. Data was collected by interviewing eleven school nurses and analyzed by using a qualitative manifest content analysis. Results The ethical dilemmas experienced by the school nurses were categorized in four categories and eleven subcategories. Building and maintaining trustful relationships with the children and their parents was important for the school nurses. The wish to do right was experienced as difficult since it meant to identify maltreated children, to report it, and at the same do good and do no harm. The school nurses felt alone and vulnerable in this situation and needed support both from colleagues and other professionals. They lacked feedback from the child protection services and were yearning for a better collaboration. Conclusion The school nurses experienced ethical dilemmas when meeting maltreated children and being obligated to report it. Supervision, support during the process and a better teamwork with the child protection services may increase the reporting rate. Education and standard assessment instruments might increase the number of identified maltreated children.   Keywords School nurses, child maltreatment, ethical dilemmas, mandatory reporting

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purpose of this study is to identify some of the expressed reasons why graduate students in the maternal and child health program of the Boston University School of Nursing choose nursery school as a long term placement. An additional benefit from such a study could be to look at how the knowledge end skill gained from a long term placement in nursery school can be used in nursing. / 2031-01-01

Elever som stannar hemma från skolan har uppmärksammats allt mer under de senaste åren och trots den svenska skolplikten i grundskolan och frivilligheten på gymnasiet väljer allt fler elever bort skolan. Elevhälsan har en viktig roll i att främja elevers närvaro i skolan, fokus ligger på att sätta in insatser i tidigt skede vid frånvaro. Syfte: Syfte med studien är att undersöka skolsköterskors erfarenheter av att arbeta med gymnasieelever som har långvarig ogiltig frånvaro. Metod: Studien genomfördes med en kvalitativ metod. Studien baseras på sexton mejlintervjuer med skolsköterskor verksamma på gymnasiet och analyserades med hjälp av innebördsanalys. Resultat: Fyra innebördsteman framkom som beskriver skolsköterskornas erfarenheter av att arbeta med gymnasieelever som har långvarig ogiltig frånvaro; hälsosamtalet möjliggör att lära känna elever, att skapa en trygg relation till elever, samarbete med andra professioner och vårdnadshavare och betydelsen av rutiner för att främja elevers närvaro. Slutsats: Skolsköterskor behöver bygga upp en förtroendefull relation till elever för att en trygg relation ska uppstå. Det är viktigt att elever blir sedda och hörda på ett respektfullt sätt i mötet med skolsköterskorna så orsaker till den långvariga ogiltiga frånvaron kommer fram. / Students who stay at home from school have attracted increasing attention in recent years. Despite the Swedish compulsory school attendance in primary school and the voluntary nature of high school, more and more students give up school. Students health has an important role in promoting students school attendance, the focus is to put in effort in the early stage at absence. Aim: The aim of the study is to investigate the school nurses experience of working with high school students who have a long term absenteeism. Method: The study was conducted with a qualitative approach. The study is based on sixteen mail interviews with nurses working in high schools that were analyzed using significance analysis. Results: Four meanings were found describing the school nurses experience of working with high school students who have a long term absenteeism; the health dialogues enables to get to know the students, to achieve a safe relationship with students, cooperation with other professions and guardians and the importance of routines to promote students attendance. Conclusion: School nurses need to build a trustful relationship with students so that a safe relationship can occur. It’s important that students are being seen and heard in a respectful way, in the meeting with school nurses so that the cause of long term absenteeism appears.

Bakgrund: Kvinnlig könsstympning är en gammal sed som är vanligt förekommande i flera länder. Seden innebär att delar av det kvinnliga könsorganet avlägsnas. Det beräknas att två miljoner flickor utsätts årligen. I vilken omfattning ingreppet sker i Sverige är okänt, men det förekommer. I Sverige är alla former av ingreppet förbjudet. Skolsköterskan har möjlighet att möta och hjälpa flickor som riskerar eller har utsatts för kvinnlig könsstympning. Syftet: Syftet med denna studie är att belysa skolsköterskors upplevelser kring kvinnlig könsstympning bland flickor i skolan. Metod: Kvalitativa intervjuer med fyra skolsköterskor i en kommun i Mellansverige samt frågeformulär från sju skolsköterskor i olika delar av Sverige. Kvalitativ innehållsanalys användes som analysmetod. Resultat: Skolsköterskorna upplevde känslor av Kluvenhet, Osäkerhet och Medkänsla. Samt att kvinnlig könsstympning var Känsligt men angeläget att samtala om. Diskussion: Resultatet i denna studie fokuserar på skolsköterskors upplevelser, vilket skiljer sig ifrån tidigare studier i ämnet. I denna studie framkommer det en osäkerhet och rädsla inför att samtala, samt en vilja att hjälpa utan att döma. Detta tyder på att skolsköterskor upplever en utmaning. De behöver stöd och utbildning för att våga möta flickor som utsatts eller riskerar att utsättas för kvinnlig könsstympning. / Background: Female genital mutilation is an old ritual common in several different countries. In female genital mutilation parts of the female genital organ are removed. About two millions girls are exposed every year. Female genital mutilation occurs in Sweden, but to what extent is unknown. All types of genital mutilation are forbidden in Sweden. School nurses have an opportunity to meet and aid girls who are at risk or have been subject to genital mutilation. Aim: The aim of this study is to highlight school nurses´ experience of female genital mutilation among girls in school. Method: A qualitative interview study with four school nurses in a municipality in the central of Sweden as well as qualitative questionnaire from seven school nurses in different parts of Sweden. The material was analyzed using qualitative content analysis. Results: School nurses experienced feelings of Ambivalence, Uncertainty and Compassion. As well as the subject being Sensitive but Vital to talk about. Discussion: The results of this study focus on school nurses experience, which differs from previous studies on the subject. The study shows an uncertainty and fear of talking, and a willingness to help without judging. This indicates that school nurses experience challenges and are in need of support and training in order to meet girls who have been or may be subject to female genital mutilation.

<p>The purpose of this study was to understand what the professionals experiences are of stressed youth. We did a qualitative study with interviewing three school nurses, one welfare officer and two recreation leaders. Research is saying that stress is increasing among the youth and that girls are more stressed than boys. It also says that medium is a big consequent for that (ex. Brun M. Sundblad, 2006). In our study we found out that the professionals thought the same thing and they meant that Internet and mobile telephones was the biggest problem for being stressed. We analysed the results with the help of Giddens (2007), Frank (2009) and Marmot (2006) theories. Giddens (2007) is saying that our society is changing and that we are becoming more self-centred individuals. He also says that our society is moving very fast and that the communications and information is spreading fast all over our world. Frank (2009) means that people are always comparing them self’s with people around them. It is the rich groups that are increasing the consumption in our society, not medium. Marmot (2006) is saying that people’s health has a big deal to do with if you are living among the same kind of people, with the same amount of  material welfare or not. If you have a lot of money and lives on a street with the same kind of people, you’re health will be better, then if it would be big differences among you. These aspects was something that we found out during our study, which the professionals did not mention, they blamed the medium for allot of the stress.</p>

Bakgrund. Den ojämlika hälsan är ett globalt problem och behöver arbetas med på många olika nivåer. Skolan är en viktig arena där mycket förebyggande hälsoarbete kan utföras. En misslyckad skolgång kan leda till sämre livsvillkor och med det risk för sämre hälsa. Det socioekonomiska perspektivet framkommer som en viktig faktor i arbetet kring ojämlikheter i hälsa. Syfte. Att undersöka skolsköterskors hälsoutmaningar utifrån ett socioekonomiskt perspektiv. Design. Studien har en deskriptiv, kvalitativ design med deduktiv ansats. Metod. Studien grundar sig på strukturerade intervjuer med åtta skolsköterskor i Uppsala kommun. Alla skolsköterskor deltog frivilligt. Intervjuerna grundar sig på en intervjuguide med 27 semistrukturerade frågor. Intervjudata har analyserats med kvalitativ innehållsanalys. Bronfenbrenners utvecklingsekologiska teori har använts som teoretisk referensram. Resultat. Studien visar att hälsoutmaningar utifrån ett socioekonomiskt perspektiv är ett mycket komplext område. Skolsköterskornas arbete ser olika ut och hon samarbetar med många olika professioner. Psykisk ohälsa och fysisk inaktivitet framkommer som det tydligaste hälsoutmaningarna och är närvarande oavsett socioekonomisk tillhörighet. Dock visar studien att sammansättningen av elever där många har låg socioekonomisk tillhörighet ger en högre belastning för skolsköterskorna. Resultatet visar också att skolsköterskors som arbetar med ungdomar från områden med hög socioekonomisk tillhörighet har mer tid att arbeta förebyggande och hälsofrämjande. Slutsats. Studien visar att mer forskning behöver göras för att få mer kunskap kring de ojämlikheter som existerar i hälsa. Genom att öka kunskap kan resurser fördelas rättvisare och ojämlikheter utjämnas framför allt hos ungdomar. / Background. The inequalities in health is a global problem and needs to be addressed from many levels. School is an important arena where a lot of health promotion can be implemented. Failing school can lead to week living conditions which in turn can lead to poor health. The socioeconomic perspective is an important factor that emerges in the work around inequalities in health. Aim. To investigate school health nurses health challenges from a socioeconomic perspective. Design. A descriptive, qualitative study with deductive frame. Method. The study is based on eight structured interviews in Uppsala municipality. All school health nurses participated voluntary. The interview guide was based on 27 semi-structured questions. The data from the interviews has been analysed by a qualitative content analysis. Bronfenbrenners ecological systems theory has been used as a theoretical framework. Results. The results show that health challenges from a socioeconomic perspective is a very complex area. The work of school health nurses varies but they all cooperate with many different professions. Mental health problems and physical inactivity emerges as the clearest health challenges and is present regardless of socioeconomic status or structure. The study shows that the composition of the students which have lower socioeconomic structure gives higher work load for the school health nurse. Conclusions. The study shows that more research needs to be done in order to increase the knowledges about inequalities in health. By increasing the knowledges resources can be distributed in an equal way and inequalities in health can be levelled up, especially for adolescents.

The most common sexually transmitted infection for both males and females is the human papillomavirus (HPV). HPV is responsible for nearly all cervical cancers. Currently, an HPV vaccine is available; however, HPV vaccination rates for US adolescents are dismal. School nurses serve as the person connecting medical and school communities, and are a critical component in assisting families traverse the medical and educational systems. Thus, there is reason to assume school nurses can be key opinion leaders regarding the HPV vaccine. The purpose of this study was to: (1) explain how the Diffusion of Innovations (DOI) theory explains school nurses' roles as opinion leaders regarding the HPV vaccine; (2) document current literature regarding healthcare providers' perspectives and practice regarding the HPV vaccine; and (3) evaluate school nurses' knowledge, attitudes, perceptions of being an opinion leader and professional practice regarding the HPV vaccine for youth. DOI states opinion leaders influence the rate of an innovation (e.g., the HPV vaccine). We argue school nurses are opinion leaders for the HPV vaccine because of their unique leadership position through their cross-disciplinary understanding of the educational and health systems. The systematic literature review included 28 studies of healthcare providers. The main barrier, vaccine cost, was identified in 12 reports. Additionally, females and older adolescents were more frequently vaccinated than males and younger adolescents. To examine school nurses' knowledge, attitudes, perceptions and professional practice regarding the HPV vaccine, the study included a sample of 413 school nurses. Structural equation modeling revealed knowledge influenced attitudes, attitudes affected perceptions and professional practices, and perceptions predicted professional practice. Furthermore, the perceptions variable was found to be a partial mediator in the model. Practitioners designing programs to engage school nurses in disseminating HPV vaccine education may benefit from questioning whether their programs might be emphasizing non-crucial elements for influencing vaccine dissemination practice (e.g., knowledge) and de-emphasizing influential elements such as attitudes and perceptions.

The overall aim of this thesis is to provide a better understanding of knowledge, attitudes, consent, and decision-making regarding Human papillomavirus (HPV) vaccination, seen from the perspectives of concerned parties – high school students, school nurses, and parents. Two quantitative studies were performed: one descriptive cross-sectional study and one quasi-experimental intervention study. Qualitative studies using focus group interviews and individual interviews were also performed. High school students’ knowledge about HPV and HPV prevention was low but their attitudes toward HPV vaccination were positive. An educational intervention significantly increased the students’ knowledge regarding HPV and HPV prevention. Their already positive attitudes toward condom use and HPV vaccination remained unchanged. The students wanted to receive more information about HPV from school nurses. The school nurses were also positive to HPV vaccination but identified many challenges concerning e.g. priorities, obtaining informed consent, culture, and gender. They saw an ethical dilemma in conflicting values such as the child’s right to self-determination, the parents’ right to make autonomous choices on behalf of their children, and the nurse’s obligation to promote health. They were also unsure of how, what, and to whom information about HPV should be given. Parents, who had consented to vaccination of their young daughters, reasoned as follows: A vaccine recommended by the authorities is likely to be safe and effective, and the parents were willing to do what they could to decrease the risk of a serious disease for their daughter. Fear of unknown adverse events was overweighed by the benefits of vaccination. Parents also saw the school nurse as an important source of HPV information. Conclusions: Positive attitudes toward HPV vaccination despite limited knowledge about HPV, are overarching themes in this thesis. School nurses have a crucial role to inform about HPV prevention. It is important that the concerned parties are adequately informed about HPV and its preventive methods, so that they can make an informed decision about vaccination. A short school-based intervention can increase knowledge about HPV among students. From a public health perspective, high vaccination coverage is important as it can lead to a reduced number of HPV-related disease cases.

Bakgrund: I Sverige minskar årligen självmorden totalt men bland 15–24-åringar kan en viss ökning ses. Bakom självmord ligger oftast depression men även utanförskap, känsla av hopplöshet och annat emotionellt lidande som kan utlösa suicidalitet. Statistiskt sett har självmordsförsöken, den enskilt största risken för fullbordat självmord, ökat kraftigt främst hos flickor. Viktigt är att ha kunskap om riskgrupper och symtom för att tidigt kunna identifiera självmordstankar och på så sätt rädda liv. Det förebyggande arbetet med att identifiera riskgrupper och förstå hur elevens situation ser ut, se dennes livsvärld, är något som skolsköterskor gör via de hälsobesök som erbjuds alla elever.   Syfte med denna studie var att beskriva hur skolsköterskor upplever att de identifierar och bemöter skolelever med självmordstankar.   Metod: Material samlades via elva asynkrona mailintervjuer och analyserats enligt fenomenologisk metod.   Resultat: Skolsköterskorna i studien upplevde att de behövde bygga upp förtroende och tillit för att eleven skall öppna sig för samtal. Symtomen ansågs vara nedstämdhet, ilska, störande beteende, sömnstörningar med mera. Informanterna förmedlade ett mod att med direkta frågor våga fråga elever vid misstanke om självmordstankar, mod att stanna kvar i elevens lidande och mod att våga lita på sin intuition i bemötandet av elevens självmordstankar. / Background: In Sweden the mount of suicides are decreasing year on year however amongst 15-24 year old's there is an increase. The underlying cause for suicides is commonly depression but also social exclusion, feelings of hopelessness and other emotional suffering. Statistically speaking suicide attempts, the sole biggest risk for completed suicide, has increased mainly in girls. It is important to have knowledge about high risk groups and symptoms to be able to identify suicidal thoughts as early as possible in order to save lives. The preventative work done by identifying high risk groups and understanding the pupil's individual situation, see their lifeworld is something school nurses do through the health check-ups that are offered to all pupils.   Purpose was to find out school nurse´ experience in identifying and meet students with suicidal behaviour.   Method Materials have been collected through eleven asynchronous mail interviews and analysed according to phenomenological method.   Results: Most importantly was to build trust and confidence so that the pupil could open up and confide. Typical symptoms that was considered by the informants was dejection, anger, disorderly behaviour, sleep issues. School nurse has the courage in order to venture upon asking pupil's openly when there are suspicions regarding their suicidal thoughts but also courage to stay in the pupil's suffering and courage to trust their own intuition in the way the pupil's suicidal thoughts are received.