Sammanfattning Bakgrund: Sverige har aldrig tidigare tagit emot så många flyktingar under så kort period som man gjorde under 2015. Många av dessa flyktingar kommer från länder med krig och förföljelse. Skolsköterskan möter flyktingbarnen och deras hälsorelaterade problem i skolan. Studien handlar om skolsköterskans upplevelser och erfarenheter av arbetet med och kring flyktingbarnen. Syfte: Syftet är att belysa skolsköterskans erfarenheter av arbetet med flyktingbarn inom skolhälsovården. Metod: Studien genomfördes med en kvalitativ induktiv ansats med semistrukturerade intervjufrågor. Sex skolsköterskor intervjuades från Kalmar och Nybro kommun i södra Sverige. Data analyserades med en kvalitativ innehållsanalys. Resultat: Skolsköterskorna hade erfarenheter av att arbetet med flyktingbarnen påverkade och förändrade deras arbetssituation. Det som utmärkte sig i skolsköterskornas erfarenheter av arbetet med flyktingbarnen var dels ett ökat arbete med journalgranskning inför vaccinationer. Det framkom också att skolsköterskorna hade erfarenheter av ökade behov av hälsovårdande insatser inom följande områden hos flyktingbarnen: svårtolkade uttrycksformer från flyktingbarnen för olika hälsotillstånd, kulturella skillnader i attityder om hälsa och egenvårdsråd, brister i tolksituationen, samt att de önskade mer utbildning kring arbetet med flyktingbarn, framförallt inom psykisk ohälsa.   Slutsats: Skolsköterskans arbete med flyktingbarnen utmärkte sig genom en ökad arbetsbelastning. Det ställdes nya krav på skolsköterskornas kompetens och arbete då andra uttrycksformer och attityder till hälsa och ohälsa gestaltades från flyktingbarnen än de som skolsköterskan tidigare var vana vid. Även brister i tolksituationen framkom. Detta var faktorer som påverkade arbetssituationen för skolsköterskorna och det framkom flera idéer om förbättring inom området. / Abstract Background: Sweden has ever received as many refugees as during the year of 2015. Many refugees migrate from countries with war and persecution. The nurses meet the refugee children on a regular basis and are confronted with their health-related problems in school. This study investigates the experience of the nurses related to their work with these children. Aim: The aim is to highlight the experience from the school nurses perspective of working with refugee children within school health care. Method: The study was conducted by using a qualitative inductive approach with semi- structured interview questions. Six school nurses were interviewed from Kalmar and Nybro, cities in the south of Sweden. Data was analyzed with a qualitative content analysis. Results: The school nurses generally felt that the work with the refugee children affected their work situation. It was also found that the school nurses experienced these children were in need of an increased amount of health care attention. The results of this study showed that the nurses needed to spend more time on reading the medical records before vaccination appointments with refugee children, as well as it was time consuming to read up on the need of supplementary vaccinations. Moreover, they found that the refugee children had different ways of communicating health care related problems and had different perspective on self-care advices. Honor-related complications as well as lingual misunderstandings were some of the new challenges for the nurses. Finally, the nurses signaled that they wanted to learn more about the work with refugee children, especially within the field of mental illness. Conclusion: The school nurse's work with the refugee children was characterized by a workload. The nurses experienced that the refugee children were communicating health care related problems differently from what the nurses were used to. There were also shortcomings in the interpretation situation. This was all factors which changed their work tasks and work situation.  The study revealed several areas of improvement regarding the school nurse's work with refugee children. These were factors that affected the workforce of the school nurses

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.

Background: Primary and secondary school children can carry a variety of different health related problems, whereas inactivity is one of them. In spite of this, the representation of physiotherapists within the school system is low. Research examining how school-based physiotherapists could affect school children’s health is yet to be presented. Since physical therapists within the field of pediatrics meet many children with different causes of ill-health, to examine their view on a school-based physiotherapist is of interest. Primary and secondary school children can carry a variety of different health related problems, whereas inactivity is one of them. In spite of this, the representation of physiotherapists within the school system is low. Research examining how a school-based physiotherapist could affect school children’s health is yet to be presented. En pediatriskt verksam fysioterapeut träffar många barn med olika bakomliggande orsaker till ohälsa, varför deras syn på skolfysioterapeut är av intresse att undersökas. Purpose: To examine physiotherapists’, operating within the field of pediatrics, view on a school-based physiotherapist possibilities to affect children’s health in primary and secondary school. Method: Descriptive, qualitative method realized by individual interviews with an inductive approach. The selected participants were six physical therapists operating within the field of pediatrics.Urvalet bestod av sex pediatriskt verksamma fysioterapeuter. En kvalitativ innehållsanalys utgjorde en grund för resultatet. Result: Five categories were formed. These were pursue informative operations regarding healthy habits, infix preventative measures to increase school children’s activity levels, providing support for children with special needs, working with school children’s physical self-esteem and assisting with professional competency surrounding the construction of school environments.The conducted interviews showed a worsened overall health state amongst school children. The health state is affected by the child’s preconditions and surroundings, but also by the decisions of which the child may choose to take based on these factors. The interviews also showed that a school-based physiotherapist’s occupation can be comprehensive. Conclusion:A school-based physical therapist may be of importance to the school health services by effecting students’ health in different ways. School based physical therapists, amongst other things, have the opportunity to increase general physical activity, operate towards a healthy lifestyle and acknowledge children living with undiagnosed disorders. As the results of this study only represent the views of physiotherapists active within pediatrics, further studies presenting other populations’ opinions of this matter, are needed.There are many elements that play a contributing role in determining a child’s health and activity level. A physiotherapist can be of importance for the work conducted by the school health services but also for the work conducted on a societal level as a school-based physiotherapist has the opportunity to acknowledge children living with undiagnosed disorders, whose needs are not fully met. As the results of this study only represent the views of physiotherapists active within pediatrics, further studies presenting other populations’ opinions of this matter, are needed. / Bakgrund: Skolbarn ärEn stor andel skolbarn är inaktiva och kan ha många olika hälsoproblem. Trots detta finns fysioterapeuter i skolan i väldigt låg omsättning. Studier kring hur fysioterapeuter i grundskolan kan påverka barns hälsa saknasStudier kring hur en fysioterapeut i grundskolan kan påverka barns hälsa saknas. Fysioterapeuter inom pediatriken träffar många barn med olika bakomliggande orsaker till ohälsaEn pediatriskt verksam fysioterapeut träffar många barn med olika bakomliggande orsaker till ohälsa, varför deras syn på skolfysioterapeut är av intresse att undersökas. Syfte: Undersöka pediatriskt verksamma fysioterapeuters uppfattningar om skolfysioterapeuters möjligheter till att påverka grundskolebarns hälsa. Metod: Deskriptiv, kvalitativ metod i form av enskilda intervjuer med induktiv ansats. Urvalet bestod av sex pediatriskt verksamma fysioterapeuter. En kvalitativ innehållsanalys utgjorde en grund för resultatet. Resultat: Fem kategorier utarbetades. Dessa var bedriva informativt arbete om sunda levnadsvanor, sätta in primärpreventiva åtgärder i syfte att öka skolbarns fysiska aktivitetsnivå, utgöra stöd för barn med speciella behov, arbeta med barns fysiska självkänsla och bistå med yrkesspecifik kompetens vid utformning av skolmiljöer.Under intervjuerna framkom en försämrad hälsobild bland skolbarn. Hälsobilden påverkas av omgivningen, barnets egna förutsättningar i form av individfaktorer och de val barnet gör i förhållande till dessa. De ansåg även att skolfysioterapeuters arbete i grundskolan kan vara omfattande. Slutsats: En fysioterapeut kan vara av betydelse för elevhälsoarbetet i grundskolan genom att påverka elevers hälsa på olika sätt. Bland annat genom att arbeta för att öka den fysiska aktivitetsnivån på skolan samt att arbeta för en sund livsstil och identifiera elever med olika typer av besvär som är odiagnostiserade. Många olika faktorer påverkar skolbarns hälsa och kan bestämma barnets aktivitetsnivå. En fysioterapeut kan vara av betydelse för elevhälsoarbetet i grundskolan men även på samhällsnivå då den har möjlighet att fånga upp barn med odiagnostiserade besvär vars behov tillgodoses i låg utsträckning. Då resultatet endast representerar pediatriskt verksamma fysioterapeuters uppfattningar krävs ytterligare studier där andra populationers uppfattningar undersöks.

Attetion Deficit Hyperactivity Disorder, ADHD, är den vanligaste barnpsykiatriska diagnosen.Syftet med denna studie var att beskriva hur skolsköterskan erfar skolsituationen för elevermed ADHD-diagnos. Fyra till sex procent av alla elever i skolan har denna diagnos (ADHD).Skolsköterskan har i sin dagliga kontakt med elever möjlighet att tidigt upptäcka och även tillviss del förhindra utvecklandet av komplikationer. Orsaken till ADHD består främst avgenetiska anlag men sociala faktorer finns och de påverkar hur svår utvecklingen blir.Metoden var en kvalitativ innehållsanalys med induktiv ansats beskriven av Lundman ochHällgren Graneheim. Datainsamlingen gjordes genom intervjuer med sex skolsköterskor. Urdatamaterialet framträdde temat Att förväntas vara som andra, men inte kunna med treunderteman. Resultaten kan användas till att öka förståelsen för elever med ADHD och derasskolsituation. Förhoppningsvis kan insikten om problemets svårighetsgrad öka motivationenatt förbättra situationen i skolan för alla elever och vuxna. Det finns många saker sompåverkar situationen för elever med ADHD, med rätt resurser och förutsättningar gesmöjlighet att påverka elevens utveckling i positiv riktning. / Attention Deficit Hyperactivity Disorder, ADHD, is today the most common psychiatricdiagnosis among children. The purpose of this study was to describe school nurses̛experiences of the school situation of pupils with ADHD. Four to six percent of all schoolpupils have been diagnosed with this illness. Due to her daily contact with school children,the school nurse has the opportunity to assist in early detection of ADHD, and can to someextent even prevent the development of possible complications. Genetic predisposition is theprimary cause of ADHD but social factors affect the severity of its development. The methodin this study was qualitative content analysis with an inductive approach described byLundman och Hällgren Graneheim. The data collection was made through interviews with sixschool nurses. Based on the analysis, the theme; Expected to be like the others, but also notbeing able, emerged with three subthemes. The results can be used to increase theunderstanding of pupils with ADHD in their school situation. Hopefully, awareness of theproblem severity increases motivation to improve the situation in schools for all studentsand adults. There are many things that affect the situation for children with ADHD. With theright resources and conditions the opportunity to influence students' development in apositive direction occurs.

Mental health is a major child public health issue in Sweden. The overall aims of this thesis are to explore girls’ and boys’ perspectives on mental health and on mental health-promoting initiatives, and to deepen the knowledge of disclosure and support for ado-lescents at risk of abuse and neglect. Four studies are included in the thesis, and a qualitative descriptive design was chosen. In three of the studies (Studies I, II, and III), adolescents in Sweden were interviewed individually or in focus-groups. In the fourth study (IV) officials and politicians in nine municipalities in Sweden were interviewed, and documents were analysed in a multiple-case-study design. In study I the adolescents were asked about the mental health-promoting dialogue with the school nurse. The results reveal that what the adolescents found important were trustiness, attentiveness, respectfulness, authenticity, accessibility, and continuity. The adolescents also had certain views on what issues to talk about in the health dialogue; physical and psychological issues should be included. In Study II, the adolescents perceived “mental health” to be an emotional experience with positive and negative aspects of internal and relational feelings. Family, friends, and school were regarded as important determinants of mental health by the adolescents. Neither girls nor boys thought that there were any major differences in mental health between girls and boys, but did think they were subject to different expectations. In Study III the results show that adolescents with families with alcohol problems are unsure whether to disclose their home situation to an adult; the adolescents seem to make a risk assessment when looking for trustworthy adults. It is a disclosure process. Friends are confidants and supportive, and sometimes facilitators for contacting adults, when support from adults is needed. Study IV show that even small grants to municipalities for children-at-risk projects lead to more activities for these children and adolescents. But children or adolescents were not involved in the planning or decision-making of the activities. The studies in this thesis show that most important thing for adolescents’ mental health is the relation between adolescents and adults, foremost parents, and between adolescents and friends. In addition, gender and age, adolescents’ perspec¬tives and par-ticipation, and society’s support, including the implementation of the UN Convention on the Rights of the Child, have an impact on adolescents’ mental health, both for ado-lescents in general and for adolescents at risk of abuse and neglect. The results are viewed in relation to the bioecological model, to illustrate how all levels in society influence mental health among adolescents, on an individual and a population plane. The findings have implications for adults: to learn more about adolescents and puberty, and about the home situation for children and adolescents at risk of abuse and neglect; to listen to suggestions from children and adolescents; to include friends in support to adolescents at risk of abuse and neglect; and to include girls and boys in all matters concerning them.