School nurses, fully-trained nurses who work within schools, are ‘the single biggest workforce specifically trained and skilled to deliver public health for school-aged children’ (Dept of Health, 2014). There is huge potential for school nurses to improve young people’s physical, emotional and psychological health, and hence support them in attending, participating and succeeding at school. This is recognised in English and Welsh policy – the 2009 Framework for a School Nursing Service for Wales has an extensive list of some of the health issues school nurses can help address. However, there is little evidence that this is reflected in wider practice.
Given the links between pupils’ health and education, it is perhaps surprising that public health research has not focused more on the role of the school nurse, which is so clearly concerned with both. To share knowledge in this area, DECIPHer recently hosted a seminar led by Judith Jerwood, a full-time school nurse at Bryntirion School in South Wales, and Christine Jenkins, the school’s deputy headteacher. They spoke about role of the school nurse, how this fits into Bryntirion’s pro-active approach to pupil wellbeing, and how this works in practice.
In recent years, Bryntirion School has developed a strong focus on health and wellbeing. Christine Jenkins explained that when she was appointed to the senior management team some years ago, it was clear that the health and social needs of pupils were beyond the capacity of the services (such as a part-time counsellor) offered by the school at that time. This recognition led to the school funding their own school counsellor and training Learning Support Officers to work with pupils needing additional support during lessons in the school. Over the years, a wider supportive network has been developed. This includes strong contacts with voluntary organisations and statutory agencies, INSET teaching training days on meeting pupils’ health and social needs, and the appointment of a specialist head of pupil personal and social education (PSE) – a role that is traditionally a part of a teacher’s job rather than the sole function.
Christine recounted how the increasing commitment to pupil wellbeing helped the school management recognise the role school nurses could potentially play in supporting not only pupils’ physical health, but also their emotional health and wider social needs. Although the school had funded their own full-time school nurse for some years, they now employ Judith Jerwood, a qualified Specialist Community Public Health School Nurse (SCPHN). During the DECIPHer seminar, Judith emphasised the role school nurses can play in addressing barriers to education, particularly school absences, and how this often involves addressing the wider needs of pupils and their families.
Judith explained that one of her main aims is to help pupils develop into adults who are health literate and use health services responsibly. The role of the SCPHN nurse has a strong focus on prevention. This includes reinforcing messages such as the importance of dental and hand hygiene in avoiding illness; assessing health needs; and the early identification of safeguarding and wellbeing issues.
It seems that working full-time at the school has helped Judith develop a strong relationship with students. A recent survey at Bryntirion found that 95% of students knew how to access the school nurse, and 70% had visited in the past year for reasons other than immunisations. This contrasts with national data from the British Youth Council, which reported that 50% of young people did not know who their school nurse was, 70% did not know how to access the school nurse, and three quarters had never visited except for immunisations. The continual presence of a nurse at Bryntirion means pupils can consult her as needed; in the four months since September 2014 Judith has received visits from pupils on 990 occasions. This compares to 245 pupil visits made to local health board school nurses who aim to hold weekly drop-ins at the other nine comprehensive schools in Bridgend. 88 similar visits were recorded in the 11 comprehensive schools in Neath/Port Talbot in the 2013 calendar year.
Judith also highlighted the importance of good relationships and regular contact with the pupils at Bryntirion in gaining knowledge of pupils’ situations and needs, and how this can impact on their wellbeing, school attendance and achievement. This is helped by good information sharing within the school. Access to school attendance records, for example, means the school nurse can understand how pupils’ individual visits to the nurse may be related to more extensive or complex needs. This has clear implications for prevention, allowing potential problems to be identified before they escalate. Being based full-time within the school in a fixed, private space also supports pupil confidentiality and helps partnership working with visiting organisations such as child and adolescent mental health services (CAMHS). Judith gave a number of examples of instances where drawing on resources and expertise from outside agencies has helped to support pupils in managing complex and chronic health needs. Results and attendance records in Bryntirion suggest this has led to fewer sickness absences and improved sickness behaviour.
Since starting at Bryntirion, Judith’s role as school nurse has expanded. It now includes working with pupils who disclose self-harm, a growing concern for schools, which may sometimes be best addressed by someone with an ongoing relationship with the young person. She also works with more vulnerable pupils such as those experiencing neglect. Judith described how working with these pupils on a one-to-one basis seems to provide a consistent source of support, helping to overcome varied health and emotional barriers to learning.
Department of Health guidance on the public health role of school nurses points out that in order to realise their potential, it is vital that ‘the role of school nurses’ contribution is clearly defined locally and robust arrangements are put into place to support multi-agency working’. Judith and Chris’s discussion of their work at Bryntirion demonstrated the enormous positive role a school nurse can play within a school. However, the session also highlighted the need for the work of key individuals to be embedded within a system that supports good communication and multi-agency working. It’s heartening to know that there is good practice out there – so what can be done to help this become more widespread?
About the author: Annie Williams is a Research Associate at Cardiff University’s Children’s Social Care Research and Development Centre (CASCADE).