The role of the school nurse in supporting the mental health of primary school children: a mixed methods study

Abstract

Background: Mental health problems in children and young people (CYP) are a global public health issue and national priority. Yet, evidence indicates that CYP are not receiving support early enough. Few empirical studies have focused on school nurses’ (SNs) contribution to supporting the mental health of primary-school-aged children. This study explores how SNs support children’s mental health from the perspective of the SNs, primary-school-aged children themselves, parents, and teachers. Methodology and Methods: An explanatory sequential mixed methods study underpinned by a pragmatist approach was conducted in Scotland. Phase One involved the administration of a national cross-sectional online survey comprising open and closed questions to nurses working in the school health service in Scotland. Phase Two employed a Single Qualitative Case Study design. Data collection involved online semi-structured interviews with qualified SNs, primary-school-aged children (9–11 years), parents and teachers in one health board area in Scotland. Creative, participatory methods were used in the interviews with children. Qualitative data were analysed thematically using the Framework Approach. Findings: SNs recognised their vital role in supporting primary-school-aged children’s mental health and their practice was holistic, strengths-based and innovative. The teachers had experience of working with SNs and this was positive. In contrast, primary-school-aged children and most parents had no experience of the SN and were unaware of the support they could offer and how to access them. They were clear that SNs should be accessible, approachable, and non-judgemental and building trusting relationships was viewed as being crucial. Barriers to SN involvement in mental health work, included workforce capacity, lack of resources, including retention of SNs, and the pandemic. Conclusion: SNs have a key public health role in supporting primary-school-aged children’s mental health and their contribution is valued by teachers’ when they have experience of working with them. This thesis identifies areas to inform the mental health work of the SN and raise their profile as specialist community public health nurses.