Learning from practice

Over the past 6 years with the support of Managers and Colleagues, Kath Lancaster, Nurse Specialist for Health Needs Assessment in Airedale PCT, has designed, developed and put into practice a Health Needs Assessment Model for the discipline of School Nursing.

Quantitative and qualitative information from the school age population, their families and their local communities is gathered through a structured process of data collection using questionnaires, a school profile and community statistics.

The benefits were that this saved school nurses time to direct help to pupils who need it most and devote more time to promoting healthy lifestyles to schoolchildren.

The data enables school nurses to identify potential problems at the earliest opportunity and intervene appropriately, by looking at trends in health related behaviour.

Pupils are also able to ask for information and support, given opportunity to make informed decisions about their lifestyles, behaviour and whether they choose healthy options.

To complement the health needs Assessment Model she has now taken her work a stage further and piloted a radical change in the way that school nurses work together using a team of four in Airedale.

Problems faced by the other teams within the PCT area was that there was a lack of time and resources to deliver the public health information and services which is a vital part of their role under the NHS modernisation agenda. Basically the teams were pushed to the limit carrying out their routine duties with individual pupils which left very little time to concentrate on public health practice.

She has recommended that each school nurse team has a mix of skills and knowledge within them and re-defined the roles within each team of school nurses, staff nurses, health care support workers so that they have a clear understanding of their responsibilities.

Kath, who was formerly a school nurse said: “The idea is very simple but effective.

School nurses are now working more closely together in teams and deliver what they are good at with the end result being that their job is more rewarding and efficient.

They each carry out appropriate tasks for their grade and competencies across many schools - rather than every school nurse trying to carrying a full range of tasks in a single school that another team member could do.

The new way of working looks at the skills, special interests and qualifications of each member of the team and how to make the most of them. For example those who have a public health degree will lead on proactive health promotion work and those with training and more experience in Mental health Issues will lead on that area of practice. The results of the project have been amazing.”

As a result of these changes school nurses have more time to concentrate on the problems, their work is more proactive than reactive and more initiatives are introduced which succeed in changing behaviour patterns. Using the data from the Health needs Assessments, school nurses now put together school health plans for each school which are then used to help schools get their healthy schools awards. They are also encouraged to work in partnership with other agencies.”

Findings from the project showed substantial rise in the number of children they can help and an increase in the amount of support they could offer.

In secondary schools the number of health interviews carried out by the school nurse increased by 69%, the referrals made by health care support workers increased by 22%, the number of child protection issues dealt with increased by 23% and mental health issues by 67%. There were also substantial increases in each of these areas in primary schools.

Examples of new Public Health initiatives were:-A change in the way drop-in sessions were delivered in schools. These were changed to reflect the problems within each individual school. For example information displays, discussion groups and role play groups were delivered alongside each other relating to self esteem and bullying. These were a great success and attendance was increased to 100 children a week compared to the previous three children on average who attended the old drop in sessions.