Implications for practice and research

• Interagency communication can be problematic; adopting an interagency approach to education and training in this area may be beneficial.

• There is a need for research exploring the impact of school nurse interventions in relation to child maltreatment from the perspective of children and young people.

Context

Child maltreatment is a global public health issue with one in four adults experiencing physical violence in their childhood.1 Effects are far reaching and long standing for children and young people; these include behavioural, physical and mental health consequences. Internationally, in a global overview of school health services, it was found that at least 102 countries had school health services with 97 countries providing services within school premises and 59 countries having dedicated school health personnel.2 School nurses have access to the vast majority of children and young people and are well placed to identify and prevent child maltreatment. Harding and colleagues’3 review examines the role of the school nurse, with an international comparison, in protecting children and young people from maltreatment.

Methods

The purpose of this review3 was to review the international literature to examine four questions: what activities do school nurses undertake to protect children and young people from maltreatment? What barriers exist to school nurses protecting children and young people from maltreatment? Can clarity be sought on the remit of the school nurse in protecting children from maltreatment? What recommendations can be made for policy, practice and future research?

Following a comprehensive search strategy, 21 studies were included in the review; the studies were from the USA (n=7), UK (n=6), Sweden (=3), Finland (n=3), Australia (n=1) and The Netherlands (n=1). School nurses were the sole focus in eight studies and were included as a sample of mixed professionals within the other thirteen studies. Following critical appraisal of the studies, findings were organised and grouped using thematic analysis.

Findings

Six main themes were identified. These were supporting the child and family (18 studies), detective work (17 studies), working with other professionals (15 studies), training and supervision (13 studies), barriers to protecting children and young people from maltreatment (12 studies) and trust (10 studies). Most studies reported a combination of the identified themes. The review highlights a number of activities that school nurses may undertake in their role to protect children and young people from maltreatment while highlighting several challenges to this including building relationships and time management.

Commentary

This review explored the role of the school nurse in protecting children and young people from child maltreatment by examining the international literature. However, it should be noted that no studies within the review are included from Africa or Asia or from less economically developed countries. Six themes were identified; it is recognised that these themes interlink with trust being important and integral to a number of themes as well as being a theme on its own. Kraft and Eriksson4 concurred with this and found school nurse’s identified building trust as crucial in supporting children who were maltreated.4 The provision of support to children and families highlighted a range of examples of school nurse involvement, with direct support including mental and emotional health support and indirect support by providing a link role across services; school nurses in all six countries reported working with different professionals.

Visibility of the school nurse is seen as key in developing trust with children and young people4; however, this was impacted by high caseloads and significant time spent on work relating to child maltreatment. However, it is not clear what the impact of this work is and some confusion over the actual role of the school nurse in child maltreatment with five studies within the review highlighting the need for greater clarity on the school nurse role in protecting children and young people.

Working with other professionals is not without its challenges; communication, clarity on roles and expectations, previous experiences and feedback were all cited within the review as challenges. Studies within the review date from 1998, with one study using data from 1984 to 1993, and it must be recognised that service delivery and school health provision has evolved and developed significantly in this time; however, the challenges highlighted specifically around poor communication still persist.