School nurses have reported stress and worry caring for young people experiencing mental health problems, but why this occurs and how they respond has not been well-explored. In this study researchers generated a substantive theory of the experiences of secondary school nurses who encountered young people with mental health problems using the original method of grounded theory. Thirty-one Western Australian school nurse participants reported that students presented with complex mental and social health needs that were not easily resolved. This was conceptualized as an untenable burden. Participants countered this by engaging in the three-stage process of tactical prioritizing. During an initial period of strategic assimilation into the school and broader community, participants referred students to external service providers. This was frequently inadequate, and participants found themselves grappling with unmet student mental health needs. Participants responded by implementing nursing strategies for optimizing outcomes in the lives of young people, while simultaneously engaging in managing self to support their own well-being.
AbbottS.BryarR.CohenR.GibbonsJ.MarksL. (2019). Extending the mental health expertise of school nurses: Evaluating a training programme. British Journal of School Nursing, 14(9), 437–442. https://doi.org/10.12968/bjsn.2019.14.9.437
2.
BestN.OppewalS.TraversD. (2017). Exploring school nurse interventions and health and education outcomes: An integrative review. The Journal of School Nursing, 34(1), 14–27. https://doi.org/10.1177/1059840517745359
3.
BohnenkampJ. H.HooverS. A.ConnorsE. H.WissowL.BoboN.MazyckD. (2019). The mental health training intervention for school nurses and other health providers in schools. The Journal of School Nursing, 35(6), 422–433. https://doi.org/10.1177/1059840518785437
4.
ConlonC.TimonenV.Elliott-O’DareC.O’KeeffeS.FoleyG. (2020). Confused about theoretical sampling? Engaging theoretical sampling in diverse grounded theory studies. Qualitative Health Research, 30(6), 947–959. https://doi.org/10.1177/1049732319899139
5.
CrossS.HermensD.ScottE.OttavioA.McGorryP.HickieI. (2014). A clinical staging model for early intervention youth mental health services. Psychiatric Services, 65(7), 939–943. https://doi.org/10.1176/appi.ps.201300221
DinaF.PajalicZ. (2014). How school nurses experience their work with schoolchildren who have mental illness – a qualitative study in a Swedish context. Global Journal of Health Science, 6(4), 1–8. https://doi.org/10.5539/gjhs.v6n4p1
8.
GinsburgG. S.DrakeK. L.MuggeoM. A.StewartC. E.PikulskiP. J.ZhengD.HarelO. (2021). A pilot RCT of a school nurse delivered intervention to reduce student anxiety. Journal of Clinical Child & Adolescent Psychology, 50(2), 177–186. https://doi.org/10.1080/15374416.2019.1630833
9.
GlaserB.StraussA. (1967). The discovery of grounded theory: Strategies for qualitative research. Aldine de Gruyter.
10.
GodseyJ.PerrottB.HayesT. (2020). Can brand theory help re-position the brand image of nursing?Journal of Nursing Management, 28(4), 968–975. https://doi.org/10.1111/jonm.13003
11.
HaddadM.PinfoldV.FordT.WalshB.TyleeA. (2018). The effect of a training programme on school nurses’ knowledge, attitudes, and depression recognition skills: The QUEST cluster randomised controlled trial. International Journal of Nursing Studies, 83, 1–10. https://doi.org/10.1016/j.ijnurstu.2018.04.004
12.
HickieI.ScottE.HermensD.NaismithS.GuastellaA.KaurM.SidisA.WhitwellB.GlozierN.DavenportT.PantelisC.WoodS.McGorryP. (2013). Applying clinical staging to young people who present for mental health care. Early Intervention in Psychiatry, 7(1), 31–43. https://doi.org/10.1111/j.1751-7893.2012.00366.x
13.
HilliY.WasshedeK. (2017). Swedish school nurses’ perspectives on caring for and promoting the health of adolescents with mental health problems-A qualitative study. Clinical Nursing Studies, 5(3), 1–9. https://doi.org/10.5430/cns.v5n3p1
14.
HollowayE. M.RickwoodD.RehmI. C.MeyerD.GriffithsS.TelfordN. (2018). Non-participation in education, employment, and training among young people accessing youth mental health services: Demographic and clinical correlates. Advances in Mental Health, 16(1), 19–32. https://doi.org/10.1080/18387357.2017.1342553
15.
JamesonB. E. (2019). Understanding empowerment, burnout, and job satisfaction in school nursing: A mixed-methods study. In Paper presented at the creating healthy work environments 2019, New Orleans, LA, USA.
16.
JönssonJ.MaltestamM.TopsA.GarmyP. (2017). School nurses’ experiences working with students with mental health problems: A qualitative study. The Journal of School Nursing, 35(3), 203–209. https://doi.org/10.1177/1059840517744019
17.
LarssonM.BjörkM.EkeberghM.SundlerA. J. (2014). Striving to make a positive difference: School nurses’ experiences of promoting the health and well-being of adolescent girls. The Journal of School Nursing, 30(5), 358–365. https://doi.org/10.1177/1059840513505223
18.
MarkkanenP.AnttilaM.VälimäkiM. (2021). Supporting student’s mental health: A cross-sectional survey for school nurses. Children, 8(2), 129. https://doi.org/10.3390/children8020129
19.
MaughanE.AdamsR. (2011). Educators’ and parents’ perception of what school nurses do: the influence of school nurse/student ratios. Journal of School Nursing, 27(5), 355–363. https://doi.org/10.1177/1059840511416368
20.
MoenØLSkundberg-KletthagenH. (2018). Public health nurses’ experience, involvement and attitude concerning mental health issues in a school setting. Nordic Journal of Nursing Research, 38(2), 61–67. https://doi.org/10.1177/2057158517711680
21.
MuggeoM. A.StewartC. E.DrakeK. L.GinsburgG. S. (2017). A school nurse-delivered intervention for anxious children: An open trial. School Mental Health, 9(2), 157–171. https://doi.org/10.1007/s12310-017-9211-x
22.
PolitD.BeckC. (2018). Essentials of nursing research: Appraising evidence for nursing practice (9th ed.). Wolters Kluwer Health.
23.
PryjmachukS.GrahamT.HaddadM.TyleeA. (2012). School nurses’ perspectives on managing mental health problems in children and young people. Journal of Clinical Nursing, 21(5-6), 850–859. https://doi.org/10.1111/j.1365-2702.2011.03838.x
RadezJ.ReardonT.CreswellC.LawrenceP. J.Evdoka-BurtonG.WaiteP. (2021). Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies. European Child & Adolescent Psychiatry, 30(2), 183–211. https://doi.org/10.1007/s00787-019-01469-4
SendallM.FlemingM.LidstoneJ. (2011). Conceptions of school-based youth health nursing. British Journal of School Nursing, 6(6), 294–303. https://doi.org/10.12968/bjsn.2011.6.6.294
28.
SendallM.FlemingM.LidstoneJ.DomocolM. (2014). School based youth health nurses and attrition: The reasons for moving on. Community Practitioner, 87(8), 30–34. http://www.proquest.com
29.
Skundberg-KletthagenH.MoenO. (2017). Mental health work in school health services and school nurses’ involvement and attitudes, in a Norwegian context. Journal of Clinical Nursing, 26(23–24), 5044–5051. https://doi.org/10.1111/jocn.14004
30.
ThomasL. (2017). Nursing children and young people: What mental health training is required?British Journal of Nursing, 26(4), 234–237. https://doi.org/10.12968/bjon.2017.26.4.234
31.
TurnerG.MackayS. (2015). The impact of school nurse interventions: Behaviour change and mental health. British Journal of School Nursing, 10(10), 494–506. https://doi.org/10.12968/bjsn.2015.10.10.494
32.
van DoornM.NijhuisL.EgelerM.DaamsJ.PopmaA.van AmelsvoortT.McEneryC.GleesonJ.ÖryF. G.AvisK. A.RuigtE.JaspersM.Alvarez-JimenezM.NiemanD. (2021). Online indicated preventive mental health interventions for youth: A scoping review. Frontiers in Psychiatry, 12(562). https://doi.org/10.3389/fpsyt.2021.580843
33.
von SimsonK.BrekkeI.HardoyI. (2021). The impact of mental health problems in adolescence on educational attainment. Scandinavian Journal of Educational Research, 1–15. https://doi.org/10.1080/00313831.2020.1869077
34.
YuF.RaphaelD.MackayL.SmithM.KingA. (2019). Personal and work-related factors associated with nurse resilience: A systematic review. International Journal of Nursing Studies, 93, 129–140. https://doi.org/10.1016/j.ijnurstu.2019.02.014
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