Högskolan i Skövde

SYFTE Att beskriva skolsköterskors erfarenheter av interaktion med elever med könsdysfori.

BAKGRUND Förekomsten av könsdysfori har ökat bland ungdomar. Ungdomar som upplever könsdysfori är mer utsatta för trakasserier, diskriminering och våld än sina jämnåriga. Skolsköterskan spelar en central roll i att stödja elevers fysiska och psykiska hälsa.

METOD Semistrukturerade intervjuer genomfördes med åtta skolsköterskor, med erfarenhet av att möta elever med könsdysfori. Data analyserades enligt kvalitativ innehållsanalys. 

RESULTAT Skolsköterskorna beskriver att elever med könsdysfori ofta brottas med ångest, depression och självskadebeteende. Vissa beskriver ett öppet och accepterande skolklimat, medan andra upplever en mer negativ skolmiljö. Skolsköterskorna betonar vikten av att etablera en god relation, vara lyhörda, inge mod, vara tillgänglig och ge stöd till eleven. Resultatet visar på behovet av en ökad kompetens hos skolpersonal för att skapa en främjande skolmiljö och förståelse för elever med könsdysfori. Skolsköterskorna beskriver behovet av samordnade insatser inom och utanför skolan för att främja elevens psykisk hälsa. 

SLUTSATS Sambandet mellan könsdysfori och ohälsa behöver synliggöras och diskuteras inom skolan. Hälsosamtalet är ett verktyg för skolsköterskan att initiera samtal om könsidentitet och ge stöd. Inkludering kräver både kompetens och ett respektfullt bemötande. Bristande kompetens kan  övervinnas genom att visa nyfikenhet, öppenhet och acceptans gentemot elever med könsdysfori.

Background: Young transgender persons who attend school are especially exposed to harassment, bullying, discrimination and violence in the school environment, experiencing an increased sense of mental and physical ill-health. School nurses work health promoting in schools and therefore have a unique opportunity to promote health among transgender students. There is however limited research on school nurses’ experiences of working with transgender students.

Aim: To illuminate school nurses’ experiences of interacting with and supporting students with transgender experiences.

Method: An inductive qualitative study with data collected through eight semi-structured interviews, analyzed through an inductive qualitative content analysis according to Graneheim and Lundman. The analysis was on the manifest level, where the steps were conducted in discussion within the research group to reach consensus through each step to ensure their connection to the aim. The analysis resulted in the findings, which is presented in two main categories with three sub-categories each.

Findings: The school nurses supported the students with trans experiences through conversations during the health dialogues, building a trusting relationship with the students, and by being a spokesperson and for the students, with other students, teachers and parents. The school nurses also experienced uncertainty in which was the proper actions to support the students with transgender experiences and feared acting wrongly and therefore not supporting the students adequately or even harming students.

Conclusions: The school nurses’ role in meeting these students is complex, where the school nurse work to build relationships with the students, but lack knowledge and tools. The lack of support and knowledge creates an ambivalence in how to best support these students, placing the school nurse before ethical dilemmas. The school nurses found support in the collaboration with the school counselor, as were the youth health clinics. School nurses should therefore, besides added education, be provided with arenas to discuss ethical dilemmas surrounding gender identity with other professionals who work in the school environment, or with adolescents.

SYFTE Att beskriva skolsköterskors erfarenhet av att möta elever med transerfarenhet.

BAKGRUND Allt fler barn och ungdomar upplever könsdysfori och osäkerhet över sin könsidentitet. Skolan är en betydelsefull arena där barn och unga spenderar stor del av sin vardag. Elever med transerfarenhet är i högre grad utsatta för mobbing och har högre risk för psykisk och fysisk ohälsa. Skolsköterskor har en central roll i att stödja elever med transerfarenhet.  

METOD Semistrukturerade intervjuer genomfördes med åtta skolsköterskor på högstadium och gymnasium. Intervjuerna analyserades enligt kvalitativ innehållsanalys.

RESULTAT Skolsköterskorna betonade betydelsen av tillit i mötet mellan elev och skolsköterska, för att skapa en trygg dialog kring trans- och könsidentitet. Det finns en stark vilja stödja elever med transerfarenhet samtidigt som utmaningar som bristande kunskap och ambivalens kring det stöd och vård som erbjuds till barn och unga. Skolsköterskorna uttryckte en oro över att eleven i framtiden skulle ångra sina beslut. En genomgående känsla av osäkerhet och rädsla för att göra fel beskrevs av skolsköterskorna, vilket kunde leda till att elever med transerfarenhet inte alltid fick stöd. 

SLUTSATS Det förekommer en brist på både kunskap och stödjande verktyg samt riktlinjer för skolsköterskor. Vilket medför att skolsköterskor känner osäkerhet i mötet och i att stödja elever med transerfarenhet. Trots detta framhålls det som avgörande att erbjuda ett respektfullt och bekräftande bemötande för att skapa en trygg miljö för dessa elever.

BAKGRUND Våld mot barn är ett globalt folkhälsoproblem och strider mot mänskliga rättigheter. Våld ger allvarliga och livslånga fysiska, psykiska och sociala konsekvenser för barnet och samhället.

SYFTE Var att beskriva hur skolsköterskor arbetarför att identifiera våldsutsatta elever.

METOD Studien består av 14 kvalitativa intervjuer med yrkesverksamma skolsköterskor runt om i Sverige. Datamaterialet analyserades enligt innebördsanalys (Dahlberg et al., 2008).

RESULTAT Fyra innebördsteman framkom: hälsosamtalet som ett verktyg, skapa relation och tillit, medveten om faktorer som försvårar samt samverka med skolpersonal.

SLUTSATS Skolsköterskan är en viktig vuxen i skolan och för att elever ska känna tillit behöver skolsköterskan bygga upp en relation till eleven. Relationskapande möten kan öppna upp för skolsköterskan att ställa frågor kring våld. Hälsosamtalet med tillhörande hälsoenkät är ett sätt för skolsköterskan att systematiskt identiera våldsutsatta elever. Begreppet våld behöver belysas i samtalet, vad är våld samt att våld mot barn strider mot barnkonventionen.

Aim: The aim of this study was to explore healthcare professionals’ experiences of working with extended home visits for parents.

Background: It is essential to identify parents, both expectant and with a newborn child, who need support in their parenting abilities at an early stage because children’s health and well-being are affected by their home environment as well as by their parents’ health and social relationships. Home visits represent a cost-effective way of identifying and supporting families with a newborn. Further research is needed to explore healthcare professionals’ experiences working with extended home visits for parents.

Methods: This was a qualitative interview study focusing on an intervention introduced in the Enhanced Parenting—Extended Home Visits project in Sweden. Data were collected via 13 semi-structured interviews with healthcare professionals who provide the intervention in antenatal care (midwives) and child health care (CHC nurses and family supporters), and a qualitative content analysis was performed.

Findings: Data analysis resulted in one theme and four categories. The theme – to provide multidimensional adapted professional support, – and the four categories – strengthened collaboration between professionals enriches their work. Home visits provide time for conversation, which promotes continuity of care and relationships with parents; being humble guests in parents’ homes provides insight; and home visits provide the opportunity to strengthen parenting and participation in the family centre. The goals of the Enhanced Parenting—Extended Home Visits project were to strengthen parents’ confidence in their parenting abilities and to build trusting relationships with healthcare professionals. The conclusion of this study, from the participants’ perspective, is that these goals can be achieved with the intervention.

Implications for Practice: Extended home visits seem to help healthcare professionals provide collaborative, multi-professional support for parents, both expectant and with a newborn child, with unique support needs.

In Sweden, the role of the school nurse is to promote students’ health and wellbeing and also to prevent illness. Wellbeing can involve creating good relationships but also includes feelings of participation and a meaningful existence. During a health dialogue the school nurse can discover students who experience mental illness, and factors that can affect students’ wellbeing. The purpose of the study was to investigate factors that may affect students’ wellbeing. A quantitative method with a retrospective longitudinal approach was applied. The study was conducted using collected data based on health questions posed to students in the first year of high school’s health visit during the 2013/14–2018/19 school years. The results show differences between girls’ and boys’ wellbeing based on their answers to health issues. Factors that may affect students’ wellbeing can pose a risk of mental illness. Mental illness is increasing in students and the increased demands at school may be the cause.

Background: Mental ill health is increasing among adolescents, and self-injury is one expression of mental ill health. Sexual risk taking among adolescents is often associated with exposure to violence. Sex could be used as a strategy to regulate negative emotions and feelings of emptiness. The health promotion work of school nurses (SNs) can be one way to identify students who are exposed to or at risk of sexual ill-health and sexual risk taking. By using the SEXual health Identification Tool (SEXIT) in health dialogues, SNs can identify students exposed to or at risk of sexual ill-health and sexual risk taking. Aim: To describe SNs’ experience of using SEXIT in health dialogues with students. Methods: An exploratory design was used. Six SNs participated in semi-structured individual interviews, and the data were analysed with qualitative content analysis. Results: Three categories were identified: ‘SEXIT provides support and structure’, ‘SEXIT provides conditions for designing a good dialogue’, and ‘working with SEXIT includes managing challenges’. Conclusions: SNs have a critical role in the identification of students with sexual ill-health and sexual risk taking as well as those exposed to violence. SEXIT could be included and systematically used in the health dialogue as it enables a natural dialogue with students about a sensitive topic and creates the prerequisites to identify adolescents at risk of sexual ill health.

Aim: This study aims to describe how school nurses identify students who are being exposed to violence.

Design: The study has a qualitative design focusing on illuminating the meanings embodied in lived experiences

Method: Fourteen qualitative interviews with school nurses were conducted and a descriptive qualitative meaning analysis was used to cast light on the phenomenon. The COREQ checklist was used to ensure trustworthiness.

Results: Four themes were highlighted: opportunity in the health dialogue, necessity to create and prove trustworthiness, cooperation with other professionals, and awareness of factors that could complicate reporting exposure to violence. The study provided new insights such as the school nurse having an important role in the identification of students exposed to violence. It is important that school nurses have an open approach and are systematic in the health dialogue, using questions about violence to create opportunities for students to talk about their living conditions.