gms | German Medical Science

Background: Increasing numbers of children with special healthcare needs and the scale-up of all-day schooling highlight the need for adequately addressing student health conditions during school time. In Germany, student health conditions are mainly addressed by school staff, mostly without formal medical training and varying levels of professional experience. However, current service provision is poorly understood, impeding the implementation of skill-mix innovations such as school nursing programs (SNPs) with potential to promote high-quality healthcare services in primary schools.

Objectives: We investigated service provision in primary schools by assessing

1.

staff sense of responsibility to address student health conditions,

2.

burden associated with and

3.

confidence in service provision as well as

4.

SNP-related change valence, defined as the value that school staff assign to the implementation of a SNP.

Methods: The analyses were based on the pre-intervention staff survey of the PrimSN Study, a pre-post study evaluating a SNP in 18 primary schools in Rhineland-Palatinate. All school staff were invited to participate in the paper-and-pencil survey. Sense of responsibility to address student health conditions and burden associated with service provision were assessed with one 4-point Likert item each (response range: disagree to agree). Confidence in service provision was investigated with a list of 20 common health conditions (4-point Likert items; response range: very unconfident to very confident). Change valence was assessed with the change valence subscale of the Organizational Readiness for Implementing Change instrument (nine 5-point Likert items; response range: 0 = completely disagree to 4 = completely agree). Data were analyzed descriptively.

Results: On average, school staff spent 20 minutes per week addressing student health conditions (inter-quartile range [IQR]: 10-60 minutes). Approximately 77% and 60% of participants felt responsible for and burdened by addressing student health conditions, respectively. 78% of school staff felt insecure when providing healthcare services with substantial variation in the extent of insecurity depending on the type of condition (95% for medical emergencies such as asthma attacks). Across schools, change valence for implementing a SNP was high (median: 3.2; IQR: 0.3).

Discussion: School staff devote substantial time towards addressing student health conditions, highlighting the scope for skill-mix innovations including SNPs. Given staff-reported insecurity, school nurses have the potential to strengthen the provision of high-quality services for a wide spectrum of health conditions including acute, chronic and mental health issues. High levels of change valence for implementing a SNP at school-level and several ongoing pilot projects point towards a window of opportunity for scaling-up SNPs.

Implications for research: This window of opportunity calls for increased efforts to investigate the effectiveness of SNPs to improve student health and educational outcomes (e.g., absenteeism) in primary schools in Germany and to develop implementation strategies that promote the scale-up of SNPs once their effectiveness has been established.

Funding: Other funding; 0003-0901 9523