Shared responsibility: school nurses' experience of collaborating in school‐based interprofessional teams

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Professionals such as nurses, doctors, psychologists, social workers and special‐educational teachers have for many years provided services in Swedish schools. Since 2011, these services have been mandated by the Swedish Education Act (SEA). What is new is the combination of services promoting pupils learning, development and health in a health promotion and prevention perspective through interprofessional teams pupil health (PH) teams 1. For Swedish school nurses (SNs), this new format presents two main challenges: collaboration with other professionals and a transition from a medical to a health‐promotion and well‐being perspective.
The SEA is based on an overall holistic perspective regarding pupils' achievement. This perspective includes health promotion, the stimulation of general development and the facilitation of learning processes. Thus, compulsory schools (grades 1–9) in Sweden must provide resources not only for pupils' learning but also for their physical and mental health, removing any obstructions to academic achievement 1. Every school is obliged to offer the services of a psychologist, a doctor, a nurse, a social worker (counsellor) and a special‐education professional. The intention behind this new PH service is a shift in viewing pupils' school‐related difficulties from a narrow diagnostic view to a more holistic and salutogenic perspective 2. We have chosen the term interprofessional team to match the intention of the SEA. Such a team is usually described as a group with common objectives that comprises professionals in complementary fields and whose members interact and share responsibility 4.
SNs are employed in Swedish compulsory schools 1 by school principals or by the school district, typically one SN for 400–700 pupils. Since 2011, the SN is one of the professions in the PH teams 1. The SN is supposed to have contact with pupils by way of a health dialogue and when performing health check 1.
Numerous articles have emphasised the need for interprofessional school‐based teams 5, but only a few studies have examined the effects of such teams: on academic achievement 11, number of referral cases 15 and the prevalence of absenteeism 12. Consequently, there is a need for more research in this field. Furthermore, the professional positions that make up PH teams vary both within and between countries, so conclusions are not easily generalised. In Norway, for example, SNs are available in school for the pupils and partner with teachers, but psycho‐educational services are provided by specific community agencies 18. In other countries, such as the United States, school‐based health centres, initially developed to provide primary care and prevent teen pregnancy, are growing in number, but more collaboration with school staff and school personnel, such as school psychologists, has been called for 11. Other school‐based interprofessional teams, such as prereferral teams, or student study teams, with the aim of preventing referrals to special education by early interventions 7, or school mental health teams, seldom include school nurses 19. Thus, to our knowledge, few countries include SNs in interprofessional teams with psychologists, school social workers and special‐education teachers in the way now proposed in Sweden; however, school nurses partnering with other school mental health and special‐education specialists have been highly recommended 20.
The qualitative shift in view proposed for the PH teams to a focus on well‐being from one on medical care can be understood in terms of salutogenic vs. pathogenic perspectives 23. Such a view on SNs is common in several countries. In Denmark and Great Britain, for example, health‐promoting dialogues with pupils are a common task for school nurses 3. Other studies have also emphasised the importance of SNs in the transition from a pathogenic to a salutogenic view 5. A salutogenic perspective focuses on developing and maintaining individuals' health.

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