An Untenable Burden: Exploring Experiences of Secondary School Nurses Who Encounter Young People with Mental Health Problems

Abstract

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.

Achieving the educational mission: Are Connecticut school nurses valued?

“…Many school nurses historically are responsible for hundreds and often thousands of students, leaving them inadequate time for safe student healthcare (Endsley, 2017; Schroeder et al, 2021; Willgerodt & Griffith, 2021). Their workload is also affected as they grapple with increasing numbers of students with complex health needs, including a broad range of physical, developmental, behavioral, and emotional challenges (Connecticut State Department of Education, 2020; Jameson et al, 2018; Moyes et al, 2022; Willgerodt & Griffith, 2021). Research shows there is an association between smaller school nurse workloads and positive student outcomes (Daughtry & Engelke, 2018; Lineberry et al, 2018; McKinley Yoder et al, 2021; Rankine et al, 2021; Schroeder et al, 2021).…”

Hidden and unacknowledged: The mental health and psychosocial interventions delivered by school nurses in Western Australia

“…Deconstructed data were then reassembled into a substantive theory (Glaser & Strauss, 1967), explicitly outlining the relationships in the coded data. For a detailed overview of the methodology see Moyes et al (2022). The focus of this paper is on a section of the substantive theory findings.…”

“…The aim of the study was to explore the experiences of secondary school nurses who encounter young people with mental health problems and develop a substantive theory to explain these experiences. The substantive theory has been described elsewhere (Moyes et al., 2022), and the aim of this paper is to highlight the activities school nurses engaged in with this cohort. The Consolidated Criteria for Reporting Qualitative research (COREQ) was used as a guide for reporting the study (Tong et al., 2007).…”

“…School nurses are employed in countries as diverse as Colombia (Ferro Carvajalino et al., 2020), the United Kingdom (Turner & Mackay, 2015) and Qatar (Al‐Dahnaim et al., 2013), but there is a paucity of literature examining school nursing in Australia. The available literature suggests Australian school nurses frequently encounter young people with mental health problems and are actively engaged with this cohort (Downie et al., 2002; Moyes et al., 2022). This is understandable as many children experiencing poor mental health first present with psychosomatic complaints (Agnafors et al., 2019) or psychosocial issues (Smith & McGuinness, 2017) which form the basis for visiting the school nurse.…”

School Nurses’ Experiences in Dealing with Adolescents Having Mental Health Problems

“…This may reflect the finding from the current study where the more experienced school nurses were more confident in their decision-making whereas the more inexperienced asked for assessment tools and knowledge on mental health problems and how to identify those who need follow-up. Moyes et al (2022) describe students with mental health problems as wicked problem describing complex problems with multiple causes and giving no correct solutions. The Finnish study stated that good interaction skills are not enough in the work of school nurses with adolescents having mental health problems.…”