Balancing Between Being Proactive and Neutral: School Nurses’ Experiences of Offering Human Papilloma Virus Vaccination to Girls

Abstract

The aim of this study was to describe the experiences of Swedish school nurses when they offered the human papilloma virus (HPV) vaccination to girls aged 10–12 years. Four focus groups with a total of 17 school nurses were conducted and analyzed using inductive content analysis. The results showed that the school nurses were balancing between keeping a neutral role and the need to increase the uptake of the HPV vaccination. They described the consent forms and information that they gave the girls and their parents to help them make an informed decision about the vaccination. There were also ethical and moral dilemmas that arose with regard to the HPV vaccinations. Our findings demonstrate the need to provide school nurses with clear guidelines and support, so they can play an active role in interacting with the girls and their parents when they offer the HPV vaccination.

The needle pricking and two modes of ‘doing good’ in the Swedish school‐based human papillomavirus vaccination programme

“…In this literature, improving the vaccination is primarily viewed as a matter of information and knowledge (Mattebo et al, 2021;Rockliffe et al, 2020). For example, Runngren et al (2020) suggest that concise guidelines should be provided to school nurses in order to reduce inappropriate variation in how information is provided to children and their parents. Similarly, the issue of 'needle anxiety' is presented as a matter of talking to the children 'about the vaccination and to educate them, as well as calming nervous girls [children] down before the procedure, and dispelling misconceptions and fears' (Rockliffe et al, 2020, p. 139).…”

“…We have also related to social scientific public health research focussed on school nurses’ work with the vaccination (Hilton et al., 2011; Mattebo et al., 2021). However, these two bodies of research only briefly mention the event of the needle pricking (e.g., Runngren et al., 2020, p. 5; Virtanen & Salmivaara, 2021, p. 1227). Moreover, the social scientific public health research adopts general ideals such as ‘autonomy’ to approach the vaccination (Gottvall et al., 2015).…”

“…This goal-oriented mode of caring allowed the school nurses to align their work with a larger policy aim of vaccinating as many children as possible (cf. Runngren et al, 2020).…”

“…The school nurses spoke about the vaccination as something that was executed not only effectively but also in an unrushed manner. They tried to achieve ‘a calm and secure atmosphere with no stress’ (Runngren et al., 2020, p. 5), which fed into the way that many of them described ‘the flow’. The school nurse Ulrika captured this paradox well, saying that ‘there’s no stress or hurry, instead it goes very rapidly’.…”

“…Outside of sociology, social scientific public health research has shown that school nurses experience their workload as affecting their ability to carry out certain tasks, such as preparing the girls for the vaccination (Rockliffe et al, 2020) or managing the vaccination alongside other tasks (Hilton et al, 2011). Research also shows that school nurses find that 'needle fear' affects girls' willingness to get vaccinated (Rockliffe et al, 2020), and that these nurses handle this by making the vaccination as comfortable as possible, for instance by allowing girls to bring a friend for support (Runngren et al, 2020). In relation to HPV vaccination decision-making, Gottvall et al (2015) suggest that school nurses strive for a decision all parties can accept, while also favouring 'the minor's right to autonomy ' (p. 59).…”