School nurses' perceptions regarding barriers and facilitators in caring for children with chronic diseases in school settings: A mixed studies review

Abstract

This study aimed to understand school nurses' perceptions regarding barriers to and facilitators for health care services for children with chronic diseases in school settings. Using the PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Web of Science databases, a mixed studies review was conducted for literature published between January 2011 and June 2020. We performed a mixedmethods systematic review using a convergent integrated approach. A quality appraisal of the included studies was conducted using a mixed-methods appraisal tool. Twenty-seven articles (10 qualitative, 10 quantitative, and seven mixedmethods) that met the inclusion criteria were analyzed. Integrated findings that emerged from data synthesis were categorized into four levels (intrapersonal level, interpersonal level, institutional level, and community and public policy level) based on a socio-ecological model framework. This mixed systematic review provides a comprehensive understanding of school nurses' perceived barriers and facilitators when providing school health care for students with chronic diseases and how these barriers and facilitators interact across multiple systems. Further policies and strategies should be developed to provide effective school health services considering this study's findings. K E Y W O R D S childhood chronic disease, mixed systematic review, school health services, school nursing 1 | INTRODUCTION Although advances in hygiene, sanitation, vaccinations, and medications have led to decreasing child mortality, the prevalence of chronic diseases among children is increasing worldwide (Perrin, Anderson, & Van Cleave, 2014). The major chronic diseases in childhood are asthma, diabetes, epilepsy, food allergies, and cancer. Asthma is a common chronic disease among children below 18 years of age, with a prevalence rate of 8.5%, followed by epilepsy and diabetes, with prevalence rates of 0.

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