The Evolution of the Role of U.S. School Nurses in Adolescent Mental Health at the Individual, Community, and Systems Level: An Integrative Review

Abstract

School nurses are crucial to addressing adolescent mental health, yet evidence concerning their evolving role has not been synthesized to understand interventions across levels of practice (i.e., individual, community, systems). We conducted an integrative review of school nurse roles in mental health in the U.S. related to depressive symptoms, anxiety, and stress. Only 18 articles were identified, published from 1970 to 2019, and primarily described school nurses practicing interventions at the individual level, yet it was unclear whether they were always evidence-based. Although mental health concerns have increased over the years, the dearth of rigorous studies made it difficult to determine the impact of school nurse interventions on student mental health outcomes and school nurses continue to feel unprepared and under supported in this area. More research is needed to establish best practices and systems to support school nursing practice in addressing mental health at all levels of practice.

Student safety in middle school: Implications for school nurse and teacher collaboration

“…While participants reported initiating referrals to the school counselor, the school nurse was not utilized. School nurses have the skills to engage in early identification, intervention, and referral for mental health concerns (McCabe et al., 2022; NASN, 2021) and may be the only clinical resource in schools (Hoskote et al., 2022; McCabe et al., 2022). Collaboration can be beneficial as teachers spend a significant amount of time with students and are in an ideal position to observe and identify students’ behavioral and mental health changes (Ekornes, 2015; Shelemy et al., 2019).…”

“…Whereas K‐12 teachers can offer their constant observation and noticing of shifts in student behavior, school nurses possess expertise in screening and referrals to mitigate suicidal risk (NASN, 2018). While the literature is limited regarding school nurse and teacher collaboration for student mental health needs (Hoskote et al., 2022), these two professionals often collaborate on the management of chronic diseases and other medical needs of students (Anderson et al., 2018; Best et al., 2018; Schaffer et al., 2016). Since, these collaborations have had a positive impact on student health outcomes (Blackwell et al., 2017; Pufpaff et al., 2015), it is reasonable to examine how collaborative efforts might improve student outcomes related to mental health.…”

The Teddy Bear Clinic: Engaging School-Aged Children in Health Education

“…School nurses collaborate, when needed, with teachers, administrators, and school counselors, as well as the primary health care providers and families, to ensure whole-child care is provided. This planning and intervention are critical components of the nursing process and can influence primary, secondary, and tertiary prevention of the deleterious effects of poor emotional and mental health on young students in the learning environment (Hoskote et al, 2022). The Teddy Bear Clinic is an example of using play therapy to screen for and to assess for any potential areas of concern regarding an individual student’s health and wellbeing, including their mental and emotional health.…”

The Mental Health of School-Aged Youth: A Call to Action for School Nursing

“…Two integrative reviews recently published in this journal lend support to this hypothesis. Hoskote and colleagues (2022) found little evidence of active engagement by school nurses in mental health service delivery to adolescents and when provided, interventions were individual-focused and part of care coordination. Kaskoun and McCabe (2022) determined that addressing students’ mental health needs was a school nurse priority but skill development, continuing education and recognition as a contributing member of the care team were key to supporting integration of mental health care into school nursing practice.…”