Swedish schoolchildren's voices of health-promoting factors: a focus group study.

Children have the right to express their views on all issues related to their health and development. The aim was to explore health-promoting factors voiced by 8- to 12-year-old children, to determine how the children prioritize those factors and inform school personnel how to develop health-promoting approach based on those findings. Focus groups, with the use of photographs, were conducted with 15 children. A deductive content analysis was used, with overall results showing that health-promoting factors are meaningful relationships and recreational activities. The results add new perspectives to the earlier model of health-promoting factors. By highlighting children's experience of what promotes health, measures at the individual, group and community level can be adapted to children's priorities, based on their own needs.

Nurse Documentation of Child Weight-Related Health Promotion at Age Four in Sweden.

(1) Background: Overweight and obesity in children have increased worldwide and tend to persist into adolescence and adulthood. The Child Health Service (CHS) has an important role in providing health-promotive interventions, and such interventions are required to be documented in a child's health record. The aim of the study was to investigate Child Health Care (CHC) nurses' documentation of weight-related, health-promotive interventions in the Child Health Care Record (CHCR) regarding lifestyle habits in connection to the four-year visit. (2) Methods: A record review of 485 CHCRs using a review template was accomplished. Of the included CHS units, four used electronic records and two used paper records. Chi-square tests and Spearman's rank-order correlations were used to analyse data. (3) Results: The results showed that CHC nurses document interventions regarding lifestyle habits to a low extent, although children with overweight/obesity seemed to undergo more interventions. There was also a difference between electronic and paper records. (4) Conclusions: The consequences of not documenting the interventions in the CHCR make it difficult to follow up and demonstrate the quality of the CHC nurse's work. There is a need for more research to gain a deeper understanding of the reasons that the work of CHC nurses is not visible in children's health records.

A Philosophical Review of School Nursing Framed by the Holistic Nursing Theory of Barbara Dossey.

This article is a philosophical review of school nursing and its constructs framed by Barbara Dossey's holistic nursing theory. The author describes the application of holistic nursing theory within the school nurse's area of activity. The review suggests that holistic nursing theory can be applied in several areas of school nursing. School nurses have a multifaceted occupation that includes meetings with students, parents, and school staff. Barbara Dossey's holistic nursing theory offers the school nurse tools to deal with people's varied experiences, feelings, and needs.

Supporting Students with Neurodevelopment Disorders in School Health Care-School Nurses' Experiences.

Students with neurodevelopmental disorders (NDDs) are present in every school, and most likely, there are a few students in every class. School health care is responsible for providing support to all students, especially those with special needs. The aim of the study was to describe school nurses' experiences of supporting students with NDDs. A qualitative method consisting of seven focus group interviews (that included a total of 35 school nurses) in Southern Sweden was conducted. Three themes were identified in the findings: helping students with NDDs to interpret sensations, detecting early signs of distress among students with NDDs, and using an inclusive design for health education. This study highlights the importance of school nurses in identifying the needs of students with NDDs and promotes a person-centered approach to achieve a healthy and safe learning environment for all students.

The Relationship Between Reported Pain and Depressive Symptoms Among Adolescents.

Pain and depressive symptoms are common reasons for adolescents to contact the school nurse. The aim was to describe the prevalence of pain (headache, abdominal pain, and back pain) and depressive symptoms among adolescents and to examine whether there is an association between pain and depressive symptoms. This cross-sectional survey included students (N = 639) in Sweden (median age: 16 years). Over half of the female participants (56%) and one third of male participants (33%) had weekly headaches, abdominal pain, or back pain. Almost every second girl (48%) and one in four boys (25%) had depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale, scores ≥ 16). There was a significant association between having pain (headache, abdominal pain, or back pain) and having depressive symptoms. It is of great importance for school nurses to adequately identify and treat the cause of pain and other factors contributing to depression.

Evaluation of a school-based cognitive-behavioral depression prevention program.

AIM: The aim of this study was to investigate the feasibility and cost-utility of a school-based cognitive-behavioral (CB) depression prevention program. METHODS: A quasi-experimental trial with an intervention group and a control group, with follow-up measurements obtained at three and 12 months after baseline, was conducted. The setting was six Swedish municipalities. The participants were students in grade 8 (median age: 14). A total of 462 students (79% girls) were allocated to the school-based CB prevention program, and 486 students (46% girls) were allocated to the control group. The school-based CB prevention program, Depression in Swedish Adolescents (DISA), was presented by school health service staff and teachers once per week for 10 weeks. RESULTS: The main outcome measures were self-reported depressive symptoms and self-rated health; the secondary outcome measures were adherence and cost-utility. The intervention group decreased their self-reported depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale) and improved their self-rated health (as measured by the visual analog scale) at the 12-month follow-up more than the control group ( p < .05). CONCLUSIONS: Given the challenges of conducting a study in a complex, everyday school setting with baseline differences between the intervention and control group, it is difficult to make accurate interpretations of the effectiveness of the intervention. However, with these limitations in mind, the results indicate that the DISA program is a feasible school-based prevention program.

Prescribed physical activity maintenance following exercise based cardiac rehabilitation: factors predicting low physical activity.

BACKGROUND: Physical activity is important to reduce mortality, morbidity and risk factors in patients with coronary heart disease. This report evaluates to what extent patients are still physically active following an exercise-based cardiac rehabilitation programme 12-14 months post-myocardial infarction and factors predicting why not. METHODS: Data from the National Quality Registry Swedeheart with post-myocardial infarction patients ( n=368) admitted from July 2012 to November 2014 were collected with outcomes of physical activity after 12-14 months. Baseline data included demographics, clinical variables, participation in exercise programmes, prescribed physical activity, health-related quality of life and self-reported health (EQ-5D-3L/EQ-VAS). A direct binary logistic regression analysis was used to identify indicators of low physical activity. RESULTS: Physical activity frequency per week (PA/week) was low, i.e. zero to three times, in older patients over 64 years ( P=0.00) and in those having problems with pain/discomfort (138 PA/week vs. 195) ( P=0.01), problems with mobility (60 PA/week vs.273) ( P=0.04) and anxiety/depression (128 PA/week vs. 205) ( P=0.04). CONCLUSION: Indicators predicting low physical activity can be used targeting improved post-myocardial infarction care outlining person-centred rehabilitation programmes and specialist nursing-led programmes.

School Nurses' Experiences Working With Unaccompanied Refugee Children and Adolescents: A Qualitative Study.

School nurses are one of the first health-care professionals to meet unaccompanied refugee children and adolescents and therefore have an important impact on health outcomes. The aim of this study was to describe school nurses' experiences working with unaccompanied refugee children and adolescents. Semistructured interviews were conducted with school nurses (n = 14) who worked with unaccompanied refugee children and adolescents. The interviews were analyzed via qualitative content analysis. The results fell into three themes: (a) knowledge of trauma-informed care, (b) knowledge of intercultural nursing, and (c) importance of self-awareness. School nurses require the development of tailor-made skills that focus on crisis, trauma, and cultural awareness to meet the complex needs associated with working with unaccompanied refugee children and adolescents.

Association of Depressive Symptoms with Consumption of Analgesics among Adolescents.

PURPOSE: To investigate the prevalence of depressive symptoms, pain (headaches and stomachaches), and analgesic consumption in addition to the association between depressive symptoms and analgesic consumption among adolescents. DESIGN AND METHODS: This cross-sectional study was conducted in southern Sweden. The survey was distributed among students in grade 8 (aged 13-15 years, n = 878). RESULTS: The prevalence of depressive symptoms (Center for Epidemiological Studies Depression Scale ≥16) was 37% among girls and 13% among boys. The prevalence rate of analgesic consumption to ease headaches and/or stomachaches during the last several weeks was 57% among girls and 29% among boys. Depressive symptoms are significantly associated with analgesic consumption among adolescents even after controlling for pain. CONCLUSION: The knowledge that there is a higher use of analgesics in adolescents with depressive symptoms implies that healthcare professionals should focus on complex psychosocial problems, not only physiological pain, in adolescents. PRACTICE IMPLICATIONS: Over the counter analgesics are frequently used by adolescents. Head and stomachaches are common reasons for students to visit the school nurse and primary healthcare facility. School nurses and pediatric nurses have to be aware of the link between depressive symptoms and pain in addition to the higher use of analgesics in adolescents with depressive symptoms. It is important to reduce the cause of the pain in order to prevent depressive symptoms and also analgesic overuse.

Mental ill-health among adult patients at healthcare centres in Sweden: district nurses experiences.

BACKGROUND: Mental ill-health among the general population is increasing in Sweden. Primary Health Care (PHC) and Healthcare Centres (HCC), where district nurses (DNs) work, bear the basic responsibility for treatment of mental ill-health, while severe mental ill-health fall under the responsibility of psychiatric specialist care. The increased prevalence of mental ill-health in the community means that DNs increasingly encounter people with mental health problems - not least as a comorbidity. How well DNs are equipped to deal with mental ill-health is currently unclear. AIM: The purpose of this study was to explore district nurses' experience of encountering and dealing with mental ill-health among adult patients at healthcare centres. DESIGN: A qualitative explorative approach was used to capture the experiences of the phenomena under study. METHODS: Individual interviews were conducted with 10 DNs working at six HCCs. The interviews were transcribed and analysed by qualitative content analysis. RESULTS: The result emerged as several subcategories captured by three categories: (i) having competence - a prerequisite for feeling confident; (ii) nursing mental ill-health requires time and commitment; and (iii) working in an organisation without preparedness, encompassed by the synthesising theme; nursing mental ill-health requires specific competence and organisational support. CONCLUSION: Working as a DN requires formal and informal competence when encountering patients with complex health needs. The findings revealed that the DNs could feel insecure regarding how to deal with patients with mental ill-health due to lack of knowledge. Assessment of patients with mental ill-health is time- and energy-consuming and calls for improved teamwork at HCCs as well as effective collaboration with psychiatric specialist care and other care givers. The DNs responsibility to fulfil their work considering the increasing number of mental ill-health among people that seeks help at HCCs needs to be acknowledged and met by the PHC organisation.

Insufficient Sleep Is Associated with Obesity and Excessive Screen Time Amongst Ten-Year-Old Children in Sweden.

PURPOSE: This study investigated sleep, television, computer habits, and obesity in school-age children. DESIGN AND METHODS: This was a cross-sectional self-report survey of 1260 children in grade 4 (mean age, 10.1) living in southern Sweden (49.1% boys). The heights and weights of 1097 (87.1%) of the children were recorded. Descriptive statistics, bivariate analyses, and multiple logistic regression were employed. RESULTS: The median length of self-reported sleep on weeknights was 9.5h. Approximately 40% of the children reported receiving <9h of sleep. The median bedtime was 9PM (21:00). On weekends, the median bedtime was 1 h later, and they delayed getting up by 1.5h. The median time spent watching TV and using a computer was 1 h each. The prevalence of being overweight (including obesity) was 18%. Insufficient sleep (<9h) was associated with being overweight, watching TV, or using a computer for two or more hours each day, difficulty falling asleep, and being tired at school. CONCLUSIONS: School-age children who receive less sleep are more likely to be overweight and report excessive television and computer use. A strong and urgent need exists to highlight the importance of healthy sleep and media habits. It is challenging for pediatric nurses and school nurses to teach children and their families about healthy sleep and media habits.

Health Among Schoolchildren From the School Nurse's Perspective.

The aim of the study was to investigate Swedish school nurses' perceptions of schoolchildren's health. The study is based on two national surveys in which school nurses responded to questions about schoolchildren's health in 2015 ( n = 181) and 2005 ( n = 129). A statistical comparison showed that physical and mental health of schoolchildren in high-risk areas was perceived as worse than that of children in low-risk areas. There were no differences regarding the number of spontaneous visits or consulting reasons related to gender in high- and low-risk areas. A national framework for data collection and reporting of schoolchildren's health may be important for school nurses to demonstrate the need for increased support in, for example, high-risk areas. By paying attention to factors that can affect schoolchildren's health, school nurses can also direct health promotion to areas where it is needed. Increased cooperation among school health professionals may also prevent illness and improve health.

Psychometric analysis of the Salutogenic Health Indicator Scale (SHIS) in adolescents.

AIM: The aim of this study was to test the psychometric properties of the Salutogenic Health Indicator Scale (SHIS) in an adolescent population. METHODS: The investigation was performed among Swedish students aged 13-15 years ( n = 817; 58% girls). The SHIS was assessed for respondent acceptability, and its psychometric properties were evaluated according to classical test theory (regarding unidimensionality, targeting, reliability, and external construct validity). RESULTS: The adolescents found it easy to complete the questionnaire, which was completed in an average of 4 minutes. Exploratory factor analysis, which is based on polychoric correlations, identified one factor, supporting the instrument's unidimensionality. Floor/ceiling effects were ⩽ 3.3%. Reliability estimates yielded a Cronbach's alpha value of 0.93; the test-retest reliability ( n = 50; 2-week interval) coefficients were 0.89 for the total SHIS score and 0.52-0.79 for item scores. Spearman correlations with other variables were based on a priori expectations (self-rated general health, 0.595; depressive symptoms, -0.773; anxiety, -0.577; and sleep problems, 0.519). CONCLUSIONS: Our observations support both the acceptability and the psychometric properties of the SHIS as a brief, unidimensional assessment tool for salutogenic health in adolescents. Further studies using modern test theory are needed to better understand the measurement properties of the SHIS, including the functioning of its response categories and its comparability between adolescents and adults.

A qualitative study exploring adolescents' experiences with a school-based mental health program.

BACKGROUND: Supporting positive mental health development in adolescents is a major public health concern worldwide. Although several school-based programs aimed at preventing depression have been launched, it is crucial to evaluate these programs and to obtain feedback from participating adolescents. This study aimed to explore adolescents' experiences with a -based cognitive-behavioral depression prevention program. METHODS: Eighty-nine adolescents aged 13-15 years were divided into 12 focus groups. The focus group interviews were analyzed using qualitative content analysis. RESULTS: Three categories and eight subcategories were found to be related to the experience of the school-based program. The first category, intrapersonal strategies, consisted of the subcategories of directed thinking, improved self-confidence, stress management, and positive activities. The second category, interpersonal awareness, consisted of the subcategories of trusting the group and considering others. The third category, structural constraints, consisted of the subcategories of negative framing and emphasis on performance. CONCLUSIONS: The school-based mental health program was perceived as beneficial and meaningful on both individual and group levels, but students expressed a desire for a more health-promoting approach.

Awareness of demands and unfairness and the importance of connectedness and security: Teenage girls' lived experiences of their everyday lives.

In recent years, a number of studies have demonstrated that stress and mental health problems have increased among adolescents and especially among girls, although little is still known concerning what girls experience in their everyday lives. The aim of this study was to describe the phenomenon of teenage girls' everyday lives, as experienced by the girls themselves. A phenomenological approach of reflective lifeworld research was used, and the findings are based on eight qualitative interviews with girls aged 13-16 years. The essence of teenage girls' everyday lives as experienced by the girls themselves can be described as consciousness regarding demands and unfairness and regarding the importance of connectedness and security. The girls are aware of the demands of appearance and success, and they are conscious of the gender differences in school and in the media that affect them. The girls are also conscious about the meaning of connectedness with friends and family, as well as the importance of the security of their confidence in friends and feeling safe where they stay. If teenage girls feel connected and secure, protective factors in the form of manageability and meaningfulness can act as a counterweight to the demands and unfairness of everyday life. For professionals who work with teenage girls, the results from this study can be important in their work to support these girls.

Challenges of Documenting Schoolchildren's Psychosocial Health: A Qualitative Study.

The aim of this study was to explore school nurses' experience of challenges related to documenting schoolchildren's psychosocial health in Sweden. Six focus group discussions were carried out. Areas for discussions included questions about situations, especially challenging to document as well as what constrains and/or facilitates documenting psychosocial health problem issues. Qualitative content analysis was used for interpreting the data. The analysis resulted in one overarching theme: having to do one's duty and being afraid of doing wrong; and three subthemes: uncertainty related to one's own ability, concerns related to future consequences, and strategies to handle the documentation. School nurses relying on their intuition and using a structured documentation model may increase the opportunities for a reliable documentation. To further develop their professional skills with regular, clinical supervision can be of great importance. This in turn may increase contributions to research and development for the benefit of schoolchildren's psychosocial health.

Evaluation of a school-based program aimed at preventing depressive symptoms in adolescents.

The aim of this pilot study was to evaluate the implementation of a universal school-based cognitive behavioral program whose target is to prevent depressive symptoms in adolescents. The study had a quasi-experimental design with pretest, posttest, and a 1-year follow-up and provides an illustrative calculation for the implementation costs of the intervention. Sixty-two students (aged 14) and seven tutors participated. A majority of the students and all of the tutors were satisfied with the intervention. The students, both females and males, rated their depressed symptoms as significantly lower after the course; and for the females, this was maintained 1-year postintervention. The implementation costs for the initial 2 years were about US$300 per student. Positive effects of a universal school-based cognitive behavioral intervention aiming at preventing depressive symptoms in adolescents were found, especially among females.

Overweight and television and computer habits in Swedish school-age children and adolescents: a cross-sectional study.

The aim of this cross-sectional study was to investigate the prevalence of overweight and obesity in children and adolescents (6-16 years), and relationships between being overweight and sleep, experiencing of fatigue, enjoyment of school, and time spent in watching television and in sitting at the computer. Trained school nurses measured the weight and height of 2891 children aged 6, 7, 10, 14, and 16, and distributed a questionnaire to them regarding television and computer habits, sleep, and enjoyment of school. Overweight, obesity included, was present in 16.1% of the study population. Relationships between lifestyle factors and overweight were studied using multivariate logistic regression analysis. Having a bedroom television and spending more than 2 h a day watching television were found to be associated with overweight (OR 1.26 and 1.55 respectively). No association was found between overweight and time spent at the computer, short sleep duration, enjoyment of school, tiredness at school, or difficulties in sleeping and waking up. It is recommended that the school health service discuss with pupils their media habits so as to promote their maintaining a healthy lifestyle.