ABSTRACT

Background: School nurses play a crucial role in promoting children's and young people's health and wellbeing through health promotion. Furthermore, they provide health advice, referrals to other services, education, family support, protection, safeguarding, service coordination, and multi-agency collaboration (DH, 2014). While previous studies have produced important data about the school nurses` perspectives and experiences working with children and young people, they provide a limited understanding of how SNs should support adolescents` mental health.

Aim: This research aimed to explore school nurses' experiences working to support adolescents' mental health in England and develop a resource to help school nurses support adolescents' mental health.

Method: This study employed a multi-method qualitative research design. The study was structured into three sequential phases: a systematic review (Phase 1), qualitative interviews (Phase 2), and co-design workshops (Phase 3). Each phase was purposefully selected to contribute distinct forms of evidence and insight, collectively informing the development of a toolkit designed to strengthen school nurses` confidence and capacity to provide mental health support to adolescents. The systematic review (Phase-1) was conducted to identify, describe, and evaluate interventions led by school nurses to support adolescents' mental health and emotional wellbeing within school-based settings. Findings from the qualitative study and the systematic review were then integrated to develop the first prototype of the toolkit. To refine the content of the toolkit, co-design workshops (Phase 3) were conducted.

Phase 1: A systematic search of six international databases was carried out to identify school nurse-led interventions to support adolescents` mental health and wellbeing within school-based settings. Narrative synthesis was used.

Phase 2: Semi-structured interviews with school nurses in England (n=18) were conducted. The framework analysis was applied to the data coded through NVivo 14.

Phase 3: Co-design stakeholder workshops (n=16 participants; 5 workshops) were conducted. The feedback from co-design workshops was used to improve and refine the content of the toolkit.

Findings:

Phase 1:The systematic review highlighted the need for additional resources to enhance school nurses' ability and confidence in providing mental health support to adolescents.

Phase 2: The findings highlighted that the ability to recognise mental health symptoms, engage effectively with adolescents, and make appropriate referrals was closely tied to nurses' foundational knowledge and experience. School nurses reported sufficient training but identified the need for further specialised education to improve their competencies. The lack of clarity undermined their professional identity, with their expertise undervalued by school staff and health care professionals, leading to feelings of invisibility and emotional frustration.

Phase-3: Overall, participants stated satisfaction with the content of the toolkit, but they identified some areas for refinement based on their experiences and individual perspectives.

Conclusion: School nurses encountered unclear role definition and a lack of resources to provide mental health support to adolescents. This study explored experiences of school nurses working with adolescents` mental health and informed the development of a toolkit designed to strengthen school nurses` confidence and competence to provide mental health support to adolescents.