Leading change

Specialist School Nurses employed by Children and Family Health Surrey led on a programme of work. They used Youth Participation Action Research (YPAR) to gather feedback and ideas from students to develop and implement a digital, interactive poster. They wanted to find a way to ensure children, young people and their families were aware of services they could access and to provide an effective and engaging ‘Universal Contact’ for students transitioning into Secondary School. The poster brings together lots of essential information about physical health and emotional wellbeing, including videos and web links, in an accessible way that young people are familiar with. This leads to improved outcomes, experiences and use of resources across the schools within the region.

Where to look

Children and Family Health Surrey provides NHS community nursing and therapy services for children and families across Surrey. Specialist School Nurses work as part of the 0-19 team, liaising with Health Visitors, schools, parents, children and young people. Their role is varied and includes managing a case load of individual children, providing public health prevention, protecting and promoting services for students, parents and schools as part of delivery of universal prevention and early intervention (Healthy Child Programme (HCP): From 5-19 years old, 2009).

Supporting this is an evidence based 4,5,6 approach for school nurses. This service model – spanning 0-19 years – sets out the service level offers, recommended universal health reviews and high impact areas to improve outcomes for school aged children (PHE, 2016). One of the health reviews is when children are 12-13 years old and transitioning into Secondary School. This provides an opportunity to provide health information and promote positive health choices for young people, as well as support and provide resources to teachers and parents. School Nurses were often unable to deliver this due to time and case-load restraints. Often covering multiple schools as the ‘named nurse’, a minimum requirement (PHE, 2014) meant it was hard to be visible and present.

This led to the Specialist School Nurses identifying that locally some young people were unaware of this service as well as other support they could access. On wider inspection, it appeared that throughout Surrey schools, there was unwarranted variation in the levels of visibility of school nurses in schools. Some areas offered weekly school nurse drop-ins or teaching sessions, meaning the nurses were more visible. In others, school nurses were not attending the school setting unless they had a safeguarding meeting. The Specialist School Nurses wanted to reduce this unwarranted variation and provide a more effective and engaging ‘Universal Contact’ at the transitioning stage for all Year 7 pupils and young people generally.

What to change

The Specialist School Nurses felt that if they had a smarter way of delivering health information, that young people could access in a way that suited them, it would create a more uniform, truly universal service. A focus group was held with local young people to find out their views on how they could be best supported. This would help shape a service that would provide parity across the county. This approach mirrors the strong proponent of reflecting consumers views when planning health services (Telford et al., 2002); in the NHS Constitution ‘The patient will be at the heart of everything the NHS does’ (Department Of Health, 2015) and is a core principal of the NMC ‘Code’ (NMC, 2018).

A review of other NHS organisations provided information about how others were providing resources online such as leaflets, posters and PowerPoint presentations. However, the nurses felt these approaches would be difficult to evaluate for impact on users. The focus group clearly told them they wanted a more instant, accessible and digital way of accessing information.

How to change

Wanting to represent the focus group’s views and using all the gathered intelligence, the Specialist School Nurses identified an opportunity to develop and design a digital poster which would act as a resource for children, young people and their families locally.

A Youth Participation Action Research (YPAR) model was adopted to gain the input of young people to design the resource. Using this approach allowed them to explore the value of a participatory approach when providing health education to young people. A secondary school agreed to host a focus group and invited Year 7 student council representatives who had been voted in by their peers. They held a focus group session in the school and reconvened the group again to give feedback on the finished resource.

Having identified the firm view was for a digital resource, this shaped the project and identified the need to purchase appropriate software to support development and enable data collection on viewing figures to evaluate impact. Project funding for a software licence supported by their employer enabled the Specialist School Nurses to begin development of the digital resource.

Once designed, the poster was presented at the regional School Nurse Forum. This allowed school nurses to put themselves forward to pilot the poster in their schools. This was important as it allowed the Specialist School Nurses to gauge the readiness to change in the wider school nurse team. More than half volunteered to contribute in some way to the project including proof-reading sections of the poster, writing suggestions for improvement and supporting their schools to run evaluations. The school nurses were then charged with disseminating the resource when it was launched in September 2018. Those able to undertake a Year 7 face-to-face contact also used the resource to structure presentations. With support from the communications team, the Specialist School Nurses used the poster on social media to communicate it effectively with school nurse colleagues, school staff and students.

The finished resource is inclusive and can be used by young people along with parents, schools and other health professionals involved in the care of young people. It allows schools to target gaps in knowledge within their communities and provide early interventions. The fact that it is digital has helped the team to make health education accessible and engage for the wider population.

Following the launch, schools are using it in a variety of ways:

• As part of their PSHE teaching;
• During assemblies;
• Sending the poster home in the parents’ mail;
• Promoting it on their social media pages; and,
• Setting up health promotion stands at their secondary schools.

Adding value

Better outcomes – Promoting emotional wellbeing and health messages in and out of school and improving service access through technology and safe social media approaches all contribute to ensuring children and young people are equipped to address challenges and become more involved in healthy choices as they progress through crucial transition stages (PHE, 2015). Ensuring resources are accessible, easy to understand and engaging will help young people to grow up with the knowledge and skills they need to look after their health and access services appropriately.

Data collected via the resource software has shown that nearly 1,000 young people, teachers and parents have accessed the resource, with 500 doing so within a one-month period suggesting return viewing, totalling more than 45 hours viewing time. This is in addition to face to face contacts with school nurses. There has been an increase in the use of the confidential school nurse text service since the resource was launched, supporting evidence that more young people are now accessing this health information.

Better experience – Using a participatory approach, the nurses have provided a resource that young people reported was useful and engaging. 90.3% of students agreed or strongly agreed that they liked the design of the resource. 88.3% agreed or strongly agreed that it was useful, while 86.3% agreed or strongly agreed that it was easy to understand.

School nurses report that using the resource during PSHE teaching allows much more flexibility and allows the students to access direct learning by focusing on topics they are interested in. Schools have also reported that they have felt confident using the resource without school nurse guidance, suggesting that more young people are likely to be exposed to information than in previous years.

Better use of resources – Although it was not possible to draw significant correlations from feedback, evidence shows that prevention and early intervention represent good value for money (PHE, 2018). School nurses are now tailoring early interventions to targeted subject areas commonly viewed on the digital resource such as: ‘photoshopping’, ‘It’s OK to be different’ and ‘gender identity’. Nurses are working with schools to provide PSHE teaching which reflects these identified needs, ensuring early support is available before situations deteriorate.

Challenges and lessons learnt for implementation

Procurement of the right software to deliver what the young people asked for was a challenge. The resource itself has been a great success but to make it more accessible for young people other software options are being explored.

Of significant learning was the value of the input of young people and continuing to listen to and act upon their feedback, facilitating this with further focus groups and surveys.

The most important part of implementing change is ensuring the vision of the project is understood by the wider team and that motivation to change is maintained. Demonstrating benefits, sharing feedback and communicating successes has been central to this.

Due to the success of the programme, the resource won ‘Best Practice Development Poster Presentation’ at the CPHVA Conference 2018 and the Year 7 resource is being promoted in all secondary schools in Surrey.

Next steps include considering ways of developing an Application which will enable students to access the resource more easily and in their own time. Student feedback about content suggests further changes; increasing information on mental health, specifically boys-related issues, and road safety.

Find out more

For more information contact:

• Katrina Sealey, Specialist school Nurse, Children and Family Health Surrey, Katrina.sealey@nhs.net
• Natasha Dawe, Specialist school Nurse, Children and Family Health Surrey, Natasha.dawe@nhs.net