The current state of international research on the effectiveness of school nurses in promoting the health of children and adolescents: An overview of reviews

PLOS ONE RESEARCH ARTICLE The current state of international research on the effectiveness of school nurses in promoting the health of children and adolescents: An overview of reviews Silke Pawils ID1☯*, Susanne Heumann1☯, Sophie Alina Schneider1, Franka Metzner1,2‡, Daniel Mays ID2‡ a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, 2 Professorship for Educational Science with a Focus on Special Education ("Emotional and Social Development"), University of Siegen, Siegen, Germany ☯ These authors contributed equally to this work. ‡ These authors share last authorship on this work * Abstract OPEN ACCESS Citation: Pawils S, Heumann S, Schneider SA, Metzner F, Mays D (2023) The current state of international research on the effectiveness of school nurses in promoting the health of children and adolescents: An overview of reviews. PLoS ONE 18(2): e0275724. https://doi.org/10.1371/ journal.pone.0275724 School nurses are engaging worldwide to promote and protect children’s health. Many researchers who examined the effectiveness of the school nurse criticized the inadequate methodology employed in many of the studies. We therefore carried out an evaluation on the effectiveness of school nurses based on a rigorous methodological approach. Editor: Mohammed Saqr, University of Eastern Finland: Ita-Suomen yliopisto, FINLAND Methods Received: December 22, 2021 Accepted: September 22, 2022 Published: February 22, 2023 Copyright: © 2023 Pawils et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting information files. Funding: SP and DM 01EL2025A (SP) 01EL2025B (DM) Bundesministerium für Bildung und Forschung (BMBF) https://www.bmbf.de NO - The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Objective In this overview of reviews we performed an electronic databank search and global research results on the effectiveness of school nurses were sought. We identified 1,494 records through database search. Abstracts and full texts were screened and summarized using the dual control principle. We summarized the aspects of quality criteria as well as the significance of the effectiveness of the school nurse. In the first step, k = 16 systematic reviews were summarized and evaluated following the AMSTAR-2 guidelines. In a second step, j = 357 primary studies included in these k = 16 reviews were summarized and assessed following the GRADE guidelines. Results Research results on the effectiveness of school nurses show that school nurses play a key role in improving the health of children with asthma (j = 6) and diabetes (j = 2), results on combating obesity are less certain (j = 6). The quality of identified reviews is mostly very low with only six studies of medium quality, of which one identified as a meta-analysis. A total of j = 289 primary studies were identified. Approximately 25% (j = 74) of identified primary studies were either randomized controlled trials (RCT) or observational studies, of which roughly PLOS ONE | https://doi.org/10.1371/journal.pone.0275724 February 22, 2023 1 / 55 PLOS ONE Effectiveness of school nurses regarding health promotion for children and adolescents: An overview of reviews Competing interests: The authors have declared that no competing interests exist. 20% (j = 16) had a low risk of bias. Studies with physiological variables such as blood glucose or asthma labeling led to higher quality results. Conclusion This paper represents an initial contribution and recommends further evaluation of the effectiveness of school nurses, particularly in the areas of mental health or children from low socioeconomic backgrounds. The general lack of quality standards in school nursing research should be integrated into the scientific discourse of school nursing researchers to provide robust evidence for policy planners and researchers. 1 Introduction School nurses are medically trained professionals who work in both the school and healthcare sectors, with the aim of making the school a health-promoting environment for teachers and pupils [1–3]. School nurses play a pivotal role in improving the health and well-being of children and adolescents by providing health promotion, health counseling, referral to other sources of help, active treatment, education, family support, care coordination, and multiagency work [1,4–6]. School nurses have a wide range of roles and responsibilities that cover three core aspects of school health 1) health literacy, 2) medical care, and 3) health promotion [7–9]. These three areas of school nursing complement each other in terms of the common goal of making the school a health-promoting environment but differ in their approaches and strategies to achieve this goal. Health literacy has the aim of enabling students and teachers to find, understand, evaluate, and apply health information to health-related decisions in order to maintain or improve health and quality of life [10,11]. Health literacy holds the educational perspective with the goal of knowledge gain. In contrast, health promotion and medical health care share the aspect of medically oriented interventions but differ from one another in their perspective on health aspects. Medical health care at schools takes the pathogenetic perspective. Here, the focus is on assessing risks for disease progression and treatment of specific diseases that can be positively influenced by specific school-based interventions. Health promotion in schools, on the other hand, argues salutogenetically. Here, the focus is on the development and maintenance of health in children and adolescents. This can be achieved through resource-strengthening measures at schools, promoting healthy behaviors such as sports and nutrition and through preventive care services, e.g. care coordination by school nurses [11,12]. All three aspects of school health cannot be clearly distinguished from each other. Most international research on school nurse interventions addressing the three aspects of school health originated in Anglo-Saxon countries [13–15] where the school nurse was first introduced and where most research has been conducted. Many of these studies evaluate school-nurse led interventions and refer to the number of days absent due to medical conditions [13,16], health risk factors such as obesity [17,18] and cigarette consumption [19,20], children with asthma symptoms [21,22], mental health conditions [23,24], the management of chronic diseases [3,25] or preventing various forms of child abuse [26–28]. Apart from more positive health outcomes for (...truncated)