INTRODUCTION

In recent decades, Spain has seen an important change in the social and family structure and, consequently, in education as well. The current educational models bring new concepts. Children enter school from a very early age and do not reveal special educational needs. Today's society presents an increasing percentage of children who attend schools with developmental disorders, pathologies or specific, acute, or chronic health situations. And in view of this, it is essential to achieve normal schooling ⁽¹⁾.

Maintaining a healthy lifestyle in young people depends to a large extent on the health education they have received. In 2019, 23.3% of children between 6 and 9 years old were overweight, while 4.2% suffered from severe obesity ⁽²⁾. 60% of students in Spain between the ages of 3 and 12 suffer from some type of severe allergy, among which 25% of anaphylactic events occur for the first time in schools ⁽³⁾.

That is why the need for a health professional integrated into the educational field is of vital importance. The school nurse is defined as the nursing professional who performs their work in the school environment, providing attention and health care to the education community. She detects, plans, and executes health interventions in schools through daily interaction. In a broad sense, the school nurse emerges as a Figure capable of identifying needs and providing care, as well as constituting a first-order element in the health education of children, healthy or with pathologies, their parents, and the entire education community ⁽⁴⁾. The Figure of the school nurse provides security in the educational environment, even preventing the teaching staff from having to take responsibility for some care or action in emergency situations ⁽⁵⁾.

The beginning of the school nurse dates back to 1981 (London). Countries such as the United States, France, Scotland, Sweden or even Saudi Arabia show a fully consolidated role of the school nurse ⁽⁶⁾. However, in Spain, this Figure of the school nurse is not institutionalized. Spain raises an important debate in which the school nurse is confronted to the community nurse, who covers the needs in school health programs ⁽⁷⁾.

The data collected by the School Nursing Observatory of the General Nursing Council (CGE), with the collaboration of different National and International associations (AMECE, ACEESE), show how Spain has one nurse for every 8,497 students, data that clearly exposes the insufficiency of this Figure on the national scene. The Spanish ratios are very far from that established by the North American Association of School Nurses (NASN): one nurse for every 750 students and one for every 350 in special education nurses ⁽⁸⁾.

Currently, Spain does not have national legislation that makes the presence of school nurses mandatory in educational centres. However, specific regulations have been identified in several autonomous communities of the country, which address and regulate the Figure of the school nurse. These regulations, reflected in official publications of the Official State Gazette (BOE), show that some autonomous communities have taken the initiative to recognize the importance of having school nurses in the educational environment and have established regulatory measures in this regard. An example is the Autonomous Community of Madrid, which has legislated and applied the role of the school nurse. However, there still exist Autonomous Communities in which the profile of the school nurse does not even exist^(8),9).

Within the national panorama, one of the most relevant investigations in relation to the school nurse has been carried out in the Autonomous Community of Madrid in 2018. It showed how parents positively value the presence and availability of a school nursing service, but also the importance of having such a Figure, not only to address the health problems of their children, but also to contribute to the health education and the training of teachers in health-related issues ⁽¹⁰⁾. The fact that most educational centres do not have school nurses forces teachers to assume functions for which they are not prepared and takes time away from their actual duties. The pandemic situation we are experiencing has added more burden and responsibility to those teachers, whose majority does not have the support of a school nurse ⁽¹¹⁾.

The role that the school nurse has played during the Covid-19 pandemic has shown that school nurses have been, and continue to be, key inside and outside educational centres. The school nurse has become the reference in terms of advising and implementing preventive measures ⁽¹²⁾.

For this reason, based on the situation described, this research set out to analyse the benefits of the role of school nursing based on its remit in order to identify the need for nursing in schools.

MATERIAL AND METHOD

An integrative, qualitative, and descriptive review of the literature was carried out following the indications of the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

An exhaustive exploratory search of the international scientific literature related to school nursing was carried out in two databases (Web of Science and MedLine) between the months of December 2021 and March 2022. Those studies that addressed both the remit of school nursing as well as the importance of its implementation in educational environments were selected, providing specific data that supports the relevance and need for a nursing role in schools.

The terms used for the search were made up of (DeCS and MeSH) “School Nursing”, “School Teachers”, “Parents”, “Health Education”; which were considered based on different equations with the Boolean operators OR and AND, allowing the selection of published articles according to the established inclusion and exclusion criteria.

The inclusion criteria were: (i) language: articles in Spanish and English, (ii) year of publication: between 2017 and 2021, (iii) accessibility: open access articles for viewing and (iv) qualitative and quantitative articles, systematic review, and meta-analysis. As exclusion criteria: (i) articles published more than 5 years ago (ii) articles that were not available in full text, (iii) articles in a language other than those included in the inclusion criteria, (iv) articles from narrative review, and letter to the editor and (v) articles related to school nursing from a clinical perspective.

RESULTS

A total of 235 articles related to the topic of interest were identified; 121 of which came from the Web of Science database and 114 from MedLine. Subsequently, duplicate records were eliminated (n=22). After reading the titles and abstracts, 187 articles were excluded. Finally, of the 26 articles identified as potentially relevant, 20 full texts were obtained. To determine the evaluation of the methodological quality, the "Practical Guide for Critical Reading of Original Scientific Articles in Health Sciences" was used. Only those that met high and medium methodological quality were included, under compliance with >45 critical reading guideline indicators. The total number of articles included in the systematic review was 10. A data matrix was used to organize the information and synthesize the evidence presented for subsequent analysis (Figure 1).

Source: self-made

Figure 1: Flowchart of the study selection process according to PRISMA recommendations. 

The characterization and results of the articles included in this integrative review of the literature which met the inclusion criteria are presented below (Table 1).

Table 1: Characterization of the studies and results included in the review. 

DISCUSSION

The objective of our research was to analyse the benefits of the role of school nursing based on their remit to identify the need for nursing in schools.

After carrying out the analysis of each one of the investigations found in the literature, it is evident that the theme of our investigation is divided into 2 categories: the remit of school nursing and its need for implementation.

CONCLUSIONS

In Spain, there is no regularization of the Figure of the school nurse. It is linked to family and community health, dependent on primary health care; therefore, it arises as a necessity. Through our review, we tried to gather how School Nursing provides great support for the education system, but also for the health system.

The collected duties show that the interventions of the nursing professional are aimed at disease prevention, pathology treatment, health promotion and education, but also at improving aspects such as academic performance, and decreased absenteeism and school procrastination.

The Figure of school nursing allows us to face health problems through health promotion and prevention. This vision is shared by teachers and parents, who consider school nursing as an utterly necessary resource within educational centres. A biopsychosocial enrichment for students, but also for parents and teachers.

Lastly, within the framework of the covid-19 pandemic, nursing has developed a relevant role in promotion and prevention. The quick adaptation of School Nursing has generated numerous benefits in the transmission of knowledge and habits to be acquired by the educational community.

The implications of this research, from a theoretical point of view, lay the foundations for future research focused on enhancing the role of school nursing and its actual need for implementation.