During these difficult times, school nurses are only too aware of how they, as a workforce, must unite to provide optimum continuity of care to school-aged children and young people.
Prior to school closures (and still, although in a much reduced way), school nurses adapted their public health offer to prioritise health protection/promotion. Recognising hand and respiratory hygiene as the single most important intervention to help break the path of COVID19; they worked tirelessly to educate schools, communities, families to self-empower and enable them to understand the imperative part they had to play to prevent and protect themselves and their wider contacts. There are some fabulous examples and reports of children and young people taking up the baton with this learning and sharing it onwards; my own 4-year-old grandson a great testimony to his school nurse who certified his whole school as ‘hand-washing warriors’! Subsequently, school nursing services up and down the country have become the ‘go-to’ expert resource on physical distancing and self-isolation for all partners.
Following school closures, colleagues found themselves being redeployed to NHS trusts and return to hands on nursing; this, naturally, causing great angst. It is not only about being confident and competent to deliver safe care, be supplied with PPE to be able to prevent infection and protect their patients as well as themselves and others, but also the personal repercussions that shift working patterns are likely to bring. There are still so many unanswered questions on which organisations like SAPHNA have been working tirelessly to help support and allay fears.
While many were redeployed early on, those who remained have been supported by NHSEi guidance ‘COVID-19: prioritisation within community health services’. This outlines what areas school nurses can temporarily suspend, and, more importantly, what areas they must prioritise and deliver on. The latter include (NHS England and NHS Improvement coronavirus, 2020):
- Phone and text service
- Safeguarding
- Emotional health and wellbeing
- Specialist school nursing.
The government also provided guidance for those who should remain at school. These include those with a social worker, on a child protection plan, those who are looked after and those with an education, health and care plan (Department for Education and Public Health England, 2020). Only around 5% of obur most vulnerable children and young people are actually attending school and the remainder are in ‘pressure cooker homes’ with no daily eyes or ears to safeguard them. We have recently seen many school nurses returning from redeployment thanks in part to our lobbying and the recognition that actually, our services are indeed needed now more than ever.
Within this new and rapidly changing framework, school nurses have urgently been reforming so that they can offer targeted early help and intervention. Critically, many school nursing services are well advanced in the use of technology and right now, when most children are at home and/or self-isolating, this is proving a lifeline for many, including those with mental health problems, long-term health conditions, and significantly, safeguarding.
Building on the success of well-established systems such as ChatHealth, ‘E-Clinics’ via online instant messaging/texts, phone calls, optimisation of Skype, Whats App, Zoom, Google hangouts and the speedily NHS introduced Microsoft Teams alongside new advice/helplines, families, schools and partners are welcoming the positive and creative school nursing offers. Health needs assessments for looked-after children, child protection plans, ‘drop-ins’, mental health interventions, support, advice and much more are being offered to our most vulnerable, critically, as possible, offering an open door and listening ear.
‘Critically, many school nursing services are well advanced in the use of technology and right now, when most children are at home and/or self-isolating, this is proving a lifeline for many… ’
For those schools offering emergency provision, services have been aligning to ensure they continue to be able to offer support and advice on a regular basis. For children in receipt of free school meals not in school, services are also working with partners to ensure access to alternatives and, as always in school nursing, many are supporting charitable efforts to fundraise and support foodbanks.
School nurses are also in everyday conversations with schools and partners in education, police, social care, etc. to define a new way of working to offer optimum safeguarding as they recognise that for many of our children not in school, this will leave many children and families even more vulnerable. Multi-agency partnership working is therefore of paramount importance, with many services coming together through virtual media on a frequent basis to maximise all efforts.
Public Health England recommends that the complete routine immunisation programme should be maintained, and it could be argued that right now it is even more important that we ensure that our children and young people receive all of their childhood immunisations.
For our colleagues in specialist school nursing, where special schools have been closed, their clinical duties continue on a much reduced level and, wherever possible, direct contact has been stopped, with nurses redeployed. These children often have complex physical and/or learning needs who, when out of school, place additional huge pressures on their families. Therefore, it is imperative that risk assessments inform this work and identified families receive additional remote and, as necessary, face-to-face contact, support, advice, referral and self-help strategies.
As key community partners, school nurses have also been tapping into and signposting families to the many volunteers and online forums that have heart-warmingly emerged.
As we have seen in previous public health outbreaks such as meningitis, mumps or flu, school nurses can and are rising to the challenge of COVID-19, building on their resilience, adaptability and willingness, but most importantly, their unique understanding and relationships they have with children and young people.
FURTHER INFORMATION
NHS England and NHS Improvement
COVID-19 prioritisation within community health services: https://bit.ly/2SUCmY4