Setting the Scene for the School Health Nursing Contribution

Catherine GleesonIndependent Consultant Nurse in School Health and part-time Practice Nurse

Every Person A Well Fed Person - Socialist Health Association29 June 2010 Manchester

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Tackling Childhood Obesity

3 aspects– Identification and monitoring– Treatment – Prevention

Where can school nursing fit?

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Foresight Report, 2007

Strategic view of obesity Complex causes of obesity epidemic Obesity can’t be prevented by individual

action alone Population level measures required Partnership required between government,

science, business , civil society

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Foresight Report - messages

Environment that supports healthy choices Synergies with other goals – social inclusion, reduce

health inequalities NHS staff training – identification and initial treatment Leadership - higher priority for prevention Acknowledgement - school choice may reduce

opportunities for walking, cycling i.e. – an ‘unintended consequence’

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School Health Nursing – Govt policies

SN identified as key role in reducing health inequalities

National Healthy Schools Programme School Nurse Development Resource Pack,

DH/DfES, 2006– Nutrition, childhood obesity and physical activity

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Obesity – School nurse role

Scarce resource – how to prioritise? Effectiveness and efficiency Individual versus population – is there room

for both? Inclusion and obesity – disabilities catered

for?

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Programmes and Interventions

Fit for Sport Jamie Oliver –role models Eat small MEND, Fit 4 life, Barnsley Drop-in advice in schools and towns Synergies – babies into books, oral health

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Scenarios linked with nutrition and exercise in schools

Parents of Ayisha, 5 yrs, ask for her to stay indoors during playtime as running around makes her asthma worse. Attendance - odd days off most weeks.

Tracey, 15 yrs is asthmatic, rarely misses school. Not particularly keen on sports. On a warm summers day she asks if she can miss the cross country run – no-one else likes it, pupils are resentful if anyone gets out of it

Craig, 12 years seems unenthusiastic about football. Attendance check - often absent on PE days. Teacher enquires and Craig says his legs ache

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Young People’s views – nutrition and exercise

Balding, 2005: decline with age in most activities except 5-a-side football, basketball, soccer, weight training, walking

Balding, 2007: >50% girls would like to lose weight But only 12% overweight using weight and height data 25% of girls age 10-11 think they have been bullied because of the way

they look

PHC study of adolescents, RCT approx one quarter want to discuss body shape / diet (Walker et al 2002)

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Pupils with disability in mainstream schools

Study of 33 pupils in mainstream secondary schools, Lightfoot et al (1999)

Only 3 (of 33) felt their condition made no difference to PE participation

Pupils valued written information to improve communication

Valued PE teachers who: allowed child to decide if able to take part; made special arrangements ‘without making a fuss of child’; were understanding

But – teachers in same school react differently SN’s unavailable so not seen as source of support

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School nurse workforce

Much smaller group – 10% of whole DN and HV service (McDonald et al 1997)

Variable provision (Cotton et al 2000) 2008 – Two national studies of community

nursing workforce– Storey et al, 2008 ‘older nurses’ study 1188 SNs– Drennan and Davis, 2008 Trends over 10 years

approx 2000 working in school nursing

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National Child Measurement Programme (NCMP)

One element of Government’s work progamme on childhood obesity

Introduced 2005 Operated jointly by DH and DCFS Non-statutory Guidance to PCTs –

performance managed on coverage Envisaged that school nurse teams would

deliver programme

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Purpose of NCMP

inform local planning and delivery of services for children

gather population-level surveillance data to allow analysis of trends in growth patterns and obesity

helps to increase public and professional understanding of weight issues in children

useful vehicle for engaging with children and families about healthy lifestyles and weight issues

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How is NCMP delivered

Includes children aged 4 and 11 in state schools (excludes Independent and Special schools)

Measure weight and height using DH standard equipment

DH Guidance (29 pages) - training No results given to children or anyone else at

school

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Logistics of measurement

Equipment to be provided by PCTs – transportation to schools

Planning with schools: room availability, fit around curriculum

Paperwork – parent’s information (15 non-English languages), can opt out

Parent can request result within 1 month

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Can aims of NCMP be met?

monitor population trends – data available from other sources – Evidence (Wake, 2009) could involve representative samples

inform local service planning – expert advice that multi-faceted interventions needed

increase public and professional understanding – unclear how?

useful vehicle for engaging with children – measurement process offers no opportunity for real engagement– Disclosure to parents – NZ ref pre school to GP

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Potential contribution of school nurses to reducing obesity

DH/DFES, 2006 School Nurse Development Pack support Healthy Schools

Food in Schools Toolkit increase overall daily exercise and healthy eating individual health plans for pupils with long term condition, disability,

obesity

drop-in clinics identify and target groups of CYP with significant health

needs, reduce inequalities e.g. 60,000 CYP looked-after (TSA, 2005, Key data on adolescence)