Journal of School Nursing
2021, Vol. 37(4) 249–258
© The Author(s) 2019
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DOI: 10.1177/1059840519864158
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Stress has a negative impact on students’ daily lives and can be associated with recurrent pain. School nurses play a key role in supporting young people with stress-related pain. The purpose of this qualitative interview study was to elucidate school nurses’ experiences of encountering students with recurrent pain when practicing person-centred care. The school nurses were based at public and private schools and worked with students aged 12-19. Data were collected through interviews with 18 school nurses and analyzed with deductive content analysis. The school nurses felt that actively listening to the students’ narratives about daily life with recurrent pain, and co-creation of a health plan, encouraged the students to participate as partners in their own care and strengthened their relation with the students. The application of a person-centred approach in school health care meant that traditional knowledge transfer was replaced with a dialogue that reflects both the student’s and school nurse’s perspective.
adolescent, pain, person-centred care, school health care, school nurse, stress, students, qualitative approach
Adolescents with recurrent pain often experience disability in everyday life (Holm, Ljungman, & Söderlund, 2012), and stress, pain, and fear can worsen the disability (Holm, Ljungman, Åsenlöf, & Söderlund, 2013). A Norwegian study showed that perceived stress in adolescence may explain adolescents’ experience of recurrent pain (Østerås, Sigmundsson, & Haga, 2015). There is a need to develop models that can support adolescents with recurrent pain to be active in everyday life (Forgeron & Stinson, 2014a, 2014b). However, there is no agreement among experts on a universally proven management that will work on every child with recurrent pain (Brusaferro, Farinelli, Zenzeri, Cozzali, & Esposito, 2018). The evidence on psychological treatments for pain management is also empirically weak, and intervention trials are still at an early research stage compared to drug trials (Markozannes et al., 2017).
A widely accepted definition of recurrent pain is reported pain that persists for 3 months. About 20–35% of children and adolescents are affected by recurrent pain (Friedrichsdorf et al., 2016), and this may persist into adulthood. One study showed that almost 17% of adult chronic pain patients reported a history of recurrent pain during childhood, and nearly 80% of those patients stated that the pain in childhood had persisted into adulthood (Hassett et al., 2013). Pain symptoms are more frequently reported over the adolescent period (Swain et al., 2014). A prevalence study of self-reported chronic pain among 7,613 adolescents in Sweden reported 6.3% back pain, 12.5% headache, and 7.1% stomachache (Gobina et al., 2019). Stress is a factor in recurrent pain, and unpredictable stress produces hyperalgesia and increased anxiety (Reichling et al., 2011). Children with recurrent pain have also shown an increased muscular resting activity and a potentiation of the startle reaction (Alfvén, Grillner, & Andersson, 2017). Stress in adolescent girls significantly increased their experiences of headaches (Björling & Singh, 2017). Headache is the most frequently reported stress-related symptom of adolescent girls (Larsson & Fichtel, 2012), and they even report high levels of mental ill health (Låftman & Magnusson, 2017).
One profession that encounters children and young people with recurrent pain on a daily basis is the school nurse in school health care. The school nurse plays a key role in health-promoting and preventive initiatives, including promoting physical health, preventing mental ill health, and supporting the development of the students in relation to the objectives of their education (Ragnarsson et al., 2019). According to the Swedish law (SFS, 2010:800), all students in secondary school and upper secondary school have the right to school health care including medical, psychological, psychosocial, and special education initiatives. Over the course of their education, all students are offered several health-related visits through the school health-care program including a general physical examination, a health counseling, and vaccinations (SFS, 2010:800). However, these visits often take an approach based on the perspective of the school nurse (Golsäter, Lingfors, Sidenvall, & Enskär, 2012). The student’s school situation is taken into account, as are the physical and psychosocial perspectives, and the findings are documented on the basis of this holistic view (Ståhl, Granlund, Simeonsson, Gare-Andersson, & Enskär, 2013). A good in-school work environment for the student facilitates learning and personal development while promoting school attendance. The school nurse participates in the school’s work environment and is focusing on the relationship between learning and health for the students (National Board of Health and Welfare, 2014). A recently published report showed that 10–15% of Swedish children and young adults suffered from mental ill health in 2017, a figure which had increased by 100% since 2006 (National Board of Health and Welfare, 2017).
To reduce mental ill health among students, the school nurse needs new approaches and support measures that promote student participation and creation of a partnership between the nurse and student (Golsäter et al., 2012). There is a need to develop models that support children and young people with recurrent pain so that they can feel better in their everyday lives (Forgeron & Stinson, 2014b). Students with recurrent pain may find it difficult to initiate contact with the school nurse, and so school health care should have a method to identify these students (Rosvall & Nilsson, 2016). Personcentred care (PCC) has been suggested as a core factor for a sustainable, affordable, high-quality health care. The PCC framework developed by the University of Gothenburg Centre for Person-Centred Care (GPCC), which is a research centre that conducts high-quality research on PCC, is based on ethical principles and mutual respect between the patient and health-care professionals. It emphasizes the importance of identifying and using the patient’s own capabilities and resources in order to allow them to be engaged as an active partner in care and treatment (Ekman et al., 2011). School nurses need to adapt the health dialogue based on each student’s needs, preferences, and resources and bear in mind that the development and growth of the student are just as important as school-related issues (Golsäter, Sidenvall, Lingfors, & Enskär, 2011). Thoroughly listening to the patient’s narrative is the point of departure for collaborative care and preparation of a jointly agreed health plan. This narrative, along with a cocreated health plan, which integrates each patient’s resources, opportunities, barriers, and goals with the expertise of the health-care professional, is the basis for establishment of a partnership. The documented health plan is accessible to both the patient and the health-care professional and contributes to the continuity and transparency of the partnership. This application of a person-centred ethic in practice has shown effects in several controlled trials in different conditions and contexts (Ekman et al., 2012, Fors et al., 2015, Larsson et al., 2015). For example, in patients with fibromyalgia, a PCC approach resulted in improvements in health status, pain intensity, pain disability, and pain acceptance (Larsson et al., 2015). However, as far as we know, no research has been conducted on the experience of working with PCC within the context of school health care. The aim of this study was to elucidate school nurses’ experiences of encountering students with recurrent pain when practicing PCC.
This is a qualitative interview study with school nurses using a deductive content analysis according to Elo and Kyngäs (2008). Ethical approval was obtained from the Regional Research Ethics Committee in Gothenburg, Sweden (ref: 172-16).
Eighteen school nurses, participating in an ongoing intervention study, Help Overcoming Pain Early (HOPE), were interviewed. The core of the HOPE intervention is to apply PCC (Ekman et al., 2011) which aims to promote students’ trust in their ability to cope with and react to recurrent pain. The intervention also includes a counseling session on pain (Wager, Stahlschmidt, Heuer, Troche, & Zernikow, 2018) and pain management (Brusaferro et al., 2018).
The HOPE intervention consisted of two parts. The first part was an education program for the school nurses. The education program was based on PCC, pain and stress education/management, and gender perspectives. The second part was the intervention for the students. The intervention started with that the school nurse listened to the student’s narratives in purpose to initiate a partnership by identifying the student’s needs and resources. At the first session, the student and the school nurse developed a jointly agreed health plan including goals, resources and need of support. The health plan was followed up at the second session, which also contained pain education material for students. In the last two sessions the health plan was reviewed and revised if necessary, for example by evaluating and discussing actions to achieve set goals or that new goals were formulated. On the fourth session, the students and the school nurse wrote a conclusion.
The school nurses were recruited by advertising in different forums. Information about the project was published first on a website and then at a national school nurse conference, both of which were organized by the Swedish Association of School Nurses. The project leader (S.N.) also provided information about the project during local meetings for school nurses at schools in western Sweden. The intention was to get a purposive sample of participants with variations of the phenomenon, such as different ages and work experience as a registered nurse and school nurse, and work in public or private schools, upper secondary or secondary schools. All eligible school nurses who wanted to participate in the study were included and were further contacted by the project leader (S.N.). The final sample of school nurses included participants who worked at public and private schools, in cities and rural areas within varied municipalities with different socioeconomic situations.
All 18 school nurses were female. Eight were registered public health nurses, seven were registered pediatric nurses, two were registered nurses, and one was a midwife. Their ages ranged from 28 to 64 years (mean = 50, median = 50), and their work experience as a registered nurse ranged from 4 to 43 years (mean = 25, median = 26) and as school nurse from 1 to 26 years (mean = 11, median = 11.5). Eight worked in upper secondary schools (with students aged 16–19), 3 in private and 5 in public schools, and the remaining 10 worked in secondary schools (with students aged 12–16), 6 in private and 4 in public schools. Twelve worked full-time (100%), caringfor 100–1,000 students (mean = 505, median = 513), and six worked part-time (75–85%), caring for 270–550 students (mean = 384, median = 379).
The school nurses included students (12–19 years old) in the HOPE intervention who had reported recurrent pain to the school nurse, including pain episodes in association with stress during the last 3 months that led to repeated visits to the school nurse. In total, the school nurses encountered 71 students who participated in the HOPE intervention.
The individual interviews were conducted out by the first author between February 2017 and May 2018, were recorded digitally, and lasted between 20 and 46 minutes (mean = 29.1, median = 27.5). The interviews were performed in a room at the school nurses’ workplace, one took place at the school nurse’s home, and six were performed over the phone. They started with same main question: “How do you experience encountering students with recurrent pain by using a personcentred approach?” The participants were encouraged to speak freely about their experiences, and similar follow-up questions such as “Can you tell me more about” were used to strengthen the researcher’s understanding of the narratives provided.
Deductive content analysis according to Elo and Kyngäs (2008) was used to analyze the data, and a matrix (Figure 1) was constructed, after the interviews, based on the core components of PCC: listening to the narrative, establishing a partnership, and shared documentation developed by the GPCC (Ekman et al., 2011).
The transcripts of the interviews were read through by all authors several times to get an overall picture of their content. Then each text section was read specifically and independently by two of the researchers (H.W. and M.G.). In the next step, meaning units related to the school nurses’ clinical practice when practicing PCC in encountering adolescents with recurrent pain were identified and placed into the three prearranged categories. Each meaning unit was then coded on the basis of its essential meaning. Next, the codes within each category were grouped into subcategories based on their similarities and differences. Throughout the analytical process, the coding and categorization were performed by all authors and were discussed within the research group until consensus was reached (Elo & Kyngäs, 2008; Table 1).
The school nurses were given oral and written information about the study, gave their written informed consent, and were informed about guaranteed confidentiality and the right to discontinue the interview at any time without having to specify the reason.
The results from the analysis of the school nurse interviews are presented in terms of three categories, each with its own subcategories: listening to the narrative, establishing a partnership, and shared documentation, and the nurses’ narratives were illustrated by citations.
One requirement for PCC was that the school nurses listened to the students’ narratives about how they experienced having recurrent pain. They tried to understand how pain affected the students’ daily lives and gain knowledge of their preferences and resources in order to reduce the pain.
Listening and encouraging. The school nurses explained that at the first encounter with students who participated in the HOPE intervention, they allowed the students to describe how they experienced their situation with recurrent pain. They listened to the students and tried to understand how their pain and the stress it caused affected daily life. Previously, before they worked with a person-centred approach, they usually did the informing rather than listening to the student. The student would describe the pain symptoms, and the school nurse would ask a series of questions about how the student ate and slept, then give advice, and ask the student to return if the pain did not go away. Now, they began by asking the student to describe how they experienced the situation. Although with the new approach it took more time for the school nurse to counsel the student, which could be perceived as negative by the school administration since resources were limited, the school nurses felt that both time and resources were saved over the long term.
The students didn’t need me any more in the same way; this saves time. Before they participated in the study, I spent a lot of time on their pain and relaxation. They frequently came spontaneously or regularly, and it’s not like that any more. I don’t need to do that work, so it’s worth it to spend time on counseling since it actually resulted in them feeling better. (Interview 15)
The school nurses said that previously they had felt uncertainty before counseling students about recurrent pain; they had too little knowledge about stress and pain to be able to counsel the students about these topics. After participating in the HOPE training program and studying the educational materials, they felt more comfortable with counseling students on this matter. The school nurses also described the advantages of having scheduled counseling with the students, so that they devoted the time needed for these meetings.
After participating in the project, the school nurses felt that they had acquired valuable tools such as listening to and encouraging the students’ narratives, which they would find useful when meeting students with stress-related pain. They felt that the HOPE intervention was something that all school nurses could easily adopt and find useful in their work.
Now I encourage them to describe their situation and focus on it, and I do this at all student appointments now, try to get more out of their narratives than I did previously. Before, I was faster to give a solution rather than actually listening. (Interview 17)
The school nurses said that in the HOPE intervention, they were more focused on what the students told them, which resulted in more detailed narratives and enabled them to better understand the students’ situation. It could be perceived as less demanding when they did not have to provide solutions but could instead step back and listen to the narrative and then discuss possibilities with the student to improve the student’s situation. The school nurses felt that this approach respected the complex problems that the students experienced.
The study helped me to discuss student health in a different way, give them attention, give them time to reflect, show them that I take the situation extremely seriously. (Interview 1)
Raising awareness through counseling. The school nurses felt that the HOPE intervention gave students with stress-related pain an opportunity for relief. They let the students express themselves in their narratives and felt that the counseling helped the students understand that their pain symptoms and their living conditions affected each other. According to the school nurses, adopting a person-centred approach made it easier to discuss the situation and understand the student. Several of the students were newly arrived immigrants, and language barriers often arose between them and the school nurse. Using aids such as pictures and videos from the HOPE intervention helped the school nurses more easily to understand the narratives of the students despite these language difficulties.
I make them aware in some way, and use pictures when we communicate, especially with the newly arrived immigrants. (Interview 10)
The school nurses based their counseling on the students’ narratives. The HOPE intervention enabled them to adapt the meetings and counseling sessions to the needs and resources of the students. They were able to offer each student the most appropriate counseling based on the student’s own narrative and circumstances.
They watch the video about stress and pain, and we discuss the idea of the psychological effect on your pain; if you can influence that you can influence your pain, because now you’re focusing on the pain, but perhaps you could release it and we can see what happens when you work with that part. (Interview 13)
A key component in PCC involved striving to establish a partnership between the student and the school nurse that entailed mutual sharing where both parties trusted each other. The student spoke about the experience of pain, and the school nurse shared professional knowledge about stressrelated pain.
Transitioning from monologue to dialogue. The school nurses said that they had increased their awareness of how they counseled the students. Previously they had spoken in a monologue, rather than engaging in a dialogue with the student. They said that they also thought about what they communicated to the students, how they expressed themselves, and which words they used. They felt that previously they were often the ones who guided the counseling sessions with the students; instead, they now based the counseling on the student’s narrative.
I’m better at being here and now. I don’t start talking about strategies ... I try to ask follow-up questions about how the pain affects them, what their daily lives are like, how it limits them. (Interview 8)
The school nurses felt that the counseling sessions had enabled them to develop professionally and their participation in the HOPE intervention had increased their knowledge of stress-related pain, which meant they felt well prepared for providing counseling.
You dare to ask that really hard question, what do you think it depends on? ... You serve as a sounding board: what can you do yourself to avoid winding up here again, reflect on your own state of health. (Interview 10)
Enabling students to find their own solutions. The school nurses stated that they had to some extent made the students passive by being too quick to find explanations for the student’s pain and its cause. In the HOPE intervention, the school nurses experienced that the students became more active and came up with likely explanations and solutions for their problems. This situation was perceived as an equal partnership. The school nurses described how the project gave them the courage to wait for the student and let the student actively participate in the problem-solving. Consequently, they felt less pressure to present solutions to the students’ problem, instead serving more in a supportive role. It was easier to follow up on the students’ progress since there was a pleasurable curiosity that had not existed before.
Participation in the project hasn’t been difficult. The students do the work themselves and use me as a tool. (Interview 1)
After the end of the project, the students who participated in it saw the school nurse less frequently for recurrent pain, stomachache, and headache and were more active in finding solutions to their own problems. The school nurses felt that the students had changed their mind-set about their situation; they now saw themselves as experts on their own symptoms and so did not need the school nurse in the same way as before.
The sooner they come, the easier it is to turn things around without giving up. One student who had stomach pain for several years, it went fast, it was like, what! And it wasn’t just a temporary fix, she no longer has pain and her anxiety disappeared. (Interview 13)
Maintaining and strengthening the relationship. The school nurses said that they already had a relationship with most of the students and that this relationship was usually a good one. The relationship was considered to be essential for gaining knowledge about the student and for the student to have the courage to tell the school nurse about how they felt. The school nurses felt that the counseling sessions included in the HOPE intervention resulted in a closer relationship with the student and the creation of trust between the student and the school nurse.
They tell you so much about themselves, so they also feel the relationship is better after these four sessions and then it’s easier to come for other things. (Interview 3)
Some of the school nurses meant that via the HOPE intervention, a new form of relationship developed with the students in the counseling sessions, and as a result, they tried even harder to understand the students. Others said that they had used a person-centred approach and had a partnership with the students even before participating in the HOPE intervention.
A school nurse’s job is always person-centred, that’s how we work ... it’s always been some kind of partnership for me and my students, it’s never been anything else. I’ve read about motivational interviewing and applied that. We’ve always worked like that here, the whole student health team. (Interview 14)
To ensure the partnership, the school nurse and the student together documented a health plan which was monitored by both parties.
Setting reasonable objectives based on the student’s situation. The school nurses considered it important to look at the student’s current situation and offer the student the materials and methods that were included in the HOPE intervention, such as counseling, relaxation exercises, videos, and images. The school nurses stated that some students found it difficult to achieve the goals of their health plan since they were in a difficult life situation and might have needed professional help in child and adolescent psychiatry. It was important to let the students hold the rudder and move at their own pace.
Two of my students have been difficult. It’s been difficult to reach them because of the extent of their problems. (Interview 11)
The school nurses explained that it was important to look at each student’s complete life situation and consider whether the student might need support from another profession. The goals they set together in the health plan should be reasonable and possible for the student to achieve even through retained functions.
Trying to bring the goals down to a reasonable level, make sure it’s possible to succeed and not set the goals too high ... find intermediate goals for better success. (Interview 18)
In the project, the school nurses used a person-centred approach by documenting goals in the health plan together with the student, based on the student’s narrative about their perceived situation. They viewed each student as unique, and the goals were set on the basis of how the student experienced the situation. The school nurses encouraged the students to set interim goals that they thought the students could achieve. School nurses and students sometimes had different views of which goals the students should set in their health plan.
The student’s goal was to find a solution: she would free up one evening a week with no obligations. I’d thought she’d choose a goal of being pain-free; we thought a little differently there. I had a different image of a goal. I thought she’d have a higher goal, higher expectations. (Interview 15)
Following up and evaluating the objectives. The school nurses created clarity and transparency, both for themselves and for the students, when they documented the health plan and set interim and final goals with the students. By documenting what they agreed on, the student’s problems became visible to both the student and the school nurse.
It’s precisely this about setting goals and following up. Yes, you write things down, what you want to change, and then you have regular meetings and evaluations, how did it go? Then they themselves are focused on the fact that it’s not just a question. In many cases, you end up talking and perhaps you follow up while you are at it, but you lose what happens along the way. But if you sit here then you have to follow up and then you also have to do what we talked about. (Interview 13)
The school nurses’ work with the students to follow up on the interim goals of the health plan was considered to be meaningful. By evaluating the health plan together, they could see what worked and what did not, and consider why. The school nurses had not previously documented this type of health plan, but they said they would continue to do so after the project. The health plan was considered to be an excellent tool that helped them structure the counseling sessions with the student and evaluate the student’s progress.
I use this tool when I meet a student who has symptoms like this; the health plan can then be made and followed up more specifically, because it’s easier for them too. Sometimes you say things, but they aren’t concrete enough for us to write them down. We talk at the health consultation, but we don’t formulate a plan. (Interview 9)
The aim of this study was to elucidate school nurses’ experiences of encountering students with recurrent pain when practicing PCC. The results show how the school nurses listened to the students’ narratives, strived to establish a partnership, and documented a health plan together with each student. The school nurses explained that they had previously been more solution-focused and that the students’ health goals were often based on the school nurses’ agenda. Because the school nurses now listened more actively, the young people themselves were perceived as expressing their goals, and the school nurses described their role as being supportive rather than as guiding the way for the interventions.
Frequent recurring pain has an impact on school functioning, and adolescents with these symptoms often have a nontraditional schooling (Yetwin, Mahrer, John, & Gold, 2018). Since the situation of each student is unique, it can be difficult to apply a general solution. It has previously been reported that there is a need for a more individualized treatment approach in students with recurrent pain (Yetwin et al., 2018), and students aged 10–17 years expressed this need themselves in an interview study (Golsäter, Sidenvall, Lingfors, & Enskär, 2010). These students had the desire to discuss their health situation and individual needs in a health consultation with the school nurse in order to gain insight into and better manage their health.
A person-centred approach not only helps to identify the patient’s needs and obstacles but also more importantly identifies and uses each person’s capabilities and resources that are seldom used in health care (Ekman et al., 2011). The school nurses in the present study stated that for them, working with a person-centred approach entailed listening to the students’ narratives about how they experienced having recurrent pain. Before participating in the HOPE intervention, they had chosen to find a solution to the students’ situation and not tried to understand, as they did now, how pain affected the students’ daily lives.
Several factors may influence recurrent pain among students. Emotional and cognitive factors such as fear, avoidance of pain, maladaptive strategies for coping with pain, and influences of anxiousness and depressive symptoms may all have an impact. Environmental factors include parental behaviors and cultural expectations about pain. The pain affects not only the adolescents themselves but also their family and friends (Landry et al., 2015). The school nurses in our study stated that when counseling a student, they tried to identify the student’s own resources and raise awareness of how to find solutions for the situation and reduce pain.
The World Health Organization (2017) reports that mental ill health has increased among children and young people, which increases the risk of socioeconomic problems later in life. The school nurse is a key figure in healthpromoting work and as a professional is tasked with supporting young people to take personal responsibility for good mental health (SFS, 2010:800, National Board of Health and Welfare, 2014). It is worth taking a critical look at our current view of what comprises mental ill health. It may be that behaviors, which are natural reactions to specific events and were previously considered to be part of life, such as sadness because of loss of loved ones, are now considered to be a diagnosable condition. Young people may gain a skewed view of reality and believe that something is wrong with them when they experience such emotions and react with stress, anxiety, and recurrent pain. It is important for school nurses to be aware of this and offer young people counseling where they can simply analyze natural reactions to various situations in life. In a study by Golsäter, Sidenvall, Lingfors, and Enskär (2010), students describe health consultations with their school nurse as an opportunity to develop trust in the nurse and gain access to their professional knowledge. In order for such a meeting to take place, the focus must be on the student’s own perception of the situation and the school nurse must be sensitive to what and how the student wants to say about the situation. A meeting based on the student’s own experience of their situation could mean that they will be able to discuss various life situations and natural reactions to them and thereby receive support from the school nurse to better manage their life situation (Golsäter et al., 2010). It is a challenging task for school nurses to use the personal preferences and needs of the student as a point of departure in the health consultations in accordance with the national program, while also fulfilling the tasks described in the national program. School nurses must consequently find a balance between a directed strategy and a flexible strategy to shape the health counseling (Golsäter, Enskär, & Harder, 2014).
The school nurses in the present study stated that a key component of PCC involved establishing a partnership with the student. They felt that in their work as school nurses, they had always tried to establish a relationship with the student, but the difference now was that it was more of a mutual relationship in which the two parties were dependent on one another. There was a shift in the balance of power since the school nurses now valued the narratives of the young people to the same degree as their own expertise. It can be a challenge to treat young people as experts because of the unspoken hierarchy found in traditional medical care. This is also reflected in a school context, where most of the utterances in health dialogues are made by school nurses (Golsäter et al., 2012), and the pupils experience the conversations as being held on a general level and not attuned to each individual (Mäenpää, Paavilainen, & Åstedt-Kurki, 2013). In contrast, a person-centred dialogue emphasizes the value of listening carefully to the student’s narrative as a platform for collaborative care (Ekman et al., 2011). This challenges professionals to remold their position and replace the standardized teaching methods, which do not always allow for individual differences, with co-created tailored care that considers the perspective of both the student and the school nurse.
Some of the school nurses said that they always worked in a person-centred way, while a majority experienced PCC as something new and different, indicating that this approach is usually not applied. School health care also recognized other concepts such as family-centred care and child-centred care (Coyne, Holmström, & Söderbäck, 2018). Components that school nurses experience as overlapping with PCC may already be applied to some extent in school health care, which may be one explanation for why some of the school nurses in this study said that they already used PCC. These contrasting views may also reflect the complexity in realizing the application of a person-centred ethic in practice.
The majority of school nurses in this study were satisfied with working in a person-centred way. This is in line with another study in which the staffs’ satisfaction at work increased when they employed this approach (Sjögren, Lindkvist, Sandman, Zingmark, & Edvardsson, 2015). According to King and Kelly (2011), it will be difficult to implement PCC unless sufficient resources are available for its development. However, if all resources are available and sufficient, the individual worker is the most important factor for adopting a new approach (Jordan, 2009). If health-care professionals are noncompliant or are not given suitable conditions in which to work in a person-centred way, this approach cannot become standard even in the presence of sufficient resources and a supportive work culture (McCormack & McCance, 2010). Our findings show that the HOPE intervention, which is based on PCC, was experienced as constructive and beneficial by the school nurses when encountering students with recurrent pain. Further research is warranted to evaluate the effects of a PCC approach in this population and the prerequisites to work with PCC in a broader school context.
This study has several limitations. The recruitment of participants to the study through advertising may bias a selection in favor of school nurses who are particularly interested in PCC as well as supporting students with recurrent pain. All participating school nurses were female; on the other hand, it is rare to have male school nurses in Sweden. The sample size may be considered as small, but for a qualitative study, 18 interviews is rather large.
Findings from this study show that a person-centred dialogue takes into account both the student’s and the school nurse’s perspective and implies to replace standardized information techniques that do not always allow for individual differences. When encountering students with recurrent pain, a person-centred approach can be applied by school nurses and immediately started in their professional practice in order to co-create and tailor the support based on the student’s situation.
We thank all the school nurses who participated in this study and told us their experiences of the HOPE intervention.
All authors contributed to the conception of the manuscript, acquisition as well as analysis of the data, and drafting of the manuscript along with the critical revisions. All agreed to be accountable for all aspects of work ensuring integrity and accuracy.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this article was obtained from Gothenburg Person Centred Care (GPCC), which had no other involvement in the study. GPCC is funded by the Swedish Government’s grant for Strategic Research Areas, Care Sciences (Application to Swedish Research Council no. 2009-1088), and co-funded by the University of Gothenburg, Sweden.
Helena Wigert, RN, MSc, PhD https://orcid.org/0000-0002-1615-1925
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Helena Wigert, RN, MSc, PhD, is an associate professor at Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg.
Andreas Fors, RN, PhD, is an assistant professor at Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg.
Stefan Nilsson, RN, PhD, is an associate professor at Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg.
Kristina Dalenius, RN, BSc, is a school health-care manager at Lerums kommun, Sektor lärande.
Marie Golsäter, RN, PhD, is a senior lecturer at Child Health Care and Futurum, Region Jönköping County and CHILD Research Group, School of Health and Welfare, Jönköping University.
1 Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
2 Centre for Person-Centred care (GPCC), Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
3 Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden
4 Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
5 Lerums Kommun, Sektor lärande, Lerum, Sweden
6 Child Health Care and Futurum, Region Jönköping County, Barnhälso-vården, Jönköping, Sweden
7 CHILD Research Group, School of Health and Welfare, Jönköping University, Jönköping, Sweden
Corresponding Author:Helena Wigert, RN, MSc, PhD, Institute of Health and Care Sciences, Sahlgrenska Academy at University of Gothenburg, Box 457, SE 40530 Gothenburg, Sweden.Email: helena.wigert@gu.se
