In May 2024, the Swedish School Nursing Congress celebrated its 80th anniversary in Stockholm – and what a celebration it was! Currently presided over by the chair for the Swedish Association of School Nurses, Mia Göransdotter Hammer, over 1 500 school nurses descended on the capital for the association's national annual congress to celebrate this history, watch (and join in with!) some inspirational performances, consider current issues facing school-aged children, and enjoy each other's company.
An excellent session by the nurse-historian, Susan Magnusson, took attendees through an insightful 80 years of school nursing in Sweden. Magnusson made the notable observation that many of the health issues that school nurses work with today; such as alcohol and drug use, smoking, poor sleep and diet; have endured across the decades, each generation presenting its new take on the old. All delegates were treated to a copy of her book: The School Nurse: how children, health and society have shaped the profession over a century. A regular feature at the congress is a movement session after the morning plenaries, and this year this was led by students from Pohlem's special needs school in Stockholm, with some choreographed, and impressively improvised, dance moves. Also featured was a performance piece from Dance for Health (Dans för Hälsa), a research-based programme that enhances mental wellbeing in young people. Without performance or choreography, the focus of Dance for Health is on the enjoyment of movement in a safe, supportive group.
Key speakers included a mother and daughter, Anna and Signe Bennich, exploring their experience of Signe's experience of anorexia nervosa. Signe described how this crept in ‘by stealth’ in her teens and that she didn't really understand what was happening; and Anna explored parental fear, worry, uncertainty and guilt, and how the illness affected the family. Through writing diaries throughout their experience, they are now able to reflect and consider what can be learned from the process. The event was closed by the humorous musings of popular comedian, actor and writer, Olof Wretling; who reflected on his journey with attention deficit hyperactivity disorder, and the dubious benefits of being ‘labelled’ with a neurodiversity disorder from an early age.
‘A new and popular feature at the congress was the opportunity to “borrow a researcher”. Here, school nurses could informally discuss their practice and ideas for research with an established researcher, consider a masters or doctoral study, and explore ideas for working collaboratively towards growing the school nursing practice evidence base.’
Borrow a researcher
A new and popular feature at the congress was the opportunity to ‘borrow a researcher’. Here, school nurses could informally discuss their practice and ideas for research with an established researcher, consider a masters or doctoral study, and explore ideas for working collaboratively towards growing the school nursing practice evidence base. Professor Pernilla Garmy, a school nurse by background, one of the researchers in this initiative, and a regular attendee at the congress, reflected on her experience of the school nurse congress over the years: ‘I remember when I first attended congress, there were hundreds of school nurses like me, it felt wonderful to be part of such a strong movement. Much school nurse work is undertaken independently, and this is such a supportive, energising event’.
‘Children and young people's mental wellbeing was a significant focus across many elements of the congress.’
Mental health and wellbeing
Children and young people's mental wellbeing was a significant focus across many elements of the congress. Both in relation to the global rises in mental health challenges since the pandemic, and also in relation to specific issues emerging in relation to childhood development. For example, autism and attention deficit hyperactivity disorder in younger children, anxiety in the early teenage years, and eating disorders predominantly affecting older teens. In the keynote address, Valentina Baltag, Unit Head for Adolescent and Young Adult Health within the World Health Organisation (WHO) highlighted that: ‘Half of all mental health conditions start before the age of 14’, and that ‘school nurses are at the forefront as these conditions emerge in a child or young person's life’. She focused in on adolescence, describing the ‘huge building project in the brain’ at this time, where neural pathways amassed during childhood are pruned; and that as a result, behaviours built in adolescence are most likely to endure. She stressed the importance of school nurses in positively influencing these behaviours.
Workforce and WHO guidance
International workforce issues debated echoed those in the UK: career progression, clear delineation of the school health offer, service funding, and the lack of understanding from other professionals regarding what school nurses actually do. With over 1 500 nurses in the room, it was a unique opportunity to survey the direct opinion of the workforce on specific aspects of the upcoming WHO implementation guidance for school health services. Delegates were asked several questions. Should the target audience for the resource be health care professionals or commissioners? Should there be a recommendation for at least one school nurse in every school (which reflects the current movement in the UK by the School and Public Health Nurses Association, the Queen's Nursing Institute and the College of Medicine calling for a school nurse in every school)? What is the best model for school nursing services? And, crucially, how to better communicate the added value of a school health service?
The importance of considering school health provision from a life-course perspective was emphasised, in the knowledge that what happens in childhood impacts healthy physical and psychological wellbeing, as well as socio-economic outcomes in adulthood. Baltag's keynote described how, according to WHO estimates, there are significant returns on investment in public health prevention approaches: $10 for every $1 invested. For initiatives that focus on school climate and school connectedness, this rises to $20 for every $1 invested. The enduring and encouraging message was that international evidence shows that the positive physical and mental health outcomes from preventive and early intervention by a school health service across the lifespan is the ‘best buy’ for limited government resources.