Public health nurses' experiences working with children who are next of kin: a qualitative study.

BACKGROUND: There are a substantial number of children who are the next of kin of parents suffering from illness or substance abuse. These children can experience emotional and behavioral problems and may need support from professionals. In Norway, the specialist health service in hospitals is required to have a designated practitioner in each department to ensure support for and follow up of children who are next of kin; however, this is not regulated by law in the health care in the municipalities. The aim of this study was to explore public health nurse's experiences working with children who are next of kin. METHODS: Qualitative interviews were conducted with 10 public health nurses working in the child health clinic and the school health service in four municipalities. Data were analysed using content analysis. Reporting of this study is conducted in accordance to COREQ's checklist. RESULTS: The analysis resulted in one main theme: 'Lack of guidelines and routines among public health nurses working with children who are next of kin'. The main theme consisted of four categories: (1) identifying children who are next of kin are incidental; (2) public health nurses must be observant and willing to act; (3) communication is an important tool; and (4) follow up over time is not always provided. CONCLUSION: The public health nurses experienced uncertainty concerning how to identify and follow up children who are next of kin but were vigilant and willing to act in the children's best interest. Doing so necessitated collaboration with other professionals. The need for guidelines around the role and responsibilities for the public health nurse were emphasized. The knowledge provided by the current study offers valuable insight into strengths and limitations in the support of children who are next of kin and can inform stakeholders in organizing sustainable support for this group.

Norwegian public health nurses' competence areas.

OBJECTIVE: To explore the competence areas of public health nurses in Norway. DESIGN: A qualitative and comparative design was employed. SAMPLE: A purposive sample of 41 public health nurses participated. MEASUREMENTS: Data were gathered from focus groups and individual interviews. The interviews centered around an open question about public health nurses' knowledge. They also discussed 10 proposed competence areas for public health nursing, developed from the literature. A qualitative content analysis was conducted on the interview transcripts, followed by a synthesis of the data from the interviews and earlier developed competencies. The 10 competence areas for Norwegian public health nursing were then refined. Finally, we compared the affirmed competence areas with earlier developed cornerstones and the new educational guidelines. RESULTS: The interviews revealed 10 competence areas. These 10 competence areas were synthesized with the 10 proposed competencies from literature. Ten affirmed competence areas, which mostly corresponded with the competences from literature, were developed. The affirmed competencies were supported by the previously developed cornerstones and new educational guidelines. CONCLUSIONS: The affirmed competencies will help promote and explain the content and focus of PHNs' work in Norway and may have implications for education and international research.

Community-based support for children who are next-of-kin for a parent experiencing illness or disability - a scoping review.

INTRODUCTION: Children who are next-of-kin, for a parent who experience illness or disability, need support. In Norway, guidelines, routines and structured approaches in the community health services are lacking regarding involving children in the care of a parent and for services when supporting children as next-of-kin. Additionally, no existing international review has focused on support from community health and social services for children who are next-of-kin to a parent regardless of the specific illness or disability. AIMS: This scoping review examined the current knowledge regarding the types of community health and social services support to children 0 to 17 years old living with a parent experiencing illness or disability. The review also identified children's support preferences and needs. METHODS: The scoping review involved five stages; identifying research question; identifying relevant articles; selecting articles; charting the data and finally, collating, summarizing and reporting the results. RESULTS: Articles which included community health and social services interventions and children's preferences or needs for support were included. The foci of interventions included preventive education, peer support, psychosocial support, and interventions focusing on family communication and recovery planning. Articles focusing on children's preferences or need for support described their wish to be recognized as a next-of-kin, having someone to talk to and professional and peer support. CONCLUSION: The review highlighted the importance of children receiving support according to their preferences. It is important to elicit children's voices, to ensure community health and social services are developed for and tailored to this population.

Public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools: A phenomenographic study.

AIMS AND OBJECTIVES: To describe the variation in public health nurses' perceptions of interprofessional collaboration related to adolescents' mental health problems in secondary schools in Norway. BACKGROUND: Mental health problems among adolescents account for a large portion of the global burden of disease and affect 10%-20% of adolescents worldwide. Public health nurses in school health services play an important role in disease prevention and promotion of physical and mental health. In order to serve adolescents with regard to mental health problems, public health nurses are dependent on collaboration with other professionals in schools. DESIGN: Qualitative interviews were conducted with 18 public health nurses working in the school health services. METHOD: A phenomenographic approach was used for interviewing and for analysing the qualitative interviews. This study is presented in line with COREQ's checklist. RESULT: The analysis resulted in three descriptive categories based on eight identified conceptions. The categories are as follows: "The formal structure has an impact on interprofessional collaboration"; "The public health nurse is an important, but not always self-evident, partner in interprofessional collaboration"; and "The primary players are the teachers in collaboration." CONCLUSION: The public health nurses describe that they had limited impact on collaboration and were dependent on both the school principal and the teachers for achieving good collaboration. Teachers have the power to decide whether to collaborate with the public health nurse, and public health nurses regard teachers as the most important collaborative partners. The public health nurses need to make themselves and their competence visible. RELEVANCE TO CLINICAL PRACTICE: The findings demonstrated that public health nurses are important collaborators, but are not always included in interprofessional collaboration. This knowledge is essential to strengthen public health nurses' roles and presence in schools, which could most certainly benefit adolescents with mental health problems in secondary school.

Experiences of interprofessional collaboration in a special school programme for adolescents who struggle with school life: an explorative study.

A growing proportion of adolescents struggle with school life and could benefit from special school programmes. School could be an arena for supporting such adolescents and, to meet these challenges, interprofessional collaboration (IPC) has been recommended for better health. The aim of the present study was to explore the experience of IPC in a special school programme offered to adolescents who struggle with school life - from the perspective of the professionals involved. Focus group interviews were carried out with four groups and fourteen participants, and the focus groups included two to five participants each. The focus group interviews were analysed using qualitative content analysis. The analyses from this study resulted in a main theme: IPC in the special school programme is unpredictable. Five categories emerged from the data, including: variations in initiative, significance of individual characteristics, informal and formal contact, lack of criteria and goals, and different obligations. The participants described IPC as differing from case to case, with a lack of criteria and goals for adolescents in the special school programme. They experienced the random nature of whoever took the initiative to collaborate, and that confidentiality and the different documentation requirements could affect IPC.

Gender differences in symptoms of depression among adolescents in Eastern Norway: Results from a cross-sectional study.

AIM: The aim of this study was to compare and describe gender differences and the associations between symptoms of depression and family conflict and economics, lifestyle habits, school satisfaction and the use of health-care services among adolescents. METHODS: Data were retrieved from Ungdata which is a cross-sectional study. Adolescents ( n=8052) from secondary school grades 8, 9 and 10 (age 13-16 years) participated in the study from 41 municipal schools in four counties. RESULTS: Girls reported a higher prevalence of symptoms of depression than boys. Gender differences were seen on all items related to symptoms of depression, family conflict and economics, lifestyle habits, school satisfaction and health-care services. Multiple regressions showed that family conflicts and economics contributed to 19.2% of the variance in symptoms of depression in girls and 12.4% in boys. School satisfaction made a strong contribution: 21.5% in girls and 15.4% in boys. The total model explained 49% of the total variance in symptoms of depression in girls and 32.5% in boys. CONCLUSIONS: Gender demonstrated a pattern through a higher proportion of girls reporting symptoms of depression, family conflict and economics, lifestyle habits, school satisfaction and use of health-care services. Even though the adolescents reported symptoms of depression, few used the school health-care services and public health nurses. This indicates that they need a person-centered approach for symptoms of depression. The findings may have important implications for planning for adolescents in school health services.

A falls case summary: Application of the public health nursing intervention wheel.

BACKGROUND: The Public Health Intervention Wheel (PHIW) is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. Public health nurses (PHNs) provide care at the three levels of practice. Prevention of falls is a public health issue and the majority of falls happen at home. Therefore, prevention and management of falls in the community could benefit from a public health systems approach by PHNs underpinned by the PHIW. CASE PRESENTATION: A hypothetical case is presented of a 78-year-old gentleman who had a fall which resulted in a fractured right acetabulum and surgery before being discharged home. METHODS: The aim of this paper was to use a case summary to illustrate PHN practice in the context of the PHIW as applied to falls management and prevention. This paper focuses on fall incidence and PHN response in Ireland and Norway. The PHIW is described and relevant interventions from the PHIW are applied to PHN practice in managing the case. CONCLUSIONS: The PHIW model provides insight into the potential scope of public health nursing in falls, articulating PHN practice in the community.

Psychotropic drug use among 0-17 year olds during 2004-2014: a nationwide prescription database study.

BACKGROUND: Time-trend studies on psychotropic drugs among children and adolescents are scarce, and most of them are outdated. The purpose of this study was to study prevalences of psychotropic drug use during 2004-2014 among Norwegians aged <18 years, overall and in psychotropic sub-groups. METHODS: Data were obtained from the Norwegian Prescription Database, which covers all dispensed prescription drugs in Norway from 2004 and onwards. Psychotropic drugs included: antipsychotics (ATC-group N05A), anxiolytics (N05B), hypnotic/sedatives (N05C), antidepressants (N06A), stimulants (N06BA), and alimemazine (R06AD01). Period (1-year) prevalence of use, overall and in subgroups of psychotropic drugs, was estimated by identifying individuals <18 years who had at least one psychotropic drug dispensed during each year. RESULTS: Psychotropic drug use increased in 0-17 year olds over an 11-year period, in which the main contributing drugs were stimulants (boys overall; 15.0 to 20.8/1000, girls overall; 3.8 to 8.5/1000), hypnotic/sedative drugs in adolescents (boys overall; 4.2 to 10.8/1000, girls overall; 2.6 to 8.8/1000) and to some extent antidepressants among adolescent girls (girls overall from 3.1 to 4.0/1000). Psychotropic drug use was, however, reduced by half in the youngest children, attributed to reduction of alimemazine only (1-year olds: boys; from 36.6 to 10.2/1000, girls; 26.9 to 7.2/1000). A higher level of psychotropic drug use was observed among younger boys, but there is a shift towards girls using more psychotropic drugs than boys during adolescence for all psychotropic drugs except for stimulants. CONCLUSION: Different trends in psychotropic drug use exist in age and gender subgroups. Psychotropic drug use has decreased among the youngest children, attributed to alimemazine, and increased in older children and adolescents, attributed mainly to stimulants and hypnotics/sedatives.

Public health nurses' perception of their roles in relation to psychotropic drug use by adolescents: a phenomenographic study.

AIMS AND OBJECTIVES: The purpose of the paper was to describe the perceptions of public health nurses' roles in relation to psychotropic drug use by adolescents. BACKGROUND: Mental health problems among adolescents are documented with studies indicating an increased use of psychotropic drugs. In Norway, care for such adolescents may fall naturally into the remit of public health nurses. DESIGN: A phenomenographic approach was used to analyse the data. METHOD: A qualitative interview study was made of 20 Norwegian public health nurses, strategically chosen using phenomenographic methodology. RESULTS: The public health nurses described three categories: discovering public health nurses who become aware of psychotropic drug use in the health dialogue with adolescents and choose to either act or not act in relation to psychotropic drug use. Those public health nurses who take action are cooperating public health nurses, who cooperate with adolescents, their families, schools and others. If cooperation has been established, supporting public health nurses teach and support the adolescent in relation to psychotropic drug use. CONCLUSION: The public health nurses who do not act can hinder or delay further treatment. Public health nurses need to acquire knowledge about psychotropic drugs, to fulfil their role in nursing mental health problems among adolescents and the increasing use of psychotropic drugs. RELEVANCE TO CLINICAL PRACTICE: The results demonstrated that public health nurses, working in health centres and schools, have the responsibility and the opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others, e.g. parents and siblings. Intervention studies are needed with regard to health promotion programmes aimed at fortifying young people's mental health.

Increase in psychotropic drug use between 2006 and 2010 among adolescents in Norway: a nationwide prescription database study.

BACKGROUND: The purposes of this study were to investigate the prevalence of psychotropic (hypnotic, antidepressant, and anxiolytic) drug use among adolescents aged 15-16 years during the period 2006-2010 according to gender and subcategories of psychotropics, and to study psychotropic drug use over the period 2007-2010 among incident users in 2007. METHODS: This was a one-year prevalence and follow-up study based on information retrieved from the nationwide Norwegian prescription database for the period 2006-2010. The study population consisted of adolescents aged 15-16 years who had filled at least one prescription for a psychotropic drug in the study period. The main outcome measures were filling of hypnotic, antidepressant, and/or anxiolytic drug prescriptions. RESULTS: Overall use of psychotropic drugs increased from 13.9 to 21.5 per 1000 among boys and from 19.7 to 24.7 per 1000 among girls during the 2006- 2010 period. Hypnotic drugs, and melatonin in particular, accounted for most of the increase. For melatonin, the annual median amount dispensed was 180 defined daily doses through the period until 2010, at which time it decreased to 90 defined daily doses. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010. CONCLUSION: This study shows an increase in hypnotic drugs dispensed for adolescents in Norway, mainly attributable to the increasing use of melatonin. The amount of melatonin dispensed indicates more than sporadic use over longer periods, despite melatonin only being licensed in Norway for use in insomnia for individuals aged 55 years or older.

Mental distress and subsequent use of psychotropic drugs among adolescents-a prospective register linkage study.

PURPOSE: To investigate the association between mental distress, other factors, and subsequent use of psychotropic drugs in adolescents aged 15-16 years. METHODS: This study is based on information retrieved from the Norwegian Youth Health Surveys (2000-2003) and linked to prescription data from the Norwegian Prescription Database (2004-2009). The study population included 11,620 adolescents aged 15-16 (87% response rate) years. Self-reported mental distress (Hopkins Symptom Checklist-10 score 1.85) was recorded along with health and lifestyle habits, education plans, and family economics. Incident psychotropic drug use (outcome measure) was defined ≥1 prescriptions of one of the following psychotropic drugs: anxiolytics, hypnotics, antidepressants, or phenothiazines registered in the Norwegian Prescription Database. RESULTS: Overall, 15.5% of the adolescents reported mental distress, 75% of them were girls. For both genders, incident psychotropic use was significantly higher among those reporting mental distresses at baseline, compared with the rest of the participants. The highest psychotropic drug use was observed among mentally distressed girls (27.7%). Mental distress was significantly associated with incident use of psychotropic drugs (odds ratio: 2.25, 95% confidence interval: 1.97-2.55). After adjustment for confounding factors and inclusion of potential mediating factors, the odds ratio attenuated to 1.59 (95% confidence interval: 1.35-1.86). CONCLUSIONS: The prevalence of mental distress among adolescents may have consequences for health promotion. Public health nurses in Norway, working in health centers and schools, have a responsibility to promote health and prevent health problems. They have the opportunity and a responsibility to identify vulnerable young people.