Toolkit for school nurses

Introduction

This toolkit has been drawn up by Alcohol Concern following discussion with a range of professionals, including nurses and teachers. It is one of five interlinked sets of materials for a different professional groups working with children in generic settings. The starting point for the project overall is that, at present, the needs of children whose parents misuse alcohol go largely unrecognised by most professionals; but much can be done by professionals routinely in contact with such children to promote resilience to long-term harm. A key problem for many professionals is that they (often quite unconsciously) see parental alcohol misuse differently to a range of other problems facing many children. They feel a disproportionate sense of inadequacy in dealing with the issue and fear the need to react within the context of potential child protection concerns more so than they would in respect of other problems commonly faced by children living in difficult family situations.

The importance of the role of school nurses
Although school nurses may have only infrequent contact with individual children, the contact that they do have may be at a time and in circumstances that give them a unique opportunity to address difficult issues. Unlike a teacher, they do not generally have the opportunity of spending every day getting to know a child and of forming ongoing relationship. However the very nature of the nurse’s rather more detached, yet caring, role may sometimes provide the setting in which a child is able and willing to talk about problems that they are experiencing.

The brief of a school nurse is, of course, very broad, covering specifics such as vaccinations and special clinics (eg auditory) through to a fairly complex role in carrying out health promotion that is appropriate to the age group of children, the national curriculum and the individual circumstances of the local population. This may encompass working with groups of children, but also providing training for teachers on specific issues. The school nurse will also be dealing with parents and pupils on an individual basis as well as linking in with other health and welfare professionals as required. This latter role embraces referring children on, as well as taking up matters with an individual child as required, say, by a doctor. However, the role of school nurses and the value of working in the school context to further the health and welfare of children often goes unrecognised by mainstream health services.

As well as many different ‘audiences’ – teachers, children of different ages in groups and individually, parents, other health and welfare professionals, etc. – school nurses deal with a very wide range of topics. Each of these requires a particular level of knowledge, expertise and skill in order to be able to deal appropriately with issues as they present themselves. However, one area that is not covered in any of the training for school nurses’ qualifications is that of alcohol misuse or the impact of parental drinking on their children.

Like many other professional groups, school nurses will tend to have a general view of alcohol related issues and even this may vary considerably depending on their nursing practice experience. Nonetheless, their wider background knowledge and training means that they are well equipped to play a significant role in reducing the long-term harm suffered by children as a result of their parents’ drinking

This toolkit aims to help school nurses to understand the nature of the impact of parental drinking and to apply their existing skills and knowledge to minimising the harm that it causes.

Enabling nurses – what these materials do and do not offer
This toolkit has been drawn up for school nurses, based on the problems and issues they themselves have identified as arising when dealing with a child from a family where alcohol misuse is an issue.

It is important, at the outset, to acknowledge that the role of school nurses in supporting children is limited to within the context of their particular role in relation to children in the school setting. It is also important to point out that this particular set of materials focuses on supporting the child affected by a problem drinker and not on alcohol misuse by children themselves. Finally, we are not advocating, in this toolkit, involvement with parents - whether this be to find out about the extent of the alcohol problem or to assist them in dealing with them. This is both in recognition of the limitations of the school nurse’s role and because, regardless of what their parents do or do not change about their alcohol misuse, children can be supported in developing resilience to harm. These materials show how.

The aim of this toolkit is that school nurses should:

Have information about the effects of parental alcohol misuse on children and what can be done to support these children, both individually and within the wider school context
Have information that addresses key issues that arise within the context of schools and their educational role.

The intended outcomes are that nurses should:

Feel enabled to recognise where this might be the problem
Know what they can do to support a child and to facilitate resilience to harm
Know when matters should be referred elsewhere (and to where) and, importantly, when they need not be referred
Feel as confident of dealing with a child where alcohol is an issue, as they would with a child from a family with, say, a pending divorce situation.