Background to the Research

• Children attending special schools often have long term healthcare needs that require ongoing medical and nursing care. This research was carried out to examine the nursing inputs needed by special schools in NI. A survey of the special schools was undertaken to provide information about the pupils' medical and health care needs and to identify how these were currently being met.
• The survey also determined the 'hands-on' care by nurses in schools as well as the advice and training provided by health care professionals to school staff. This information was cross-checked with the 11 Health and Social Services Trusts in NI who have responsibility for nursing and other health care provision.
  

Research Approach

• The research method involved questionnaires and school visits. Two postal surveys were undertaken, the first with the principal teachers in the 47 special schools in NI and the second with the Directors of Nursing Services in 11 Health and Social Services Trusts in NI.
• 42 of the postal questionnaires to special schools were returned completed and all replies were received from all 11 Trusts. In addition, members of the working party guiding the project undertook visits to 8 special schools to talk to staff; to meet the pupils with medical needs and to observe current practice. A standard pro forma of questions was drawn up to help clarify some of the findings from the questionnaire responses.
• Schools were categorised as SLD, MLD or 'other'. There were 12 MLD schools and 21 SLD schools included in the results. The nine 'other' schools included in the results included schools for children with physical disabilities, behavioural problems, language and communication problems and sensory impairment.
  

Main Findings

• SLD and 'other' schools were more likely to have a nurse who was resident in the school on either a part time or a full time basis compared to MLD schools.
• MLD schools (83%) were more likely to report contact with the visiting School Nurse compared to SLD schools (71%) and 'other' schools (63%)
• SLD schools (57%) were more likely to report contact with the community nurse (learning disabilities) compared to MLD schools (25%).
• 'Other' schools (13%) were more likely to report contact with a paediatric nurse compared to SLD schools (5%) and MLD schools (0%)
• SLD schools reported having contact with a median of two nurses (range 0-5) while MLD schools reported contact with a median of one nurse (range 0-5) and 'other' schools had a median of one nurse (range 0-2).
• Weekly contact with the school nurse was reported by six schools in total (15%) while a further school reported a contact rate of approximately 10 times a year and eight schools reported infrequent contact. Seven schools reported contact with the school nurse through school medicals.
• Both MLD schools and 'other' schools reported that the school nurse was the one they would contact most frequently. SLD schools, however, indicated a wider range of nurses with the most frequent being school nurses, the community nurse (learning disabilities) and district nurses.
• There were significant differences among the three types of schools in relation to nurse involvement in the assessment of children's needs and care plans. This was reported to happen in only 1 MLD school but occurred in three quarters of the SLD schools with usually the school nurse and the community nurse (learning disabilities) involved. Over two fifths (44%) of 'other' schools had a school nurse involved in assessments and care plans.
• Nurses attended the reviews for certain children or all children in 25% of MLD schools, 81% of SLD schools and 33% of 'other' schools.
• Nurses provide very little 'hands on' care within MLD schools. They are, however, involved in doing specific tasks within the other special schools. The most common task being peg-tube feeding in SLD schools and administering medications in the other schools. These tasks are required in just over 50% of schools and all other tasks are required in fewer than 50% of the schools.
• Nurses reported having a greater advisory role within SLD schools than they do in the other schools. In SLD and MLD schools the nurses were mainly involved in advising on specific medical conditions and treatments and on short-term medical problems. In schools classed as 'other' their advisory role was more likely to be around moving and handling. In SLD schools nurses also advised more on emotional and behavioural difficulties, the administration of medications and on managing children's special needs in a school context.
• Around 80% of schools reported that the training given to school staff to address the health needs of the children was specific to the individual child's medical/nursing needs. Nearly all schools reported that this was done in an easily understood way and almost 75% said the training provided was timely.
• The visits to schools provide opportunities to explore several issues in more detail with school staff. In the eight schools visited all but one felt that over the past 5 years more pupils were presenting with medical needs. All felt that nursing input was essential and some insisted that a school based nurse was necessary.
• In all schools, classroom assistants provided much of the medical and nursing care. In several schools only nurses administrated medications and tube-fed patients. Therefore there was some variation of practice across the special schools.
• The article concludes that there is little consensus as to the form that nursing inputs to special schools takes; the nurses that are best placed to co-ordinate and deliver these inputs; the balance between hands-on care provided by nurses and their guidance and supervision of school staff in doing this, and the co-ordination of nursing inputs with other healthcare professionals.
• The authors conclude that closer examination should be made of the role and function of nurses in relation to meeting these needs. They point to the two differing models, firstly that proposed by the Department of Education guidance published in 1996 which promotes the greater use of the visiting school nurse service. The second model is that which is already happening in a proportion of special schools in NI and favoured by a number of principal teachers. This involves the employment of specialist nurses within special schools on a whole or part time basis.