107
Introduction
The purpose of health services for children is to
enable as many children as possible to reach
adulthood with their potential uncompromised
by illness, environmental hazard or unhealthy
lifestyle (NHS Executive, 1996, p. 6).
School health services emerged in an ad hoc
fashion in the late nineteenth century out of
individual pioneering intentions that no child
should be disadvantaged in education for
health reasons. The impetus derived from
public health concerns. That underlying
objective for the school health service remains
valid in 1998 and has historically been a
shared intention between education and
health.
After school health services were trans-
ferred from local authority management to
health service management in 1974, school
nursing as a specific professional activity
became a common pattern of service across
Britain. In 1976, the Court Report recom-
mended specialist training for school nurses.
Medical and dental inspection plus referral
for treatment of pupils in attendance at school
became a legal requirement by the National
Health Service Act 1977 (para 5[1][a]).
The school health service includes both
doctors and nurses; however, school nurses,
because of their numbers and easier accessi-
bility within the school environment, have
come to be equated with what most people
mean when they refer to the school health
service itself. In addition, the two decades
since the Court Report have been a period of
considerable change in both the nature of
children’s health needs and in the substance
and practice of school nursing.
The health of children and young people in
Britain is the explicit focus of 16 different
strategic and legislative documents which
have emerged since the late 1980s, most
during the 1990s[1]. There has not, however,
been clarity about who is responsible for
coordinating a national children’s health
strategy for either England and Wales or for
Scotland or Northern Ireland. The school
health service might well be expected to play a
key role.
The trend in school health services in
England, however, has been towards local
Health Education
Number 3 · May · 1998 · pp. 107–115
© MCB University Press · ISSN 0965-4283
The changing role of
school nursing within
health education and
health promotion
Diane DeBell and
Gil Everett
The authors
Diane DeBellis Director of Research and Reader in Social
Policy at City College Norwich, Norwich, UK.
Gil Everett is a former Research Fellow in Social Policy at
City College Norwich and currently a postgraduate student
at the University of East Anglia. City College Norwich is a
regional college of Anglia Polytechnic University.
Abstract
Reports on a detailed study of a school nursing service
which has revealed the untapped value of the service and
a generally poor understanding of what, precisely, school
nurses do, and the nature of their skills and experience.
Focuses on one aspect of this study: the changing nature of
the school nursing role in health education and health
promotion. Finds that school nurses have adjusted their
practice to meet the changing nature of children's health
needs. They now increasingly work to health education
and health promotion agendas and are acting in a health
advisory role. Calls into question the need for universal
health screening, particularly for older children, as the core
activity of school nursing. Concludes that the service
should in future be designated as being for “children of
school age”, and that the range of sites where school
nursing is delivered should be extended.
The research team would like to thank Brenda
Brown for initiating this research and East Norfolk
Health Authority for funding the work.