Department of Nursing and Health Promotion, Faculty of Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
Department of Physiotherapy, Faculty of Health, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
J Clin Nurs. 2017 Dec;26(23-24):4716-4725. doi: 10.1111/jocn.13823. Epub 2017 Jul 3.
To gain a better understanding of school nurses' perceptions of the challenges involved in implementing national guidelines on managing overweight and obesity in adolescents.
National guidelines for the management of childhood overweight and obesity are developed in many countries to translate scientific knowledge into practice. However, several challenges are involved in their implementation.
A qualitative design with focus group interviews was chosen for data collection. Six focus group interviews with 21 school nurses were conducted. Data were analysed by qualitative content analyses.
National guidelines provided new directions for managing overweight and obesity in school health services. School nurses were assigned new tasks and responsibilities, which they felt they were not sufficiently prepared for, nor were they supported by extra resources. Challenges in implementation of the guidelines were identified at various levels: system level (implementation strategy, available resources, training and support, professional collaboration, referral options); individual school nurse level (perceived competence, burden of responsibility, attitudes and emotions); subject level (sensitivity of weight-related issues); and professional level (scepticism to a body mass index cut-off of 25 kg/m as the starting point for intervention).
School nurses felt overwhelmed in terms of implementing the guidelines. This indicates barriers not being sufficiently identified or acted upon during implementation. Further, the nurses' scepticism about the body mass index cut-off for intervention, and their experience that measuring and follow-up of adolescents' weight development was their responsibility alone, indicates that important discussions are needed on this as an adequate measure as well as on the professional division of responsibilities.
Having a proper strategy for implementation, and ensuring that necessary clinical structures and resources are available, is crucial. Including school nurses in developing and implementing such strategies is vital for success in implementing national guidelines.
更好地了解学校护士在实施青少年超重和肥胖管理国家指南方面所面临挑战的看法。
许多国家都制定了儿童超重和肥胖管理的国家指南，以将科学知识转化为实践。然而，在实施过程中涉及到许多挑战。
选择定性设计和焦点小组访谈来收集数据。进行了六次有 21 名学校护士参加的焦点小组访谈。通过定性内容分析对数据进行分析。
国家指南为学校卫生服务中管理超重和肥胖提供了新的方向。学校护士被赋予了新的任务和责任，他们觉得自己没有充分的准备，也没有得到额外资源的支持。在不同层面上发现了指南实施的挑战：系统层面（实施策略、可用资源、培训和支持、专业协作、转诊选择）；个体学校护士层面（感知能力、责任负担、态度和情绪）；主题层面（与体重相关问题的敏感性）；以及专业层面（对 BMI 切点为 25kg/m2 作为干预起点的怀疑）。
学校护士在实施指南方面感到不知所措。这表明在实施过程中没有充分识别或应对障碍。此外，护士对干预 BMI 切点的怀疑，以及他们认为测量和随访青少年体重发展是他们自己的责任，表明需要对此进行重要讨论，作为一种适当的措施，以及专业责任分工。
制定适当的实施策略，并确保有必要的临床结构和资源是至关重要的。让学校护士参与制定和实施这些策略对于成功实施国家指南至关重要。
