Understanding the Experiences of School Nurses in Caring for Sexual and Gender Minority Youth
Statement of Problem
Across the United States, 132,000 school nurses play critical roles in the public health of youth and adolescents, serving as a bridge between our health care and education systems. School nurses not only help treat and manage students’ physical health conditions, but they also conduct behavioral assessments and can be key mental health providers for students—often for those who do not have access to other mental health providers.
Sexual and gender minority (SGM) youth—those who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer and/or intersex—experience well-documented disparities in suicidality, depression, anxiety, bullying and school victimization. Prior literature has shown that SGM youth may seek out school nurse services at higher rates than their heterosexual, cisgender peers for reasons such as feeling safer using a school nurse’s bathroom, seeking counseling services from school nurses, and looking for quality information on sexual and reproductive health specific to the experiences of SGM youth.
Despite the potential of school nurses to serve as resources for crisis management and guidance counseling for SGM youth, very little is known about the care school nurses provide for these youth. More specific research on school nurses needs to be conducted as they have the potential to serve as informed providers and advocates for SGM youth and their specific needs in schools and can also help foster safer, more inclusive school climates.
Description
Through this study, we plan to describe and understand the experiences of school nurses in caring for SGM youth across the U.S., including to explain barriers and facilitators to education and/or the provision of quality care. We also seek to contextualize the care provided by school nurses to SGM youth by school setting, geographic location, sociopolitical climate and nurse practice characteristics.
In May 2023, we sent a survey to 2,000 randomly sampled school nurses who are members of the National Association of School Nurses to learn about their knowledge, attitudes, and practices in caring for SGM youth. From this survey, we will analyze information about school setting characteristics, nursing practices, LGBTQ school climate, and demographic characteristics to identify positive and/or negative support patterns, constructive care, and areas for improvement.
We received more than 1,500 responses to this survey and recruited for this pilot grant study from participants who expressed interest in follow-up interviewing. Our interviews followed a semi-structured interview guide that contained questions centered around five domains: (1) close relationships with students and providing psychosocial support; (2) general mental health of youth and the mental health of SGM youth; (3) the school nurse’s perception of their role in caring for SGM youth; (4) the interfacing of the school nurse role with the roles of other professionals; and (5) the influences of district-, local-, and state-level policies on providing care for SGM youth.
We are now analyzing data from the interviews through thematic analysis, a technique used in grounded theory that involves the identification and use of theoretical codes to achieve a framework to understand a social phenomenon.
Findings from this study have the potential to uncover useful information on the knowledge, attitudes, and practices of school nurses in caring for SGM youth in the U.S., and importantly, to further our understanding of how school district-, local- and state-level policies influence the use of best practices.
Next Steps
We are currently completing data analyses from both the survey and interview phases. Knowledge gained from this study is critical to understanding how best to support school-aged SGM youth and can be applied to developing standards of care for SGM youth in early academic settings.
Suggested Citation
Children's Hospital of Philadelphia, PolicyLab. Understanding the Experiences of School Nurses in Caring for Sexual and Gender Minority Youth [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].