The social-labor characteristics of the participating SNs based on the care model they provide in the schools where they work (exclusive model, that is available in a single the school; itinerant model, that is available for several schools simultaneously; or attends occasionally the school, in cases where their attention is needed) are shown in Table 1.
Overall, the exclusive model was the most common situation (45.8%), followed by the SN attending occasionally school (32.8%), and finally the itinerant model (21.4%). Most SNs were women (92.8%), with a mean age of 41.3 (SD = 8.92) years. No significant differences were observed in gender distribution or age across different contractual situations.
Regarding the hiring organization characteristics of SNs, the Education Department (48.4%), the school itself (20.9%), and private companies (22.3%) predominate in the exclusive model compared to the other models, with the Health Department being the institution that most frequently contracts in the itinerant models (66.7%) and for nurses who attend occasionally (73.7%) (p < 0.001). In relation to the characteristics of schools, SNs in the exclusive model were distributed across different types of schools, with a notable presence in Schools of Infant, Primary, and Secondary Education (44.9%) and Schools of Infant and/or Primary Education (30%), and to a lesser extent in Institutes of Secondary Education and/or Baccalaureate (3.8%). However, in itinerant models (39.2%) and in cases of occasional attendance (39.5%), a higher percentage of SNs were situated in various types of schools grouping schools of different characteristics (p < 0.001).
Likewise, concerning the type of funding of the school, most SNs worked in publicly funded schools although this hiring was more reflected in itinerant models (88.2%) and in cases of occasional attendance (86.8%) than in the exclusive model (52.3%) (p < 0.001).
Most SNs stated they were present in schools in urban areas (exclusive model 88.9%), with a higher percentage of schools in rural areas for itinerant models (78.4%) and in cases where the nurse attends occasionally (73.7%) (p = 0.011).
Regarding the number of students in the schools, no significant differences were observed. Most SNs in the exclusive model (44.4%) and itinerant models (49%) worked in schools with fewer than 500 students, and in the case of occasional attendance model (42.9%) in schools with 501–1499 students.
Finally, most SNs worked in schools that were not located in disadvantaged areas. However, significant differences were observed between contractual models in relation to this variable, with it being more common for nurses working in disadvantaged areas to be in itinerant models (64.4%) or attending occasionally the school (63.6%) (p < 0.001).
m: missing values
In Table 2, the characteristics of schools are shown based on the availability or not of a SN in the school according to the responses of the school staff. Out of 1194 participants, 65.2% are women, the mean age of the respondents is 50.5 years old, 78.2% are directors or responsible for the school, and 55% (n = 320) affirmed having a SN in their school. 45.5% (n = 124) affirmed that the nurse was in the schools according to the exclusive model, 21.4% (n = 56) itinerant, and 32.8% (n = 89) attended occasionally the school.
One of the characteristics of the school associated significantly with the availability of a SN, according to the responses of the school staff, was the type of school. Participants from special education schools more frequently affirmed having a SN (10.1% yes vs. 2.2% no), while schools of Infant and Primary Education have less availability of SN (56.3% yes vs. 68.7% no) (p < 0.001), despite the latter being the highest percentage of participating schools. Regarding funding, although most participating schools were public, there was a higher availability of SNs in subsidized schools (17.3% yes vs. 10.5% no) and private schools (1.2% yes vs. 0.1% no) (p < 0.001). The location of the school was also related to the availability of a SN (p < 0.001). Thus, schools located in urban areas had a higher availability of SNs (82.4% yes vs 72.6% no) compared to rural schools (17.7% yes vs 27.4% no) (p < 0.001). Regarding the number of students, the availability of a SN was higher in schools with ≥ 1500 students (11.2% yes vs. 3.2% no) and lower in schools with < 500 students (65.5% yes vs. 73.1% no) (p < 0.001). Finally, there were no significant differences regarding the availability of a SN according to the school location in a disadvantaged area or not, and regarding the perceived need for the establishment of health training programs for teachers, which was considered necessary by the majority (96.4%).
Table 2
Characteristics of school based on the availability of a School Nurse (SN) in the school, according to responses from school staff (N = 1194)
|
|
Availability of SN (N = 1194)
|
|
|
|
Si
|
No
|
p
|
Type of school (N = 1181)
|
Nursery School
|
1(0.3%)
|
2 (0.2%)
|
< 0.001
|
Primary and Secondary School
|
178 (56.3%)
|
594 (68.7%)
|
Primary School
|
4 (1.3%)
|
9 (1%)
|
Secondary School and High School
|
58 (18.4%)
|
161 (18.6%)
|
Nursery, Primary, and Secondary School
|
43 (13.6%)
|
80 (9.3%)
|
Special Education school
|
32(10.1%)
|
19 (2.2%)
|
Type of Funding (N = 1194)
|
Public
|
263 (81.4%)
|
779 (89.4%)
|
<0.001
|
Subsidized
|
56(17.3%)
|
91(10,5%)
|
Private
|
4 (1.2%)
|
1 (0,1%)
|
Location (N = 1194)
|
Rural
|
57(17.7%)
|
239 (27.4%)
|
< 0.001
|
Urban
|
266(82.4%)
|
632 (72.6%)
|
Number of Students in the school (N = 1191)
|
< 500
|
211(65.5%)
|
635(73.1%)
|
< 0.001
|
Between 501 y 1499
|
75 (23.3%)
|
206(23.7%)
|
≥ 1500
|
36 (11.2%)
|
28 (3.2%)
|
School located in a disadvantaged area (N = 1106)
|
YES
|
88 (29.4%)
|
261 (32.3%)
|
0.197
|
No
|
211 (70.6%)
|
546 (67.7%)
|
¿Do you consider it necessary to establish health training programs aimed at teachers? (N = 1194)
|
YES
|
313 (96.9%)
|
834 (95.8%)
|
0.233
|
No
|
10 (3.1%)
|
37 (4.2%)
|
In Table 3, the responses of the participants representing the PAs are shown based on the availability of a SN. Out of 582 participants, 91% are women, with an average age of 43.9 years. About 74.8% are representatives of the PAs. Among them, 40.2% (n = 234) stated that there is a SN available in the school. Furthermore, 63.8% (n = 141) mentioned that the SN was available at the school in exclusivity, 23.1% (n = 51) stated that the nurse worked itinerantly across multiple schools, and 13.1% (n = 29) mentioned that the nurse attended occasionally.
A significant difference was observed (p = 0.002) in the availability of a SN based on the existence of children with a disease at the school (30.3% yes vs 19.3% no). This availability also varied according to the type of school (p < 0.001), as participants from special education schools were more likely to have a SN (7.3% yes and 0.9% no) despite most participating schools being primary schools. Regarding the location of the school, those located in urban areas had a higher availability of SNs (82.9% yes vs 71% no) (p < 0.001).
In relation to the number of students, the availability of a SN was higher in institutions with ≥ 1500 students (12.5% yes vs. 2.7% no) and lower in institutions with < 500 students (52.5% yes vs 60.1% no) (p < 0.001). However, no significant differences were observed in the availability of a SN based on the type of funding of the school, its location in a disadvantaged area or not, and in relation to the perceived need for the implementation of health training programs directed at teachers, which was considered mostly necessary (99%).
Table 3
Characteristics of schools according to the availability of a School Nurse (SN) in the schools, according to the responses of representatives of the PAs (N = 582)
|
|
Availability of SN
|
|
|
|
Si
|
No
|
p
|
Children in the school with some illness
|
YES
|
71 (30.3%)
|
67 (19.3%)
|
0.002
|
No
|
163 (69.7%)
|
281 (80.7%)
|
Type of school
|
Nursery School
|
2 (0.9%)
|
2 (0.6%)
|
0.002
|
Kindergarten and Primary School
|
119 (51.3%)
|
175 (51.5%)
|
Primary School
|
9 (3.9%)
|
21 (6.2%)
|
Secondary School and High School
|
69 (29.7%)
|
114 (33.5%)
|
Kindergarten, Primary, and Secondary School
|
16 (6.9%)
|
25 (7.4%)
|
Special Education schools
|
17 (7.3%)
|
3 (0.9%)
|
Type of funding
|
Public
|
216 (92.3%)
|
327 (94%)
|
0.396
|
Subsidized
|
17 (7.3%)
|
21 (6%)
|
Private
|
1 (0.4%)
|
0 (0%)
|
Location
|
Rural
|
40 (17.1%)
|
101 (29%)
|
< 0.001
|
Urban
|
194 (82.9%)
|
247 (71%)
|
Number of students in the school
|
< 500
|
105 (52.5)
|
200 (60.1%)
|
< 0.001
|
Entre 501 y 1499
|
70 (35%)
|
124 (37.2%)
|
≥ 1500
|
25 (12.5%)
|
9 (2.7%)
|
School located in a disadvantage area.
|
YES
|
23 (12.4%)
|
53 (17.9%)
|
0.104
|
No
|
163 (87.6%)
|
243 (82.1%)
|
Do you consider it necessary to train teachers in health education?
|
YES
|
232 (99.1%)
|
344 (98.9%)
|
0.730
|
No
|
2 (0.9%)
|
4 (1.1%)
|
In Table 4, the perceived need for a SN by the school staff and PAs (Parent Associations) representatives is presented based on reported characteristics of the schools.
For the school staff, the perceived need for the SN was averaged at 4.58 (SD = 0.73). In this group, the variables associated with the perceived need were the location, with a higher perceived need in schools located in urban areas (4.64, SD = 0.66) compared to rural areas (4.40, SD = 0.88) (p < 0.001), in schools located in disadvantaged areas (4.67, SD = 0.66) compared to those that did not (4.55, SD = 0.74) (p = 0.013), if they had a SN available (4.81, SD = 0.42 vs 4.50, SD = 0.80), if they operated under the exclusivity model (4.90, SD = 0.31) versus the model where the nurse attends occasionally (4.66, SD = 0.54) (p < 0.001), and if they considered teacher's healthcare training necessary (4.60, SD = 0.71 vs 4.26, SD = 1.05).
For the PAs group, the perceived need for the SN was averaged at 4.57 (SD = 0.76). In this group, the variables associated with the perceived need were the role, with a higher perceived need among parents (4.76, SD = 0.54) compared to PA representatives (4.46, SD = 0.86), the existence of children with illness in the school (4.73, SD = 0.76 vs 4.52, SD = 0.75), the location, with a higher perceived need in schools located in urban areas (4.65, SD = 0.68) compared to rural areas (4.33, SD = 0.93) (p < 0.001), according to the number of students in the school, with a higher perceived need in larger schools (4.88, SD = 0.33) versus smaller ones (4.47, SD = 0.81) (p = 0.003), if they had a SN available (4.82, SD = 0.49 vs 4.41, SD = 0.86), if they operated under the exclusivity model (4.94, SD = 0.25) versus the itinerant model (4.65, SD = 0.80) (p < 0.001), and if they considered teacher's healthcare training necessary (4.59, SD = 0.71 vs 2.50, SD = 1.76).
Finally, it is worth mentioning that the satisfaction level with the SN, reported by participants who had a SN available at the school, was 4.44 (SD = 0.93) for the school staff and 4.32 (SD = 0.89) for the PAs. Furthermore, a positive Pearson correlation was observed between the perceived need for the SN and the satisfaction level with the SN in both groups (school staff r = 0.171, p = 0.002; PAs r = 0.310, p < 0.001).
Table 4
Perceived need for school nurse (SN) by school staff and PA (parent’s associations) representatives according to reported characteristics of schools
School Staff
|
PAs
|
|
|
Anova
|
|
|
Anova
|
School staff (n=1194)
|
Perceived need for SN
|
F
|
p
|
PAs (n=582)
|
Perceived need for SN
|
F
|
p
|
Gender (n=1194)
Male
Female
Non-binary
|
4.60 (0.64)
4.57 (0.77)
4.33 (0.58)
|
0.40
|
0.670
|
Gender (n=582)
Male
Female
Non-binary
|
4.38 (0.91)
4.60 (0.74)
4.50 (0.71)
|
2.26
|
0.105
|
Person's role (n=1194)
Principal/Head of school
Head of Studies
Teacher
Secretary
Vice Principal
|
4.57 (0.71)
4.58 (0.90)
4.67 (0.64)
4.42 (0.96)
4.75 (0.50)
|
1.35
|
0.251
|
Person's role (n=582)
Father
Mother
PA Representative
|
4.76 (0.54)
4.73 (0.56)
4.46 (0.86)
|
9.63
|
<0,001
|
|
|
|
|
Children at the school with any illness (n=582)
Yes
No
|
4.73 (0.76)
4.52(0.75)
|
8.11
|
0,005
|
Type of school (n=1194)
Preschool
Primary and Preschool
Primary School
Secondary and High School
|
5.00 (000)
4.59 (0.72)
4.77 (0.44)
4.58 (0.73)
|
1.62
|
0.152
|
Type of school (n=581)
Preschool
Primary and Preschool
Primary School
Secondary and High School
Primary, Secondary, and High School
Special Education school
|
4.75 (0.50)
4.58 (0.76)
4.53 (0.94)
4.54 (0.81)
4.51 (0.55)
5.00 (0.00)
|
1.45
|
0.205
|
Type of Funding (n=1193)
Public
Subsidized/Private
Private
|
4.60 (0.71)
4.46 (0.83)
4.40 (0.89)
|
2.72
|
.066
|
Type of Funding (n=582)
Public
Subsidized/Private
Private
|
4.57 (0.77)
4.61 (0.55)
5.00 (0.00)
|
0.20
|
.819
|
Location (n=1194)
Rural
Urban
|
4.40 (0.88)
4.64 (0.66)
|
26.46
|
<.001
|
Location (n=581)
Rural
Urban
|
4.33 (0.93)
4.65 (0.68)
|
19.01
|
< .001
|
Number of students in the school (n=1191)
<500
Entre 501 y 1499
≥ 1500
|
4.57 (0.73)
4.60 (0.72)
4.66 (0.72)
|
0.59
|
.554
|
Number of students in the school (n=532)
<500
Entre 501 y 1499
≥ 1500
|
4.47 (0.81)
4.63 (0.76)
4.88 (0.33)
|
6.01
|
.003
|
School located in a disadvantaged area (n=1106)
YES
No
|
4.67 (0.66)
4.55 (0.74)
|
6.25
|
.013
|
School located in a disadvantaged area (n=582)
SI
No
|
4.70(0.59)
4.53 (0.82)
|
2.85
|
.092
|
Service delivery model (n=271)
Exclusive model
Itinerant model
Attends it occasionally
|
4.90 (0.31)
4.86 (0.40)
4.66 (0.54)
|
8.60
|
<.001
|
Service delivery model (n=220)
Exclusive model
Itinerant model
Attends it occasionally
|
4.94(0.25)
4.65 (0.80)
4.66 (0.55)
|
9.37
|
< .001
|
Is there a SN in your school (n=1193)
YES
No
|
4.81 (0.42)
4.50 (0.80)
|
46.74
|
<0,001
|
Is there a SN in your (n=581)
YES
No
|
4.82 (0.49)
4.41 (0.86)
|
45.11
|
<0,001
|
Do you consider it necessary to train teachers in health education?
(n=1194)
Yes
No
|
4.60 (0.71)
4.26 (1.05)
|
9.93
|
.002
|
Do you consider it necessary to train teachers in health education?
(n=582)
YES
No
|
4.59 (0.71)
2.50 (1.76)
|
48.95
|
< .001
|