Health promotion
Developing health services
designed for young people
T
o enable us to aspire to high quality care, services
must focus on preventive health care and be designed
to be assessable by our target populations. Unhealthy
choices and missed prevention opportunities are part of the
cause of the high number of long-term health conditions
developing in our population. The financial cost to the NHS
of these long-term conditions is high and numerous years
of healthy life are lost as the result of known behavioural
and lifestyle factors. Healthy Lives, Healthy People (DH,
2010) identifies lifestyle-driven health problems regarding
obesity, smoking, alcohol and sexually transmitted infections
as the biggest current concern in the UK. A recent review
led by Michael Marmot (2010) demonstrated that health
inequalities are still a dominant feature of across England.
This has raised the profile of the social determinants of
health and the importance of addressing the conditions
of everyday life that lead to inequalities. Figure 1 shows
how the determinants of health can have an impact on
the outcomes for young people. The health of young
people is the result of a complex interplay of genetic, social,
environmental, economic and cultural factors. Looking at the
determinants of health discussed, it is crucial that resources
are targeted at areas of need in the correct way to try to reduce
health inequalities.
It is recommended that frontline staff members need
to be more involved in developing practice, allowing
high quality integrated care to be delivered. However, to
achieve this leadership the workforces skills need to be
developed to allow change to be taken forward and quality
services developed. School nurses are skilled in leading
teams that promote health improvement, working within
a progressive model where services are universal but also
targeted towards those with specific needs.
School nurses can act as a bridge between
education, health and social care supporting work
making health services more accessible to parents,
pupils, carers and staff . DH (2006: 9)
We are currently in a time of economic uncertainty
with large cuts in public spending. This could have a
detrimental effect on the long-term health outcomes of
children and young people. Kennedy (2010) acknowledges
investment in early intervention and the prevention of ill
health helps to reduce the social gradient of health and
saves money in the longer term.
Healthy Child Programme and
young people
The Healthy Child Programme (DH, 2009) sets out
May 2011 Vol 6 No 4 British Journal of School Nursing
Abstract
The Healthy Child Programme sets out an evidence-based, preventive
programme supporting current research which demonstrates lifestyles
and habits established during childhood, adolescence and young
adulthood influence a persons health throughout their life. Healthy Lives
Brighter Futures identifies the importance of targeting services toward
young people, ensuring they receive high quality support and advice on
making healthy choices such as alcohol, drugs, smoking, sexual health.
During the developmental stage of adolescence young people strive for
independence and begin to make decisions that impact on the rest of
their lives.
School nurses are skilled in leading teams that promote health
improvement. They working within a progressive model where services
are both universal and targeted towards those with specific needs. If
young people are involved in service design and delivery they are more
likely to access services and promote them within their peer group.
Consultation with young people also allows effective evaluation of the
service ensuring quality is maintained and service delivery improved. The
article explores the role of the school nurse when involving young people
in service development and the implications this has for future practice.
Key words
n Health service development n Young people n Service design
n Ethical considerations n School nursing
an evidence-based, preventive programme supporting
current research, which demonstrates that lifestyles and
habits established during childhood, adolescence, and
young adulthood influence a persons health throughout
their life.
It is the responsibility of the NHS and other stakeholders
to ensure young people are able to access specialist services
where they are able to feel comfortable accessing support
at times that are convenient for their needs. The services
that reach every child and young person have a crucial
role in shifting the focus from dealing with consequences
of difficulties in childrens lives to trying to prevent things
from going wrong from the start. School nurses can play
an important role in promoting the health and wellbeing
of pupils and initiating and supporting activities by
way of drop-in clinics in schools (Simmonds, 2010).
School nurses are skilled at leading teams that promote
health improvement. They are the heart of the public
health workforce, being able to assess, plan, deliver and
Hannah Tall, Specialist Community Public Health Nurse (School
Nursing), Norfolk Community Health and Care NHS Trust
Email: hannah.tall@nhs.net
193
Health promotion

Upstream Midstream Downstream

Education Lifestyle factors Complex health needs
Attainment Risk-taking behaviour Genetic susceptibility to disease
Aspiration Food and nutrition Prevalence of disease
Employment Sexual health Aetiological factors
Household income Attitude
Opportunities Beliefs
Social resources Identity
Social capital Health literacy
Community involvement Emotional regulation
Population density Peer relationships
Safety and crime Family relationships
Culture and religion Attachment to primary carer
Computer and internet access
Housing
Mobility and transport

Young
person
Age, sex,
ethnicity

Figure 1. Example of determinants of health that can apply to adolescents.

Table 1. Aspects of the Healthy Child Programme

Emotional health and
Build resilience in children and young people
wellbeing
Provide health information, support and guidance to children, families and young people on healthy
Promoting healthy eating, physical activity
weight PSHE, public health assemblies and parental drop-in sessions in primary schools can be utilized to help
support schools, children and families in making healthy choices
Provide young people with health information through PSHE, drop in clinics and one-to-one
Improving sexual health
appointments
Reducing teenage Ensure services are accessible and young people friendly (DH, 2007)
pregnacy Working with Family Nurse Partnership programme

Support young people through PSHE programmes and one to one appointments
Substance misuse Provide health information on alcohol, drugs and tobacco
Refer to more specialist services if required

Screening programmes Provide childhood measurement programme

Immunization Provide HPV vaccination programme
Identify and respond appropriately to early signs that a family, child or young person are in need of
Safeguarding
additional support. Safeguard and promote welfare of a child or young person

Supporting parents Support change to reduce risks to family health and wellbeing
and carers Role of Family Nurse Partnership

Supporting children Support children and young people in managing the physical and emotional effects of these conditions
with long standing to help them achieve their full potential
illness or disability Ensure children and young people with additional needs have access to specialist services
Source: Interpretation based on the Healthy Child Programme (DH, 2009)

194 British Journal of School Nursing May 2011 Vol 6 No 4

 Health promotion

evaluate public health programmes for the school aged

population. School nurses are well positioned to work
with other professionals and agencies to agree a range of
contributions, interventions and opportunities for each
Rung 7-8Young people
child, young person and his/her family. Youth initiated
make decisions with
Table 1 illustrates the application of the Healthy Child shared decisions
minimal adult support
Programme within school health teams and collaborative
work with health, education, social care and other relevant Youth initiated
agencies to support children and young people and their Rung 6Participatory
and directed
families. Healthy Lives Brighter Futures (DH, 2009) identifies action research is an
the importance of targeting services toward young people example of this
Adult initiated
ensuring they receive high quality support and advice on shared decisions
making healthy choices over issues such as alcohol, drugs, Rung 4-5Young
smoking, sexual health (Table 2 provides some examples of people are consulted
Consulted and
key issues that currently influence or affect young peoples and informed but still
informed
health). Early positive experiences with services are likely to adult-led
give young people confidence to access a wide range of these Assigned but
in the future. The Childrens Plan (DCSF, 2007) recommends informed Rung 13Very adult
that services should be located in places where young orientated and the
people visit. A report by the Parliamentary Office of Science Tokenism participation is not
and Technology (2004) suggests that locations, opening meaningful, may be seen
hours and long waiting times at sexual health services can Decoration as patronizing
conflict with school or home commitments, thus reducing
visiting opportunities. The Youre Welcome guidelines (DH, Manipulation
2007) lay out recommendations for services, ensuring they
are accessible and appropriate for young people. Bekaert
and Mcpherson (2005) suggests that sexual health and
contraception services should be developed in the light of a
local needs assessment that encompasses provider and client Figure 2. Harts Ladder of Participation. Adapted from Hart (1992)
views. Confidentiality and easy access to services should be
ensured. Because of the lack of evidence on location of clinics quality is maintained and improved service delivery. Youre
it would be best practice to complete a needs assessment with Welcome (DH, 2007) recommends that young people should
young people, asking them what services they would find be actively involved in service design and development.
beneficial, when they would access the service and which However, this involvement must be meaningful and must
locations would be most convenient or preferred. not be seen as a tick box exercise. If not carried out
correctly, young people might become cynical, which will
The consultation process should explore young have negative consequences for future involvement. The
peoples opinions on a service. If their views are quality and levels of participation can be assessed using
taken into account regarding the location, timing Roger Harts Ladder for Participation (Figure 2).
and environment it is more likely to be successful Involving vulnerable young people in service
and tailored to their needs. Bekaert and Mcpherson development will help them feel more comfortable about
(2005: 141) accessing the service. It is crucial that a wide variety of
young people are involved in service development to
Although young people may desperately seek health ensure it represents marginalized groups.
services, they will not engage with them unless their
unique needs are met. It is crucial that young peoples Participants must be members of the target
views and opinions are always taken into account when community, and care should be taken to ensure
designing services. that important subgroups are represented i.e. social
class, ethnic groups and family structures. Lengua
Involving young people in service et al (1992: 7)
design
Every Child Matters (DSCF, 2004) promotes the involvement Finding an appropriate method for doing this is crucial.
of children and young people in developing services to Questionnaires, for example, can be useful, but if a young
ensure that they are designed to meet their unique needs. person has low levels of literacy, it may deter them from
If young people are involved in service design and delivery participation.
they are more likely to access services and promote them Focus groups can be an effective method, as young
within their peer group. Consultation with young people people need to feel that their views are generally listened to,
also allows effective evaluation of the service, ensuring allowing them to contribute meaningfully to developments

May 2011 Vol 6 No 4 British Journal of School Nursing 195

Health promotion
Table 2. Some key issues in
young peoples health
Alcohol
Approx 7.1 million residents in UK are thought to have hazardous
or harmful levels of alcohol consumption and binge drinking
(Drinkaware, 2011).
UK youth now have among the highest levels of alcohol
consumption in European Union (Drinkaware, 2011).
Binge drinking increases the risk of antisocial behaviour, contributes
to unprotected sex and drug consumption (Drinkaware, 2011).
Sexually transmitted infections
The incidence of sexually transmitted infections has been rising
since the early 1990s (World Health Organization, 2006)
Genital Chlamydia trachomatis is the most commonly diagnosed
bacterial sexually transmitted infection in the UK (Sanders, 2007;
Clutterbuck, 2004). Chlamydia has an incubation period of one to 3
weeks, however, after this time often does not show any symptoms,
but left untreated can lead to serious health problems. Between
1040% of women with untreated chlamydial infection develop
symptomatic pelvic inflammatory disease (Sanchez, 2006).
Teenage pregnancy
Since 1998 teenage pregnancy has been on a steady downward
trend. Although young people can be caring competent parents,
longitudinal studies show that children born to teenage parents are
more likely to experience negative outcomes in later life (Barner and
Skinner, 2007).
Mental health
One in 10 children between the ages of 115 years has a mental
health disorder (Office for National Statistics, 2005).
Mixed anxiety and depression is the most common mental health
disorder in Britain (YoungMinds).
and decision-making. Focus groups can reduce the
researchers power and control, and places control over the
interaction to the participants (Barbour, 2001). However,
personalities and status within the group can influence
individual participation (Parahoo, 2006). This could be
seen as intimidating for vulnerable groups, as certain
issues may be sensitive for some young people. Morgan
and Krueger (1993) also found that some people may be
more likely to self-disclose during open discussions, it is
therefore crucial that ground rules are agreed among the
young people prior to commencing the group.
Developing the service
Developing programmes and services aimed at improving
health and wellbeing is a complex task, and working
effectively as part of a multi-agency team is an essential
public health skill. The achievement of building a successful
team lies in leadership skills and the ability of the person
initiating the work to motivate and gain the commitment of
others. Networking allows an opportunity to gain support
196
for the project and may allow additional people to become
involved. It is crucial that the perspectives of individuals,
communities and professionals are sought to ensure the
service innovation meets their needs. The Health and
Care Social Act 2001 states that NHS organizations have
a statutory duty to involve and consult patients and the
public on the planning and development of services.
It may be necessary to organize a meeting with potential
stakeholders to gain their support and ensure effective
partnership working. It is crucial that the aims and
objectives of the meeting are clearly defined and the project
idea is marketed in an appropriate way that develops
vision and enthusiasm. Croghan (2007) suggests school
nurses should work in partnership with communities and
other services to improve the public health of children and
young people.
Legal and ethical issues when
young people access services
The school nurse is in a trusted, privileged position to
be able to work with young people. When young people
access services it is crucial that they are aware of the duty
of confidentiality that the school nurse has and when it
is necessary to disclose information (e.g. when there are
concerns about a vulnerable child or adult). It is crucial
that school nurses explain their duty of confidentiality to
young people so that an honest and open relationship that
is built on trust can be obtained. Young people may be
worried about accessing services if they fear information
will be passed on to their parents or carers. However, it is
good practice for the school nurse to encourage the young
person to talk to their parents or carers if they feel able.
Working in partnership with the family is often crucial in
helping support and address issues that the young people
may have.
During the developmental stage of adolescence young
people strive for independence and begin to make decisions
that impact on the rest of their lives. The development of
autonomy is crucial. Autonomy is defined as:
A state of being independent or self-governing.
Spears and Kulbok (2004: 144)
However, as adolescents are not a homogeneous group,
it needs to be recognized that each individual will develop
at a different rate physically and psychologically. It is
therefore crucial that school nurses are able to understand
the different developmental stages adolescents experience
and be able to offer appropriate support. Adolecence is a
time of rapid cognitive change for example the ability to
think more abstractly about situations allows adolescents
to transfer learning from one scenario to another, allowing
them to think ahead about possible consequences of
their actions. Adolescents tend to lack impulse control,
demonstrating more irrational behaviours, and often
make decisions based on their feelings rather than logical
thought processing. A more comprehensive understanding
of neurological development in adolescence may improve
British Journal of School Nursing May 2011 Vol 6 No 4

our ability to understand the young persons perspective
and better engage them in the health choices they make.
In order for school nurses to promote autonomy and
independence in young people it is crucial that they
have a good understanding of the legal frameworks
which encompass young peoples rights to consent
and confidentiality. The age at which young people
become autonomous appears to be governed by law; the
Fraser guidelines (Gillick v West Norfolk and Wisbech
health Authority (1986) are a framework which allows
health professionals to assess a young persons level of
competence. This framework is not related to the age of
the young person but to the level of emotional maturity,
and it will also vary dependent on circumstances. It
is imperative that the school nurse can demonstrate
clearly how the decision was made, therefore concise
documentation is essential (RCN, 2008). However, a
young person is still entitled to confidentiality regardless
of Fraser competency, this is crucial as without
confidentiality the young person will be reluctant to
seek advice (R Axon V Secretary for Health, 2006).
It is important that the young person is aware of the
limitations to this confidentiality, for example, if the
young person or other vulnerable person was at risk
of serious harm (DH, 2003). It would in this situation
be necessary to disclose information. However, it is
best practice to explain this to the young person before
disclosure, the young person may be able, with support,
to divulge information themselves. Understandably the
young person may be upset or angry about the need
for disclosure, the school nurse can minimize this by
always being honest and open with young people before
they disclose any information by explaining clearly the
confidentiality policy.
When working with young people it is a dilemma to
balance the rights of the young person over their family,
as parental support and cooperation are required for
most health care interventions to be effective (Paul,
2004). It is imperative that the rights and welfare of the
young person are always the primary consideration.
However, it is an integral part of the school nurses role
to help the young person build relationships with their
parent and carers.
The ethical principle of beneficence is the capacity for
promoting and achieving good, and involves acting in a
way that will benefit the young person. This is crucial when
working with young people. However, it can be a challenge
to balance the autonomy of the young person with the
school nurses duty to look after their best interests.
Beyerstein (1993) proposes that practitioners require
a grasp of ethical theory to reason and help prioritise
principles where there is conflict. Edwards (1996) argues
that action may be based on moral principles such as
beneficence and non-malfeasance; however, practitioner
knowledge cannot be assumed to decide what is best for
young people as it would lead to an imposition of their
own values on the young person.
May 2011 Vol 6 No 4 British Journal of School Nursing
Health promotion
Evaluation of the service
development
Evaluation is an important step in developing services
and making improvements. The framework of health
promotion has to take into account efficiency and cost
effectiveness when developing a new initiative (Thorogood
2004). Linnan and Steckler (2002) identified the key
components of process evaluation; this type of evaluation
takes into account wider social, cultural, political and
economic factors. The planning and evaluation of services
are important tools to help practitioners work in the most
efficient and effective ways. The improvements to the
school nursing service for children, young people and
families would be evaluated from the start. This would
allow continuous monitoring, meaning that changes could
be made to the service if users needs are not being met,
ensuring continuous service improvement. A questionnaire
could be designed to allow young people to assess the
effectiveness with the advice and support they receive in
the young persons clinic. However, careful consideration
needs to be given when designing questionnaires such as
avoiding leading questions, allowing appropriate response
choices (Bowling, 2002). Using a Likert scale could be a
productive way to measure young peoples satisfaction of
the service, as it can reveal attitudes among groups in a
short period of time without high expenditure (Sechrist
and Pravikoff, 2002). Developing a pilot questionnaire
initially and trialling with a small group can help reduce
problems (Parahoo, 2006). Laws et al (1998) discuss the
importance of children and young peoples views being
sought in planning, delivery and evaluation of services
to ensure improvements are made that meet their unique
needs. Quantitative methods could also be used to collect
numerical data such as monitoring numbers of service
users at a young persons clinic, for example. A formal
audit could also be carried out by the NHS trusts audit
department. By reviewing care in this way practitioner can
identify priorities for action planning and improvement
(Scally and Donaldson, 1998).
Key Points
nn School nurses are skilled in leading teams promoting health
improvement, working within a progressive model where services
are universal and targeted towards those with specific needs.
nn Young peoples involvement must be meaningful and not seen as a
tick box exercise. If not carried out correctly this could have negative
consequences for future involvement.
nn During the developmental stage of adolescence, young people strive
for independence and begin to make decisions that impact on the
rest of their lives. The development of autonomy is crucial.
nn In order for school nurses to promote autonomy and independence
in young people, it is crucial that they have a good understanding
of the legal frameworks which encompass young peoples rights to
consent and confidentiality.
197
Health promotion
Conclusion
It is useful to have a variety of approaches to evaluation
as this demonstrates a clearer picture when information
is disseminated to service users, other colleagues and
stakeholders. It is necessary to disseminate information to
implement evidence-based practice, and allow good practice
to be shared. This can be carried out at team meetings or
professional conferences (Scullion, 2002). It is also necessary
to present clear information to stakeholders to secure future
funding or continue to receive support for the initiative. It
is therefore crucial that children, young people and their
parents are aware of the school health service and the benefits
it could offer them. Farrow (1996) reflects that for the school
nursing service to survive, its value must be recognized.
Unfortunately there is still a chronic shortage of school nurses
and the aim of training/recruiting one school nurse per high
school cluster set under the previous government has not
been met (DH, 2004a; DH, 2004b). The scope for school
nursing to deliver on public health is high. However, without
proper investment and recruitment strategies this will not
improve. As levels of school nurses are low, it is even more
crucial that our unique skills are shared and disseminated to
others to allow us to work together in the best possible way
to meet the needs of young people. BJSN
Conflict of interest: None declared
Barbour RS (2001) Checklists for improving rigour in qualitative
research: a case of the tail wagging the dog? BMJ 322(7294): 11157
Barner E, Skinner A (2007) Teenage Pregnancy: a rapid transition for
teenagers but a trap for young adults. Youth Affairs Unit, De Montfort
University
Bekaert S, Macpherson A (2005) Adolescents and sex: The handbook for
professionals working with young people. Radcliffe publishing, Oxford
Beyerstein D (1993) The functions and limitations of professional codes
of ethics. In: Winkler ER, Coombs JR, eds. Applied Ethics. Blackwell,
Oxford
Bowling A (2002) Research methods in health: investigating health and
health services. 2nd edn. Open University Press: Guildford
Croghan, E (2007) School nursing in the 21st Century. British Journal of
School Nursing 2(3): 94100
Dahlgren G, Whitehead M (1991) Policies and Strategies to Promote Social
Equity in Health. Institute for further studies, Stockholm
Darzi (2008) High quality care for all: NHS next stage review final
report. www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_085825 (accessed 14 April 2011)
Department of Health(2003) NHS code of practice. The Stationery
Office, London
Department of Health (2004a) Choosing Health: Making Healthy Choices
Easier. The Stationery Office, London
Department of Health (2004b) The Chief Nursing Officers review of
nursing, midwifery and health visiting contribution to vulnerable chil-
dren and young people. www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/DH_4086949 (accessed
14 April 2011)
Department of Health (2007) Youre Welcome Quality CriteriaMaking
Health Services Young People Friendly. The Stationery Office, London
Department of Health (2009) Healthy lives, brighter futures-
The strategy for children and young peoples health. www.
dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_094400 (accessed 14 April 2011)
Department of Health (2009) Healthy Child Programme 519.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_107566 (accessed 14 April 2011)
Department of Health (2009) Healthy lives, brighter futures
The strategy for children and young peoples health. www.
dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_094400 (accessed 14 April 2011)
Department Health (2010) Healthy lives, healthy people: our strat-
198
egy for public health in England. www.dh.gov.uk/en/Publichealth/
Healthyliveshealthypeople/index.htm (accessed 14 April 2011)
Department for Children Schools and Families (2007) The childrens
plan: Building brighter futures. Department for Children, Schools and
Families. The Stationery Office, London
Department for Education and Skills (2007) Every Child MattersChange
for Children. Children and Young People. www.everychildmatters.gov.
uk/children/ (accessed 14 April 2011)
Department for Education and Skills, Department of
Health (2006) Looking for a school nurse. www.
dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_4132195 (14 April 2011)
Drinkaware (2011) Binge drinking: the facts. www.drinkaware.co.uk/
facts/binge-drinking (accessed 14 April 2011)
Edwards D (1996) Nursing Ethics: A Principle-based Approach. Macmillan
Press, London
Farrow S (1996) The role of the school nurse in promoting health In: A
Scriven and J Orme, eds. Health Promotion: Professional perspectives:
14456
Gillick v West Norfolk and Wisbech Area Health Authority (1986) AC 112
1 ALL ER
Hart R (1992) Childrens Participation: From Tokenism to Citizenship.
NICEF Innocenti Research Centre, Florence
Kennedy I (2010) Getting it right for children and young people:
Overcoming cultural barriers in the NHS so as to meet their
needs. www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_119445 (accessed 14 April 2011)
Laws J, Boyle J, Harris F, Harkness A, Nye C (1998) Screening for pri-
mary speech and language delay: a systematic review of the literature.
Int J Lang Commun Disord 33 Suppl: S21S3
Lengua LJ, Roosa MW, Schupak-Neuberg E, Michaels ML, Nourse Berg
C, Weschler LF (1992) Using focus groups to guide the development
of a parenting program for difficult to reach, high risk families. Family
Relations 41(2): 1638
Linnan L, Steckler A (2002) Process evaluation for public health interven-
tions and research: an overview. In: Steckler A, Linnan L, eds. Process
Evaluation for Public Health Interventions and Research. Jossey-Bass,
San Francisco, CA
Office for National Statistics (2005) Mental health of children and young
people in Great Britain, 2004. www.statistics.gov.uk/downloads/
theme_health/GB2004.pdf (accessed 14 April 2011)
Office of Public Sector Information (2001) Health and Social Care Act.
www.legislation.gov.uk/acts/acts2001/ukpga_20010015_en_1 (accessed
14 April 2011)
Paul M (2004) Decision-making about childrens mental health care: ethi-
cal challenges. Advances in Psychiatric Treatment 10(4): 30111
Marmot M (2010) Fair society Healthy lives. www.marmotreview.org/
AssetLibrary/pdfs/Reports/FairSocietyHealthyLives.pdf (accessed 14
April 2011)
Morgan DL, Krueger RA (1993) When to use focus groups and why. In:
Morgan DL (Ed) Successful Focus Groups: Advancing the State of Art.
Newbury Park, Sage: 319
Parahoo K (2006) Nursing Research principles, process and Issues. Second
edition. London, Palgrave Macmillan
Parliamentary Office of Science and Technology (2004) Teenage
sexual health. Postnote 217. www.parliament.uk/documents/upload/
POSTpn217.pdf (accessed 14 April 2011)
R (on the application of Axon) v Secretary for State for Health (2006)
EWHC 37
Royal College of Nursing(2008) Adolescence: boundaries and connec-
tions: An RCN guide for working with young people. RCN
Sanchez E (2006) What does the national chlamydia screening pro-
gramme mean for nurses in primary care? Primary Health Care
16(8): 303
Sechrist K, Pravikoff D (2002) Cinahl Information Systems. Glendale,
Ca
Scally G, Donaldson LJ (1998) Clinical governance and the drive for
quality improvement in the new NHS in England. BMJ 317(7150):
615
Scullion P (2002) Effective dissemination strategies. Nurse Res 10(1):
6577
Simmonds S (2010) Chlamydia screening in rural schools. British
Journal of School Nursing 5(4): 1978
Spears JH, Kulbok P(2004) Autonomy and Adolescence: A Concept
Analysis. Public Health Nurs 21(2): 14452
Thorogood M, Coombes Y (2004) Evaluating Health Promotion: prac-
tice and methods. 2nd edn. New York, Oxford University Press
World Health Organization (2006) Prevention and control of sexually
transmitted infections: draft global strategy Report by the Secretariat.
59th World Health Assembly A59/11. WHO
British Journal of School Nursing May 2011 Vol 6 No 4
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