School Nurses’ Health Dialogue with First Graders and Their Caregivers

Background: Schools are key settings for health promotion. In Norway, mandatory School Health Services include a universal, voluntary first‑grade health dialogue involving the child, caregivers, and the school nurse. National Guidelines set recommended topics and procedures, but practical guidance is limited, and practice varies.

Aim: To explore how school nurses in Norway plan and conduct health dialogues with first graders and their caregivers. By exploring the practical aspects of these dialogues in depth, the study aims to enhance understanding of their implementation and contribute to quality assurance in health‑promoting efforts within School Health Services.

Methods: Exploratory qualitative design with six focus groups and ten individual interviews with school nurses from rural and urban contexts, small and large communities, and varied socioeconomic and cultural backgrounds. Data were analyzed using reflexive thematic analysis.

Results: Three intersecting themes were constructed: strategies for trust‑based relationships, the conflict between quality and quantity, and striving for consistency and professional autonomy. School nurses described preparation, clear and sensitive communication, and child‑friendly approaches that foster safety and participation. They also reported time constraints, workload, and administrative demands that challenge quality and continuity. School nurses adapt National Guidelines through individualized strategies to meet systemic expectations and the needs of children and caregivers.

Conclusions: Trust is a necessary condition for meaningful health dialogues and is fostered through school nurses’ communication and supportive environments. Organizational challenges require school nurses to balance competing priorities and may affect the quality of care. School nurses demonstrate adaptability while navigating the tension between adhering to National Guidelines and exercising professional autonomy. Clear yet adaptable Guidelines, increased investment in School Health Services, and systemic changes to reduce workloads are needed to support both quality and quantity in care delivery.

Implications: Trust can be strengthened by welcoming, safe environments, sensitive and sincere communication, visible presence in schools, and child‑friendly tools that enhance engagement and lower barriers to help‑seeking. Policy should address time and resource constraints through investment, collaboration, and practical guidance in National Guidelines, including standardized tools for sensitive topics, while allowing local adaptation and preserving professional autonomy. Future research should evaluate tools and methods for dialogues and include children’s and caregivers’ perspectives to ensure equitable, responsive services.