The role of school nurses in preventive health care amid the COVID-19 pandemic in Poland

Background
School nurses play a central role in providing preventive health care for pupils in Poland. The COVID-19 pandemic disrupted the organization of school health services, creating new challenges and requiring additional solutions.

Objectives
The main objective is to analyze the key challenges of implementing preventive health care for students during the COVID-19 pandemic from the perspective of school nurses.

Material and methods
A nationwide anonymous online survey was conducted between June and October 2021 among 847 school nurses and hygienists. The study assessed the prevalence and risk of COVID-19-related incidents in schools (infection, isolation, quarantine) and identified organizational solutions applied by nurses, with particular attention to school location. Data were analyzed using descriptive statistics, chi-square tests, and univariate logistic regression.

Results
Quarantine was the most common COVID-19-related incident (63.6% of schools), followed by confirmed infections (55.6%) and isolation (30.8%). Rural schools had significantly lower risks of infection [OR = 0.317 (95% CI: 0.209–0.482)], isolation [OR = 0.488 (95% CI: 0.341–0.698)], and quarantine [OR = 0.429 (95% CI: 0.280–0.657)] compared with urban schools. Nurses adopted various coping strategies, including extending services beyond classroom time, providing telephone counselling, contacting doctors for health examinations, and using online platforms. The use of specific solutions differed significantly by school location.

Conclusions
The COVID-19 pandemic required school nurses to adapt and expand their professional activities to maintain preventive health care for pupils. Rural schools showed lower risks of COVID-19-related incidents, likely linked to smaller school size and lower population density. Targeted support, resource allocation, and peer-to-peer exchange are needed to strengthen the resilience of school nursing in future crises.