Can you share some of your favourite ways to engage pri­ma­ry school-aged chil­dren in health education? 

Some years ago at Yala­ta, the clin­ic Health Work­er and nurs­ing teams worked with chil­dren at school to teach some anato­my and phys­i­ol­o­gy and increase com­fort with clin­ic staff/​instruments.

We start­ed by draw­ing and cut­ting out images of dif­fer­ent organs and vel­cro­ing them on chil­dren – dis­cussing the role of each organ and strate­gies for main­tain­ing organ health.

We then made some organs to use dif­fer­ent clin­ic tools. Using a kid­ney dish and Plas­ter of Paris we made an ear – toi­let rolls were used as a canal, cel­lo­phane as a tym­pan­ic mem­brane and cus­tard as pus. The class pre­sent­ed these to the ENT team when visiting.

Using a bal­loon and Plas­ter of Paris we made an eye – (using the plas­ter saw to split) we used a mag­ni­fy­ing glass as a lens and plait­ed wool as an optic nerve – the cast was filled with jel­ly.
With sup­port of the local butch­er, we accessed sheep organs, and dis­sect­ed hearts, kid­neys, liv­er and lungs (after inflat­ing the lungs with 02). We also tried an exper­i­ment with petrol and brains (sniff­ing was an issue at the time) but didn’t real­ly get any scary results!

Although no for­mal mea­sures were used – there was an increased liai­son between school and clin­ic as well as an improved com­fort lev­el with young­sters and the clinic.

— Mark Good­man RN and CRANAplus Facilitator

What tips do you have for new-to-rural/re­mote nurs­es prepar­ing to work with chil­dren in a school setting? 

Work­ing with kids is bet­ter for both par­ties when you are viewed as both a health pro­fes­sion­al and also a peer. Form­ing rela­tion­ships out­side of the work set­ting and being seen out and about in com­mu­ni­ty can be ben­e­fi­cial. When I first moved to Gunbalanya, 

I played bas­ket­ball at the court and also in one of the com­pe­ti­tions which was an awe­some way to meet locals and not just be seen as a nurse. 

Form­ing rela­tion­ships with teach­ers, prin­ci­pals and oth­er school work­ers is also essen­tial to cre­ate a bet­ter under­stand­ing of the cur­rent issues amongst dif­fer­ent age groups that could ben­e­fit from health promotion. 

With such knowl­edge, you can find appro­pri­ate sup­ports that are avail­able to kids and ado­les­cents. A wealth of pro­grams exist and can be accessed and applied eas­i­ly by remote area nurs­es – all it takes is a quick search online or reach­ing out to a col­league to see what’s work­ing for them!

— Mic­ah Haslam RN and 2023 CRANAplus Ear­ly to Remote Prac­tice Award recipient

What is the best part about work­ing with chil­dren in rur­al and remote communities? 

Chil­dren in rur­al and remote com­mu­ni­ties are incred­i­bly resilient and robust and live their some­times chal­leng­ing lit­tle lives with such infec­tious happiness. 

It cer­tain­ly does not take too much effort to reveal some big and small teeth, amongst oth­er things, that are exposed by the widest of grins. Every child out here has a grin from ear to ear.

These beau­ti­ful chil­dren are no dif­fer­ent from their city coun­ter­parts, with their curi­ous natures and nat­ur­al inno­cence. They are chil­dren. They do, how­ev­er, take a minute or two to take you in. Those deep, pierc­ing eyes look back at you, with the matu­ri­ty and knowl­edge of present Elders and Elders past. They are the future and we ought to dream with them and dream for them as we walk with them on Country.

— Lucy Wat­son RN

Draw­ing from your recent expe­ri­ence in oral health, what can nurs­es do to improve oral health aware­ness and engage­ment in school-aged children?

There needs to be an ele­ment of trust and mutu­al respect between the nurse and the kids. This can be achieved dur­ing school vis­its by imple­ment­ing fun kinaes­thet­ic learn­ing activ­i­ties where every­one gets involved in the learn­ing process.

I always start with fun oral health sci­ence exper­i­ments where the kids can touch, feel, look and mon­i­tor the exper­i­ment. For exam­ple, involv­ing the kids in mak­ing their own den­tal plaque, watch­ing it grow over the week and drawing/​documenting/​measuring their find­ings is a suc­cess­ful hands-on approach to break­ing the ice – and you only need two cups and a pack­et of yeast, sug­ar, and water.

I then dis­cuss: what plaque is, why we have teeth and why we need to brush them.

I do not use big fan­cy den­tal words when engag­ing with kids, I break it down into a lan­guage that they under­stand. Kids love all things gross – farts, poo, wee, spit­ting, etc. – so I call den­tal plaque ​‘bug poo’, and no one wants bug poo in their mouth!

The kids think this is gross and hilar­i­ous and are very hap­py to engage in activ­i­ties that involve remov­ing bug poo from their mouths.

I then move to the use of plaque (AKA bug poo) dis­clos­ing tablets where the nurse, kids and teach­ers chew the tablets togeth­er, spit out the excess dye (again, all things gross!) and then brush our teeth together.

This activ­i­ty edu­cates the kids on the cor­rect tooth brush­ing tech­niques to remove plaque and it cov­ers the dif­fer­ent ele­ments of our tooth struc­ture: molars – back teeth chew­ing; canine – dog teeth rip­ping; ante­ri­or – cut­ting teeth bit­ing foods.

Doing this activ­i­ty togeth­er cre­ates a trust­ed envi­ron­ment and empow­ers the kids through edu­ca­tion and engage­ment. It also cre­ates a safe envi­ron­ment where kids can seek help
if they are expe­ri­enc­ing oral health pain/​problems where there is no shame. Aspects of hand and face hygiene can be incor­po­rat­ed into oral health aware­ness edu­ca­tion. Not only will this address the preva­lence of poor oral health, but it will also edu­cate kids on the impor­tance of good eye and heart health.

Oral health is often over­looked in the med­ical field, yet it is the gate­way to our sys­temic sys­tem. All too often, poor oral health con­di­tions become chron­ic and need urgent inter­ven­tion, result­ing in teeth removal. Yet, like most things, it can be pre­vent­ed through edu­ca­tion, aware­ness and ear­ly treat­ment. As I say to all my patients, only brush the teeth you want to keep!

— Kar­leigh Bar­bour RN

Can you paint a pic­ture of what it is like to work with chil­dren in very remote set­tings? How do very remote nurs­es tend to approach school visits? 

In very remote Aus­tralia many chil­dren have extreme­ly tran­sient lifestyles so do not attend one school con­sis­tent­ly. School atten­dance is low and fragmented. 

Remote nurse-led clin­ics are under-resourced and can’t com­mit to reg­u­lar school vis­its, acute care takes pri­or­i­ty. Health care pro­vid­ed through the school is there­fore oppor­tunis­tic and gen­er­al­ly tar­get­ing acute problems. 

The pre­lim­i­nary work of liais­ing with the rel­e­vant per­son in the school and/​or edu­ca­tion depart­ment may take weeks, espe­cial­ly fac­tor­ing in ser­vice provider staff turnover. 

Par­ents need to be con­sult­ed and a clear under­stand­ing of what the nurse will be doing at the school with chil­dren reached.

Once the nurs­es are vis­it­ing the school, they may iden­ti­fy acute prob­lems, but they then must locate par­ents for con­sent to treat, man­age or refer as appro­pri­ate. Often the des­ig­nat­ed car­er for a par­tic­u­lar child isn’t in com­mu­ni­ty and it takes time to work through the process with the cur­rent car­er, who has no idea that this is hap­pen­ing.

The most suc­cess­ful vis­its were those where edu­ca­tion­al ses­sions were pro­vid­ed to groups of girls, accom­pa­nied by senior old­er women who help with inter­pret­ing. The con­tent of the ses­sions was iden­ti­fied by the women and old­er girls. They usu­al­ly focused on basic anato­my, and how the body works. The pop­u­la­tion groups I work with all hunt bush tuck­er, so chil­dren from a young age are used to see­ing lizards and kan­ga­roos gut­ted. They have a frame of ref­er­ence to relate con­cepts of basic anato­my back to.

— Lyn Byers RN, RM, NP, FCRANA+