Identifying and addressing health problems of school children through the Omaha System: a nurse-led intervention study in suburban Istanbul

Abstract

Background

Health problems such as anxiety, depression, obesity, and dental caries are increasingly common among school-aged children. Early detection and timely interventions are essential to promote healthy childhoods and reduce future healthcare burdens. Especially in Turkey, few studies have addressed schoolchildren’s health problems holistically, particularly using the Omaha System. This study aimed to identify the physiological, psychosocial, health-related behavioral, and environmental health problems of migrant and non-migrant schoolchildren in suburban Istanbul, to implement person-centered nursing interventions through the Omaha System, and to examine factors associated with these problems.

Methods

This is a descriptive, cross-sectional, one-group pre-intervention assessment design with integrated nursing interventions study. Data to create each schoolchild’s health file were collected using the Children’s Depression Inventory, the Screen for Child Anxiety Related Emotional Disorders, the Adolescent Lifestyle Profile, anthropometric measurements, a Snellen vision checklist, and an oral and dental health checklist. These data, together with information obtained from individual interviews with the children, were integrated into electronic records in the Omaha System, which guided the identification of health problems and the implementation of person-centered nursing interventions.

Results

The sample consisted of 918 children aged 10–14 years (grades 5–8); 51% were female, and 5% were Syrian migrants. The most frequent problems were oral health issues (29%), mental health concerns (14%), personal care difficulties (12%), and nutritional problems (11%). A total of 49 targets were used from the Omaha System, resulting in 14,586 interventions. Interventions were primarily classified as teaching, guidance, and counseling (48.5%), followed by survey category (24%). Migration status was significantly associated with mental health (p =.001), personal care (p =.002), nutrition (p <.001), and physical activity (p <.001).

Conclusion

Nurse-led interventions using the Omaha System effectively addressed common and preventable health problems among schoolchildren, underscoring the need for scalable, evidence-based school health programs tailored to vulnerable populations.

Introduction

Health problems among schoolchildren are steadily increasing, with conditions such as anxiety, depression [1, 2], vision impairments, malnutrition, developmental delays [3], and dental caries becoming more prevalent [4]. Additionally, lifestyle-related problems such as obesity and physical inactivity are of growing concern due to their association with chronic diseases later in life [5] 2,5 [2, 3, 6]. Among these children, migrant schoolchildren are particularly at greater risk, as they tend to experience these health problems more frequently and largely due to disadvantaged living conditions [6–8]. Addressing these issues effectively which can lead to chronic and complicated health problems in adulthood, place a burden on the health system, and affect success in schools requires comprehensive, evidence-based data that are specific to child subgroups and national contexts, as well as the implementation of holistic, nurse-led intervention programs [9–11].

Turkey is one of the European region countries with a significant young population. School-age children constitute 22% of Turkey’s total population, approximately 18.7 million, with 51% being male. More than one-quarter of them are children aged 10–14 years. Among them, 84% attend public schools, 8% are enrolled in private schools, and 7% participate in distance education [12]. Additionally, Turkey is home to over 3.5 million refugees of Syrian origin, 18.5% of whom are of school age [13]. Following a recent legal reform, the Turkish education system consists of four-years of primary education, four-years of lower secondary education, and four-years of upper secondary education. Except for special cases, children are required to begin school upon reaching 69 months of age [5]. Although most schools have a guidance counsellor in Turkey, this service is not universally available. Basic school health services, such as immunization, are typically provided by healthcare professionals working in community health centers. While a regulation introduced in 2022 by the Ministry of National Education aims to appoint school health nurses, it appears that widespread implementation remains unlikely in the near future [14]. Public schools in Turkey do not provide breakfast or lunch. Consequently, many students either bring food from home or purchase low-nutritional, ready-to-eat items from school canteens. This dietary pattern contributes to nutrition-related health problems such as growth retardation [15] and obesity [16, 17]. Furthermore, ongoing economic crises and worsening poverty have intensified malnutrition, interpersonal conflict, and emotional stress among children from diverse socioeconomic backgrounds and family structures(6,18).

Protecting children’s health is one of society’s foremost priorities [2]. In this context, numerous international [15, 19–22] and national studies [9, 16, 23–27] have examined various aspects of schoolchildren’s health. However, research specifically focusing on the health of schoolchildren with migrant background or poor socioeconomic conditions remains limited in many countries, including Turkey [8, 28, 29] which are primarily concentrated on topics such as obesity, nutrition, and school-based nursing care [23]. Yet, comprehensive monitoring of a wider range of health problems, such as growth and development, mental health, abuse and neglect, personal hygiene, oral and dental health, and exposure to violence using holistic nursing frameworks is still scarce [31].

The Omaha System, an electronic nursing classification tool designed to support systematic and holistic and systematic assessment intervention, has been used in only a limited number of studies in this context [9, 30]. Therefore, this descriptive, cross-sectional, one-group pre-intervention assessment with integrated nursing interventions aimed to identify the physiological, psychosocial, health-related behavioral, and environmental health problems of migrant and non-migrant schoolchildren living in the suburbs of Istanbul, to implement person-centered nursing interventions addressing these problems through the Omaha System, and to examine the factors associated with these health problems. The following research questions guided this study:

• What physiological, psychosocial, environmental health problems, and health-related behaviors, as defined according to the Omaha System, are observed among migrant and non-migrant lower secondary school students living in a suburban area of Istanbul?

• What types of nursing interventions, guided by the Omaha System, were implemented in response to the identified health problems?

• Is there a significant association between students’ sociodemographic characteristics and the health problems they experience?

Materials and methods

Sample and settings

This study employed a descriptive, cross-sectional, one-group pre-intervention assessment design with integrated nursing interventions. The study population consisted of migrant and non-migrant schoolchildren living in a suburb on the European side of Istanbul, an area attracting both internal and international migrants due to its employment opportunities. The selected school is located in a neighborhood characterized by informal settlements, low socioeconomic status, and a high prevalence of internal and international migration, with a predominance of precarious living conditions. As a result, the study population primarily consisted of children from vulnerable families.

In line with the objectives of the O-MASM project, the school was selected using purposive sampling. Within the selected school, all students from grades 5 to 8 (ages 10–14) were included, constituting a school-based total population (census) sample.

Inclusion criteria were enrolment in grades 5 to 8 at the selected secondary school and willingness to participate. Exclusion criteria included children who did not speak or understand Turkish, Kurdish, or Arabic, due to the unavailability of translation resources; those who declined participation; and those whose parents did not provide consent.

The total student population across the participating school was 1,100. Of these, 100 forms were excluded due to incompleteness, and 32 children were unavailable during the data collection period. Consequently, the final sample comprised 918 students with complete and analysable data.

Measurement

Descriptive characteristics assessment form

It consisted of sociodemographic characteristics such as age, gender, migrant status, Anthropometric measurements (weight and height), chronic disease record, oral health chart (caries, fillings, gingival bleeding), and Snellen vision screening chart.

Children`s Depression Inventory scale is used to measure the level of depression in children [31]. The scale can be filled in by reading it to the child or by the child herself/himself. It evaluates their last two weeks. It is likert type scale, points between 0 and 2. The highest score is 54 and the higher total score is meant the higher the severity of depression level, the suggested cut point is 19 [32]. A validity and reability of the scale has been conducted by Öy in Turkey and the Cronbach`s Alpha factor was 77 [33]. In the present study, the Cronbach’s alpha coefficient for the scale was 0.84.

Screen for Child Anxiety Related Emotional Disorders is a 41-item questionnaire developed by Birmaher et al. (1999) [34] and adapted into Turkish by Çakmakçı (2004) [35], with established validity and reliability. Both parent and child forms are available. Items are rated on a 0–2 scale, and a total score of 25 or higher indicates a potential risk for an anxiety disorder. The scale comprises subscales measuring panic, generalized anxiety, separation anxiety, Social Anxiety Disorder (social phobia), and school phobia. Total scores range from 0 to 82, with each subscale having its own scoring range. The instrument demonstrates good internal consistency, with Cronbach’s alpha coefficients ranging from 0.74 to 0.93, and acceptable test-retest reliability, with coefficients between 0.70 and 0.90 [34]. In the present study, the Cronbach’s alpha coefficient for the scale was 0.89.

Adolescent Lifestyle Profile is a questionnaire used to measure healthy lifestyle behaviors in adolescents. It is based on Pender’s Health Promotion Model and includes 40 items across seven subcomponents, which are health responsibility, physical activity, nutrition, positive life perspective, interpersonal relations, stress management and spiritual health [36, 37]. It uses a 4-point Likert scale. Scores range from 40 to 160, with higher scores reflecting healthier behaviors. There is no cut-off point. The Turkish version of the scale has been validated and its reliability established, with a Cronbach’s alpha of 0.87 [38]. In the current study, the Cronbach’s alpha coefficient for the scale was 0.89.

Nightingale Notes Software, developed by Champ Software (Mankato, MN), is an electronic reporting tool grounded in the standardized terminology of the Omaha System. Originally developed in 1975 by a group of academics and nurses affiliated with the Visiting Nurse Association in the United States, the Omaha System has been validated through rigorous, evidence-based research [39, 40]. It is a comprehensive, research-based, standardized taxonomy designed to enhance the documentation, implementation, and data management processes across the continuum of care [41].

Recognized as a standardized nursing terminology since 1992 in the United States, the Omaha System is internationally utilized across a wide range of health-related fields, including school health, occupational health, home care, clinical practice, and nursing education [25, 42, 43]. To date, it has been adopted in more than 27 countries and translated into several languages, including Dutch, Danish, Czech, Turkish, French, Spanish, Norwegian, and Japanese [43, 44].

The Nightingale Notes software, which is based on the Omaha System, comprises two main sections. The first section is used to record demographic and general health information. The second section incorporates the three core components of the Omaha System. Among these, the Problem Classification Scheme and the Intervention Scheme were utilized in the present study. However, the Problem Rating Scale for Outcomes could not be employed due to time constraints imposed by the school curriculum and limited available resources [42].

The Problem Classification Scheme includes four domains, which are environmental, psychosocial, physiological, and health-related behaviours and encompasses 42 distinct health and environmental problems, along with 335 associated signs and symptoms. The Intervention Scheme consists of four categories: teaching, guidance, and counselling; treatments and procedures; case management; and surveillance, incorporating 76 intervention targets (see Fig. 1). The Turkish version of the Omaha System was validated and its reliability established in 2006 [42]. Data collected via the Nightingale Notes software can be exported in Excel, PDF, or graphical formats for further analysis.

Fig. 1.

The Omaha System

Data collection

All school children, along with their families, school administrators, and teachers, were informed about the objectives and procedures of the O-MASM project (see flow-chart in Fig. 2). It was implemented in two stages to assess and address the health needs of schoolchildren. In the first stage, baseline data including lifestyle behavior scales, mental health screening, anthropometric measurements, Snellen vision tests, and oral health screenings were collected. Data collection instruments and scales were completed in classrooms under supervision, taking approximately 30–45 min per child, while anthropometric, vision, and oral health assessments were performed by final-year undergraduate nursing students under the supervision of public health nursing specialists in a designated school health room. Based on these assessments, a school health file was created for each student, and common health problems were identified; these findings will be reported separately.

Fig. 2.

The flow-chart of O-MASM project

In the second stage, which is the focus of the present study, each schoolchild’s file was reviewed in depth, individual interviews were conducted, and electronic records were created in the Omaha System. Schoolchildren’s health problems were comprehensively defined, and person-centered nursing interventions were implemented. The frequency and type of follow-up were determined according to the nature and triage of each identified health problem. All these activities including file review, interviews, intervention implementation, follow-up, and evaluation were carried out exclusively by public health nursing specialists, who were present in the school health room every Thursday to perform regular observational assessments Although follow-up monitoring was originally planned from September 2019 to June 2020, it was discontinued in March 2020 due to school closures and the transition to remote education during the COVID-19 pandemic [45]. Consequently, the post-intervention assessments based on standardized scales could not be conducted.

Language support and cultural adaptation

To enhance inclusivity, language support was provided throughout the study. Among the public health nursing internship students, those whose native language was Kurdish and/or Arabic were paired with schoolchildren who had difficulties in speaking and understanding Turkish. This support was available both during data collection and, when needed, later in the process of nursing interventions and evaluations.

Data analysis

Data entered into the Nightingale Notes software were exported in Excel format (Microsoft Corporation, Redmond, WA) and subsequently imported into SPSS version 25.0 (IBM Corporation, Armonk, NY) for statistical analysis. Descriptive statistics were used to summarize demographic characteristics and outcome variables. Comparative analyses were performed using the chi-square test and independent samples t-test, where appropriate. Additionally, a matrix visualization technique was employed to illustrate the distribution patterns and relationships within the dataset [41].

Results

Sociodemographic characteristics

The participants were 918 children aged 10–14 years. Most (51%) were female. Over 38% of them were studying at 8th Grade, and 17% of them were studying at 5th Class. Five-percent of the participants were migrant from Syria (Table 1). All migrant students were able to communicate in Turkish; however, only three students were not proficient at an advanced level. For these students, support was provided by nursing students who shared the same mother tongue, ensuring accurate communication and data collection. This approach minimized potential language barriers and maintained the integrity of the data.

Table 1.

Characteristics of the Schoolchildren (N:918)

Characteristics	n	%
Age(year)
10	148	16.1
11	220	25.1
12	149	16.2
13	203	22.1
14	188	20.5
Gender
Male	453	49.3
Female	465	50.7
Nationality
Turkey	869	94.7
Syria	49	5.3
School degree
5th class	160	17.4
6th class	225	24.5
7th class	182	19.8
8th class	351	38.2

Problems school children according to the problem classification scheme

We diagnosed thirty-five of the 42 health problems of the problem classification Scheme of the Omaha System among participants. These health problems were diagnosed for 2293 times. These health problems were mostly related to psychosocial domain (34.5% [12]), physiological domain (34% [12]), followed by health-related behaviors domain (20% [7]), and environmental domain (11% [4]). Table 2 shows the prevalence of the first four common health problems and signs-symptoms in each domains among the secondary schoolchildren. However, the most common health problems diagnosed in present study were as follows in descending order: oral health (29% [656]), Mental health (14% [329]), Personal care (12% [272]), Nutrition (11% [260]), Physical activity (7% [166]), Interpersonal relationship (6% [136]), Substance use (4% [95]) and Sleep and rest patterns (4% [93]). It was seen that some children exposed to neglect (2% [49]) and abuse (1% [30]) problems.

Table 2.

Domains, problems and health and sign-symptoms according to Omaha System problem classification list of schoolchildren (N: 918)

95% of the health problems were diagnosed as individual problems, 55% of the problems were diagnosed as actual problems and 23.5% were diagnosed as potential health problems. Majority of potential health problems were diagnosed in Personal care, Interpersonal relationship, Nutrition, Oral health, Substance use and Sleep and rest patterns. However, neglect and abuse problems also diagnosed in the present study. We used signs-symptoms 2269 times and the seven most common signs-symptoms were cariosity (36% [458]), sadness/hopelessness/lower self-esteem (21% [270]), difficulty establishing/maintaining a relationship (2.9% [37]), sedentary lifestyle (2.6% [33]), malnutrition (2.3% [30), Anxiety/unidentified fears (2.3% [29), and over weight (BMI 95th percentile or more in children) (2.1% [27]) (Table 2).

Nursing interventions for secondary schoolchildren according to the intervention scheme

The Fig. 3 summarizes the first four common health problems of the children and their recorded categories, targets and frequency of interventions. We used 49 of the 76 targets in the Omaha System Intervention Scheme. We applied a total of 14.586 interventions based on the targets. The eight most frequently used targets were as follows: Nursing care (23% [3.356]), medical/dental care (16% [2.350], personal care (13.5% [1.968]), signs/symptoms-mental/emotional (9% [1.321]), exercise (4% [626]), behavior modification (4% [625]), education (4% [554]), and signs/symptoms-physical (4% [545]). Majority of the interventions were frequently applied in teaching, guidance and counseling category (48.5%), and then in survey category (24%).

Fig. 3.

Shows a matrix visualization of problems and interventions for a single schoolchildren with five identified problems. Problems are displayed on the Y-axis, categorized by color. Targets are shown on the X-axis. The intensity of shading reflects the number of interventions, with darker shades indicating higher frequency

The relationship between the health problems of the problem classification Scheme of the Omaha System and sociodemographic characteristics of the children

Table 3 shows the relationship between health problems and sociodemographic characters of the students. There was a significant association between mental health problem (χ2(1) = 10.217, p=.001), personal care (χ2(1) = 9.295, p=.002), nutrition ((χ2(1) = 13.136, p=.000), physical activity (χ2(1) = 33.753, p=.000) and whether the students were from Turkey or Syria. However, there was no any significant association between oral health problems and defined sociodemographic characteristics of the students (p˃0.05). Addition to that, there was a significant association between the different age groups (10–12 years and 13–14 years) and neglect (χ2(1) = 9.205, p=.002) and abuse (χ2 = 4.705, p=.03).

Table 3.

The Relationship between the health problems of the problem classification scheme of the Omaha System and sociodemographic characteristics of the children (N:918)

Problems/ Statistics	Results (n/%a)	Nationality		The Classes				The ages
		Turkey	Syria	5th	6th	7th	8th	10–12 years	13–14 years
Oral health	yes	618/94	38/6	108/17	171/26	127/19	250/38	376/57	280/43
	no	251/96	11/4	52/20	54/21	55/21	101/39	151/58	111/42
		χ2=0.942 df = 1	0.332	3.765	df:3	0.288		0.008 df:1	0.930
Mental health	yes	301/91.5	28/8.5	55/17	113/34	68/21	93/28	216/66	113/34
	no	568/96	21/4	105/18	112/19	114/19	258/44	311/53	278/47
		χ2 = 10.217**	df = 1	χ2 = 33.901**	df = 3			χ2 = 14.260** df = 1
Personal care	yes	248/91	24/9	45/16.5	100/37	40/15	87/32	170/62.5	102/37.5
	no	621/96	25/4	115/18	125/19	142/22	264/41	357/55	289/45
		χ2 = 9.295* df = 1		χ2 = 32.917**	df = 3			χ2 = 4.100* df = 1
Nutrition	yes	235/90	25/10	44/17	79/30	59/23	78/30	167/64	93/36
	no	634/96	24/4	116/18	146/22	123/19	273/41.5	360/55	298/45
		χ2 = 13.136** df = 1		χ2 = 13.099*	df = 3			χ2 = 6.907* df = 1
Physical activity	yes	141/85.5	24/14.5	26/16	63/28	30/17	46/13	111/67	54/33
	no	728/97	25/3	134/18	162/21.5	152/20	305/40.5	416/55	337/45
		χ2 = 33.753** df = 1		χ2 = 21.581**	df = 3			χ2 = 8.007* df = 1
Neglect	yes	42/89	5/11	7/15	19/40	14/30	7/15	37/79	10/11
	no	827/95	44/5	153/17	206/24	169/19	344/40	490/56	381/44
			.09b	χ2 = 14.840*	df = 3			χ2 = 9.205* df = 1
Abuse	yes	27/790	3/10	8/27	8/27	8/27	6/20	23/77	7/23
	no	840/95	46/5	152/17	217/24	174/20	345/39	504/57	384/43
			.212b	χ2 = 5.007	df = 3			χ2 = 4.705* df = 1

χ2: Pearson Chi-Square * p<.05 **p≤.001 a: Within each problem b: Fischer`s Exact test

Discussion

Healthy schoolchildren are the future of a healthy society. Therefore, it is extremely important to prevent common health problems in schoolchildren, diagnose existing health problems at an early stage, and protect their health in order to ensure their healthy growth and development and a healthy future. Within this scope, the psychosocial, physiological, health-related behaviours and environmental health problems of migrant and native Turkish children attending primary school in a low socio-economic, migrant-dense slum neighbourhood in Istanbul were comprehensively diagnosed through this electronic health study, and nursing interventions were implemented to address these problems via the Omaha System. Additionally, the relationship between the sociodemographic characteristics of these children and their health problems has been analysed. Therefore, it is one of the rare studies conducted in the field of school health. To the best of our knowledge, this study is among the first in Turkey to provide culturally sensitive and holistic nursing care to migrant children through communication in their native languages, such as Kurdish and Arabic.

In this study, the most commonly encountered health problems among schoolchildren were psychosocial health problems, such as mental health problems (e.g., depression and anxiety) and interpersonal relationship difficulties. These were followed by physiological health problems, such as oral health and vision problems, and health-related behavioral problems, including malnutrition, being underweight or overweight, and insufficient physical activity. When compared to the results of national studies conducted with similar age groups using the Omaha System, the findings related to physical health problems and health-related behaviors were similar in content; however, the prevalence rates in those studies were much higher than those observed in the present study. In contrast, the prevalence of psychosocial health problems was found to be lower in the national studies compared to the current study [9, 17, 25, 46–48] Additionally, the results of this study revealed that the prevalence of all the aforementioned health problems, particularly physical health problems, was significantly higher among migrant children compared to Turkish children. These findings were consistent with those of another school-based study in Turkey that included migrant children [29, 49]. In line with this, similar studies conducted in other countries such as Chile and Jordan have shown that migrant children exhibit significantly higher levels of lower body mass index [8] and emotional symptoms [28] compared to their native peers. These results can be explained in relation to lower socioeconomic status, which is associated with quality of life [18, 50], unhealthy eating behaviors [17], and the life disadvantages caused by migration [51]. However, in a similar study conducted by Dost (2024) among schoolchildren of comparable age groups during the COVID-19 pandemic, psychosocial health problems were found to be nearly twice as prevalent as in the present study [26]. One possible explanation for this discrepancy could be the impact of the restrictions imposed by the COVID-19 pandemic on individual and community health [26]. In this study, unlike other Turkey-based studies using the Omaha System conducted among schoolchildren of the same age group, problems related to neglect and abuse were identified [9, 25]. A notable finding of this study is that there was no statistically significant difference between migrant and Turkey-origin children. However, when analyzed proportionally, the prevalence of both problems was higher among migrant children. These results indicate that schoolchildren, particularly those with migrant backgrounds, are being deprived of their most fundamental human rights namely, safe and healthy living conditions. As such, these problems urgently require a multidisciplinary approach and the development of evidence-based, person-centered, and migrant-friendly solutions. Furthermore, another striking and multifaceted problems emerging from the current study is malnutrition, which was identified as a significant problem and found to be significantly associated with migration status. The emergence of these findings may be attributed to several interconnected factors, including the disadvantaged living conditions resulting from low socioeconomic status [47], the insecure and exploitative environments often associated with migration, fragile family structures, and an education system that lacks the provision of free school meals conditions which collectively undermine children’s well-being. Therefore, as demonstrated in our study, addressing the widespread poverty among children, supporting families, and integrating a social welfare-oriented perspective into the education system are critically important. These measures are essential for ensuring every child’s fundamental rights to adequate nutrition and a safe living environment, both of which must be prioritized at policy and practice levels.

In this study, 49 out of 76 nursing intervention targets defined within the Omaha System were utilized. The most frequently addressed targets included nursing care related to students’ needs and problems, medical/dental care, personal care, signs/symptoms, mental/emotional, and exercise. The planning of these interventions was based on a timeline that prioritized urgent, individual-based health problems such as abuse and pain as well as commonly observed health problems. However, when examined overall, nearly half of the nursing interventions implemented in the current study fell under the category of teaching, guidance, and counseling. Similarly, in other school health intervention studies conducted in Turkey using the Omaha System, the most frequently selected nursing intervention category was also teaching, guidance, and counseling [9, 25]. These findings align with expectations consistent with the school health concept. This is because interventions within this category aim to protect and promote students’ health by addressing identified health problems while also supporting students and their families through education, empowerment in self-care and coping skills, problem-solving, encouragement, and the promotion of healthy lifestyle behaviors. However, due to methodological limitations and constraints imposed by the school environment, it was not possible in this study to assess the extent to which students practically implemented these interventions in their daily lives. Nevertheless, similar studies have shown that education contributes to the development of healthy lifestyle behaviors, such as physical activity [21, 52], and oral health [15, 20, 53].

Limitation and strengths

One of the key strengths of this study is that it employed the Omaha System—an internationally validated and reliable electronic nursing intervention framework—to systematically identify and address the health problems of schoolchildren from both disadvantaged Turkish communities and migrant backgrounds. The implementation of appropriate, evidence-based nursing interventions using this system further enhances the study’s contribution to school health nursing. The Omaha System facilitates the development of a standardized language among school health nurses at national and international levels, and supports the documentation of nursing services in a manner that is permanent, accessible, transparent, and measurable.

Another significant strength is the inclusion of Syrian-origin migrant children, made possible by providing Arabic and Kurdish language support for those with limited Turkish proficiency, despite the relatively small sample size. This inclusive approach not only helps to fill a critical gap in the scientific literature concerning migrant children’s health but also supports the advancement of culturally sensitive nursing practices.

Moreover, this study is the first school health initiative utilizing the Omaha System to examine the relationship between identified health problems and sociodemographic characteristics.

Nevertheless, the study has certain limitations. Most notably, the ‘Problem Rating Scale for Outcomes’ which is a component of the Omaha System could not be implemented due to sample size limitations and scheduling constraints within the school setting. The study is also limited by the absence of post-intervention outcome assessment, as the COVID-19 pandemic led to early school closures before the project could be completed. Consequently, the ability to rigorously assess the impact of the nursing interventions on the identified health problems was constrained. Additionally, some of the data relied on children’s self-reports, which may limit the objectivity of the findings. Finally, the results are specific to the children who participated in the study and cannot be generalized to a broader population.

Conclusion

A comprehensive, highly valid, and widely used electronic-based Omaha System was utilized to holistically and culturally sensitively identify health problems among schoolchildren, and nursing interventions were implemented to address these problems. Among the diagnosed health problems, mental illnesses and psychosocial health problems ranked first, followed by physiological problems such as oral health and health-related problems like nutrition and physical inactivity. A significant association was found between all these health problems and migration status. School health nursing interventions were implemented for all these problems, with the majority of interventions falling under the categories of health education, guidance, and counselling. However, due to resource, organizational limitations and as well as early school closures caused by the COVID-19 pandemic, the impact of these nursing interventions on health problems could not be evaluated. Therefore, it is recommended that longitudinal and interventional studies be conducted to examine the long-term outcomes of nursing interventions for children’s health problems and to develop national health programs, alongside qualitative studies to explore the underlying causes of these health issues and to analyze students’ emotional expressions, including their metaphors for anxiety and depression and their coping strategies, in order to gain a deeper understanding of their experiences and needs. Additionally, one of the most striking findings of this study is that problems such as abuse, neglect, and malnutrition were found to be more prevalent among children with a migrant background, but were also observed among the general school-aged population. The results of this study are expected to contribute to filling existing knowledge gaps in the field and to serve as a scientific resource for school health professionals-including nurses, physicians, psychologists-and policymakers in the development of prolonged programs.

Author contributions

NK: Conceptualization, study design, data collection, planning and implementation of nursing interventions, writing of the article, critical review. SO: Conceptualization, study design, data collection, planning and implementation of nursing interventions, critical review. OKO: Conceptualization, study design, data collection, planning and implementation of nursing interventions, analysis, data analysis, writing of the article, critical review.

Funding

This study was conducted without any external or internal financial support.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

The Ethics Committee permission required to conduct the research was obtained from the Marmara University Faculty of Medicine Clinical Research Ethics Committee (Decision Number: Approval Number: 09.2019.388). prior to data collection.In addition, formal permission was granted by the Provincial Directorate of National Education, and the participating school administration also provided written approval for the study. Written informed consent was obtained from all participating students and their parents or legal guardians, who were contacted through the school administration and the students themselves. The school administration and classroom teachers fully cooperated with the research team, facilitating the implementation of the project by arranging the school health room, providing necessary resources, and supporting other logistical needs throughout the study. The research was conducted in accordance with the principles of the Declaration of Helsinki.

Consent for publication

Authorization for the use of the Omaha System form was granted before conducting this study. Since the data from participants were collected anonymously, consent for publication is not applicable.

Writing assistance use of AI assistance

During the development of this manuscript, the author utilized ChatGPT (ChatGPT-4o) for support with language editing, including grammar correction and sentence restructuring to enhance clarity.

Competing interests

The authors declare no competing interests.