Expert school nurses' experiences of reopening schools during the COVID-19 pandemic: A qualitative study

BACKGROUND

There is limited information about expert school nurses' experiences regarding the reopening of schools in the school setting during the COVID-19 pandemic.

PURPOSE

This study aimed to explore the views and experiences of reopening schools among expert school nurses during the COVID-19 pandemic.

METHODS

We conducted semi-structured interviews with five focus groups of 24 school nurses. A grounded theory methodology was used to analyze emergent concepts, categories, and themes.

DISCUSSION

We identified five themes related to the experiences of expert school nurses during the COVID-19 pandemic: unprepared response system, fighting alone, centering the response system, redefining roles, and together against.

CONCLUSION

Despite the high workload of school nurses during the COVID-19 pandemic, the expert school nurses led to clarification and expansion of the role of the school nurse role, and highlighted the relationships among school staff who were essential participants of the school health team during the pandemic.

PRACTICE IMPLICATIONS

It is imperative to shift the perception that school nurses are health professionals who play key managerial roles with collaboration within and beyond the school.

Engaging School Communities During COVID-19: The Role of School Nurses

We explored the role of school nurses during the COVID-19 pandemic by conducting interviews and focus groups with them in 2022 and 2023 in an urban public school district. Findings indicated that school nurses played an essential public health role in engaging the school community, overseeing COVID-19 testing, and enforcing risk mitigation strategies during the pandemic. Our results contribute to understanding school nurses' experiences during the pandemic and highlight the need for training and support for their vital role. (Am J Public Health. 2024;114(S5):S402-S404. https://doi.org/10.2105/AJPH.2024.307591).

Notes From the Field: Diverse Partner Perspectives Improve the Usability and Equity Focus of Implementation Guides

Context

School-based asthma programs (SBAPs) have improved health and educational disparities among youth with asthma.

Design

To support scaling out effective SBAPs, our school partners identified a need for online implementation guides that are "always available," to meet the needs of school nurses' demanding schedules. School nurses play a key role in the adoption and implementation of SBAPs, so it is important to ensure the implementation guide would be highly usable and acceptable to them.

Objective

Accordingly, our research team collaborated with human-centered design experts to identify the "user journeys" of school nurses and co-created our online implementation guide as a public-facing website with input from local and national school nurse partners.

Main Results

In this perspectives article, our school nurse implementation partners and human-centered design experts reflect on challenges overcome in this process of developing a tailored implementation guide to school nurses and offer lessons from the field to others seeking to co-create implementation guides with community partners.

Addressing Stress in High School Students During the COVID-19 Pandemic

Safety isolation protocols in response to the COVID-19 (coronavirus disease 2019) pandemic have had the unintended consequence of social isolation for adolescents, youth who have a developmental need for autonomy and peer connection. Social isolation alone can lead to various psychological effects such as anxiety, stress, low mood, fear, frustration, and boredom. School nurses serve a vital role in addressing stress among adolescents by initiating early interventions, ensuring positive school experiences for students, and providing support surrounding the development of mental health disorders. Through implementation of NASN's Framework for 21st Century School Nursing Practice, school nurses address stress among high school students during the COVID-19 pandemic. Innovative interventions can include recognizing signs and symptoms of stress on physical and emotional health, advocating for mental health literacy curriculums, social prescribing, incorporating anticipatory guidance related to health promotion lifestyle practices into each school health encounter, and creating a virtual school health office to reach students while COVID-19 safety isolation continues.

Cultivating Student Belonging and School Connectedness

The effect on students from the COVID-19 pandemic, violence related to racism, and loss of customary school routines may cause loss of both school connection and a sense of belonging. School nurses can positively influence student belonging and school connection as they encounter students throughout in-person school and virtual school environments. School nurses build connections with students whom they know and outreach to students whom they identify as vulnerable in the areas of belonging and school connectedness. With a mind-set of the Framework for 21st Century School Nursing Practice and in collaboration with a school team implementing a multitiered system of support, school nurses intentionally outreach and cultural sensitivity to grow positive school climate that benefits students.

Adoption of Emergency Action Plans in Secondary Schools: A Study of School Nurses' Knowledge and Behavior

BACKGROUND

The adoption of an emergency action plan for athletics (AEAP) minimizes the consequences of injuries. School nurses may play an important role in the adoption of an AEAP. The purpose of our study was to describe school nurse's knowledge and perceptions related to AEAP adoption.

METHODS

An online survey, following the Precaution-Adoption Process Model, examining respondents' readiness to act, was distributed to 1228 school nurses to evaluate their knowledge and perception of an AEAP, with N = 131 (10.6%) responding.

RESULTS

Sixty-one school nurses were unaware of AEAP adoption at their school. A lack of athletic training services at the school was associated with not adopting an AEAP. The most frequently reported barrier to adopting an AEAP related to finances. When nurses reported perceiving more barriers to adopting an AEAP, their schools were less likely to adopt one.

CONCLUSIONS

A large number of nurses were unaware if their school adopted an AEAP. There is a need to improve nurses' knowledge and perceptions to promote AEAP development.

Does Every Student Count! in Your State? Update on the National School Nurse Dataset

The NASN launched a new data initiative in 2018 called: The National School Health Data Set: Every Student Counts! The initiative includes three distinct foci or prongs. This article reports on the progress of states participating in Every Student Counts! For more information on NASN's initiative and to learn how school nurses can join the data revolution, go to http://nasn.org/everystudentcounts .

Health and Academic Equity in Schools: Is Nursing Far Enough Up Stream?

When the Robert Wood Johnson Foundation in partnership with the National Academy of Medicine announced the Town Meeting discussions of the Future of Nursing 2030, the president of the National Association of State School Nurse Consultants felt that the voice of School Nursing was crucial to informing the national discussion on health equity and health promotion. Sharonlee Trefry, State School Nurse Consultant, wanted to be sure that the leadership team of the Future of Nursing 2030 heard about the needs of the nation's 56.6 million elementary and secondary public and independent school students. Serving in an even greater role today with regard to promoting equity in healthcare and educational access, school nurses recognize and address social determinants of health every day all day working to grow the next generation of healthy citizens.

Using Data and Research to Heal the Future

This invited testimony was given during a Robert Wood Johnson Foundation and Campaign for Action meeting held in New Orleans, LA. The meeting was held in conjunction with the Future of Nursing Town Hall in Chicago that focused on social determinants of health. The focus of the meeting was school health and social determinants of health. The author, serving as Director of Research for NASN, was asked to specifically focus on NASN's efforts related to data and research, as well as social determinants of health.

Factors Associated with School Nurses' and Personnel's Professional Practice to Encourage Parents to Vaccinate Against Human Papillomavirus

BACKGROUND

School nurses and personnel play a vital role in promoting the human papillomavirus (HPV) vaccine. The purpose of this study was to identify factors associated with school nurses' and personnel's professional practice to provide parents with HPV vaccine information and to encourage parents to vaccinate their child against HPV.

METHODS

School nurses and personnel from Ohio and Missouri completed a survey to assess their professional practice in providing HPV vaccine information and encouraging parents to vaccinate their child against HPV. Independent variables included demographics, HPV knowledge/attitudes, perceptions of their as an opinion leader for the HPV vaccine, self-efficacy to provide vaccine education, and perception of school district support.

RESULTS

Providing parents with HPV vaccine information was predicted by age, role within the school, grade-serving, knowledge, perceptions, self-efficacy, and district support; accounting for 38% of the variance (p < .000, R²  = .38). Encouraging parents to vaccinate their child against HPV was predicted by perception, self-efficacy, and grade-serving; accounting for 39% of the variance (p < .000, R²  = .39).

CONCLUSIONS

To enhance school nurses' and personnel's professional practice, interventions should focus on nurses' and personnel's perception of their role as opinion leaders and self-efficacy to provide HPV education and vaccine recommendation.

A Differentiated Practice Model for School Nursing

School nursing is notable for autonomous practice and independent decision-making. School nurses practice within a complex school health services environment that is subject to constant change, the influence of multiple stakeholders, and a chronic state of uncertain resources. Other professional challenges faced by school nurses are a lack of standardized entry education requirement, inadequate theoretical research with practice application, and expanding role responsibilities. Administrative restructuring of school nursing services using a differentiated practice model could be a method to address the challenges of school nurse practice. A model of differentiated school nursing practice is proposed as a starting point for the national school nurse audience to consider this alternative to the master's entry requirement. School nurse role responsibilities are divided among three levels of practitioners: generalist, master's prepared, and school nurse policy analyst. Each level features an increased scope of responsibility based on higher educational attainment. Research regarding how differentiated practice has been implemented in other health care settings is described. Implications for the implementation of differentiated practice in school health services are discussed, including the need for cooperation among stakeholders, possible cost considerations, and how school nurse education might be affected.

[Oral Health in Schools and the Process of School Nursing Care]

The decayed, missing, filled (DMF) index for permanent teeth among Taiwanese students remains above 2.0, which is the target standard established by the World Health Organization (WHO). Therefore, it is imperative that oral healthcare be promoted effectively in campus and community settings. This article conducts an analysis of relevant academic, education, and health authority survey statistics and discussions, and summarizes the three stages of oral health care from 1991 and the signing by the Ministry of Health and Welfare and the Ministry of Education of the plan for health promotion in schools in 2002. Based on the school hygiene law, although the incidence of dental cavities has been declining over the years due to campus oral healthcare promotion efforts, there remain issues in need of improvement. Oral health issues must be addressed through initiatives such as the school nurse health angel program, encouraging tooth cleaning after lunch, the National Dental Hygiene Tournament, implementing the use of fluoride mouthwash, regular oral exams, and implementing corrective measures during health screenings. The results of this empirical study offers policy advice on reducing the incidence of dental cavities among school-age children in Taiwan. In light of the deep relationships between school nurses and students, teachers, and parents, it is our mission to ensure that oral healthcare in Taiwan will soon reach WHO standards and meet the expectations of parents and society.

Introducing the 3S (Student-School Nurse-School Community) Model

Data collection and use is an integral competency for school nursing practice. The 3S (Student-School Nurse-School Community) Model is a visual representation of how to categorize school health data and identify what data are needed. This article introduces the model and shows a logical progression of how data align to influence outcomes and provides a tool for analyzing school health data.

School nurse asthma program reduces healthcare utilization in children with persistent asthma

OBJECTIVE

We examined the impact of a novel, school nurse-supervised asthma therapy program on healthcare utilization.

METHODS

We retrospectively reviewed charts of 84 children enrolled in this program in central Massachusetts between 2012 and 2015. Physicians identified children with persistent asthma and poor medication adherence. These children were enrolled in the program to receive daily-inhaled corticosteroid at school, supervised by their school nurse, with ongoing communication between physician's office and school nurse through the school year. This program relied on established family, provider and school resources rather than research staff. The primary outcome was change in the number of emergency department (ED) visits in the year before and after enrollment. Secondary outcomes were hospital admissions, school absences, and rescue medication use.

RESULTS

The study population was on average 10.5 years old, 63% male, 67% Hispanic, 19% black, 14% white with 95% using Medicaid insurance. Asthma-related ED visits over a 1-year period decreased 37.5%, from a pre-intervention mean of 0.8 visits to a post-intervention mean of 0.3 visits (p < 0.001). Asthma-related hospital admissions decreased from a pre-intervention mean of 0.3 admissions to post-intervention mean of 0 admissions (p < 0.001). Asthma rescue medication refills decreased by 46.3% from the pre- to post-intervention period (p = <.001). There were also non-significant declines in school absences and oral steroid use for children enrolled.

CONCLUSIONS

We demonstrate a significant reduction in healthcare utilization for children enrolled in this unique school nurse-supervised asthma program, which utilizes a clinical-school partnership to deliver preventative asthma medication to school-aged children under sustainable conditions.

Supporting the health and well-being of school-aged children through a school nurse programme: a realist evaluation

BACKGROUND

The school nurse's role varies across countries. In Scotland, the Chief Nursing Officer recommended that the role should be refocused. The refocused programme emphasises nine care pathways with a view to improve pupils' health and wellbeing. Two sites were identified to test this new programme. Our aim was to assess how, for whom and under what circumstances the programme works in order to provide learning to support school nurse training and intended national roll-out.

METHODS

This study was a mixed methods study, using a realist evaluation approach, and conducted in three phases. In phase one, six nurse managers from both study sites took part in individual interviews or focus groups and this was complemented by programme documents to develop initial programme theory. In phase two, the programme theory was tested using qualitative data from 27 school nurses, and quantitative data from the first 6 months of the programme that captured patterns of referral. The programme theory was refined through analyses and interpretation of data in phase three.

RESULTS

The findings show that the programme enhanced opportunities for early and improved identification of health and wellbeing needs. The context of the nine pathways worked through the mechanism of streamlining referral of relevant cases to school nurses, and yielded positive outcomes by extending school nurses and thus children's engagement with wider services. The mental health and wellbeing pathway was the most frequently used, and nurses referred complex mental health cases to more specialist mental health services, but felt less equipped to deal with low to moderate cases.

CONCLUSIONS

The programme facilitated early identification of risk but was less successful at equipping school nurses to actually deliver specific interventions as intended. Capacity building strategies for school nurses should seek to enhance intervention delivery skills within the parameters of the pathways. Realist evaluation provided a useful framework in terms of identifying contextual and mechanistic influences that required strengthening prior to wider implementation.

Administrator Leadership Styles and Their Impact on School Nursing Part II. A High-Performance School Nurse-Building Administrator Relationship Model

There is a significant disparity in roles, responsibilities, education, training, and expertise between the school nurse and building administrator. Because of this disparity, a natural chasm must be bridged to optimize student health, safety, well-being, and achievement in the classroom while meeting the individual needs of both professionals. This article constructs and presents a new school nurse-building administrator relationship model, the foundation of which is formed from the pioneering and seminal work on high-performance professional relationships and outcomes of Lewin and Drucker. The authors posit that this new model provides the framework for successful school nurse-building administrator interactions that will lead to optimal student outcomes.