Marginalization and School Nursing

The concept of marginalization was first analyzed by nursing researchers Hall, Stevens, and Meleis. Although nursing literature frequently refers to this concept when addressing “at risk” groups such as the homeless, gays and lesbians, and those infected with HIV/AIDS, the concept can also be applied to nursing. Analysis of current school nursing literature and research suggests school nursing may be a marginalized specialty, encompassing many of the characteristics of marginalization including isolation, role confusion, and barriers to practice. School nurses can reduce or eliminate these characteristics by increasing their visibility and collaborative opportunities in the educational and nursing communities while also providing mentoring opportunities to new school nurses.

Young Caregivers: Effect of Family Health Situations on School Performance

Recognition, assessment, education, support, and research of young caregivers is yet to be well established throughout the United States. Studies show that as a result of family caregiving, employees miss work, arrive late, have telephone interruptions, and pass up promotions. Education is essentially the work-life of a student. Research among 12,681 public school students in Palm Beach County, Florida, shows that more than 1 in 2 middle and high school youth (6,210) have the dual role of young caregiver and student; one third of all students (67.1% of young caregivers) miss school/after school activities, do not complete homework, and/or are interrupted in their studying—their work-life. As demonstrated in the United Kingdom, assessment, education, and support of young caregivers in school and in the community can improve education outcomes. Proactive school nurses have the opportunity to identify, assess, and promote the well-being and academic success of U.S. student-caregivers.

Quality of Life in Adolescents With Type 1 Diabetes Who Participate in Diabetes Camp

Quality of life in adolescents with Type 1 diabetes is a growing area of interest in pediatric research. The complex diabetes regimen imposes challenges for an adolescent. Adolescents diagnosed with diabetes are a group that appears to be at risk for having a poor health-related quality of life. Although research supports the positive relationship of social support and well-being in adolescents, there are few studies discussing quality of life in adolescents that are based on the factor of social support. This study compared the quality of life in adolescents with Type 1 diabetes who have attended at least one diabetes camp to the quality of life of those who have never attended diabetes camp. Results provided evidence of the value of social support.

Access to School Health Services: Differences Between Full-Time and Part-Time School Nurses

This study examined differences in student access to health services between schools with nurses 2 days/week ( n = 7) compared to schools with nurses 5 days/week ( n = 7). The study found statistically significant differences in numbers of nurse visits per 100 students. Of the 30 health conditions/activities investigated, 28 were statistically significantly higher with full-time school nurses than with part-time school nurses. It would be expected that 5-day/week nurses would be involved in health service activities 2.5 times as often as 2-day/week nurses. However, this study found that 21 of the 30 health service activities in schools with 5-day/week nurses were accessed by students more often than the expected 2.5 times that of the schools with nurses 2 days/week. This suggests a significant unmet need for access to health care services in schools with only 2-day/week nurses.

School Nurse Summer Institute: A Model for Professional Development

The components of a professional development model designed to empower school nurses to become leaders in school health services is described. The model was implemented during a 3-day professional development institute that included clinical and leadership components, especially coalition building, with two follow-up sessions in the fall and spring. Coalition building is an important tool to enhance the influence of the school nurse in improving the health of individuals, families, and communities. School nurses and nursing educators with expertise in the specialty of school nursing could replicate this model in their own regions.

Increasing Immunization Compliance

School nurses often have the responsibility to ensure that students meet all immunization requirements for school entry and school attendance. In large inner-city school districts, many obstacles exist which make this task daunting and often result in lengthy absences and exclusions for students. It is critical that school nurses find creative and systematic ways to meet these challenges, which include working parents, lack of access to primary care, lack of transportation, cost of immunizations, poor compliance and follow-up, myths regarding immunizations, and the impact of the Health Insurance Portability and Accountability Act (HIPAA) legislation. This article describes an immunization project that removed most of those barriers for high-risk students and gave the school nurses tools to succeed in achieving higher levels of immunization compliance in inner-city schools. Since the immunization project’s conception, compliance in the district has risen from an overall level of 50–60% to 90–100%, along with better record-keeping and the prevention of exclusions.

Making Schools Safer and Healthier for Lesbian, Gay, Bisexual, and Questioning Students

This article describes some of the special health and safety concerns that many lesbian, gay, bisexual, and questioning youth face in schools. Among these problems are increased drug and alcohol use, sexually transmitted infections and pregnancy risks, depression and suicidality, and increased likelihood of being a victim of harassment or assault. School nurses can play a unique role in the lives of these students. A needs assessment is reviewed that describes school nurses’ perceived professional responsibility and their actual practice with regard to lesbian, gay, bisexual, and questioning youth. Five barriers to optimal health care for these students are discussed. Methods that encourage students to view the school nurse as an ally, as well as issues surrounding disclosure or “coming out,” are discussed. Special considerations of confidentiality, community agency referral, and family disclosure are discussed. Appropriate interventions at school and ways to begin to change the school climate are also presented.

Evaluation of the “Respect Not Risk” Firearm Safety Lesson for 3rd-Graders

The purpose of this study was to evaluate the MORE HEALTH “Respect Not Risk” Firearm Safety Lesson for 3rd-graders in Pinellas County, Florida. Six schools representative of various socioeconomic levels were selected as the test sites. Qualitative and quantitative data were collected. A total of 433 matched pretests/posttests were used to determine the effectiveness of the class in increasing student knowledge about firearm safety. The results revealed a significant increase in the mean scores on the posttest compared with the pretest. Qualitative findings showed the lesson was positively received by both students and teachers, and 65% of responding students reported discussing the lesson with family members. School nurses are encouraged to take a leading role in promoting firearm injury prevention to students.

Conversion of School Nurse Policy and Procedure Manual to Electronic Format

Policy and procedure manuals are essential to establishing standards of practice and ensuring quality of care to students and families. The Olathe District Schools (Kansas) Technology Department created the Virtual File Cabinet to provide online access to employee policies, school board policies, forms, and other documents. A task force of school nurses was formed to convert the nursing department’s policies, procedures, protocols, and forms from hard copy to electronic format and make them available on the district’s Virtual File Cabinet. Having the policy and procedure manuals in electronic format allows for quick access and ease in updating information, thereby guaranteeing the school nurses have access to the most current information. Cost savings were realized by reducing the amount of paper and staff time needed to copy, collate, and assemble materials.

Anger Expression and Blood Pressure in Adolescents

The clinical significance of childhood hypertension is important as elevated pressures during childhood are found to follow a progressively increasing track into adulthood. Little work has been done to examine the relationship of emotions and emotional behavioral factors to the development of hypertension in children. Using the Roy Adaptation Model as a guide, this study investigated the relationship of anger expression and blood pressure (BP) among adolescents 16–18 years of age. Participants were 63 urban high school seniors. Measurements included the Anger Expression Inventory, a Demographic Questionnaire, and measures of systolic and diastolic blood pressure. Analysis revealed significant positive relationships between anger expression with blood pressure, and a significant inverse relationship between blood pressure and the control of anger for girls. No significant relationships between anger expression and blood pressure were noted for boys. The majority of students (53%) were found to have high normal or hypertensive blood pressure readings, putting them at increased cardiovascular risk.

The Effectiveness of a Mobile Clinic in Improving Follow-up Eye Care for At-Risk Children

PURPOSE

To investigate the potential of a mobile ophthalmic unit in the schoolyard to improve the follow-up rate for children who have failed an optometric in-school screening program. Previously, the optometric program made referrals to the center and only 53% of students attended the desired ophthalmology consultation.

METHODS

This was a cohort study of students conducted in elementary school lots in socioeconomically disadvantaged communities. The mobile ophthalmic unit visited schools where students with parental consent who needed examination had been identified by an in-school optometric vision care program.

RESULTS

A total of 132 students were referred by the optometric program, of whom 95 (72%) had complete signed consent forms. Eighty-two patients (62%, confidence interval: 54% to 70%) were successfully seen by the mobile unit. Compared to the historical rate of successful completion of ophthalmology consultation (53%), a statistically significant improvement in follow-up was noted (P = .036). On a Likert scale of 1 to 5, the mean school nurse satisfaction rating was 4.8.

CONCLUSIONS

The findings demonstrate the potential impact of mobile eye clinics at schools in connecting children with ophthalmic care. [J Pediatr Ophthalmol Strabismus. 2016;53(6):344-348.].

Innovation Relay: Empowering School Nurses to Find New Solutions for Old Problems

NASN's 48th Annual School Nurse Conference-Learning, Linking, Leading-included the first ever innovation relay contest. The relay was based on a design developed by the Institute of Healthcare Improvement's Innovation Relay. Participation included 43 contestants from 16 states and one foreign country. Teams were given 24 hours to develop a solution. This article describes the process utilized, the problem introduced, and a brief synopsis of each team's solution. The ongoing purpose of the exercise is to encourage innovation by school nurses as they experience student health-related barriers in the academic setting.

"Headache Tools to Stay in School": Assessment, Development, and Implementation of an Educational Guide for School Nurses

BACKGROUND

Headache is the most common type of pain reported in the pediatric population, and chronic headache is an increasingly prevalent and debilitating pain condition in children and adolescents. With large numbers of students experiencing acute headaches and more students with chronic headache reentering typical school settings, greater availability of tailored evidence-based practice guidelines for school nurses is imperative.

METHODS

A 2-armed study was developed to assess the need for and evaluate the use and favorability of a headache-driven school nurse guide. Students and their parents were first surveyed on their school nurse's headache knowledge and management skills. School nurses were also interviewed on their desire for a headache educational tool. This feedback aided in developing a headache resource guide. Next, the guide was distributed to school nurses who provided feedback after a 3-month trial.

RESULTS

Results indicate that "Headache Tools to Stay in School" is a useful resource in facilitating communication among health care providers, students, families, and school personnel on how to best meet the complex needs of students with headaches.

CONCLUSIONS

Given the guide's favorability, we encourage school nurses to demand the creation of additional evidence-based resources. Continued dissemination of this guide may improve students' headache management under the informed care of school nurses, and may encourage the development of more evidence-based guides across various medical conditions.

School Nurse Case Management: Achieving Health and Educational Outcomes

Educators and health care professionals alike understand that healthy students are likely to be successful learners. The goal of school nurse case management is to support students so that they are ready to learn. This article describes the outcomes of a 4-year process improvement project designed to show the impact of school nurse case management on attendance, behavior, academic performance, quality of life, and health compliance in a large southeastern urban school district. Recognizing a need for standardized practice, the School Health Leadership Team created a case management policy, procedures, forms, a data collection process, and ongoing education and mentoring. The policy enabled school nurses to select students with health and learning needs, target specific outcomes, implement interventions, and document the gains made. In the 4 years of this project, 84% of the students case managed improved in 1 or more of the 5 target areas.

Adolescents’ Attitudes About Obesity and What They Want in Obesity Prevention Programs

Obesity is a major pediatric public health problem. Adolescents are a priority population for intervention strategies. School nurses are in key positions to design intervention strategies to promote healthy lifestyles and prevent adolescent obesity in the students they serve. To design effective programs, school nurses need to know what components their students perceive as important. This study involved the development and administration of a questionnaire to middle school students to determine their attitudes about overweight/obesity and what they felt would work for them. Adolescents are willing to exercise more, to change eating habits to include more fruits and vegetables, drink more water, and eat less junk food. They are not willing to give up soda, video/computer games, and watching television to improve their health. School nurses can use this questionnaire to collect data that will assist in the development of effective programs for their students.

Community-Acquired Methicillin-Resistant Staphylococcus aureus: Considerations for School Nurses

Methicillin-resistant Staphylococcus aureus (MRSA) is a disease-causing organism that has been present in hospital settings since the 1960s. However, a genetically distinct strain of MRSA, called community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), has emerged in recent years in community settings among healthy individuals. While this organism has been found to be less resistant to antibiotics, it is also more virulent and capable of causing a spectrum of illnesses. School nurses must be aware of the risk factors for this infection and understand its signs, symptoms, diagnostic testing, and management. With this knowledge, school nurses can help protect students, staff, and community members from this increasingly prevalent pathogen.

Overcoming Medicaid Reimbursement Barriers to Funding School Nursing Services for Low-Income Children With Asthma

BACKGROUND

School nurses can provide direct services for children with asthma, educate, and reinforce treatment recommendations to children and their families, and coordinate the school-wide response to students' asthma emergencies. Unfortunately, school-based health services today depend on an unreliable patchwork of funding. Limited state and local funds lead to extremely low nurse-to-student ratios, resulting in missed opportunities for prevention and care of asthma and other health conditions.

METHODS

We carried out a nonsystematic review of legal, government, private health foundation, and medical literature.

RESULTS

Many health services for asthma and other conditions provided in school settings are services typically covered by Medicaid and the Children's Health Insurance Program (CHIP) when offered in other settings. However, complex reimbursement rules, questionable policy guidance establishing a "free care rule," and other barriers have limited the ability of schools to seek Medicaid/CHIP reimbursement for these services. Recent legal developments may help overcome some of these barriers, and new flexibilities in Medicaid law bring opportunities for increased reimbursement of school-based health services.

CONCLUSIONS

Policymakers should call on the Centers for Medicare and Medicaid Services to abandon the "free care rule" and issue other guidance that would enable schools to appropriately obtain Medicaid reimbursement for nursing services.

Are School Nurses an Overlooked Resource in Reducing Childhood Obesity? A Systematic Review and Meta-Analysis

BACKGROUND

Schools are a key setting for childhood obesity interventions, yet nurses are not often included in delivering these interventions. The objective of this systematic review and meta-analysis was to examine school-based interventions involving nurses in a role beyond anthropometric measurement for effect on change in body measures.

METHODS

We performed a systematic review and meta-analysis of these papers.

RESULTS

The literature search produced 2412 articles. Eleven met inclusion criteria for the systematic review (4 randomized controlled trail [RCT], 7 quasi-experimental) and 8 for the meta-analysis. None have been included in prior meta-analyses. Four studies restricted eligibility to overweight and/or obese children; 7 included all children regardless of body weight. Random effects meta-analytic models represent data from 6050 (body mass index [BMI]), 5863 (BMIz), and 416 (BMI percentile) children, respectively. Pooled analyses demonstrated statistically significant decreases in BMI (6 studies: -0.48 [95% CI -0.84, -0.12]; I(2) =91.2%, Q=68.1), BMIz (5 studies: -0.10 [95% CI: -0.15, -0.05]; I(2) =0, Q=2.3), and BMI percentile (3 studies: -0.41 [95% CI: -0.60, -0.21]; I(2) =0, Q=2.0).

CONCLUSIONS

These findings are similar to those of other meta-analyses of school-based interventions and suggest that school nurses can play a key role in implementing sustainable, effective school-based obesity interventions.