A nursing intervention to ensure a safe playground environment

A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population

This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.

What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review

Risky outdoor play has been associated with promoting children’s health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional “good quality” studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children’s risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed.

The effect of safer play equipment on playground injury rates among school children

BACKGROUND

Changes to Canadian Standards Association (CSA) standards for playground equipment prompted the removal of hazardous equipment from 136 elementary schools in Toronto. We conducted a study to determine whether applying these new standards and replacing unsafe playground equipment with safe equipment reduced the number of school playground injuries.

METHODS

A total of 86 of the 136 schools with hazardous play equipment had the equipment removed and replaced with safer equipment within the study period (intervention schools). Playground injury rates before and after equipment replacement were compared in intervention schools. A database of incident reports from the Ontario School Board Insurance Exchange was used to identify injury events. There were 225 schools whose equipment did not require replacement (nonintervention schools); these schools served as a natural control group for background injury rates during the study period. Injury rates per 1000 students per month, relative risks (RRs) and 95% confidence intervals (CIs) were calculated, adjusting for clustering within schools.

RESULTS

The rate of injury in intervention schools decreased from 2.61 (95% CI 1.93-3.29) per 1000 students per month before unsafe equipment was removed to 1.68 (95% CI 1.31-2.05) after it was replaced (RR 0.70, 95% CI 0.62-0.78). This translated into 550 injuries avoided in the post-intervention period. In nonintervention schools, the rate of injury increased from 1.44 (95% CI 1.07-1.81) to 1.81 (95% CI 1.07-2.53) during the study period (RR 1.40, 95% CI 1.29-1.52).

INTERPRETATION

The CSA standards were an effective tool in identifying hazardous playground equipment. Removing and replacing unsafe equipment is an effective strategy for preventing playground injuries.

Accidents in the school environment: perspectives of staff concerned with data collection and reporting procedures

School-accident reports document incidents that have resulted in children requiring assistance from staff in the education and healthcare sectors. This study was undertaken to investigate the collection and use of data by agencies concerned with the school-accident problem. Our aim was to determine if the annual collection and use of such a large body of data might be improved through better management procedures. Interviews were conducted with primary and secondary school staff in one education authority. Interviewees completed a questionnaire on accident activity and accident reporting in their school. In the healthcare sector, staff from the Schools' Office and the ambulance unit servicing the schools provided information on their collection and use of data. Our survey found that accident activity is usually a private matter for individual schools, shared to varying degrees with the education authority. Playgrounds, children's behaviour and footwear carried much of the blame for the injuries sustained. Staff generally accepted the current accident rates. The compilation of accident data by the Schools' Office, accident and emergency department, and ambulance service were compromised by deficiencies in computerization and computer software. The management and utilization of school-accident data could be improved by better collaboration within and between the education and healthcare agencies.

Playground injuries in children: a review and Pennsylvania Trauma Center experience

ISSUES AND PURPOSE

To describe patient demographics, injury characteristics, and circumstances of playground injuries in children admitted to Pennsylvania trauma centers and to identify injury prevention strategies.

DESIGN AND METHODS

Retrospective, descriptive study of 234 children ages 1 to 18 years sustaining playground-related injuries and whose hospital data were entered into the Pennsylvania Trauma Outcome Study.

RESULTS

Most of the injuries occurred between April and September (77%), and noon to 6 P.M. (69%). Falls from playground equipment constituted the highest proportion of incidents (73%). Of 421 injuries (M = 1.8/patient), most were upper extremity (n = 117) and head (n = 110) injuries.

PRACTICE IMPLICATIONS

Nurses can advocate for playground safety by teaching children to play safely and recommending age-appropriate equipment and protective surfacing.

Establishing a research agenda for school nursing

During 1996, representatives from two professional organizations--American School Health Association and National Association of School Nurses--met collaboratively to identify and rank order key questions regarding contemporary research needs in school nursing services. This article summarizes existing literature and proposes areas for research. Recommendations are offered for nurses, school health program administrators, educators of school nurses, professional organizations, and others who plan and provide health care for school-aged youth.