Guidelines for adolescent preventive services: a role for the school nurse

Improving access to school health services as perceived by school professionals

BACKGROUND

The organisation of health assessments by preventive health services focusing on children's health and educational performance needs to be improved due to evolving health priorities such as mental health problems, reduced budgets and shortages of physicians and nurses. We studied the impact on the school professionals' perception of access to school health services (SHS) when a triage approach was used for population-based health assessments in primary schools. The triage approach involves pre-assessments by SHS assistants, with only those children in need of follow-up being assessed by a physician or nurse. The triage approach was compared with the usual approach in which all children are assessed by physicians and nurses.

METHODS

We conducted a cross-sectional study, comparing school professionals' perceptions of the triage and the usual approach to SHS. The randomly selected school professionals completed digital questionnaires about contact frequency, the approachability of SHS and the appropriateness of support from SHS. School care coordinators and teachers were invited to participate in the study, resulting in a response of 444 (35.7%) professionals from schools working with the triage approach and 320 (44.6%) professionals working with the usual approach.

RESULTS

Respondents from schools using the triage approach had more contacts with SHS and were more satisfied with the appropriateness of support from SHS than respondents in the approach-as-usual group. No significant differences were found between the two groups in terms of the perceived approachability of SHS.

CONCLUSIONS

School professionals were more positive about access to SHS when a triage approach to routine assessments was in place than when the usual approach was used. Countries with similar population-based SHS systems could benefit from a triage approach which gives physicians and nurses more opportunities to attend schools for consultations and assessments of children on demand.

Adolescent Smoking Cessation: Development of a School Nurse Intervention

The purpose of this study was to examine the feasibility of a range of strategies to engage and to enhance secondary school nurse involvement in teenage smoking prevention and cessation. School nurses were willing to assist students to quit smoking, but they felt unprepared. Information provided by nurses involved in a three-stage review, pilot-testing, and trial design resulted in the development of a resource for nurses. This resource comprised individual student approaches (brief intervention based on motivational interviewing and written activities designed to help students examine their smoking behavior), approaches to assist parents (letter of support for parents of students who smoke), and school newsletter items. Each component of the resource was found by school nurses to be appropriate, useful, and complementary to their other school-wide approaches to assist adolescents to quit smoking. Nurses also reported an interest to expand or to enhance their smoking cessation role in the school.

The role of schools in strengthening delivery of new adolescent vaccinations

Schools offer an opportunity to deliver new vaccines to adolescents who may not receive them in their medical home. However, school budgets and health priorities are set at the local level; consequently resources devoted to health-related activities vary widely. Partnering with schools requires soliciting buy-in from stakeholders at district and school levels and providing added value to schools. With appropriate resources and partnerships, schools could carry out vaccination-related activities from educating students, parents, and communities to developing policies supporting vaccination, providing vaccines, or serving as the site at which partners administer vaccines. Activities will vary among schools, but every school has the potential to use some strategies that promote adolescent vaccination.

Childhood smoking: the research, clinical and theoretical imperative for nursing action

BACKGROUND

Tobacco smoking is a major international health issue which nurses are ideally positioned to address. Childhood represents a critical period for intervention to prevent/reduce smoking. During childhood, the majority of smokers first experiment with smoking, are initiated into the smoking subculture and become addicted to tobacco. Children are highly susceptible to smoking as a result of developmental factors, which promote or facilitate high-risk behaviours, limited coping skills, limited defences and inadequate legal protection against youth-focused marketing of tobacco.

AIM

This paper is intended to sensitize nurses to the magnitude of childhood smoking as an international health problem and to familiarize them with current intervention approaches and care issues pertinent to child and adolescent populations.

METHOD

An extensive literature review was conducted to determine the impact of childhood smoking at the personal and community level, characteristics of child smokers, the processes associated with smoking cessation, intervention approaches and intervention models for use by nurses across the spectrum of clinical settings.

FINDINGS

Evidence exists that behaviourally based interventions by nurses for smoking prevention/cessation are effective with children. Key components of effective behaviourally based antismoking approaches for smokers include addressing self-efficacy to quit, providing social support, resisting temptation to smoke and discussing issues related to relapse and relapse prevention. For all children, the reinforcement of non-smoking behaviour is essential. Intervention models, which can be incorporated into routine clinical care of individual children or with groups, emphasize the importance of parental involvement, routine screening for tobacco use and provision of a clear message that smoking and tobacco use is unhealthy.

Health promotion and the role of the school nurse: a systematic review

This paper describes findings from a systematic review of the literature on the effectiveness of school nurses in promoting the health of school children. The paper gives a brief account of the background to the study and the search strategy adopted. Some key findings are presented and discussed. The brief for the review was to seek evidence of effectiveness in the practice of school nurses. The results of the review were disappointing, in that little research of acceptable quality was found and little could be said about effectiveness. The result is therefore a more diffuse review that gives a summary of descriptive research and current views and opinions, although it does also present some pointers for future research. The study was funded by Health Promotion Wales.

Meeting the preteen vaccine law: a pilot program in urban middle schools

California, the most populous state in the nation, is one of many states that implemented vaccination requirements for preteens. While kindergarten requirements are well-established and accepted by parents, implementation of preteen vaccination requirements requires inter- and intra-institutional adjustments, educational and public relations efforts, and an augmentation of vaccination delivery systems. This article describes a pilot program in two middle schools in an urban school district and offers planning strategies and practical tools to assist school nurses and health providers to implement preteen requirements.

The clinical nurse specialist's role in school health

This article explores the role of the clinical nurse specialist (CNS) in school health. School nurse roles and responsibilities are expanding from their original emphasis on providing direct care and education to children and their parents to community-oriented care. CNS roles and practice areas have expanded to fill needs in a variety of settings, with a variety of clients. The identified CNS roles of clinician, educator, consultant, researcher, and leader/manager provide a comprehensive approach to providing school health services directly to individuals and indirectly through community-oriented care. A CNS's expertise is essential to assist with providing comprehensive care to students, their families, and the community through comprehensive school health services.