Dissociative Identity Disorder in Schools Part II

Dissociation is a well-established outcome of early life trauma, but school nurses may not be aware of resources and recommendations available to support students who experience it. If dissociation or behaviors consistent with dissociation are present, trauma-informed care (TIC) principles can guide individualized care of the student. Part I of this two-part article provided a pertinent background on dissociation, dissociative identity disorder (DID), the effects of social media, and TIC. Part II offers specific recommendations for implementing these principles in school nursing practice and follows the student vignette through the school year. Due to their holistic approach to care and long-standing leadership in providing TIC, nurses can significantly affect health, safety, and access to learning for students expressing dissociative experiences at school.

A Description of Suspected Concussions in Football-Related Activities among K-12 Students in Utah

The circumstances and nature of concussions among youth who play tackle, flag, or touch football are not well understood. This study used data from Utah's Student Injury Reporting System (SIRS) to explore suspected concussions among K-12 students sustained during participation in football-related activities (tackle, flag, or touch football). Descriptive statistics and chi-square analyses showed that 54.7% of suspected concussions due to football-related activity were among elementary and middle school and 41.3% were among high school students. Most suspected concussions resulted from being struck by or against something (81.9%) and occurred during school-sanctioned games and practices (37.9%), lunch, lunch recess, and recess (34.8%), or physical education class (22.7%). The type of school activity and context for suspected concussions varied by school level. School nurses and others in Utah may use study findings to customize concussion prevention efforts by school level and activity.

The Role of Nursing in the School Setting to Lead Efforts to Impact Child Trafficking: An Integrative Review

Registered professional and advanced practice nurses in the school setting, as a specialized practice entity, are leaders in implementation of evidence-based practice, skilled coordinators of care, advocates for students, and experts in designing systems assisting individuals and communities to reach full potential. Child trafficking (CT) is an emerging public health threat impacting safety and well-being of students present in the school setting. This literature review identified four themes in five studies: (1) training impacts nurses' knowledge, awareness, and attitudes; (2) school nursing is underrepresented in training, education, prevention, response, and research; (3) lack of collaboration exists between school staff and school nurses; and (4) formal education and length of experience impact levels of interventions school nurses are able to provide. School nurses are opportunely situated to intervene as advocates for vulnerable children to develop a coordinated, effective response to CT risk factors, mitigating risk and fostering resiliency with systems-based change.

A State-Level Examination of School Nurses' Perceptions of Condom Availability Accompanied by Sex Education

School nurses are often sources of health-care support for teens with sexually transmitted infections (STIs) and unintended pregnancies. However, providing prevention (e.g., condoms) and teaching technical skills (e.g., condom use) needed to reduce high-risk sexual behavior may require a change in perceptions and policies. This study used a cross-sectional study design to assess nurses' perceptions of condom availability accompanied by sex education programs among high school nurses (n = 87) in Kansas. Results showed that school nurses in this study supported condom availability, were comfortable providing condoms, and felt condom availability was within the scope of their job but were less likely to provide condoms because of external barriers. Common barriers include administration, parents, cost, community support, and policies. School nurses, by virtue of their access to the majority of Kansas' adolescents, have the potential to provide sex education and tools such as condoms, so young people can prevent STIs and unintended pregnancies.

A Pain Reporting Tool for School-Aged Baseball Pitchers

Rates of injury to school-aged athletes are of concern to pediatric providers and can be prevented when players, coaches, and parents recognize and address pain. The aim of the present study was to evaluate the use of a pain-reporting tool. In this study, 34 baseball players aged 10-16 years reported pain surrounding 135 separate pitching experiences. Those participating in another sport on the same day as pitching rated pain intensity as significantly higher than those who did not. Approximately 19 pitches were thrown before participants noticed pain. Ice and analgesics were used appropriately to manage pain. School nurses are well positioned to discuss pain reporting and common injuries with young athletes, parents, and athletic coaches. Sharing proactive ways to elicit information about pain is suggested. Implications for future research include the study of young athlete experiences with pain and development of educational initiatives regarding the importance of reporting pain.

Bullying Victimization Type and Feeling Unsafe in Middle School

Given their significance to school violence, this study quantifies the association between bullying victimization and perceptions of safety separately for victimization where the type is not specified versus victimization that is physical in nature. Generalized liner mixed modeling was employed with 5,138 sixth- to eighth-grade students in 24 schools who self-reported on their bullying victimization and perceptions of school safety on an anonymous survey in fall 2015. Results indicate a multiplicative interaction exists with regard to the odds of feeling unsafe at school among those who were bullied at all (odds ratio [ OR] = 3.1) compared to those who were bullied physically ( OR = 9.12). For school nurses who work with students with a variety of concerns and health issues, this research indicates that the use of bullying victimization as an outcome, proxy and/or predictor, requires inquiry into the type of bullying experienced to aid in the care and support received.

Exertional Heat Illness Among Secondary School Athletes: Statewide Policy Implications

Exertional heat illness (EHI) is a leading cause of preventable death among student athletes. While causes and preventative measures for EHI are known, school districts may not be implementing evidence-based practices. This descriptive, exploratory study explored school policies, resources, and practices of coaches in a mid-Atlantic state in the prevention and identification of EHI; 397 responded. Ninety-three percent knew of EHI, but only 52% scheduled acclimatization. Coaches reporting a heat emergency plan (56%) were significantly more likely to follow other evidence-based recommendations: altering equipment ( p < .0001, odds ratio [ OR] = 2.53), monitoring environment ( p < .0001, OR = 2.56), providing acclimatization ( p < .0001, OR = 2.50), having athletic trainers at practices ( p < .0001, OR = 4.75), and believed that they could handle the emergency until EMS arrival ( p < .001, OR = 2.48). School districts should comply with evidence-based guidelines. School nurses play a key role in education, developing emergency plans and training coaches in first aid.

Association Between State Assistance on the Topic of Indoor Air Quality and School District-Level Policies That Promote Indoor Air Quality in Schools

Nationally representative data from the 2012 School Health Policies and Practices Study examined whether state assistance on indoor air quality (IAQ) was associated with district-level policies and practices related to IAQ and integrated pest management (IPM). Districts in states that provided assistance on IAQ were more likely than districts not in such states to (1) have an IAQ management program (p < .001); (2) require schools to conduct periodic inspections of the heating, ventilation, and air conditioning system (p < .05); of the building for cracks, leaks, or past water damage (p < .01); for mold (p < .01); for clutter that prevents effective cleaning and maintenance (p < .05); of the plumbing system (p < .01); and for condensation in and around school facilities (p < .001); (3) have an engine idling reduction program ( < .001); (4) have a policy to purchase low-emitting products (p < .05); and (5) require IPM strategies (p < .05). Increasing the number of states that provide IAQ-related assistance to school districts and schools may improve school IAQ.

School-based childhood sexual abuse prevention programs: an integrative review

One prevention strategy for childhood sexual abuse (CSA) involves educational programs delivered to children in the school environment. The purpose of this integrative literature review was to determine the state of the science on school-based CSA prevention programs. The authors extracted data from 26 articles that fit inclusion criteria to answer research questions on types of programs, methods used to evaluate programs, and program success. Analysis of the extracted data led to the identification of seven categories of teaching learning content. Delivery methods included films, plays, discussion, and role play. Most authors used an untreated or placebo control group pretest/posttest design for evaluation. According to the child outcome measures chosen, the majority of programs were successful. The review also found school nurses rarely involved in these programs. Although not a traditional aspect of their responsibilities, information from this review can help school nurses implement a school-based CSA prevention program.

The effect of coping knowledge on emergency preparedness in elementary school students

The purpose of this study was to examine the effect of coping knowledge for emergency preparedness in Korean elementary school students. A school-based coping education program was provided seven times to 271 fourth- and fifth-grade students in two urban schools by researchers with the school nurses. The Process Model of Stress and Coping and Self-Care Deficit Theory were the theoretical frameworks used to guide this research. The Coping Knowledge for Emergency Situations Questionnaire, developed by the authors, was used to gather data. In the coping education group, there was statistically significant improvement in the coping knowledge (t = 4.589, p < .001) from that of the control group (n = 270). The results highlight the importance of emergency preparedness for elementary school students and the need to develop educational programs for various emergency situations.

Relative weights of the backpacks of elementary-aged children

The purpose of the study was to describe the range of relative backpack weights of one group of elementary-aged children and the extent to which they exceeded recommended levels. A second purpose was to explore whether gender and age help predict the relative weight of children's backpacks. Ninety-five 8- to 12-year-old elementary school students (56% girls; 88% car or bus riders) participated. Their school backpacks were weighed, and their age, gender, and mode of transportation to school were recorded. Only 40% of the sample carried backpacks that were less than 10% of their body weights. Five percent of the students' backpacks exceeded 20% of their body weights. Neither age group nor gender significantly predicted relative backpack weight or relative weight levels. Recommendations are made for ways to reduce the weight these young children carry.

Rural school employees' status, awareness, and perceptions of adult vaccinations

As key members of the school environment, it is important for school employees to be vaccinated. Employees are in direct contact with children in close quarters for long periods of time and such an environment can easily serve as an outbreak center for vaccine-preventable communicable diseases such as measles. Despite the fact that most school employees believe vaccines are safe and effective and many school employees report they are up-to-date with their vaccines, a closer examination reveals discrepancy between belief and behavior. This research study evaluates the vaccination status, awareness, and perceptions of school employees located in a large rural school district in Utah. As a vaccine advocate, the school nurse can be influential in providing adult vaccination education for school employees, thus increasing awareness of the importance of adult vaccines and knowing one's vaccination status. Additionally, school nurses might need to meet with school district policy makers to promote vaccine mandates for school employees and to assist in the creation of containment plans in the event of a measles outbreak at school.