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.

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.

Steps to Stock: Keeping Students Safe With Fully Implemented Stock Epinephrine

Laws have been passed across the United States to either allow or mandate the use of stock epinephrine in the school setting. The challenge remains for our schools to fully implement the use of this life-saving medication. Barriers to implementation exist, but quality tools are available to support the school nurse.

Increasing Sexual and Reproductive Health Education Equity for Hispanics in Schools

In the United States, the overall teen birth rate has been decreasing. In 1991, the teen birth rate was 61.8 births for every 1,000 teen females, but in 2014, the same overall rate decreased to 24.2 births for every 1,000 teen females. Unfortunately, this decrease has not reflected equally across all the races/ethnic groups. In 2014, the teen birth rate for Hispanics was 38 births per 1,000 teen females. The NASN is aware about the disparities on teen birth among racial/ethnical groups and has released a specific statement about the role of school nurses on the improvement of pregnancy outcomes. This article explains the cultural, linguistic, and educational barriers faced by Hispanic teens with limited English proficiency when preventing pregnancy and describes the development and implementation of a sexual and reproductive health education curriculum. The implications for school nurses will be discussed.

A Review of Four Health Procedures That School Nurses May Encounter

The school nurse plays a vital role in providing care and meeting the health needs of students in the school setting. Students attend school with chronic conditions and complex medical problems such as quadriplegia, cerebral palsy, spina bifida, and muscular dystrophy. It is the responsibility of the school nurse to provide appropriate assessment, early intervention, and care for children in the school environment. The purpose of this article is to review and discuss the knowledge and skills the school nurse needs to care for students with central venous lines, gastrostomy tubes, altered urinary elimination, and tracheostomies.

Implementation of a School Nurse-led Intervention for Children With Severe Obesity in New York City Schools

PURPOSE

The Healthy Options and Physical Activity Program (HOP) is a school nurse-led intervention for children with severe obesity. HOP was developed by experts at the New York City Department of Health and Mental Hygiene and implemented in New York City schools beginning in 2012. The purpose of this study was to evaluate HOP implementation with the goal of informing HOP refinement and potential future HOP dissemination.

DESIGN AND METHODS

This study entailed a retrospective analysis of secondary data. Analytic methods included descriptive statistics, Wilcoxon rank sum and Chi square tests, and multivariate logistic regression.

RESULTS

During the 2012-2013 school year, 20,518 children were eligible for HOP. Of these, 1054 (5.1%) were enrolled in the program. On average, enrolled children attended one HOP session during the school year. Parent participation was low (3.2% of HOP sessions). Low nurse workload, low school poverty, higher grade level, higher BMI percentile, and chronic illness diagnosis were associated with student enrollment in HOP.

CONCLUSIONS

As currently delivered, HOP is not likely to be efficacious. Lessons learned from this evaluation are applicable to future nurse-led obesity interventions.

PRACTICE IMPLICATIONS

Prior to implementing a school nurse-led obesity intervention, nursing workload and available support must be carefully considered. Interventions should be designed to facilitate (and possibly require) parent involvement. Nurses who deliver obesity interventions may require additional training in obesity treatment. With attention to these lessons learned, evidence-based school nurse-led obesity interventions can be developed.

Supporting the Health and Well-Being of Transgender Students

Throughout the United States, there has been a rise in public discourse about transgender people and transgender issues. Much of this attention stems from passed and proposed anti-LGBTQ (lesbian, gay, bisexual, transgender, queer or questioning) legislation, including "bathroom bills" that would require transgender people to use public facilities corresponding with the sex designated on their birth certificates. With the recent discussion and legislation impacting school-aged children and adolescents, what does this mean for school nurses and how can they care and advocate for their transgender students? In this article, we aim to empower school nurses to join the discussion, advocate for inclusive and equitable school policies, and deliver gender-affirming care to transgender students. We will explain transgender identities; transgender-related stigma, prejudice, discrimination, and health concerns; gender-affirming approaches in caring for transgender youth; and implications for school nurses. School nurses play a key role in creating a space that is welcoming and affirming where transgender students can thrive.

Analyzing Who, When, and Where: Data for Better Targeting of Resources for School-Based Asthma Interventions

BACKGROUND

Rates of uncontrolled asthma vary by demographics, space, and time. This article uses data on ambulance-treated asthma attacks in children to analyze these variations so that school districts can improve their asthma management interventions.

METHODS

Incidence rates of 1826 ambulance-treated asthma attacks for children aged 5-18 years were calculated for school zones for elementary, middle, and high schools in the Houston (Texas) Independent School District (HISD). Zones with rates in the upper quartile were identified as the highest rate zones and were compared with other school zones in the district by demographics, location, and timing of attacks.

RESULTS

The ambulance-treated asthma rate was respectively 5, 3, and 2 times greater in the highest rate school zones compared with all other school zones for those school levels. Ambulance-treated asthma attacks in the high-rate school zones occurred most at midday and in the evening and high-rate zones were often geographically contiguous. Schools in the high-rate zones had a higher percent of socioeconomically disadvantaged students and were more often without a school nurse.

CONCLUSION

Spatial and temporal analysis of ambulance data can be valuable tools for schools to focus policy and program interventions for the students in need of improved asthma management.

Records—The Achilles’ Heel of School Nursing: Answers to Bothersome Questions

This article addresses practice issues related to school health records and school nursing documentation. Because the issues have been posed by practicing school nurses, the article is in Question and Answer (Q&A) format. Specifically, the questions addressed concern the following: ownership and storage location of student health records when the school nurse is contracted from a community health agency rather than employed by the school district; documentation of sensitive health information on students’ health records including pregnancy, drug and alcohol abuse, mental illness, history of suicide attempt, and HIV status; inclusion of medical diagnoses and current medications on a student’s Individual Educational Program (IEP); and Health Insurance Portability and Accountability Act (HIPAA)-permitted communications between school nurses and health care providers related to students’ immunization status, regarding a student’s treatment needs in school, and via facsimile (e.g., records of immunizations, completed physical examination forms, and medical orders). HIPAA, the Family Educational Records and Privacy Act (FERPA), and other laws are addressed as appropriate, and resources for obtaining further information are included.

Using Expanded Individualized Health Care Plans to Assist Teachers of Students With Complex Health Care Needs

As special education teachers have increasing numbers of students requiring health care procedures in their classrooms, school nurses need to help these teachers maintain a safe, healthy environment for their students. Part of this consists of having teachers know the steps to take should certain problems arise. This article examines the receptivity of using an expanded version of an individualized health care plan (IHP) to provide critical information to address health care problems, as well as having individualized education program (IEP) objectives for instructional targets identified in the IHP. The findings of this study indicate that a high percentage of school nurses and special education teachers were in favor of an expanded version of the IHP. There was also support for teaching students to independently or partially participate in performing their own health care procedures and having this instruction formalized as IEP objectives.

The Effects of Budget, Delegation, and Other Variables on the Future of School Nursing

The purpose of this exploratory research study was to survey Kansas school nurses to determine the impact of budget, delegation, and other variables on the future of school nursing. Issues of education and certification status, educational budget, delegation, school nurse-to-student ratio, number of school buildings assigned, Metropolitan Statistical Area, and years of school nursing experience were also investigated. The Budget Impact School Nurse Questionnaire online survey was used to gather data. Findings revealed that school nurses were well prepared academically, but that many school nurses lacked certification. The use of UAPs and the future of school nursing were significantly affected by budget constraints, delegation, number of buildings assigned, legislative contact, and Metropolitan Statistical Area (urban location). Education in delegation and years of experience as a school nurse significantly affected opportunities for health education. The findings depicted budget, school nurse staffing, delegation, and geographic areas as the main variables that have an impact on school nursing.

School Nurses’ Perceptions of Empowerment and Autonomy

The purpose of this study was to explore Kanter’s Theory of Structural Power in Organizations, using school nurses and to answer the research question of whether there is a relationship between empowerment and autonomy in school nurses. This study found a positive relationship between the nurses’ perceptions of empowerment and autonomy. The school nurses surveyed perceived themselves to have a high degree of autonomy and a moderate degree of empowerment, and they reported that their access to informal power structures was higher than their access to formal power structures in their school systems. School nurses can benefit by understanding factors that can increase their empowerment in the workplace. They need to understand the organizational structure of their workplace to increase their effectiveness and job satisfaction.

Knowledge of School Nurses in the U.K. Regarding Sexual Health Education

In the U.K., a current government health strategy indicates that school nurses should be key contributors to sexual health education because they have access to the school-age population. However, there appears to be little research that investigates whether school nurses are the most appropriate health care professionals or indeed have sufficient knowledge to contribute to this topic in the schools. The purpose of this study was to examine the sexual health knowledge of school nurses, using a survey to assess school nurses employed in a large central region of the U.K. The results suggest that although their general knowledge of the topic was adequate, school nurses have insufficient knowledge to effectively teach about sexually transmitted infections or emergency contraception. This has implications for school nursing because it appears that school nurses may have inadequate knowledge about sexual health to contribute to sex education in schools.

Parental Perceptions of the Schools’ Role in Addressing Childhood Obesity

As childhood obesity has increased, schools have struggled with their role in this epidemic. Parents with a school-age child in a suburban latchkey program were surveyed regarding their perceptions of childhood obesity, body mass index, and the school’s role in prevention and treatment of obesity. More than 80% of participants identified inactivity, poor eating behavior, lack of parental control in what children eat, and eating too much as the main causes of childhood obesity. Parents preferred receiving information about their child’s body mass index from the school via a letter from the school nurse. Participants agreed that physical education classes, as well as units on nutrition and weight control, should be present in schools. Parents also supported eliminating junk food machines and offering special low-calorie meals. By supporting these strategies, parents indicated that schools should have a role in childhood obesity. School nurses can advocate for parental preferences in their school district.

No-Nit Policies in Schools: Time for Change

No-nit policies that exist in many schools throughout the United States were established years ago based on fear and misinformation, rather than scientific evidence. Children who are found to have live lice are no more infectious on the day of diagnosis than they had been prior to the discovery. Transmission of head lice requires close personal contact, which is not common in the school setting. To date, no scientific literature exists to support the exclusion of children from school due to head lice infestation. Therefore, there is a need to develop updated school policies using research-based evidence to determine the best method of treating infestations while allowing children to remain in school.

Lack of Follow-up Exams After Failed School Vision Screenings: An Investigation of Contributing Factors

Programs to facilitate professional eye exams after failed school vision screenings often are based on the assumption that funding and access to services are major obstacles to care. Despite such programs, many children do not receive professional exams. The purpose of this study was to identify additional barriers to follow-up eye care. School nurses in an urban, mid-western public school district identified elementary school students who had not received follow-up eye exams after failed school vision screenings. Parents of these students were interviewed during the summer to determine financial, logistical, social/family, and perceptual barriers to care. Family issues, parental perceptions of vision problems, and difficulty planning ahead were found to be significant factors. Strategies to increase follow-up compliance and recommendations for overcoming barriers to care were also identified.

School Nurses’ Support for Bereaved Students: A Pilot Study

Children may have difficulty with schoolwork because of grief over the death of an important person in their lives. School nurses provide support to these children. This pilot study consisted of a Web-based survey completed by 6 school nurses in a 3-county area in Washington state. The purpose of this pilot study was to assess the need for additional support for bereaved children and the extent to which school nurses meet the needs of these students. Results indicated that many school nurses have large caseloads that preclude spending as much time with bereaved students as the nurses feel is necessary. Bereaved students exhibit a wide variety of grief symptoms that may interfere with learning. In addition, rural areas do not have adequate community bereavement resources that nurses can use to refer students who need help beyond that offered at school. Nurses must be more active in supporting students within the school setting despite limited resources.

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 Healthy Learner Model for Student Chronic Condition Management—Part I

A significant number of children have chronic health conditions that interfere with normal activities, including school attendance and active participation in the learning process. Management of students’ chronic conditions is complex and requires an integrated system. Models to improve chronic disease management have been developed for the medical system and public health. Programs that address specific chronic disease management or coordinate school health services have been implemented in schools. Lacking is a comprehensive, integrated model that links schools, students, parents, health care, and other community providers. The Healthy Learner Model for chronic condition management identifies seven elements for creating, implementing, and sustaining an efficient and effective, comprehensive community-based system for improving the management of chronic conditions for school children. It has provided the framework for successful chronic condition management in an urban school district and is proposed for replication in other districts and communities.

Implementing and Evaluating the National Healthy School Program in England

The purpose of this article is to trace development of the National Healthy School Program (NHSP) from a global concept to implementation at the local school level in England with a view toward clarifying and, more importantly, determining if implementation is proceeding as planned, as evidenced by the presence of process evaluation. The NHSP is designed to serve as a catalyst for health promotion in schools by identifying core health themes linked to evaluation principles in the whole-school approach. In this analysis, process evaluation of the NHSP whole-school approach indicates that program data are collected and recorded, but these data are not used to form an evidence-based program implementation strategy to transform the data into action. The NHSP brings valuable concepts to the global school health community that should be embraced because schools are increasingly being recognized as key settings for health promotion activities.

Comparison of Health-Related Quality of Life Among 10- to 12-Year-Old Children With Chronic Illnesses and Healthy Children: The Parents’ Perspective

The purpose of this study was to evaluate mothers’ and fathers’ perception of their child’s health-related quality of life (HRQOL) among 10- to 12-year-old Icelandic children with or without chronic health condition or illness. A total of 912 Icelandic parents (510 mothers and 402 fathers) and 480 children (209 boys and 271 girls) participated in the study. The Icelandic fathers of children who visited the school nurse over a period of 1 week perceived HRQOL of their children to be significantly lower than the mothers. A gender difference was found between the parents; mothers perceived their children to have significantly higher school functioning than fathers. Both mothers and fathers of children with chronic health condition/illness perceived their children to have significantly lower HRQOL than did the parents of children without a chronic health condition. The findings underline the importance for school nurses to develop and test interventions for school-age children with chronic health conditions or illnesses.

Data Integrity: Beware of Viruses

School nurses and health office employees are the creators and caretakers of legal documentation. School nurses have an ethical and legal obligation to protect the integrity of electronic student health records. Although there are many threats to data integrity, from inadequate hardware to electrical surges, one of the most pervasive threats to data is computer viruses. There are many precautions that can be taken to protect electronic student health data from viruses in the school health office.

Gender Differences in Health Risk Behaviors and Physical Activity Among Middle School Students

Adolescence is a period of accelerated growth and change, bridging the complex transition from childhood to adulthood. This period offers adolescents an opportunity to begin planning for their futures and to adopt healthy attitudes about risk behaviors that can continue into adulthood, thus setting the stage for a lifetime of desirable health behaviors. This study used the Youth Risk Behavior Survey on middle school students and examined the gender differences of health risk behaviors among 674 8th-graders from an urban setting. The results showed that males were more likely to be involved in fights, to initiate alcohol use, and to participate in physical activity; whereas females were more likely to try to lose weight with unhealthy practices, such as fasting and laxatives. School nurses are in a prime position to promote adolescent health in the school setting by providing health-related services and teaching to help students initiate and maintain healthy lifestyles.

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.