The Journal of School Nursing recent issues

School Health Services Delivery Scholarship

Cowell, J. M. — Mon, 23 Nov 2009 15:42:25 PST

A Policy Change Strategy for Head Lice Management

Andresen, K., McCarthy, A. M. — Mon, 23 Nov 2009 15:42:25 PST

The purpose of this project was to formulate an effective change strategy for head lice management in a group of five separate school districts within one county. Despite a desire to use evidence to support their practice, school nurses often encounter educational system barriers that prevent independent management of health conditions. The use of collaborative community relationships, identification of underlying hierarchy structures in school policy development, and targeted system education were the catalysts for changing beliefs and ultimately policy within these school districts. The focus of this project was to develop a policy change strategy for head lice. The strategy provides direction for successful health policy advocacy using evidence-based practices for other health issues within the education setting.

Defining, Delivering, and Documenting the Outcomes of Case Management by School Nurses

Engelke, M. K., Guttu, M., Warren, M. B. — Mon, 23 Nov 2009 15:42:25 PST

Case management is a component of school nurse practice that provides an opportunity to demonstrate the contribution that school nurses make to the health and academic success of children, particularly children with chronic health conditions. However, case management programs vary in their mission and scope, leading to confusion about what it means to be a case manager. Many programs acknowledge the difficulty in tracking outcomes and sustaining results. Using a capacity-building approach, the Case Management Project (CMP) developed a definition of case management and a set of baseline and outcome measures to assist school nurses to become effective case managers and track their outcomes.

Weight Perception and Dieting Behavior Among Korean Adolescents

Lee, G., Ha, Y., Vann, J. J., Choi, E. — Mon, 23 Nov 2009 15:42:25 PST

This study examines relationships among weight status, weight perceptions, and dieting behaviors in South Korean adolescents. As perceptions of an ideal body for teens in Korea have changed over time, it is important for school nurses to understand these relationships to help students achieve health. A cross-sectional survey of 3,191 8th and 2,252 11th-grade students from 21 middle and high schools across Korea completed a self-administered questionnaire. The prevalence of overweight among adolescents was 17.5% in males and 6.0% in females. Overall, 65.9% of students perceived their weight status accurately. Females overestimated their weight status 2.3 times more often than males. Male students underestimated their weight status 2.7 times more frequently than females. Approximately one third of participants misperceived their weight status, with variations existing between males and females. Study results suggest the need to develop male- and female-specific interventions to promote healthy body images and body weight.

School Nurses Who Only Care for Children With Special Needs: Working in a Teacher's World

Kruger, B. J., Radjenovic, D., Toker, K. H., Comeaux, J. M. — Mon, 23 Nov 2009 15:42:25 PST

Published qualitative studies have not focused on nurses who solely care for children with special health care needs. The purpose of this study was to explore and describe (a) the work of school nurses who care exclusively for these children, (b) nurses' interaction with parents, staff, or providers, and (c) the challenges, benefits, and support for their role. Data from on-site observation and in-depth interviews with experienced, long-term employed nurses (n = 13) were analyzed using qualitative descriptive inquiry. Performing a personally satisfying clinical role, school nurses adapted to a "teachers world" by working alone, feeling responsible; begging, bartering, and subsidizing; and embracing school as family. They bridged home and school by doing for children, building relationships with parents, and knowing the child. Nurses need to be supported through peer supervision and adequate resources to provide family-centered care to students in a setting dominated by education professionals.

School Nurses' Knowledge of Autism Spectrum Disorders

Strunk, J. A. — Mon, 23 Nov 2009 15:42:25 PST

The purpose of this study was to determine school nurses' working knowledge of autism spectrum disorders (ASDs). The current knowledge of school nurses was investigated by means of a mixed-method exploratory descriptive pilot study. Instrumentation included a scale that measured the knowledge of school nurses in regard to ASD, including medication usage and side effects, communication skills, safety issues, collaboration skills, and community resources. Survey results indicated that the majority of school nurses are knowledgeable about ASD, including symptomology and related medications. Results also suggested that school nurses are not as knowledgeable concerning communication skills, behavioral therapies, and safety issues. This study confirms a need for school nurses to enhance their knowledge of ASD, to familiarize themselves with the policy and health care networks that they collaborate with, and to communicate effectively with students, parents, educators, and community members in dealing with ASD.

A Correlational Study of the Relationship Between a Coordinated School Health Program and School Achievement: A Case for School Health

Vinciullo, F. M., Bradley, B. J. — Mon, 23 Nov 2009 15:42:25 PST

The study was conducted to determine whether there is a relationship between the Coordinated School Health Program (CSHP) and student academic performance. Data were collected from schools and the community for three reports for 50 states and the District of Columbia (DC). The School Health Policies and Programs Survey (SHPPS), the National Assessment of Educational Progress (NAEP), and the U.S. Census 2000 Profile were used to study the relationships among three parameters: (a) The intervention called a CSHP: (b) Student achievement; and (c) Rate of poverty in each state. A stepwise regression analysis was conducted, controlling for poverty using state-level data. Components of a CSHP had statistically significant relationships with academic achievement. Students in states with policies promoting students' health demonstrated higher academic scores and higher rates of high school completion.

State Regulations for School Nursing Practice

Praeger, S., Zimmerman, B. — Mon, 23 Nov 2009 15:42:25 PST

The purpose of this article is to present a state-by-state summary of rules and regulations governing school nursing practice in the United States. Official government and agency sites were reviewed to determine providers of services in schools, criteria for becoming a school nurse, protection of titling, mandates for school nursing, and the requirements for continuing to practice as a school nurse. Trends were identified after verifying regulatory information. The majority of states credential school nurses for practice, with Departments of Education being the most frequent authorizing agency. Almost half (n = 23, 45%) of the states refer to the role of licensed practical nurses in the school setting. Requirements for becoming a school nurse range from licensed practical or vocational nurse (LPN) to registered nurse–bachelor of science degree in nursing with additional education and experience. Limitations related to data collection issues and implications for practice, education, and leadership are discussed.

Background Literature for Publication

Cowell, J. M. — Mon, 21 Sep 2009 13:43:43 PDT

Caring for the Student With Wolff-Parkinson-White Syndrome

Prenni, P. G. — Mon, 21 Sep 2009 13:43:44 PDT

Wolff-Parkinson-White syndrome is a cardiac condition in which an extra electrical pathway within the heart causes an abnormal increase in heart rate. It affects one to three people of every 1,000 people worldwide, occurring more often in males. Diagnosis usually occurs during young adulthood, so it is important for school nurses to be familiar with the condition. Prophylactic treatments, as well as surgical intervention to permanently block the extra pathway, are options for people with Wolff-Parkinson-White syndrome. Tachycardia associated with Wolff-Parkinson-White syndrome can occur occasionally even when prophylactic treatment is administered. School nurses must know how to properly assess and treat episodes of tachycardia that may occur in the school setting. With proper education, school nurses can help provide a safe school environment for students with Wolff-Parkinson-White syndrome and promote successful academic achievement.

Can Individualized Health Care Plans Help Increase Continence in Children With Dysfunctional Elimination Syndrome?

Boisclair-Fahey, A. — Mon, 21 Sep 2009 13:43:44 PDT

School-age children with dysfunctional elimination syndrome (DES) do not always have school support for their treatment plans, including an every 2-hr voiding schedule. The objective of this study was to increase school support of treatment plans by allowing access to bathrooms, thereby improving continence. An eight-question survey about bathroom access at schools was given to parents at baseline. The author contacted school nurses requesting that treatment plans be incorporated into individual health plans (IHPs) with teacher support of the IHP. Six weeks later, school nurses were contacted and parents completed a postintervention survey to determine whether IHPs were supported by teachers. Voiding diaries were used to document continence. Seventeen parents completed the survey at baseline, and 13 children were enrolled in the intervention. After the intervention, 100% of the children had IHPs and teacher support of treatment plans. Ninety-two percent had increased continence. IHPs improved teacher support of children’s treatment plans and improved their continence.

Mothers of Children with Special Health Care Needs: Documenting the Experience of Their Children's Care in the School Setting

Anderson, L. S. — Mon, 21 Sep 2009 13:43:44 PDT

The numbers of children with special health care needs (CSHCN) have increased in schools. This study was conducted to document mothers’ experiences of the care their CSHCN receive across health care and educational settings. Data were collected during standardized, open-ended, one-on-one interviews with 10 mothers of CSHCN in urban, suburban, and rural areas in a Midwestern state. Interviews were transcribed and content analysis revealed five themes: (a) communication, (b) educational system issues, (c) mother as a caregiver and expert, (d) navigating the system, and (e) strategies and coping. Describing and understanding experiences of mothers of CSHCN is important to developing appropriate supportive interventions.

Delegation Guided by School Nursing Values: Comprehensive Knowledge, Trust, and Empowerment

Gordon, S. C., Barry, C. D. — Mon, 21 Sep 2009 13:43:44 PDT

As health care institutions in the United States respond to shrinking budgets and nursing shortages by increasing the use of unlicensed assistive personnel (UAP), school nursing practice is changing from providing direct care to supervising activities delegated to UAP. Therefore, delegation is a critical area of concern for school nurses. The purpose of this qualitative research study was to explore values guiding the delegation of health care tasks to UAP in school settings from the perspective of the school nurse. An inquiry focus group was conducted with 64 Florida school nurses. Values guiding delegation were comprehensive knowledge, trust, and empowerment. These values provided a framework for guiding the delegation process.

The CHEER Study to Reduce BMI in Elementary School Students: A School-Based, Parent-Directed Study in Framingham, Massachusetts

Mon, 21 Sep 2009 13:43:44 PDT

Childhood obesity may be lessened by parent-focused interventions. A pilot parent-directed trial with 46 parents of overweight and obese elementary school students was conducted at two ethnically diverse public schools in Framingham, Massachusetts. Parents were randomly assigned to either the Materials Group, which received mailed educational materials, or the Materials plus Personal Encounters Group, which received educational materials through interactions with community health workers (CHWs). Parents completed baseline and post-intervention surveys; children’s body mass index (BMI) percentiles were measured at baseline and post-intervention. There were no differences in the reduction of children’s BMI between groups. However, the mean BMI percentile for all children dropped from 94.1 to 90.6 (p = .005), while there was no change in BMI among a nonrandomized contemporaneous control group. Findings are limited by the lack of a true control group and small sample size. Results from this school nurse and CHW outreach program to parents are encouraging.

Emotion Locomotion: Promoting the Emotional Health of Elementary School Children by Recognizing Emotions

Mon, 21 Sep 2009 13:43:44 PDT

Emotion recognition is a critical life skill children need for mental health promotion to meet the complexities and challenges of growing up in the world today. Five nursing students and their instructor designed Emotion Locomotion, a program for children ages 6–8 during a public health nursing practicum for an inner-city parochial school. Emotion Locomotion used an analogy that the "engine" of a train represents the "individual" and the train "cars" represent various emotions, such as happiness, sadness, calmness, and anger. Analysis of pre- and posttest scores showed an increase in appropriate student responses that involved identifying emotions from photographs and in recognition of vocabulary words representing emotions. Students' role playing during puppet shows demonstrated increased appropriate expression of emotions and healthy ways to deal with feelings during scenarios. Programs such as Emotion Locomotion present opportunities to expand the outreach of school nurses and colleges of nursing through community partnerships to provide critical life skills for student populations.

Adherence to National Asthma Education and Prevention Program's "How Asthma-Friendly Is Your School?" Recommendations

Jones, S. E., Wheeler, L. S., Smith, A. M., McManus, T. — Mon, 21 Sep 2009 13:43:44 PDT

School health policies and programs provide the framework for a safe and supportive environment for students with asthma. School Health Policies and Programs Study 2006 data were examined to assess whether schools nationwide have policies and programs consistent with the "How Asthma-Friendly Is Your School?" checklist from the National Asthma Education and Prevention Program. Adherence to some of the recommendations on the checklist was high. For example, 80% or more of schools allowed students to carry and self-administer asthma medications, and obtained and kept asthma action plans. For other recommendations, however, far fewer schools had the recommended polices or programs; most notably, less than one third of schools had a full-time Registered Nurse. Improvements in many school policies and programs are needed so that students have a safe and supportive school environment to help them control their asthma while away from home.

Starting the School Year

Cowell, J. M. — Thu, 23 Jul 2009 12:03:52 PDT

Vision, Voice, Visibility

Delack, S. — Thu, 23 Jul 2009 12:03:52 PDT

History and Expansion of Section 504 Student Eligibility: Implications for School Nurses

Zirkel, P. A. — Thu, 23 Jul 2009 12:03:52 PDT

This article presents an explanation of the eligibility criteria for K-12 students under Section 504 and its sister statute, the Americans with Disabilities Act (ADA). The explanation shows the evolving application of Section 504 to students in terms of three phases: awareness, constriction, and expansion. The latest phase, expansion, started with the January 1, 2009, effective date of the ADA Amendments (ADAA), which dramatically reversed the previous phase of judicial constriction of the eligibility criteria. The changes affect two of the three criteria in the definition of disability under Section 504 and the ADA: (a) an expanded list of illustrations of "major life activities" and (b) much less restrictive standards for interpreting "substantially limits." As a result, the school nurse plays a more critical role as a member of or consultant to the school teams that determine student eligibility for and the contents appropriate in 504 Plans.

Understanding HPV Disease and Prevention: A Guide for School Nurses

Lockwood-Rayermann, S., McIntyre, S. J. — Thu, 23 Jul 2009 12:03:52 PDT

Oncogenic human papillomavirus (HPV) causes 99.7% of all cervical cancers. HPV Types 16 and 18 are responsible for approximately 77% of cases, and peak prevalence occurs in females younger than 25 years of age. The recent implementation of HPV vaccination provides females with the opportunity to prevent infection. School nurses are advocates of student health and often a primary source of information. Therefore, they can play a key role in promoting vaccination prior to sexual debut. They can also promote regular cervical screening postvaccination, which may not be apparent to many students and parents. To deal with such issues, school nurses need a firm understanding of HPV and its role in cervical cancer. A greater understanding of HPV disease and prevention among school nurses, students, and parents may lead to greater reductions in the burden of cervical and other HPV-related diseases.

Caring for Student-Athletes Following a Concussion

Piebes, S. K., Gourley, M., Valovich McLeod, T. C. — Thu, 23 Jul 2009 12:03:52 PDT

The school nurse plays a dynamic role in the care and treatment of a concussed athlete. Concussions in the adolescent populations are of special concern due to their potential impact on mental development and cognitive function, as well as an increased risk of serious complications including second impact syndrome. The complexity of a concussion requires collaboration between of a variety of health care and school personnel to create an optimal situation for the student-athlete and their family. As the primary health care provider for students during the school day, school nurses can help ensure all necessary steps are taken to aid the recovery of an injured student-athlete. It is important that school nurses are up-to-date on current concussion information to allow for optimal care following injury and during the recovery process.

Population-Based Estimates of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Among High School Athletes--Nebraska, 2006-2008

Buss, B. F., Mueller, S. W., Theis, M., Keyser, A., Safranek, T. J. — Thu, 23 Jul 2009 12:03:52 PDT

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of skin and soft-tissue infections among athletes. To determine statewide incidence among high school athletes, we surveyed all 312 Nebraska high schools regarding sport programs offered, program-specific participation numbers, number of athletes with physician-diagnosed MRSA infections, and athlete’s sport at infection onset. Among 271 (86.9%) schools responding, MRSA infections were reported among one or more athletes by 4.4% (12/270) and 14.4% (39/271) during school years 2006–2007 and 2007–2008, respectively. From 2006–2007 to 2007–2008, MRSA incidence per 10,000 wrestlers increased from 19.6 to 60.1, and incidence per 10,000 football players increased from 5.0 to 25.1. We did not identify differences in distribution of MRSA infections on the basis of grade, school enrollment, location, or number of participants per team. Incidence of reported MRSA infections among football players and wrestlers was substantially higher during 2007–2008, compared with 2006–2007.

Part II--Factors Associated with School Nurse Ratios: Key State Informants' Perceptions

Maughan, E. — Thu, 23 Jul 2009 12:03:52 PDT

This paper is the second of a two-part series examining factors influencing school nurse to pupil staffing ratios. The paper reports data from a qualitative study exploring the social and political factors that potentially influence ratios. Interviews were conducted with 30 key state informants from these states. Content analysis of the data identified common themes. Positive factors reported to influence ratios included: the approach taken to effect change, value placed upon school nurses, local support (from both educators and parents) and community buy-in, fear of litigation, and dynamic leadership. Barriers to improving ratios included: lack of funding and misunderstanding of the role of the school nurse. Philosophical beliefs and state geography were "swing" factors that influenced staffing positively or negatively. This study adds to our knowledge of the factors influencing staffing and highlights important social and political factors that school nurses can target to improve nurse to pupil ratios.

Use of Evidence-Based Practice in School Nursing: Survey of School Nurses at a National Conference

Adams, S. — Thu, 23 Jul 2009 12:03:52 PDT

Primary and acute care settings are the focus of a concerted effort to implement evidence-based practice (EBP) in health care; yet, little attention has been given to use of EBP among school nurses. The aims of this study were to (a) describe current use of EBP among school nurses attending a national school nurse conference, (b) describe demographic, individual, and organizational factors associated with EBP use, and (c) identify resources needed to enhance EBP use. A survey designed for this study was distributed during a national school nurse conference. Descriptive statistics, correlations, and independent t tests were used to analyze respondent data regarding the current level of EBP use, awareness, skills, and information sources. Respondents also identified resources needed to increase use of EBP, which included networking opportunities, predeveloped EBP guidelines, and education on outcome evaluation. The results from this study will be used to develop strategies to increase the use of EBP in the school setting.

Applying Findings to Practice

Praeger, S. — Thu, 23 Jul 2009 12:03:52 PDT

The Future of The Journal of School Nursing

Denehy, J. — Tue, 12 May 2009 08:40:32 PDT

The Integration of Children Dependent on Medical Technology Into Public Schools

Raymond, J. A. — Tue, 12 May 2009 08:40:32 PDT

Advances in medicine have increased the survival rates of children with complex medical conditions, including those who are dependent on technology such as ventilators and tracheostomies. The process of integrating children dependent on medical technology into public schools requires the collaboration of a multidisciplinary team to ensure that both their educational and health care needs are met. As coordinator of the school health program, the school nurse plays a vital role throughout the integration process and during the time the student is enrolled in the school. This article presents a case study that demonstrates the steps in the integration process, the roles of the team members, and implications for school nursing practice.

The Behavioral Ecological Model as a Framework for School-Based Anti-Bullying Health Promotion Interventions

Dresler-Hawke, E., Whitehead, D. — Tue, 12 May 2009 08:40:32 PDT

This article presents a conceptual strategy which uses the Behavioral Ecological Model (BEM) as a health promotion framework to guide school-based bullying awareness programs and subsequent anti-bullying strategies for school nursing practice. Anti-bullying frameworks and tools are scarce despite the extent of the problem of bullying. This article reviews existing literature centered on the BEM and illustrates how the model can be applied to the school-setting. This is the first time that a multilevel framework has been proposed for school-based anti-bullying in the form of a model. The BEM is a useful tool for assisting in the development of more comprehensive programs to influence anti-bullying intervention in school-based nursing practice.

Evaluating Parent Satisfaction of School Nursing Services

Read, M., Small, P., Donaher, K., Gilsanz, P., Sheetz, A. — Tue, 12 May 2009 08:40:32 PDT

The Conceptual Model of Nursing Health Policy (CMNHP) was used to guide this study of client satisfaction as one component of an ongoing assessment of the Essential School Health Service (ESHS) Programs conducted by the Massachusetts Department of Public Health. Random samples of parents/guardians of students who use the school nursing services were surveyed to determine the extent to which they were satisfied with school nursing services. The results indicate that parents/guardians have a high level of satisfaction with school nursing services. Mean rank satisfaction scores of parents of children with special health care needs were significantly higher then those parents of children without special health care needs. School nurses were encouraged to share the results of the study with various stakeholders in their school district.

Part 1--Factors Associated with School Nurse Ratios: An Analysis of State Data

Maughan, E. — Tue, 12 May 2009 08:40:32 PDT

Despite the recognized importance of school nurses, the ratios of nurse to pupil are insufficient in many states across the country. The purpose of this study was to describe school nurse-to-pupil ratios by state and to statistically identify factors that may influence these ratios. Funding per pupil unit in general and support services and laws mandating school nurse ratios were some of the factors found to be associated with school ratios. Although the study has significant limitations, this is the first study of its kind to examine factors associated with ratios using secondary databases that are state-specific. Data such as this provide a context for studying those factors potentially influencing ratios. Further studies are needed to explore the numerous potential determinants described in the literature. Once key factors are identified, school nurses can effectively focus their efforts to lower school nurse-pupil ratios.

Southeast Asian Parents Raising a Child With Autism: A Qualitative Investigation of Coping Styles

Luong, J., Yoder, M. K., Canham, D. — Tue, 12 May 2009 08:40:32 PDT

Autism is a developmental disability increasing in incidence over the past decade. Parents of children with autism experience prolonged levels of stress and isolation. Using qualitative research design, nine parents of children with autism participated in this study that focused on the effect of autism on the family, coping styles, and support systems. The target population was first-generation Southeast Asian American parents. Results revealed nine coping style patterns: (a) denial/passive coping, (b) empowerment, (c) redirecting energy, (d) shifting of focus, (e) rearranging life and relationships, (f) changed expectations, (g) social withdrawal, (h) spiritual coping, and (i) acceptance. The school was considered the primary supportive entity. Although findings may not be unique to the Southeast Asian group, the research provides an in-depth perspective on their lived experience, their struggles, and strengths. Insight gained from this investigation can help school nurses better understand the affect of autism on families, identify specific needs, and address these needs by advocating for appropriate supportive programs.

Childhood Obesity Study: A Pilot Study of the Effect of the Nutrition Education Program Color My Pyramid

Tue, 12 May 2009 08:40:32 PDT

The need for successful nutrition interventions is critical as the prevalence of childhood obesity increases. Thus, this pilot project examines the effect of a nutrition education program, Color My Pyramid, on children’s nutrition knowledge, self-care practices, activity levels, and nutrition status. Using a pretest–posttest, quasiexperimental design, 126 fourth- and fifth-grade students from experimental and control schools are compared. The intervention program incorporates an online component www.MyPyramid.gov, Orem’s Self-Care Deficit Nursing Theory, and consists of six classes taught over a 3-month period. Results indicated that the program increased nutrition knowledge in the control group. Furthermore, it increased activity time from pretest to posttest and decreased systolic blood pressure for children in both groups; however, there were no significant differences in BMI percentiles. The findings indicate that Color My Pyramid can be successfully employed in school settings and thus support school nursing practice.

Applying Findings to Practice

Praeger, S. — Tue, 12 May 2009 08:40:32 PDT