Increasing teachers' confidence during health emergencies: A hands-on quality improvement program led by the school nurse.

INTRODUCTION: One in four school-age children has a chronic health condition, with approximately 6% of them having multiple chronic health conditions. These students are at an elevated risk of individual health emergencies during school hours. While teachers receive online training to assist in these emergencies, they lack practicing with rescue medications. METHODS: We developed a Quality Improvement (QI) program that had a) a live presentation; b) a hands-on workshop to practice using rescue medications for allergies, asthma, seizures, and diabetes; c) fliers with first-aid guidelines; and d) a web-based reference toolkit. Teachers' confidence and knowledge were measured using the Learning Self-Efficacy Scale and a knowledge questionnaire with a pre- and post-intervention survey. We also assessed their clinical skills using the rescue medications. RESULTS: 129 teachers took part in this QI program. We collected 95 pre- and 81 post-surveys, with 47 matched. We saw statistically significant increases in confidence, as well as in the individual cognitive, affective, and psychomotor domains. Teachers also increased their overall knowledge. Collaterally, other district-wide improvements developed. CONCLUSION: This evidence-based, hands-on QI program provided teachers the opportunity to put into practice clinical skills, increasing their confidence to help students when experiencing an individual health emergency. Furthermore, changes beyond the primary goal of this QI program were implemented, highlighting the lead role of the registered nurse as the public health advocate. IMPLICATION TO PRACTICE: Laypeople benefit from hands-on training to learn clinical skills. This program serves as a basis for improving health emergencies preparedness in schools.

Learning from the Past and Moving Forward: Implementing School Nursing Research Priorities.

The editorial "School nursing research and research implementation priorities," highlights how the National Association of School Nurses (NASN) research priorities are crucial to moving school nursing and school health research forward. In this editorial we echo the importance of school nurses reading and understanding published articles in The Journal of School Nursing and contributing to research that informs school nursing practice. Each of the NASNs research priorities is vital to the science supporting school nursing practice. We encourage school nurses and researchers, and implementation scientists to partner to contribute school nursing evidence that guides the specialties' practice and informs policy to positively impact student health and education outcomes.

Smoothing the Way Into School Nursing Practice.

Role transition can be a struggle for new or seasoned nurses moving into the specialty of school. School nursing, a specialized field that entails a scope of practice and competencies very different from other settings, is not taught in many primary nursing education programs. New nurses may find themselves unprepared for their role without a proper orientation, causing them to feel anxious and not ready to care for students properly, leading to attrition. This article describes the barriers and facilitators to smooth role transition and provides evidence-based orientation strategies for new school nurses.

School Nurses on the Front Lines of Healthcare: The Approach to a Student With Anxiety and Posttraumatic Stress Disorder.

Mental illness is common, and its severity ranges from subclinical to severe, where the condition affects daily social and academic functioning. Because of its ubiquity, it is necessary that school nurses have an enhanced understanding of some of the mental health conditions that children and adolescents may be facing. As will be discussed, some mental health concerns present with somatic symptoms that may bring the student into the school nurse's office. If the nurse identifies mental health symptoms, he or she may be able to intervene, provide support, and direct the student for further management if necessary. This article will focus on anxiety in general before focusing on specific anxiety disorders, including posttraumatic stress disorder. We will begin by defining these conditions and then move into discussing potential present-day stressors, such as fear and anxiety associated with the recent coronavirus disease 2019 pandemic, and screening tools before closing with some suggestions for practice and a case wrap-up.

Effectiveness of an Evidence-Based Practice Educational Intervention among School Nurses.

The evidence-based practice (EBP) approach to high-quality care is designed to improve patient outcomes. However, little research has been conducted to determine how EBP is adopted and implemented among school nurses in Taiwan. This study evaluated an EBP training program implemented among school nurses in Taiwan to determine whether and how effectively it improved their knowledge levels, attitudes, skills, and self-efficacy. A pretest-posttest research design was employed. Participants were recruited via convenience sampling from among 193 primary schools throughout Tao-Yuan and New Taipei City in Taiwan. The EBP program implemented both mobile learning technology and the flipped classroom format. The learning outcomes were evaluated before, immediately after, and at a 3-month follow-up. In this regard, the data were collected using the School Nurse Evidence-Based Practice Questionnaire. The results showed that the participant scores for the items of knowledge and self-efficacy significantly increased over the study period. Somewhat differently, scores for the skill items significantly increased from the pre-test to the immediate post-test, but significantly decreased from the immediate post-test to the final follow-up. Overall, however, the EBP program led to marked improvements in knowledge, skills, and self-efficacy. These findings can help guide the development of a creative evidence-based school nursing curriculum.

School-Based Health Care.

School-based health care encompasses a variety of health care professionals and practice models, including school nursing, school-based health centers, and school-based mental health programs. Services can be delivered in person or via telehealth. School-based health care is an important mechanism for removing barriers to health care services and for reaching adolescent patients. This article illustrates the various models of school-based health care, the particular benefit of school-based health care for adolescents, and opportunities and challenges in maintaining and sustaining a school-based health program.

Data and Information Literacy: A Fundamental Nursing Competency.

Nurses in the 21st-century are expected to be data and information literate and proficient in data management. Nurses graduating from baccalaureate programs must be able to use computers and information systems and apply data and evidence to inform practice. Those competencies are also essential for the entire nursing workforce. That puts the onus on school nurses, school nurse supervisors, school districts, and state affiliates to take responsibility for comprehensive data and information literacy professional development. Fortunately, the National Association of School Nurses (NASN) has anticipated the needs of the membership. NASN included data and information capacity building as a part of The National School Health Data Set: Every Student Counts!, a national standardized data set and data collection initiative.

Advocating for Students and School Nursing: NASN Contributions to the Future of Nursing 2020-2030.

The Future of Nursing (FON) 2020-2030 will be an important roadmap for advancing the profession of nursing. The final FON document is meant to address nursing as a whole-not specific specialties-as well as address changes needed in the entire healthcare system that would facilitate patient safety and care. To ensure inclusion of the needs of school-age children and nurses employed outside the traditional hospital setting in the proceedings, the NASN offered comments at the first public meeting of the Committee on the Future of Nursing in March 2019 (Figure 1) and followed the other town hall meetings carefully. NASN submitted the following observations and suggestions in the form of a memo to the FON 2020-2030 Committee for consideration in the final report.

A Statewide Cross-Sectional Survey of School Nurses' Knowledge and their Role in the Management of Concussed Students.

The school nurse plays a vital role in reintegrating the concussed student into the academic environment. The objective of our survey study was to understand the self- reported level of knowledge of school nurses regarding the diagnosis and management of patients presenting with symptoms of concussion, what responsibilities they have to the concussed student, and to identify the educational resources used. We had a 91.7% response rate and found that most school nurses did not learn about concussions in nursing school; 85% used the CDC HEADS UP website as their educational resource, and the majority reported their knowledge level as fair and wanted more information. Furthermore, 81% took care of at least one concussed student during the past 3 months, 78% had managed the return-to- learn protocol, and 40% managed the return-to-play protocol. Areas for improvement are highlighted and preferred methods to educate were surveyed.

Rapid E-Learning for professional development in school-based diabetes management.

The number of school aged youth in the United States requiring assistance in the management of diabetes has reached over 200,000. School nurses are often charged with the training of personnel and provision of assistance to children with this chronic disease. The need for quick, efficient, and accessible training methods is necessary to ensure school nurses have the most current information necessary to perform their duties. The purpose of this study was to assess the effectiveness of a rapid e-learning module for school nurse professional development in school-based diabetes management. A sample (N = 1977, n = 1127) of school nurses was asked to complete a module addressing current and/or changing information on diabetes management, the training of staff charged with assisting students, and the associated pre- and post-tests for the module. A total of 678 nurses completed the pre-test, while 449 nurses completed the post-test. T-test results for independent samples indicated a significant increase (p < 0.001) in knowledge at post-test. Results support the contention that e-modules are a convenient and effective way to provide professional development opportunities and improve nurses' knowledge.

Equipping School Health Personnel for Diabetes Care with a Competency Framework and Pilot Education Program.

BACKGROUND: Schools struggle to support health needs of students with diabetes due to limited funding/resources. A competency framework can help individual schools clarify the knowledge and skills required for school-based diabetes care within their unique context, and inform the development of standardized diabetes education for health staff. METHODS: A consensus-building technique, known as the Delphi method, was used to create a competency framework for diabetes care at school with a panel of 37 stakeholders. A continuing education program based on the resultant framework was developed and pilot-tested with school nurses. Pretest and post-test scores on knowledge, perceived competence, and self-efficacy were compared to evaluate the effectiveness of the program. RESULTS: Consensus was obtained for a total of 70 competencies: 22 competencies for health aids, 36 additional competencies for school nurses, and 12 additional competencies for diabetes resource nurses. Thirty school nurses completed the continuing education program and demonstrated significant improvement in diabetes knowledge, self-efficacy, and competence in pathophysiology and diabetes care tasks (p < .01 for all). CONCLUSIONS: Developing a consensus framework is an excellent starting place for stakeholders to identify the skills and knowledge required for various school personnel and to ensure that all school health staff members receive adequate diabetes education.

The Mental Health Training Intervention for School Nurses and Other Health Providers in Schools.

School nurses encounter many students presenting with mental health needs. However, school nurses report that they need additional training and resources to be able to support student mental health. This study involved a multilevel, stakeholder-driven process to refine the Mental Health Training Intervention for Health Providers in Schools (MH-TIPS), an in-service training and implementation support system for school health providers, including school nurses, to increase their competence in addressing student mental health concerns. Findings highlighted the importance of mental health content including assessment, common factors of positive therapeutic mental health interactions, common elements of evidence-based mental health practice, and resource and referral mapping. Additionally, multifaceted ongoing professional development processes were indicated. Study findings indicate that, with recommended modifications, the MH-TIPS holds promise as a feasible, useful intervention to support school nurse practice and ultimately impact student mental health and educational outcomes.

Impact of Education on School Nurses' Knowledge of Inflammatory Bowel Disease.

Background/Aims: School nurses' knowledge of inflammatory bowel disease (IBD) has not been evaluated. We aimed to investigate school nurses' knowledge of IBD and determine whether education could improve this knowledge. Methods: School nurses were invited to complete self-reported questionnaires on IBD. Then, IBD specialists from tertiary referral hospitals provided a 60-minute lecture with educational brochures on two occasions, with a 3-month interval. Within 6 months after the educational interventions, school nurses were asked to complete the same IBD questionnaire via e-mail. Results: Among 101 school nurses who were invited to participate, 54 nurses (53.5%) who completed two consecutive questionnaires were included in this study (median age, 45 years; range, 25 to 59 years; 100% female); 11.1% and 7.4% of the study participants had no knowledge regarding ulcerative colitis and Crohn's disease, respectively. They had heard of IBD most frequently from doctors (33.3%), followed by internet sources (25.9%). After 6 months, the number of nurses who could explain IBD to students with over 30% confidence increased from 24 (44.5%) to 42 (77.8%) (p＜0.001). Most nurses (81.5%) reported that the educational intervention was helpful for managing students with abdominal pain or diarrhea. The number of students who received IBD-related welfare services from the Daegu Metropolitan Office of Education doubled when compared with the corresponding number during the prior educational year. Conclusions: There is room for improvement in school nurses' knowledge of IBD. A systematic educational program on IBD should be implemented for these nurses.

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.

A nursing student's reflective account of decision-making in a school nursing setting.

Reflection is integral to professional revalidation and enhancing nursing practice; it is an art and a science to be learned. Learning the art of reflection begins as a student in clinical placement settings. Drawing on a reflective model, this article presents an account of one second-year children's nursing student's experiences in a community-based placement with a school nursing team. A school nurse appointment was reflected on where advice was offered to a 13-year-old student with sleep difficulties, low affect and lethargy, which included avoiding caffeinated drinks, reducing use of a laptop and mobile phone before going to sleep, and establishing a regular bedtime routine. Providing nursing care to this young person enabled the nursing student to improve their decision-making skills, become more self-aware, increase their confidence when communicating with a patient and reinforce the importance of applying theory to practice.