Process and outcomes of school nurse case management for students with asthma.

There have been many studies that have examined the impact of school-based asthma programs on students with asthma. However, most studies do not provide adequate elaboration on the components of the program. Therefore, replication of these programs is difficult. This study examines the process of school nurse case management, which includes the development of individualized goals and the provision of specific interventions. The process is then linked to several outcomes (parent perception, quality of life, and academic success). The study demonstrates the complexity of case management provided by school nurses and how goal attainment is related to the outcomes. The study supports policy recommendations that advocate for the importance of professional school nurses in improving the health and well-being of students with asthma.

School nurse evaluations: making the process meaningful and motivational.

The professional standards of school nursing practice provide a framework to help school nurses focus on their unique mission of promoting health and academic achievement for all students. Without the standards, the nurse's role can become task oriented and limited in scope. By using an evaluation tool that reflects the standards, nurses not only become aware and begin to understand the standards; they also become directly accountable for meeting them. In addition, developing an evaluation process based on the standards of school nurse practice increases the visibility of school nurses and helps school administrators understand the role of the school nurse. This article describes how one school district integrated the scope and standards of school nursing into the job description and performance evaluation of the nurse. The process which is used to complete the evaluation in a manner that is meaningful and motivational to the school nurse is described.

School nurses and children with diabetes: a descriptive study.

BACKGROUND: Managing diabetes in children is complex. The aims of this descriptive study were to describe the care provided to children with diabetes by school nurses using case management, to identify differences in care on the basis of the workload of the nurse and the age of the child, to explore the role of the nurse in responding to emergencies, and to describe the relationship between case management and quality of life. METHODS: School nurses completed an expanded health assessment. Individualized goals were established and interventions were provided on the basis of a protocol. Quantitative and qualitative data for children enrolled during the 2009-2010 academic year were analyzed. RESULTS: Eighty-six children were enrolled. The most common goals were related to establishing a safe school environment. Interventions varied depending on the workload of the nurse and the age of the child. Nurses assigned to 1-2 schools provided more intervention days (mean, 40.3 days) than did nurses assigned to 3-4 schools (mean, 24.4 days) (P < .05), particularly in the area of direct care. A total of 25 students experienced an emergency at school that initiated a cascade of events involving the parent (in 100% of cases), the teacher (in 96%), management of hyperglycemia (in 100%), and/or management of hypoglycemia (in 96%). For teens, case management improved quality of life, particularly the ability to communicate with health professionals. LIMITATIONS: The sample was small, and there was no comparison group. CONCLUSIONS: School nurses are effective in using case management to enhance the health and well-being of children with diabetes. This study should be replicated with a larger sample, a comparison group, and the inclusion of clinical outcomes.

Does the school nurse-to-student ratio make a difference?

Public schools must provide an appropriate education for students with complex health needs. Chronic illnesses such as asthma and diabetes, social morbidities, injuries, and conditions that limit learning such as poor vision commonly affect school-aged children. School nurses often assume a leadership role in providing services for these children. However, although a national standard for school nurse/student ratio has been proposed, little research has examined the relationship between different school nurse-to-student ratios, level of health services provided in schools, and student outcomes. This study examined data in a 21-county region in eastern North Carolina served by a regional school nurse consultant. The school nurse-to-student ratio in these counties ranged from 1:451 to 1:7,440 based on full-time equivalencies. Two systems offered no school nursing services. Data from school years ending in 2000-2002 were considered in the analysis. A significant correlation was found between the increased presence of school nurses and services provided to children with diabetes (r = -.52, p = .000) and asthma (r = -.43, p = .002). Schools with better ratios provided more counseling services to children for social conditions such as depression and unintended pregnancy (r = -.38, p = .006), and more follow-up for school-related injuries (r = -.43, p = .003), and a higher percentage of children with vision problems received follow-up care (r = -.37, p = .007). A case analysis of one school district that experienced a significant improvement in nurse/student ratio over the study period provides further evidence that school nurses make a difference.

Defining, delivering, and documenting the outcomes of case management by school nurses.

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.

School nurse case management for children with chronic illness: health, academic, and quality of life outcomes.

More children with chronic illnesses are attending school, and some of them struggle academically because of issues related to their health. School-based case management has been suggested as one strategy to improve the academic success of these children. This study tracked the academic, health, and quality of life outcomes for 114 children with asthma, diabetes, severe allergies, seizures, or sickle-cell anemia in 5 different school districts who were provided case management by school nurses. The children ranged in age from 5 to 19 years. At the end of the school year, children experienced an improvement in quality of life and gained skills and knowledge to manage their illness more effectively. Classroom participation, grades, and participation in extracurricular activities also increased for many children. The study provides evidence of the positive impact school nurses have on children with chronic illness and suggests ways they can measure the outcomes of their interventions.

North Carolina School Nurse Leadership Institute.

Recognizing that school nurse leaders are essential to the development of school nurses, the North Carolina School Nurse Leadership Institute was developed to enable school nurse leaders to update and advance their leadership skills. The Institute was a collaborative endeavor between the North Carolina Department of Health and Human Services, Eastern Area Health Education Center, and East Carolina University School of Nursing. School nurse leaders were empowered to assume a role in public policy, and they were provided opportunities to network with leaders in other counties throughout the state. A combination of face-to-face and asynchronous discussion via the Internet was used to foster continuous rather than episodic learning. Participant evaluations were positive and indicated a significant increase in learning in key areas.