Implementing a School-Based Health Center Virtual Care Program: A Qualitative Exploration of the School Nurse Perspective.

BACKGROUND: School-based health centers (SBHCs) have the capability to overcome youth barriers to care. Virtual care programs (VCP) facilitate connection between school nurse and off-site SBHC providers and can increase the reach of SBHCs. This project aimed to examine Denver Public School nurses' perspectives of a pilot VCP. METHODS: Thirteen semi-structured qualitative interviews were conducted and coded using an inductive approach to identify key themes. RESULTS: Four major themes emerged: (1) obtaining consent, finding space, and capacity are challenges and nurses have suggestions; (2) nurses enjoy feeling like a valued member of a health care team, and providing additional resources to students; (3) nurses perceive benefits in providing free, efficient, higher level of care; (4) adopting novel technology is a facilitator and challenge; limitations included space and privacy. CONCLUSIONS: Key findings can be utilized to further inform practice.

Notes From the Field: Diverse Partner Perspectives Improve the Usability and Equity Focus of Implementation Guides.

Context: School-based asthma programs (SBAPs) have improved health and educational disparities among youth with asthma. Design: To support scaling out effective SBAPs, our school partners identified a need for online implementation guides that are "always available," to meet the needs of school nurses' demanding schedules. School nurses play a key role in the adoption and implementation of SBAPs, so it is important to ensure the implementation guide would be highly usable and acceptable to them. Objective: Accordingly, our research team collaborated with human-centered design experts to identify the "user journeys" of school nurses and co-created our online implementation guide as a public-facing website with input from local and national school nurse partners. Main Results: In this perspectives article, our school nurse implementation partners and human-centered design experts reflect on challenges overcome in this process of developing a tailored implementation guide to school nurses and offer lessons from the field to others seeking to co-create implementation guides with community partners.

Essential Strategies for School Nurses to Move Upstream in Support of Healthy Students and a Healthy Planet.

Human health is dependent on the health of the planet. Overwhelming evidence indicates that environmental degradation and climate change is negatively affecting planetary health and is on a worsening trajectory. The health of our children, especially those who live in poverty, suffer from chronic disease, or are otherwise disadvantaged, will benefit most from successful efforts to change this trajectory or will suffer the most if we do nothing. School nurses, members of the largest and most trusted group of healthcare providers, have a professional and ethical obligation to address environmental degradation and the impact on our students and communities. Research suggests that knowledge about climate change and the associated health impacts are positively correlated to school nurses' attitudes and behaviors. This article aims to raise school nurse awareness, understanding, and agency regarding the possible trajectories of environmental degradation, implications to the health and well-being of current and future generations of children, and evidence-based actions to positively influence the trajectory. The Framework for 21st Century School Nurse Practice™ advocates a practice model that is student centered and provides a mind-set for school nursing to approach the topic of planetary and environmental health.

Building Bridges for Asthma Care Program: A School-Centered Program Connecting Schools, Families, and Community Health-Care Providers.

Asthma imposes tremendous burden on children, families, and society. Successful management requires coordinated care among children, families, health providers, and schools. Building Bridges for Asthma Care Program, a school-centered program to coordinate care for successful asthma management, was developed, implemented, and evaluated. The program consists of five steps: (1) identify students with asthma; (2) assess asthma risk/control; (3) engage the family and student at risk; (4) provide case management and care coordination, including engagement of health-care providers; and (5) prepare for next school year. Implementation occurred in 28 schools from two large urban school districts in Colorado and Connecticut. Significant improvements were noted in the proportions of students with completed School Asthma Care Plans, a quick-relief inhaler at school, Home Asthma Action/Treatment Plans and inhaler technique (p < .01 for all variables). Building Bridges for Asthma Care was successfully implemented extending asthma care to at-risk children with asthma through engagement of schools, health providers, and families.

Building Bridges for Asthma Care: Reducing school absence for inner-city children with health disparities.

BACKGROUND: Children with asthma are at increased risk for experiencing health and educational disparities because of increased school absence. School nurses are well positioned to support asthma management and improve school attendance. OBJECTIVE: We sought to implement and assess the effect of the Building Bridges for Asthma Care Program on improving school attendance and measures of asthma control. METHODS: Children with asthma (age, 5-14 years) in the Denver Public School System (n = 240) and the Hartford Public School System (n = 223) were enrolled in the Building Bridges Program during the 2013-2014 and 2014-2015 school years and followed until the end of the second school year. The primary outcome was school absence, with secondary outcomes, including asthma control, measured based on Childhood Asthma Control Test or the Asthma Control Test scores and rescue inhaler use. RESULTS: Participants experienced a 22% absolute decrease in school absenteeism, the number of children with an Asthma Control Test/Childhood Asthma Control Test score of less than the control threshold of 20 decreased from 42.7% to 28.8%, and bronchodilator use greater than 2 times per week decreased from 35.8% to 22.9% (all changes were significant, P < .01). CONCLUSIONS: Children enrolled in the Building Bridges for Asthma Care Program experienced reduced school absence and improved asthma control.

Caring for the Student With Asthma at School: What's Out There to Help the School Nurse?

Asthma is a high impact health issue in the school setting. One in 10 children comes to school with asthma, and it is the leading cause for absenteeism causing 13.8 million missed school days each year. Where can the school nurse turn for help? The following article provides evidence-based resources to assist school nurses in caring for their students with asthma.

Competency-Based Framework and Continuing Education for Preparing a Skilled School Health Workforce for Asthma Care: The Colorado Experience.

School health teams commonly address the needs of students with asthma, which requires specific knowledge and skills. To develop a skilled school health team, a competency-based framework for managing asthma in schools was developed. A modified Delphi with 31 panelists was completed. Consensus (≥80% agreement) was reached for all 148 items regarding the appropriateness as a minimum competency for asthma care in schools. The resultant Colorado Competency Framework for Asthma Care in Schools guided the development and pilot testing of a continuing education curriculum for school nurses. Pre- and postassessments demonstrated significant improvements in knowledge and self-confidence related to asthma care in schools and inhaler technique skills. This work is the first to use a consensus process to identify a framework of minimum competencies for providing asthma care in schools. This framework informed a continuing education curriculum that resulted in improved knowledge, confidence, and skills for school nurses.

Leveraging Partnerships: Families, Schools, and Providers Working Together to Improve Asthma Management.

Asthma is one of the most common illnesses of school-aged children and can lead to both health and educational disparities. Children from low socioeconomic backgrounds and racial/ethnic minorities suffer the greatest impact. They often lack the asthma self-management skills to successfully monitor, navigate, and negotiate appropriate asthma care. School settings are a strategic point of contact for this additional support. School nurses can monitor for signs of asthma worsening, manage symptoms, provide care coordination, and reinforce self-management skills. Likewise, school-based asthma programs have the potential to reduce health and educational disparities, but it is the strong linkage to the asthma care provider that is critical to successful school-based asthma management. Healthcare providers are encouraged to establish partnerships with families through patient-centered care and schools through clear communication and care coordination to ensure asthma is well controlled so the child is in school and ready to learn.

Creating District Readiness for Implementing Evidence-Based School-Centered Asthma Programs: Denver Public Schools as a Case Study.

Asthma is a common chronic childhood disease that is associated with high rates of school absenteeism and educational disparities. Effective school-based programs exist that are able to reduce school absenteeism and the burden that asthma exacts on students. However, despite the availability of effective school-centered asthma programs conducted as research projects, many schools have struggled to implement the programs and experience their benefits. As the literature from the implementation sciences highlights, readiness of the school environment is crucial and central to success. This is an often overlooked and underacknowledged aspect to successful implementation. This article provides a case study of a large school district, highlighting its experience in preparing the district for broad-scale implementation of a school-centered asthma program.