Identification of Workload Measurement Indicators for School Nursing Practice.

Many school districts rely on caseload or student to school nurse ratios that are not grounded in evidence-based research. There is a need for a comprehensive workload instrument to describe the work of school nurses that incorporates the complexities of the role and includes acuity, care processes, and social determinants of health. The purpose of this qualitative study was to identify workload activities from a previous Delphi study that can be empirically measured as items for a workload instrument. A nationally representative sample of 27 school nurses participated in four focus groups, describing activities important to the measurement of workload. Focus group input resulted in identification and confirmation of workload activities that impact school nurse workload. Use of the National Association of School Nurses' Framework for 21st Century School Nursing Practice™ was integral in capturing gaps and important workload activities for a potential workload instrument.

Factors Related to School Nurse Workload.

Recognizing the need for a school nurse workload model based on more than the number of students in a caseload, the National Association of School Nurses issued recommendations related to measuring school nurse workload. Next, a workforce acuity task force (WATF) was charged with identifying the steps needed to further the recommendations. As a first step, the WATF focused on identifying existing literature and practices related to school nurse workload. The purpose of this article is to synthesize and categorize the factors that were identified, delineate sources for collecting and retrieving these factors, and make recommendations for clinicians and researchers interested in developing instruments to measure school nurse workload.

The use of change theory to facilitate the consolidation of two diverse Bachelors of Science in Nursing programs.

BACKGROUND: Consolidation of resources, programs, and even universities are measures that university systems consider for economic reasons. The transformation and restructuring of two diverse nursing programs utilized an organizational change tool to guide the consolidation efforts. PURPOSE: Insights on how to use an organizational change model and lessons learned are shared for higher education units that may face consolidation. METHODS: The ADKAR Change Management Model, one of many organizational change resources, was advantageous in consolidating two diverse nursing programs when two universities were mandated to become one. CONCLUSIONS: Change is inevitable yet when faced with transition and transformation, thoughtful and strong, committed leaders who portray open transparent communication are an absolute requirement for sustained change. To guide the process, the ADKAR Change Management Model is an insightful and worthwhile resource.

Development of an International School Nurse Asthma Care Coordination Model.

AIM: To identify and compare how school nurses in Reykjavik, Iceland and St. Paul, Minnesota coordinated care for youth with asthma (ages 10-18) and to develop an asthma school nurse care coordination model. BACKGROUND: Little is known about how school nurses coordinate care for youth with asthma in different countries. DESIGN: A qualitative descriptive study design using focus group data. METHODS: Six focus groups with 32 school nurses were conducted in Reykjavik (n = 17) and St. Paul (n = 15) using the same protocol between September 2008 and January 2009. Descriptive content analytic and constant comparison strategies were used to categorize and compare how school nurses coordinated care, which resulted in the development of an International School Nurse Asthma Care Coordination Model. FINDINGS: Participants in both countries spontaneously described a similar asthma care coordination process that involved information gathering, assessing risk for asthma episodes, prioritizing healthcare needs and anticipating and planning for student needs at the individual and school levels. This process informed how they individualized symptom management, case management and/or asthma education. School nurses played a pivotal part in collaborating with families, school and healthcare professionals to ensure quality care for youth with asthma. CONCLUSIONS: Results indicate a high level of complexity in school nurses' approaches to asthma care coordination that were responsive to the diverse and changing needs of students in school settings. The conceptual model derived provides a framework for investigators to use in examining the asthma care coordination process of school nurses in other geographic locations.

School Health Services for Children With Special Health Care Needs in California.

Children with special health care needs (CSHCN) are at risk for school failure when their health needs are not met. Current studies have identified a strong connection between school success and health. This study attempted to determine (a) how schools meet the direct service health needs of children and (b) who provides those services. The study used the following two methods: (a) analysis of administrative data from the California Basic Educational Data System and (b) a cross-sectional online survey of 446 practicing California school nurses. Only 43% of California's school districts employ school nurses. Unlicensed school personnel with a variety of unregulated training provide school health services. There is a lack of identification of CSHCN, and communication barriers impair the ability to deliver care. Study results indicate that California invests minimally in school health services.

The development and implementation of an interdisciplinary on-line academic course using a life course perspective.

The University of Wisconsin-Madison Pediatric Pulmonary Center (UW PPC) provides interdisciplinary leadership training for graduate students and postgraduate professionals. The training includes a three-credit on-line course entitled Interdisciplinary Care of Children with Special Health Care Needs. This paper describes the course, the content and organization of which was guided by the life course perspective (LCP). The UW PPC team used the LCP to guide course organization, content development, and evaluation approaches. UW PPC trainees took responsibility for content areas, performed literature reviews and reviews of resources, and suggested student activities. Course content was focused on the child with special health care needs (CSHCN) embedded in contextual environments of family, community, culture, and larger social and public policy arenas. The content included three case-study videos that followed a child with cystic fibrosis from birth to age 18. Key concepts of the LCP were woven in throughout the videos and other course materials. Emphasis was on representing development of the individual during critical/sensitive periods and on social determinants of health. At semester's end, qualitative and quantitative student evaluation results were very positive for all areas of the course. The final course paper, organized similarly to course modules, synthesized all aspects of the course. A successful paper included LCP concepts woven throughout to show integration of course content. The LCP provided a useful framework for course organization and content, and served as a lens through which students came to understand the care needs of CSHCN and their families. A course such as this can serve the important goal of educating future maternal child health professionals in using the LCP to understand how multiple determinants of health interact across the life span to produce health outcomes in this population.

The international school nurse asthma project: barriers related to asthma management in schools.

AIM: This article is a report of an international study of barriers to asthma care from the perspectives of school nurses in Reykjavik, Iceland and St. Paul, Minnesota, in the context of their schools, communities and countries. BACKGROUND: Globally, asthma affects the health and school performance of many adolescents. School nurses play a key role by providing care to adolescents with asthma in school settings. Understanding universal barriers to asthma management in schools is important for developing interventions that are effective in multiple societal contexts. DESIGN: Exploratory, descriptive study. METHODS: Parallel studies were conducted from September 2008-January 2009, through six focus groups among school nurses (n = 32, in Reykjavik n = 17 and St. Paul n = 15) who were managing asthma in adolescents. Focus groups were audio-recorded and transcribed verbatim in English or Icelandic. The Icelandic transcripts were translated into English. Descriptive content analytic techniques were used to systematically identify and categorize types of barriers to asthma care. RESULTS: School nurses in both countries identified common barriers, such as time constraints, communication challenges and school staff barriers. The primary difference was that St. Paul school nurses identified more socio-economic and health access barriers than school nurses in Reykjavik. CONCLUSION: Greater cultural and linguistic diversity and socio-economic differences in the student population in St. Paul and lack of universal healthcare coverage in the US contributed to school nurses' need to focus more on asthma management than school nurses in Reykjavik, who were able to focus more on asthma prevention and education.

Education and information for practicing school nurses: which technology-supported resources meet their needs?

School nurses care for children with a variety of health-related conditions and they need information about managing these conditions, which is accessible, current, and useful. The goal of this literature review was to gather and synthesize information on technology-supported resources and to determine which met the educational needs of school nurses. Successful online educational programs were interactive and self-directed. The most common barriers were lack of time to find educational information, lack of knowledge about computers, technology, the Internet and specific programs, and lack of administrative support from school officials to use technology to access information and evidence for practice. Recommendations for successful use of technology to meet practicing school nurse's educational needs are offered.

Predictors of parenting stress in a diverse sample of parents of early adolescents in high-risk communities.

BACKGROUND: Parenting stress is associated with negative parenting practices, which have been linked to increased youth health risk behaviors. It is important, therefore, to understand the most salient contributors to parenting stress in families who live in communities considered at high risk of the development of youth problem behaviors. OBJECTIVE: On the basis of a model derived from the model of parenting stress of R. R. Abidin (1995), the contributions to parenting stress of child factors (age, social skills, and problem behaviors), parent factors (gender, health, and race or ethnicity), and contextual factors (family structure, conflict, social support, education, and income) were explored. METHODS: A secondary data analysis using bivariate correlations and multiple and hierarchical regression was conducted to identify the relative influence of these factors on parenting stress in a national sample of 824 parents (primarily mothers, those from racial or ethnic minorities, and those who have low income) of adolescents aged 10-18 years. RESULTS: Analyses indicated strong associations between child behavior and parenting stress (p < .001). There was a positive association between youth age and parenting stress. Single parents and parents in poor health reported significantly high levels of parenting stress; families with high levels of involvement and cohesion reported significantly less stress. The data support the multivariate model of parenting stress of R. R. Abidin (1995). DISCUSSION: Parents of adolescents experience a high level of parenting stress that can compromise their ability to parent effectively. Identification of child, parent, and contextual characteristics that are associated with parenting stress may facilitate our understanding of how healthcare, social service, and education providers can prepare and support parents to reduce the risk of problem behavior.

Parent-child communication processes: preventing children's health-risk behavior.

PURPOSE: Review individual, family, and environmental factors that predict health-risk behavior among children and to propose parent-child communication processes as a mechanism to mediate them. CONCLUSIONS: Improving parent-child communication processes may: reduce individual risk factors, such as poor academic achievement or self-esteem; modify parenting practices such as providing regulation and structure and acting as models of health behavior; and facilitate discussion about factors that lead to involvement in health-risk behaviors. PRACTICE IMPLICATIONS: Assessment strategies to identify youth at risk for health-risk behavior are recommended and community-based strategies to improve communication among parents and children need development.

The development and implementation of eSchoolCare: a novel health care support system for school nurses.

School-aged children with chronic conditions (CCC) are increasing in number and bring health needs into classrooms, with implications for learning. Changing technologies and complex care requirements for CCC have left school nurses, the primary health care professional in educational settings, seeking support and further training to provide quality care for CCC. This article describes the development and implementation of a Web-based program, eSchoolCare, designed to extend the expertise of professionals in an academic health care system to school nurses to improve CCC care. The eSchoolCare project serves as an exemplar of an innovative health care delivery support system.

Strengthening families program (10-14): effects on the family environment.

This study examined whether parent-youth dyads participating in the Strengthening Families Program 10-14 (SFP 10-14) would demonstrate greater postprogram family cohesion, communication, involvement, and supervision and if youth would report less alcohol, tobacco, and other drugs involvement in contrast to a comparison group. From 16 randomly selected schools, we recruited 167 parent-youth dyads: 86 from intervention and 81 from comparison schools. The intention-to-treat analysis found one significant change in family environment. Considering dose, it was found that among dyads receiving a full dose, all the outcomes were in the expected direction and effect sizes were moderate. Among dyads receiving a partial dose, 10 of 18 outcomes were in the direction opposite that expected. Youth participation in alcohol, tobacco, and other drugs was very low and did not differ postprogram. Although the expected outcomes were not realized, findings descriptive of dosage effects make a valuable contribution to the field. Study of factors that distinguish intervention completers from noncompleters is recommended.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 5: parent-adolescent and teen parent-child relationships.

PURPOSE: The purpose of this paper is to examine nursing's contribution to understanding the parent-adolescent and the teen parent-child relationships. CONCLUSION: Relationships between parents and adolescents may reflect turmoil and affect adolescents' health and development. The social and developmental contexts for teen parenting are powerful and may need strengthening. Several interventions to help teen mothers interact sensitively with their infants have been developed and tested. PRACTICE IMPLICATIONS: Nurse researchers have begun to provide evidence for practitioners to use in caring for families of adolescents and teen parents to acquire interaction skills that, in turn, may promote optimal health and development of the child.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 3: Interaction and the parent-child relationship--assessment and intervention studies.

PURPOSE: This integrative review concerns nursing research on parent-child interaction and relationships published from 1980 through 2008 and includes assessment and intervention studies in clinically important settings (e.g., feeding, teaching, play). CONCLUSIONS: Directions for research include development of theoretical frameworks, valid observational systems, and multivariate and longitudinal data analytic strategies. PRACTICE IMPLICATIONS: Observation of social-emotional as well as task-related interaction qualities in the context of assessing parent-child relationships could generate new questions for nursing research and for family-centered nursing practice.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 4: parent-child relationships at risk.

PURPOSE: The purpose of this integrative review is to synthesize nursing scholarship on parent-child relationships considered fragile because of parent-child's chronic condition or occurrence within a risky context. CONCLUSIONS: Most reviewed studies demonstrated negative effects of risk conditions on parent-child relationships and documented importance of child, parent, and contextual variables. Studies were predominately single investigations. Varying theoretical perspectives complicated interpretation. Mainly White, middle-class, and small samples limited generalizability. Important areas for further research were identified. PRACTICE IMPLICATIONS: Nurse researchers identified factors that may interfere with the parent-child relationship. Nurses are in a position to support families under these circumstances.

Mothers of children with special health care needs: documenting the experience of their children's care in the school setting.

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.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 1: Introduction.

PURPOSE: Understanding the parent-child relationship is fundamental to nursing of children and families. The purpose of this integrative review is to explore nursing scholarship published from 1980-2008 concerning parent-child relationships. Study approaches are examined, critiqued, and future directions for research identified. CONCLUSIONS: A historical review of nursing research is presented and methods described as an introduction to a review series of the parent-child relationship. IMPLICATIONS: Definition and explication of the parent-child relationship is a first-step in understanding factors amenable to nursing intervention. A clear definition of the concept of parent-child relationship will support further study using appropriate theoretical frameworks, and enable development and testing of supportive nursing interventions.

Furthering the understanding of parent-child relationships: a nursing scholarship review series. Part 2: Grasping the early parenting experience--the insider view.

PURPOSE: The purpose of this integrative review is to systematically and critically synthesize nursing scholarship on parents' perspectives of the parent-child relationship during infancy. CONCLUSION: Research has shown that the process of establishing the parent-child relationship is highly individualized and complex. Numerous barriers and facilitators influencing this relationship have been identified that are relevant to nursing. PRACTICE IMPLICATIONS: Nurses have an important opportunity to positively affect the developing parent-infant relationship. Screening parents for depression and providing parents with resources and support are key nursing interventions supporting the parent-infant relationship.