Addressing School Connectedness, Belonging, and Culturally Appropriate Care for Newly Immigrated Students and Families.

School connectedness is the degree to which students experience acceptance, inclusion, and care by school personnel and peers. A sense of belonging incorporates an emotional connection to the community. School connectedness and belonging are protective factors that promote student engagement, accomplishment, and community performance. Despite the rise in students from immigrant families in the United States, belonging and connectedness for youth from diverse cultural and linguistic experiences are understudied. School-based nurses, our term, is inclusive of advanced practice pediatric, family, and psychiatric nurse practitioners, are well-positioned to support school connectedness for youth who may encounter hurdles to health care because of cultural and linguistic differences. We present practice suggestions for language, culture, and inclusion using three health conditions experienced by youth: anxiety, asthma, and obesity. School-based nurses and other school personnel who provide linguistic and culturally appropriate care can support students in feeling connected and included in their school communities.

Chronic Health Condition Management and School-Based Health Centers in New York: Findings From the 2020 School Health Profiles Survey.

School-based health centers (SBHCs) are associated with numerous positive aspects of student health services. Many schools in the United States (US) do not have transparent policies on chronic health condition (CHC) management. Of particular concern is the underreporting of the delivery of health services in U.S. schools concerning CHC management and its relationship with the presence or absence of a SBHC. Data from the 2020 School Health Profiles (SHP) Survey were examined in New York public secondary schools. Specific health services were reviewed, together with the presence or absence of a SBHC, including daily medication administration, stock rescue medication, case management services, community partners, chronic disease-specific education, and assurance that students with CHCs were enrolled in an insurance program. A significantly greater proportion of schools with a SBHC compared with schools without a SBHC provided: (1) daily medication administration (92.9% vs. 86.5%; p < .001), (2) stock or rescue medication (84.9% vs. 77.4%; p < .001), (3) case management services (83.1% vs. 67.2%; p < .001), (4) disease-specific education for families (63.1% vs. 57.2%; p = .022), (5) student and family connection to community health services (84.2% vs. 76.5%; p < .001), and (6) ensured that a protocol existed whereby students with a CHC were enrolled in an insurance plan if eligible (79.6% vs. 66.8%; p < .001). Findings suggest that data on a national scale include essential facts for states to consider concerning school health policies and practices. Additional research should examine the intricacy of elements connected with school-based health care to understand better the care provided to children with CHCs.

The Significance of Social Development Support in Schools: The Critical Role of School Nurses.

The growth of social development entails a progression where youth learn to interact with those around them. This manuscript provides interventions school nurses may use to incorporate social development into their daily practice and interactions with students. Social-emotional skills are pivotal to children's and adolescents' health, well-being, and academic success. Healthy social development can lead to improved self-confidence and better social relationships and have long-term benefits into adulthood. There is still much to learn about how the COVID-19 pandemic has affected the social development of children and adolescents. Nevertheless, school personnel, including the school nurse, must collaborate to support students, families, and each other to cultivate an environment that connects social development with education, health, and well-being.

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.

The Role of School Connectedness in Supporting the Health and Well-Being of Youth: Recommendations for School Nurses.

The importance of students feeling connected in school cannot be overstated, as this perception is crucial to support their health and well-being. A lack of school connectedness can lead to adverse physical and mental health outcomes, including bully victimization. Numerous factors, including individual, social, and environmental, influence students' perceived sense of school connectedness. School nurses are well positioned to establish and maintain school connectedness due to their knowledge, accessibility to students, and familiarity with the school environment. This article details the importance of school connectedness and describes the associations between school connectedness, bullying, and mental health. In addition, we offer recommendations geared toward school nurses regarding strengthening school connectedness and promoting a culture of care and inclusivity within school environments, especially salient in the context of the COVID-19 pandemic.

Risk Factors Associated With Bullying at School and Electronic Bullying in U.S. Adolescent Females With Asthma.

Although adolescent females with asthma are at increased risk for bullying, relationships between bullying at school and electronic bullying and demographics, mental health issues, and substance use have not specifically been studied in these young women. The purpose of this research was to examine such relationships among adolescent females with asthma. Complex sampling software was used to extrapolate frequencies and χ2 analyses to adolescent females with asthma. In this U.S. sample of adolescent females with asthma (n = 1,634), younger age, mental health issues, and substance use were significantly related to bullying at school and electronic bullying, while race/ethnicity and grade in school were significantly related only to bullying at school. In general, findings are consistent with previous research regarding relationships between bullying and risk factors among all U.S. adolescent females. Guidance by school nurses is needed to create effective supports for victimization reduction in this vulnerable group.

School Nurses Matter: Relationship Between School Nurse Employment Policies and Chronic Health Condition Policies in U.S. School Districts.

The increasing prevalence of chronic health conditions (CHCs) in school-aged children highlights the need to better understand school health services' role regarding CHCs. Using U.S. nationally representative district-level data from the 2016 School Health Policies and Practices Study, we examined whether having policies on school nurses' employment was associated with having policies on CHCs and whether having such policies varied by geographic location. Compared to districts without such employment policies, districts with such policies (52.3%) were significantly more likely to have CHC management policies. For each CHC policy examined, more than 20% of school districts did not have the CHC policy, with Northeast districts having the greatest proportion of such policies and West districts having the least. Thus, many students' CHC needs may not be met at school. It is important for school nurses to play a key role in advocating for the development of school-based policies on CHCs.

Mental Health Screenings: Practices and Patterns of These and Other Health Screenings in U.S. School Districts.

Schools' health screenings can identify students' missed health concerns. Data from the 2016 School Health Policies and Practices Study were used to determine the proportion of U.S. school districts with physical and mental health screening policies and the proportion that arrange off-campus mental health services. We also examined differences between districts with and without mental health screening policies regarding having physical health screening policies, patterns of these policies, and off-campus mental health service arrangements. Eleven percent of districts had no policies on any of the four physical health screenings assessed, and 87% lacked policies on mental health screenings, the latter especially concerning considering the impact of COVID-19. Districts with policies on mental health screenings were significantly more likely to have body mass index (p < .01) and oral health (p < .001) screening policies, and to arrange for off-campus case management (p < .001), family counseling (p < .05), group counseling (p < .01), self-help (p < .05) and intake evaluation (p < .05).

School Nurses as Vital Members of 504 and Individualized Educational Program Teams: Do District-Level Policies Make a Difference in School Nurses' Involvement?

In 2019, 10 to 20 million school-aged youth were identified as having a chronic health condition or disability. However, little is known about U.S. school district policies on school nurses' participation in Individualized Educational Program (IEP) and Section 504 teams to support these youth. Using nationally representative district-level data from the 2016 School Health Policies and Practices Study, we examined whether U.S. school districts have policies on school nurse participation in IEP and 504 development. In addition, we examined the relationship between having such policies and policies on (a) creating and maintaining school teams to assist students with disabilities and (b) the participation of other essential school staff in IEP and 504 development. Among districts with policies regarding school nurse participation in IEP development versus those that did not, a significantly greater proportion had policies on student support teams and counselors' participation on IEP teams (79.2% vs. 44.4%, p < .001, and 98.7% vs. 56.2%, p < .001, respectively). In addition, among districts with policies on school nurse participation in 504 development versus those that did not, a significantly greater proportion also had policies on support teams and counselors' participation on 504 teams (77.5% vs. 43.1%, p < .001, and 97.2% vs. 50.7%, p < .001, respectively). We also examine regional and locale differences in these policies. Findings encourage discussion on student support teams' role in school districts for students with chronic health conditions and disabilities, how school nurses can be essential team members, and better coordination of student care to promote children who are engaged, healthy, and supported within the school community.

An Evidence-Based Framework for Implementation of a School-Community Partnership.

School-community partnerships (SCPs) are collaborative efforts between schools and community organizations geared toward improving the health of school-age children through care coordination. These partnerships are ideal for youth with acute and chronic illness because they can implement evidence-based interventions and offer skills and education to support youth self-management and academic success. Utilizing the chronic condition of asthma as an exemplar, this article highlights several successful SCPs and how they are mutually beneficial to both the school and community. Additionally, this article offers strategies for stakeholders, including school nurses, to establish an SCP. SCPs lay the foundation for supporting community- and school-based health and lend themselves to a healthier future for youth.

Factors Associated With School Nurses' Self-Efficacy in Provision of Asthma Care and Performance of Asthma Management Behaviors.

Asthma is a chronic disease affecting nearly 6 million children in the United States and accounts for nearly 14 million missed school days. School nurses' performance of asthma management behaviors (AMBs) may reduce exacerbations, thereby decreasing emergency visits and hospitalizations and increasing attendance at school. Self-efficacy can have a positive effect on AMBs. More research is needed on the interplay between environmental factors in school nurses' work setting, self-efficacy in providing asthma care (hereafter "self-efficacy in asthma care"), and performance of AMBs. This study used a descriptive cross-sectional online survey design with practicing registered school nurses in Pennsylvania (N = 231). Data analysis included descriptive statistics, correlation tests, and multiple regression. In separate models, self-efficacy in asthma care and student-nurse ratio were significantly associated with performance of AMBs. Schools and school nurses need stronger efforts to strengthen self-efficacy in asthma care, with the goal of increasing nurses' performance of AMBs.

School Nurses' Role in Self-Management, Anticipatory Guidance, and Advocacy for Students With Chronic Illness.

This article offers tangible support for school nurses to understand, recognize, and integrate self-management promotion, anticipatory guidance, and advocacy into practice. The article utilizes the chronic condition of asthma as a case exemplar, but many of the recommendations apply to other aspects of chronic illness self-management promotion. School nurses are in an ideal position to advocate for students and families and to support evidence-based self-management promotion. In the school setting, gaps currently exist regarding best practices for the promotion of self-management and anticipatory guidance for children with chronic illnesses. Future interventions within school settings should focus on multisystem level collaboration with care coordination efforts between providers and social support systems, internal and external, to the school system. These policies and this resource development will ultimately support the promotion of self-management for children with chronic illness in the school environment and maximize health outcomes.

From Intention to Action: Nurses as Policy Advocates for Asthma Care in Schools.

Nurses are familiar with policy at the federal, state, local, and institutional levels, but drafting a policy memo might be new to some. School nurses may have an interest in writing a health policy memo on their own, with colleagues, as part of a nursing organization, or with students who are interested in learning about policy development, school health, and safety. The intention of writing a policy memo is to offer a concisely written analysis of an issue, including background, landscape, and available options, along with recommendations for action to persons in authority, such as congressmen, senators, local officials, or school boards. The first section of this article serves as an exemplar of a policy memo, using the public health topic of asthma. Next, the article focuses on barriers to policy development for this condition in schools and offers selected strategies to address those barriers. While a discourse concerning barriers is not a typical component of a policy memo, this section shows how school nurses can draw on evidence to consider the best way to make positive change. To construct a sturdy argument for change, school nurses need to appreciate potential counterarguments, which is why this exemplar is included.

A Review of School Nurses' Self-Efficacy in Asthma Care.

Asthma is the most common pediatric chronic respiratory illness and has a significant influence on children's health, school attendance, and overall school success. Despite the effect of education and training, gaps remain in understanding school nurses' self-efficacy (SE) in asthma care. The purpose of this integrative literature review is to gain a greater understanding of school nurses' SE in asthma care. Themes and topics in the current school nursing literature regarding SE in asthma care include the value of continuing education, educational interventions, and the use of resources in clinical practice such as the asthma action plan. This review indicates the importance of developing a greater understanding of the unique features of school nursing, the necessary resources, and the external factors that influence practice. Further research to establish a framework to evaluate how a change in practice may support school nurses' SE and promote positive student health outcomes is needed.

Can Grit Be Nurtured in Undergraduate Nursing Students?

Grit, a positive psychological trait, is a character trait of great benefit to the practice of nursing. Nurses who exemplify a combination of excellence, determination, and compassion in their practice are often described as having grit. This article discusses the five major traits of grit and the development and nurturing of these traits in both nursing students and novice nurses. The topic of the development of grit is relevant to school nurses who find themselves in mentor roles with nursing students and with nurses new to school nursing.