An Exploratory Study of Bullying Exposure Among School Nurses: Prevalence and Impact.

The frequency and consequences of bullying directed at school nurses (SNs) are poorly understood. The purpose of this study was to describe the prevalence and impact of bullying directed at school nurses, determine predictors of bullying directed at school nurses, and evaluate the individual and organizational impact of exposure to bullying directed at school nurses. School nurses (n = 334) completed an online survey comprised of the Negative Act Questionnaire-Revised, Perceived Stress Scale, National Institute for Occupational Safety and Health General Social Survey 2010 Quality of Worklife Module, Michigan Organizational Assessment Questionnaire, and open response items to determine their experiences with, and impact of, bullying. Descriptive and inferential statistics were calculated for quantitative data, while content analysis was used to analyze responses to open-ended survey items. One third of participants reported occasional or frequent bullying. Content analysis revealed three themes, including unexpected parent behavior, staff incivility, and formal reporting. Findings support the development of an educational intervention to assist school nurses in the prevention and management of bullying exposure.

A Retrospective Review of School Nurse Approaches to Assessing Pain.

BACKGROUND: When students with intellectual disability (ID) experience pain, the pain may limit the extent to which they may engage in school activities. Although school nurses are primarily responsible for addressing students' pain, there are many barriers to identifying pain in students with ID. AIMS: The purpose of the present study was to describe pain assessment practices of school nurses for students with and without ID. DESIGN: A retrospective review was conducted of 4,660 school health office visit records for elementary school students presenting to the health office with headache, stomachache, or sore throat. METHODS: Data were extracted and transcribed to a matrix. Data extracted included school grade, referral source, visit month, gender, cognitive ability, chief concern, pain assessment, external contact, and disposition. Descriptive statistics were calculated. RESULTS: School nurses spent more time on average addressing pain in neurotypical students than in students with ID. Neurotypical students more often presented with a teacher and were dismissed from school, but parents and guardians were contacted less often for these students, when compared to students with ID. Quantified pain ratings were documented for 1% of visits. CONCLUSIONS: Because pain intensity ratings were rarely documented, the utility of such ratings in the school setting may be low. Alternatively, obtaining pain intensity ratings from younger children may be challenging without the use of appropriate tools. Nurses, teachers, and other staff providing education and care to students with ID may require pain training. Implementation of tools that elicit student pain information from parents/guardians in the school setting could decrease point-of-care contact during the school day and proactively provide information on unique child pain behaviors.

A Pain Reporting Tool for School-Aged Baseball Pitchers.

Rates of injury to school-aged athletes are of concern to pediatric providers and can be prevented when players, coaches, and parents recognize and address pain. The aim of the present study was to evaluate the use of a pain-reporting tool. In this study, 34 baseball players aged 10-16 years reported pain surrounding 135 separate pitching experiences. Those participating in another sport on the same day as pitching rated pain intensity as significantly higher than those who did not. Approximately 19 pitches were thrown before participants noticed pain. Ice and analgesics were used appropriately to manage pain. School nurses are well positioned to discuss pain reporting and common injuries with young athletes, parents, and athletic coaches. Sharing proactive ways to elicit information about pain is suggested. Implications for future research include the study of young athlete experiences with pain and development of educational initiatives regarding the importance of reporting pain.

Safety Culture and Patient Safety Outcomes in East Asia: A Literature Review.

This review examined associations between safety culture aspects and patient safety outcomes in East Asian hospitals and identified relevant research priorities. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 16 articles were identified for review. Patient safety nursing activity was the most commonly investigated outcome in relation to safety culture aspects. Among safety culture aspects, feedback and communication, frequency of event reporting, teamwork within units, and managers' support for patient safety were most significantly related to patient safety outcomes. Areas for further research include the use of theory or theoretical frameworks, consensus upon the scoring strategies for computation of safety culture scores, and selecting appropriate units of analysis and statistical analyses. Finally, researchers should examine relations between unit-specific and nation-specific safety culture and patient safety outcomes, given the influence of cultural attitudes and behaviors on patient safety.

"There was Only One Nurse for Everyone": Student Reflections of a School Nursing Clinical Experience.

PURPOSE: Undergraduate nursing faculty face challenges when teaching pediatric clinicals. Changes to pediatric care and hospital admissions have contributed to a shortage of clinical sites where students can learn to care for children with varied nursing needs. The purpose of this study was to describe benefits and barriers of pediatric clinical placements with a school health component. DESIGN AND METHODS: A qualitative analysis of 38 student reflective journals was conducted to identify experiences following student participation in school nursing clinicals. RESULTS: Three themes and three sub-themes were identified. Major themes included: benefits of the clinical experience, suggestions for improvement, and an appreciation for the school nurse role with subthemes of greater responsibility than anticipated, resource constraints, and lack of support. CONCLUSIONS: School nursing clinical experiences allow nursing students to interact with children with broad range of ages, abilities, and health statuses, and preview a professional pathway they may otherwise never be exposed to. School nursing experiences also help nurse educators address the shortage of inpatient pediatric clinical site placements while facilitating student exposure to the impact of social justice and social determinants on child health. PRACTICE IMPLICATIONS: Nurse educators are encouraged to incorporate school nursing clinical experiences in pediatric curricula. Partnering with school districts in which student enrollment reflects diversity in culture, socio-economic status, and access to healthcare should be a priority so students may see first-hand the impact of social determinants on the health of clients and populations.

Educators' Experiences Identifying Pain Among Students in Special Education Settings.

If special educators cannot identify pain in students with intellectual disability (ID), students cannot be referred to the school nurse for assessment and management. The purpose of this study was to examine how special educators identify pain in the school setting. Twenty-four special educators participated in focus groups aiming to (1) identify educators' observations and perceptions of pain in students with ID and (2) determine the decision-making processes educators use to determine the need for student presentation or referral to the health office. Overall, special educators know students well enough to differentiate pain-related behaviors from normal well-child behaviors, prioritize student safety, and draw on personal experiences with pain when addressing pain in students with ID. Special educators welcome opportunities to learn more about pain in children with ID. Teachers, nurses, and other professionals should share knowledge about and experiences of working with students in pain to improve practices.

Toward total student health: A qualitative pilot study.

Objective: Colleges should aim to cultivate healthy behaviors among students by addressing alterations in wellness students view as important. The purpose of this study was to determine the self-perceived wellness-related concerns and behaviors of college students. Participants: Thirty-seven undergraduate students participated in this study between January and March 2017. Methods: Focus groups served as a data collection method. Groups were recorded and transcribed verbatim. Directed and conventional approaches to data analyses were employed. Results: Participants expressed concern regarding four campus wellness topics: nutrition, economics, mental health, and campus safety. Participants offered solutions for improving campus wellness, representing a fifth theme. Conclusions: Health concerns for college students and realistic solutions to address concerns were identified across focus groups. Overall, students cared about their own health, as well as the well-being of other students. Future directions include conducting a Web-based survey among students to assess prevalence and impact of select health and wellness topics.

Incorporating medication administration safety in undergraduate nursing education: A literature review.

OBJECTIVE: The purpose of this review was to identify methods for incorporating medication administration safety in undergraduate nursing education. DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines directed this review. DATA SOURCES: A search of four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Google Scholar, and MedLine/PubMed MedLine/PubMed) as well as hand searches were conducted to identify original research published between 2005 and 2018. REVIEW METHODS: Original empirical research describing a method for incorporating medication administration safety concepts in nursing education and examining its effectiveness on undergraduate nursing students' outcomes were selected for review. Articles describing medication safety education for graduate students, students other than those in nursing, and practicing nurses were excluded. RESULTS: Twelve original research articles were included for review. Three methods for incorporating medication administration safety in undergraduate nursing education were identified: simulation experiences, technology aids, and online learning modules. Most studies were conducted in North America. The use of different interventions as well as different outcome measures was noted as a limitation to the collective body of research in this area. Also, there was a lack of information regarding psychometric properties of instruments used among the studies reviewed. CONCLUSION: Simulation experiences, use of technology aids, and online learning modules helped increase medication safety competence of nursing students. However, simulation equipment, select technology aids, and online learning may not be available for all nursing programs; therefore, educators should consider developing and testing classroom-based educational interventions. Moreover, future researchers should use or develop psychometrically sound instruments to measure nursing students' outcomes including competencies about medication administration safety.

CE: Original Research: Pain in Nonverbal Children with Medical Complexity: A Two-Year Retrospective Study.

: Purpose: Children with medical complexity experience frequent pain. But it can be challenging to recognize unexpected behaviors as pain related, especially in the absence of self-report. Often these children undergo extensive workups aimed at diagnosing the sources of pain. This study had three objectives: to describe the signs and symptoms parents of nonverbal children with medical complexity found worrisome, to describe the sources of pain in these children, and to describe nursing pain assessment practices in this population. DESIGN AND METHODS: Retrospective chart review was used to identify the initial presenting symptoms, sources of pain, and nursing documentation for 46 children with medical complexity who were admitted with a chief concern of pain to a 395-bed pediatric teaching hospital in the northeastern United States. RESULTS: Irritability, pain, feeding intolerance, and "not acting like herself [or himself]" were common parent-reported symptoms that prompted further evaluation. On average, five diagnostic studies were taken to identify a source of pain, and four specialty services were consulted during the admission. Nursing assessments of pain were documented approximately every three hours; the mean pain intensity score documented was 1.1 out of 10. The discharge diagnoses included infection (including urinary tract infection), seizures, constipation, chronic pain, failure to thrive, dehydration, and subdural hematoma. CONCLUSIONS: The discharge diagnoses covered a wide range. A systematic approach to pain evaluation could help to ensure that the diagnostic process is both thorough and efficient. Common childhood ailments such as constipation or urinary tract infection, as well as other causes, must be considered when diagnosing pain in this population. Practice implications include consulting parents regarding changes in a child's behavior.

Characteristics of Reviews Published in Nursing Literature: A Methodological Review.

Integrative and systematic reviews present synthesized research. Scholars have called for increased rigor and reporting in reviews. The purpose of this methodological review was to describe the characteristics of nurse-led reviews. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines directed the review process. Many reviews did not clearly report the search strategy used and methods for data extraction and quality appraisal, indicating that there has not been an increase in rigor. Authors of reviews are encouraged to report sufficient methodological details, so peer reviewers and consumers can determine whether the methods were rigorous enough to contribute meaningful results.

Forming Focus Groups for Pediatric Pain Research in Nursing: A Review of Methods.

BACKGROUND: Within current priorities for pain research set by the American Society for Pain Management Nursing, there is a paucity of pediatric pain research. Qualitative approaches are helpful when researching topics about which little is known. Focus groups are one method of qualitative data collection and have been successfully implemented with children and parents. AIMS: The purpose of this paper was to identify ideal conditions for nurse researchers to employ when using focus groups as a data collection method for studies aiming to investigate pain in children. The aims of this paper are to identify focus group conditions (1) facilitating adequate scientific rigor and trustworthiness and (2) eliciting the richest data from participants. METHODS: A critique of research studies that used focus groups with children, parents/caregivers, or nurses in hospital or community settings was performed to achieve the stated aims. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines directed the process of selecting studies for inclusion in this review. RESULTS: The final sample for critique included four studies. Methods such as transcription processes and approaches to analysis used in the four publications were appraised for scientific rigor and usefulness in pediatric pain research. CONCLUSIONS: Researchers investigating priority areas must consider trustworthiness and strategies to eliciting quality data when planning to employ focus groups as a data collection method. Nurses in the clinical setting can use findings of this report to strengthen pain assessment practices as well as evaluate qualitative work for inclusion in evidence-based policies.

Improving School Nurse Pain Assessment Practices for Students With Intellectual Disability.

School nurses are afforded minimal resources related to assessing pain in students with intellectual disability (ID) and have called for continuing education. The purpose of this study was to measure the effectiveness of an education program regarding best practices for assessing pain in students with ID. Educational sessions were presented to 248 school nurses. Pre-, post-, and follow-up surveys measured (1) difficulty school nurses face when assessing pain, (2) knowledge and use of pain assessment methods, and (3) intent to change and actual changes to professional practices. Participants experienced less difficulty assessing pain following the educational program. Almost all participants intended to change pain assessment practices, but large caseloads limited new practice adoption. Policy makers must consider population size and acuity when determining school nurse staffing. Trainings and other resources should be made available to school nurses in order to make pain assessments for students with ID more thorough and efficient.

Precepted Experiences for Doctoral Student Nurses.

Across many levels of nursing education, mentored experiences are an essential part of learning. To enhance understanding, learning, and comfort for those new to professional roles, experienced and skilled professionals provide motivation while teaching professional skills, demonstrating technical competence, and displaying behavior expected of a professional. Educator preparation topics such as curriculum development, evaluation, and lesson planning are not typically included in PhD programs, leaving PhD students feeling unprepared to teach (Hudacek & Carpenter, 1998; Ivey, 2007). The lack of educator pedagogy forces nurse faculty members to learn on the job (Gardner, 2014; Oermann, 2017). Preceptorships are among the faculty role development opportunities not commonplace for aspiring nurse educators; these opportunities for PhD students to observe and model nurse educators have been noted as limited (Gardner, 2014). Experts have called for more educator-focused learning experiences and preceptorship opportunities in PhD programs (National League for Nursing Board of Governors, 2002; Oermann, 2017). The purpose of this article is to describe a creative approach to introducing nurses enrolled in doctoral programs to the faculty role within the academic setting.

Strategies to Reduce Nursing Student Test Anxiety: A Literature Review.

BACKGROUND: Nursing students are plagued by test anxiety. Chronic stress, heavy academic workloads, and rigorous progression standards are antecedents of test anxiety in nursing students. The purpose of this article is to identify helpful interventions to decrease test anxiety in prelicensure nursing students. METHOD: This systematic review was completed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Four electronic databases were searched using the terms nurs*, anxiety, test, NCLEX, strategies, and exam*. RESULTS: Seven articles were identified for inclusion in this review. Following analysis, two categories of test anxiety interventions for nursing students were identified: environmental adjustments and student behavior modifications. CONCLUSION: Faculty members should consider using the test anxiety reduction interventions described in this article. Priorities for future research include studying the effects of test anxiety reduction interventions on examination grades. [J Nurs Educ. 2017;56(3):145-151.].

Using Theory Integration to Explore Complex Health Problems.

Although nursing leaders call for theory utilization in research, use remains low within the discipline. The purpose of this article is to explore the application of interdisciplinary integration of models and theories to nursing research. An example of theory integration for the purposes of guiding a study relevant to school nursing is described. A conceptual-theoretical-empirical structure based on the Neuman's systems model, a nursing theory, integrated with the social communication model of pain, a psychology model, was developed to guide the study to examine pain assessment for schoolchildren with intellectual and developmental disabilities.

'It's Not Easy': School Nurse Pain Assessment Practices for Students with Special Needs.

Assessing pain in children with special needs presents unique challenges for school nurses, as no evidence-based or clinical standards to guide practices have been established for use in the school setting. Additionally, school nurse staffing has not kept pace with the growth in the population of children with special needs, which has increased by 60% since 2002. The aim of this study was to explore school nurses' pain assessment practices for students with special needs. A cross-sectional study was conducted via the web. Participants/Subjects: Of 3,071 special needs school nurses invited, 27% participated (n = 825). STATA13 was used to analyze descriptive statistics, while content analysis was performed in NVIVO 10. The majority of participants assessed pain in students with special needs using objective assessments (97.34%) and consultations with teachers (91.09%) and parents (88.64%). School nurses utilize pain assessment methods used previously in other practice areas, and rated pain assessment practices at the low benchmark of adequate. Overall, school nurses assess pain by selecting approaches that are best matched to the abilities of the student with special needs. When assessing students with special needs, nurses should utilize objective clinical assessments, teacher consultations, and parent input scales. In addition to continuing education, policies facilitating lower nurse-to-student ratios are needed to improve pain assessment practices in the school setting. Research to understand the perspectives of nurses, teachers, parents, and students is needed to support the creation of evidence-based policies and procedures.