School Nursing During a Pandemic.

School nurses gear up for more COVID-related challenges this fall.

Original Research: Concussions at School: The Experiences and Knowledge of School Nurses.

BACKGROUND: School nurses' knowledge about and confidence in managing concussions are important to ensure continuity of care between a student's school and home environments. This mixed-methods study explored concussion-related knowledge, confidence, and management experiences among urban and rural school nurses in Washington State. METHODS: Public school nurses, identified via state educational service district websites and recruited by e-mail, completed an online survey assessing their concussion knowledge and confidence levels. Following the survey, a subset of respondents participated in semistructured interviews aimed at exploring their confidence in managing concussions. RESULTS: Of the 945 school nurses to whom the survey was sent, 315 responded (33% response rate). Most survey respondents held an RN license (89.6%) and were from urban areas (90.8%). Overall, the respondents exhibited accurate concussion knowledge; only one significant difference was noted based on rural-urban status. Correct responses were given for most questions (67.4% to 98.7% correct responses). In interviews with a subset of six school nurses, emergent themes pertained to communication, assessment, and monitoring, and the nurse's role in postconcussion management. Barriers can include a lack of relevant school policies, low concussion awareness among teachers and parents, and limited resources. CONCLUSIONS: The study findings suggest that school nurses possess high levels of concussion knowledge and confidence in managing concussions. Continuing education remains important to ensure that current research and evidence inform practice regarding ongoing concussion management among school-age children.

School nurses' perceptions regarding barriers and facilitators in caring for children with chronic diseases in school settings: A mixed studies review.

This study aimed to understand school nurses' perceptions regarding barriers to and facilitators for health care services for children with chronic diseases in school settings. Using the PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and Web of Science databases, a mixed studies review was conducted for literature published between January 2011 and June 2020. We performed a mixed-methods systematic review using a convergent integrated approach. A quality appraisal of the included studies was conducted using a mixed-methods appraisal tool. Twenty-seven articles (10 qualitative, 10 quantitative, and seven mixed-methods) that met the inclusion criteria were analyzed. Integrated findings that emerged from data synthesis were categorized into four levels (intrapersonal level, interpersonal level, institutional level, and community and public policy level) based on a socio-ecological model framework. This mixed systematic review provides a comprehensive understanding of school nurses' perceived barriers and facilitators when providing school health care for students with chronic diseases and how these barriers and facilitators interact across multiple systems. Further policies and strategies should be developed to provide effective school health services considering this study's findings.

Developing an Understanding of Adolescents' Knowledge, Attitudes, and Practices Toward COVID-19.

Adolescents are more likely to engage in risky health practices related to COVID-19. Their compliance with infection control measures is a key factor to mitigate the spread of the disease. The purpose of this study was to explore the knowledge, attitudes, and practices toward COVID-19 and their correlates among Jordanian adolescents. An online cross-sectional survey was utilized. A total of 1,054 Jordanian adolescents aged 12-18 completed and returned the survey. Overall, Jordanian adolescents showed a good base of knowledge regarding COVID-19 (regardless of their demographic characteristics) and tended to hold positive attitudes toward the country's curfew and other protective measures. The majority of adolescents reported that television and social media were their main source of information on COVID-19, while few reported receiving such information from their schools. The majority reported practicing effective health protective behaviors to prevent the spread of COVID-19, which was significantly predicted by their knowledge and attitudes toward these measures. However, there was a relatively small, yet clinically significant, percentage of adolescents who showed poor knowledge on COVID-19, had negative attitudes toward protective measures, and reported being engaged in risky practices related to infection spread. Tailored efforts are needed to improve the levels of knowledge, attitudes, and practices among adolescents. Raising awareness and promoting positive attitudes are vital to change adolescents' health practices. Policy makers should ensure that school nurses are available in all schools and working to their full scope. School nurses are the eyes and ears of public health and primary care. They are essential members on pandemic preparedness, reopening and reentry planning teams, and can lead health care in schools and practice in a holistic culturally competent proactive manner to address the needs of students.

A conceptual framework for effective dissemination and implementation of a policy on school health in rural Nigeria.

BACKGROUND: There is a marked inequality between children in public schools and their counterparts in private schools in terms of school healthcare in rural Nigeria. This is because of the ineffective dissemination and implementation of a policy on school health in public schools. Effective dissemination and implementation of such policy can reduce the prevalence of risky health behaviours amongst young people and have a positive effect on academic performance. OBJECTIVES: The purpose of this study was to develop a conceptual framework for the effective dissemination and implementation of a policy on school health in rural Nigeria. METHODS: This study consisted of four phases as follows: an empirical phase, concept classification, framework development and critical reflection on the conceptual framework. An exploratory, descriptive and contextual research design was used to develop the framework. The work of Dickoff et al. was used to classify concepts from the empirical phase. Chinn and Kramer's nursing theory on generative method was used for the development of the conceptual framework and for critical review. RESULTS: The framework consisted of six components, namely, departments of health and education (context); health or educational professionals in the ministries (agents); health or educational practitioners, pupils, parents and communities (recipients); ratification of a policy on school health, stakeholder engagement, training as well as monitoring and evaluation (process); communication, collaborative partnership, commitment and support (dynamics); and effective dissemination and implementation of a policy on school health. CONCLUSION: The framework would be a firm foundation and contribution to improve the health of children in public schools, and well-being and academic performance that would be a good feat towards the future endeavour. The findings of the study are pertinent to school health nursing practice, education and research.

Challenges and Opportunities in Population Health: The Role of School Nurses as Complexity Leaders.

The school nurse role parallels the growing complexity of health care, education, and the social needs of youth in the United States. The complex and chaotic environment of the school setting requires leaders to be flexible and to have the ability to recognize and tackle the ever-changing needs of this environment. School nurses are in a prime position to enact change and drive the culture of the community, giving it purpose, while allowing its members to have a focus on their work. Nurses, as complexity leaders, are positioned to understand that change is a continual process that stems from collaboration, complex systems thinking, and innovation mindsets.

Theater of the Oppressed and bullying: nursing performance in school adolescent health.

OBJECTIVE: to assess the effects of an intervention based on the Theater of the Oppressed in reducing school bullying. METHOD: a quasi-experimental study with 232 first-year high school students from two public schools in the city of Cuiabá, Mato Grosso State, Brazil. An intervention was performed with the Theater of the Oppressed, a theatrical methodology created by Augusto Boal and inspired by Paulo Freire's "Pedagogy of the Oppressed", in which one school composed the intervention group, and another school, the comparison group. Both groups were assessed for involvement in bullying situations before and after intervention. For data analysis, Poisson Regression models with random effect were used. RESULTS: intervention group presented a significant decrease in direct victimization (physical and verbal aggression). CONCLUSION: the Theater of the Oppressed represents an important strategy in reducing bullying victimization among school adolescents.

Use of Technology in Managing Diabetes in Youth, Part 1: Continuous Glucose Monitoring: Information and Tips for the School Nurse.

Glucose monitoring is an essential component of type 1 diabetes (T1D) treatment. Continuous glucose monitoring (CGM) systems measure glucose levels every few minutes and provide valuable trend information about the direction and speed glucose levels are changing. Use of CGM is increasing rapidly in youth with T1D and consistent use of CGM is associated with improved glycemic control. School nurses are a vital part of the care team for a student with T1D, and therefore, must be comfortable using CGM to support their students at school. This is the first article in a three-part series on the use of technology in managing diabetes in youth. The purpose of this article is to describe CGM devices, including calibration requirements and interpretation of trend arrows and provide tips for school nurses in incorporating CGM into the student's individualized healthcare plan. Part 2 in this series will focus on insulin pumps and Part 3 will focus on special considerations and problem solving when using diabetes technology in the school setting.

Lesson Plan Basics: Teaching in the Classroom With Confidence.

The ability to confidently teach a lesson to students, staff, or families is a skill all school nurses need to have. When a lesson plan is developed, a clear "road map" is created that guides the lesson and documents what is taught. Using the eight components described in this article, school nurses can develop a comprehensive lesson plan and teach with confidence.

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.

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.

Application of Components of the Massachusetts' Sports Concussion Regulations to All Students With Concussion: A Survey of School Nurses.

Appropriate management by schools of all students with a concussion, regardless of the cause, has not received the same attention as sports-related concussions. Focus groups conducted with Massachusetts School Nurses in 2015 found that some had applied protocols required in the state's sports concussion regulations to all students with concussion, not just student athletes. We surveyed high school nurses in Massachusetts to examine (1) the extent of this practice and (2) the extent to which protocols for all students with concussion are included in school policies. Of 168 (74%) responding, 94% applied the return-to-learn and play, and medical clearance requirements to all students with concussion, regardless of how or where the concussion occurred and 77% reported their school's policy required these protocols for all students with concussion. A significant association (odds ratio: 13.3, 95% confidence interval [2.4, 72.8], p <.01) existed between the two measures. These findings have important clinical and academic implications.

Addressing Self-Injury in Schools, Part 1: Understanding Nonsuicidal Self-Injury and the Importance of Respectful Curiosity in Supporting Youth Who Engage in Self-Injury.

Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. School nurses are often a first point of contact for young people experiencing mental health challenges, and yet they often report they lack knowledge and training to provide care for persons who engage in NSSI. In the first of two parts, this article provides school nurses with a better understanding of NSSI and the distinctions between NSSI and suicidal behaviors, discusses the role of nurses' knowledge and attitudes on their ability to care for their patients' mental health needs, and discusses approaches for developing a respectful, empathic manner for working with and supporting youth who engage in self-injury. Part 2 will offer a strategy for brief assessment of NSSI and reflect on two case studies and their implications for school nursing practice.

Addressing Self-Injury in Schools, Part 2: How School Nurses Can Help With Supporting Assessment, Ongoing Care, and Referral for Treatment.

Nonsuicidal self-injury (NSSI) is defined as the deliberate, self-inflicted damage of body tissue without suicidal intent and for purposes not socially or culturally sanctioned. School nurses are often a first point of contact for young people experiencing mental health challenges, and yet they often report they lack knowledge and training to provide care for persons who engage in NSSI. In the second of two parts, this article offers a strategy for brief assessment of NSSI, as well as reflection on two case studies and how to offer support, ongoing care, and referral for treatment to youth who engage in self-injury.

School nurses' self-assessed cultural competence when encountering children of foreign origin: A cross-sectional study.

The purpose of this study was to investigate associations between school nurses' self-assessed cultural competence in health visits with children of foreign origin and demographic variables, by using a cross-sectional design. A Web-based questionnaire assessing cultural competence and demographic variables was distributed to a nationally representative sample (n = 816) of school nurses in Sweden. Data were analyzed using regression analysis. School nurses assessed themselves as culturally aware and moderately culturally competent, but not as culturally knowledgeable, culturally skilled, or comfortable in cultural encounters. Cultural competence was related to education in cultural diversity, how often nurses encounter children of foreign origin, and nurses' country of origin. In total, these variables explained 23.6% of the variation in school nurses' cultural competence. Because school nurses regard themselves as moderately culturally competent, a foundation for promoting children's health on equal terms in school health care exists. However, education in cultural diversity combined with other additional strategies is needed to further strengthen school nurses' cultural knowledge, skills, and comfort level in encounters with children of foreign origin.

Health in the school: perceptions of being adolescent.

OBJECTIVE: To understand adolescents' perceptions on school health. METHOD: Qualitative and descriptive research grounded on Maurice Merleau-Ponty's phenomenology, which was developed with 90 adolescent students from a federal school of the state of Rio de Janeiro. Data were produced by gathering answers to the following question: what is your perception on school health? Those who chose to write their answer to the guiding question deposited the manuscripts in polls. RESULTS: School health is linked to hygienist practices and to the hegemonic assistentialist model. Nevertheless, we assigned senses and meanings to the practice of physical activity and health education by integrating and expanding behavioral strategies and healthy habits. FINAL CONSIDERATIONS: a healthy school environment implies the protagonism of adolescents in school health promotion actions.

Health in the school: perceptions of being adolescent / La salud en la escuela: las percepciones del ser adolescente / A saúde na escola: percepções do ser adolescente

ABSTRACT Objective: To understand adolescents' perceptions on school health. Method: Qualitative and descriptive research grounded on Maurice Merleau-Ponty's phenomenology, which was developed with 90 adolescent students from a federal school of the state of Rio de Janeiro. Data were produced by gathering answers to the following question: what is your perception on school health? Those who chose to write their answer to the guiding question deposited the manuscripts in polls. Results: School health is linked to hygienist practices and to the hegemonic assistentialist model. Nevertheless, we assigned senses and meanings to the practice of physical activity and health education by integrating and expanding behavioral strategies and healthy habits. Final considerations: a healthy school environment implies the protagonism of adolescents in school health promotion actions.

RESUMEN Objetivo: Comprender las percepciones del ser adolescente sobre la salud en la escuela. Método: Investigación cualitativa, descriptiva, basada en la fenomenología de Maurice Merleau-Ponty, desarrollada con 90 alumnos adolescentes de una escuela federal del estado de Río de Janeiro. Se recogieron los datos por medio del discurso hablado en respuesta al cuestionamiento: ¿cuál es su percepción sobre la salud en la escuela? Aquellos que optaron por escribir la respuesta a esta cuestión principal la depositaron en urnas. Resultados: La salud en la escuela se encuentra vinculada a las prácticas higienistas y al modelo hegemónico asistencialista. Sin embargo, sentidos y significados fueron asignados a la práctica de actividad física y educación en salud -estrategias integradoras y multiplicadoras de comportamientos y hábitos saludables. Consideraciones finales: El hacer salud en la escuela pasa por el protagonismo del ser adolescente sobre su salud en la reorganización de las acciones de promoción de la salud en la escuela.

RESUMO Objetivo: Compreender as percepções do ser adolescente acerca da saúde na escola. Método: Pesquisa qualitativa e descritiva apoiada na fenomenologia de Maurice Merleau-Ponty, desenvolvida com 90 alunos adolescentes de uma escola federal do estado do Rio de Janeiro. Os dados foram produzidos pelo discurso falado em resposta ao questionamento: conte para mim qual a sua percepção sobre a saúde na escola. Aqueles que optaram pela resposta escrita à questão norteadora depositaram os manuscritos nas urnas. Resultados: A saúde escolar encontra-se presa às práticas higienistas e ao modelo hegemônico assistencialista. No entanto, sentidos e significados foram atribuídos à prática da atividade física e de educação em saúde - estratégias integradoras e multiplicadoras de comportamentos e hábitos saudáveis. Considerações finais: O fazer saúde na escola passa pelo protagonismo do ser adolescente sobre sua saúde na reorganização das ações de promoção em saúde escolar.

How to use visual methods to promote health among adolescents: A qualitative study of school nursing.

AIMS AND OBJECTIVES: Public health nurses attended a 3-day course to learn the use of visual methods in health dialogue with adolescents. The aim of this study was to explore how to use visual methods to promote health among adolescents in a school nursing context. BACKGROUND: Photovoice is a visualising technique that enables adolescents to participate in health promotion projects in a school setting. Photovoice also enhances work of public health nurses and other health professionals. DESIGN: This was a qualitative action research study. We developed and conducted a course in visual methods and used data from focus group discussions in combination with participant observations involving public health nurses working in school health services. METHODS: We conducted focus group interviews (n = 40) using separate semi-structured discussion guides before and after a course in visual methods. The interviews were audio recorded and transcribed verbatim, and we documented the workshops (n = 8) through field notes. We collected the data from January-October 2016. Data were analysed and coded into themes and subthemes using systematic text condensation. We reported the study in accordance with the COREQ checklist. FINDINGS: Public health nurses found photovoice useful in school nursing. The use of images offered pupils an active role in dialogues and more control in defining the topics and presenting their stories. When nurses allowed adolescents to bring images into conversations, they discovered new insights into public health promotion. The public health nurses pointed out the benefits and challenges of using new methods in practice. CONCLUSION: Public health nurses considered photovoice to be useful in health promotion and other public health issues. Involving pupils in bringing images to conversations offered them an active role and voice in health promotion. RELEVANCE TO CLINICAL PRACTICE: We recommend the use of photovoice and visual technologies (e.g., smartphones) in health promotion activities for adolescents.

Asthma care coordination in schools by school nurses: An integrative literature review.

OBJECTIVE: The purpose of this integrative literature review is to document and synthesize the available evidence on school nurse asthma care coordination challenges and explain the components of asthma care coordination/case management at schools. DESIGN: The Whittemore and Knafl guidelines were followed for this integrative literature review. SAMPLE: Twelve diverse primary sources-one qualitative study, eight quantitative studies, and three mixed-method studies-were used for the review. MEASUREMENTS: Data were analyzed using the matrix method. RESULTS: A total of 12 papers met the inclusion criteria. The initial group categorization was based on variables, patterns, and conceptual classification. Results were divided into two categorizations of asthma care coordination program components and asthma care coordination challenges at schools; subthemes were identified under the categorizations. CONCLUSIONS: The results showed that care coordination was key for students with chronic diseases including asthma. Asthma care coordination has many challenges, but school nurses can drive effective asthma care by including the essential components of care coordination. Successful asthma care coordination may prevent health care fragmentation, emergency room visits, hospitalization, and school absenteeism, and can increase asthma knowledge and the quality of life for students and parents.