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ABSTRACT BACKGROUND METHODS RESULTS CONCLUSIONS Adverse childhood experiences (ACEs) are associated with behavioral health challenges and high school dropout, and behavioral health is associated with high school dropout. Less is known about the role of behavioral health challenges in the relationship between ACEs and high school dropout.Using data from the Panel Study of Income Dynamics (2013) and its 2014 Childhood Retrospective Circumstances Study supplement, the current study conducts mediational path analysis to examine the direct and indirect effects of cumulative ACEs on high school dropout via adolescent depression, anxiety, and substance use.Experiencing more ACEs was associated with depression, anxiety, and substance use. Only depression and substance use were associated with high school dropout. There was a significant direct effect between increased ACEs and high school dropout and significant indirect effects via depression and substance use, but not anxiety.Adolescent behavioral health interventions to address the long‐term effects of ACEs may also support academic achievement. School‐based interventions, particularly those aligned with trauma‐sensitive school frameworks and engaging various school personnel, including school nurses, should be considered. Community‐ and policy‐level interventions aimed at primary prevention of ACEs are also needed. [ABSTRACT FROM AUTHOR]

ABSTRACT Context Objective Design Results Conclusions Starting face‐to‐face education while the COVID‐19 pandemic was ongoing was a risk for public health. Determining teachers’ initial reactions to public health practices during this high‐risk period may contribute to the redesign of public health and school nursing policies.The aim of this research is to examine the relationship between primary school teachers’ COVID‐19 fear levels and COVID‐19 vaccine attitudes.The research has a descriptive correlational design. The data were obtained from teachers working in primary schools (n = 430). Simple random sampling method was used in the data collection process. Data were obtained with the Scale of Attitudes Towards COVID‐19 Vaccine and Fear of COVID‐19 Scale.In the study, 50.5% of teachers reported that they were afraid of catching COVID‐19, 41.9% said their risk of catching COVID‐19 was “high,” and 87.7% reported that they voluntarily got the COVID‐19 vaccine. Of the teachers, 4.6% (n = 20) stated that they regretted getting vaccinated. A positive and significant relationship was found between teachers’ Fear of COVID‐19 Scale and COVID‐19 Vaccine Attitude Scale scores (r = 0.133, p < 0.001).During the pandemic, it was observed that teachers’ fear level of COVID‐19 increased with the start of face‐to‐face education. In addition, it is seen that teachers started to have doubts about some public health practices. This may indicate that public health nurses should take a more active role in school health practices. [ABSTRACT FROM AUTHOR]

Background: The number of adolescents reporting that they are stressed has more than doubled among both boys and girls. Most focus is given to girls because they typically not only report higher levels of stress but also feel stressed more frequently than boys do. However, studies have confirmed that boys' experience of stressors is the same, implying that genders are equally prone to experiencing stress. Although male and female adolescents appear to experience stress in a similar way, how they cope with these stressors might differ. This study focused on boys' experiences of stress and how they cope with it. Method: Eight focus groups were conducted with 39 adolescent boys aged 12–19 years enrolled in four schools in southern Sweden. The data was analysed inductively with conventional content analysis. Results: The analysis resulted in three categories: Stress perception – time as a key factor, Identifying stressors and levels of stress, and Silent struggles and distractions. The boys had experienced considerable stress in their lives, despite their limited understanding of the concept. Their coping skills focused on engaging in sports or distracting themselves from stressors while relying less on social support from peers, school staff, or family. Conclusions: Adolescent boys might need assistance in identifying stress and clearly voicing their specific concerns. They should also be provided with spaces that are free from stigmatization and judgement. Parents, teachers, and school nurses should be equipped with the appropriate tools and education on how to discuss stress and mental health in general with adolescent boys to prevent possible negative long-term consequences for both their physical and mental health. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionsA qualitative data analysis was conducted to better understand experiences of asthma exacerbation among school staff through thematic analysis of stories of children in respiratory distress.Qualitative thematic analysis was performed on 40 virtual or in-person interviews conducted with 44 staff from districts participating in a stock inhaler pilot program. Transcripts were iteratively coded by five coders. Stories of instances when a stock inhaler may have been helpful were subject to additional thematic analysis by one coder.Forty-five stories across 27 interviews were identified. Major themes were split into “Provocation” and “Outcomes of Asthma Incident.” “Educational and Communication Factors” in asthma exacerbations were discussed more often than environmental ones. Outcomes were divided into “Disposition” (with 14 participants choosing to describe incidents where emergency services were contacted), “Emotional Response,” and “School Response.” “Trauma for Students” was mentioned only by school nurses.Stock inhaler programming can alleviate helplessness, reduce trauma, and avoid costly hospital visits. Personal narratives can be a powerful tool for understanding unique needs and developing tailored, sustainable interventions for individual districts. These stories are incredibly persuasive in convincing other schools, districts, lawmakers, and other stakeholders to implement stock inhaler programming. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Vision screening programs can provide epidemiological information regarding visual impairment in children. This study aims to report the characteristics of visual abnormalities diagnosed through the Primary School Nurse Health Readiness Program (PSNHRP) in Queensland, Australia.A retrospective review of vision screening records from the PSNHRP between January 2017 and December 2020 was undertaken. Children aged between 4 and 7 who underwent vision screening were included for review. Children with a visual acuity of worse than 6/9–1 using the Parr 4 m letter‐matching chart or those who failed the SPOT Vision Screener were referred to an optometrist or ophthalmologist for review.164 890 children underwent vision screening. 12148 children failed visual screening (7.4%) and were referred for an eye assessment. 6011 (69.4%) of the 8659 children who attended ophthalmic review had a confirmed visual abnormality. Of 164 890 screened children, 1187 (0.72%) were confirmed to have anisometropia, 3843 (2.33%) had refractive error, 194 (0.12%) had strabismus, 755 (0.46%) had anisometropic amblyopia, 136 (0.08%) had strabismic amblyopia, and 1356 (0.82%) had an unspecific abnormality. There was no statistically significant difference in the age at screening between any visual abnormality (p = 0.94). Anisometropia, refractive error, and strabismus were significantly more common in females than males (p = 0.03, p < 0.01, and p = 0.03 respectively), whereas anisometropic amblyopia was more common in males (p < 0.01).We report the prevalence of visual abnormalities detected through the PSNHRP vision screening program. Identification of medical or socioeconomic risk factors that are likely to be associated with visual abnormalities can help to optimise vision screening programs. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand why it is important that all infants, including preterm infants, receive scheduled vaccines within the specified times • To be aware that some preterm infants may experience delays in receiving scheduled vaccines • To recognise the importance of supporting vaccine decision-making in parents of preterm infants. Background: Infants born preterm (prematurely) are at risk of infection, making timely vaccination vital. However, global literature suggests that preterm infants experience vaccination delays and there is a lack of evidence from the UK exploring this issue at population level. Aim: To investigate potential vaccination delays in preterm infants in one region of England and to identify characteristics related to timeliness. Method: Existing trust data sets were analysed for infants born across a six-month period in 2018. The vaccines studied were for the primary schedule (vaccines given to children at eight, 12 and 16 weeks of age). Results: The results did not fully concur with the global evidence. In this study only infants in the moderate-to-late category of prematurity received some vaccines later than full-term infants. Conclusion: Primary healthcare professionals, such as health visitors, should maximise opportunities to support parents with their decision-making around vaccination and ensure that they keep themselves fully informed about the latest vaccination guidance. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Impact Reporting Method Patient or Public Contribution To explore the role of public health nurses (PHNs) in Norwegian primary school health services in supporting siblings who have a brother or a sister with complex care needs.A qualitative, exploratory design using focus groups combined with visual methods.Nineteen Norwegian PHNs participated in three focus group discussions between May and September 2022. The nurses were asked to draw themselves as PHNs working in primary schools. Braun and Clarke's reflexive thematic approach was used to analyse the transcribed interviews. The drawings were analysed using critical visual analysis methodology.The findings revealed that PHNs in primary schools focused on establishing good relationships and found it important to be flexible and creative. However, a challenge to successful service provision in supporting siblings and their families was that the nurses lacked support for the implementation of health promotion interventions and often felt alone. The analysis elicited three main themes: ‘the importance of relationships and flexibility in meeting siblings' needs’, ‘feeling alone with responsibility for supporting siblings’ and ‘the forgotten children: a need for coordinated services’.PHNs in school health services are in a unique position to provide support to improve siblings' mental health and well‐being. To fully benefit from PHNs' potential to support siblings, there is a need to clarify guidelines and develop evidence‐based interventions.This study provides valuable insights for health authorities, educators and practitioners on what inhibits sibling support in Norway. The study highlights the potential for PHNs to play a significant role in delivering timely health‐promoting interventions for these siblings in school settings independent of context.This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ).No patient or public contribution. [ABSTRACT FROM AUTHOR]

The professional experiences of school nurses who work outside of urban areas are not often described. We used data from a 2019 statewide survey of school nurses to describe differences between the urban and non-urban (urban cluster and rural) school nurse workforce in New Mexico. Non-urban school nurses were twice as likely as urban nurses to provide clinical services to multiple school campuses (P <.001) and more likely to serve both elementary and secondary school settings (P =.002). They were less likely than urban school nurses to be bachelor's prepared, or to have received recent continuing education on diabetes (P <.001), reproductive health (P = 0.02), LGBQ+ and transgender student health (P <.001, for each), and suicide risk assessment and screening (P =.012). Our findings underscore concerns about geographic differences in the school nursing workforce in terms of educational preparation and student access that could potentially limit the school nurse role in advancing child health equity. [ABSTRACT FROM AUTHOR]

The National School Nurse Workforce Study 2.0 describes the demographic characteristics and distribution patterns, school nursing models and activities, and practice environment among self-reported public school nurses in the United States. A random sample of U.S. public schools was surveyed, stratified by region, school level, and urban/rural locale. A total of 2,827 schools responded, yielding a 38.1% response rate. Using these data, we estimate 78,869 full-time equivalents of school nurses, with 65,052 registered nurses (RN) and 13,817 licensed practical/vocational nurses (LPN/LVN). Findings indicate school nurse distribution differences by region, locale, and income. The predominant model of school nursing practice was the RN only, followed by the RN and LPN model. In general, school nurse respondents felt supported by school staff and parents. Less than half of survey respondents stated they were supervised by an RN. Research, policy, and school nursing practice implications are discussed. [ABSTRACT FROM AUTHOR]

Many school nurses experienced increased work burden and stress during the COVID-19 pandemic. This analysis examined data from a Centers for Disease Control and Prevention cross-sectional, nationwide survey of school nurses in March 2022 to examine associations between school nurses' ability to conduct their core responsibilities and selected nurse and school factors among school nurses during the 2021–2022 school year and COVID-19 pandemic. Perceived adequate staffing and financial compensation reduced the odds of reported difficulties across all core school nursing tasks. Nurses without a registered nurse license and with higher caseloads were more likely to report difficulty in implementing specific tasks. The impact of these factors varied, with inadequate financial compensation having the largest association with school nurses' difficulty implementing all the core responsibilities. The study results improve our understanding of school nurses' challenges in implementing core school nursing responsibilities during the COVID-19 pandemic in the 2021–2022 school year. [ABSTRACT FROM AUTHOR]

This study is a cost-benefit analysis examining an urban district's partial school nurse coverage conversion to full-time coverage. Through a partnership with a health care system, the district received funding, resulting in the hiring of full-time nurses to cover all K-8 elementary schools. Researchers compared the cost of nursing services to the savings in teacher, secretary, principal, and parent productivity, reduced medical procedure costs, and grants nurses managed. The year before implementing additional nurses, the return on investment (ROI) to the community for nursing services was calculated to be $1.59 for every dollar invested in schools with full-time coverage and $1.29 for schools with partial coverage. After implementing full-time nurses in each school, there was an ROI of $1.50 during the 2015–2016 school year, $1.64 for 2016–2017, and $1.67 for 2017–2018. The analysis provides evidence that full-time coverage could result in a positive ROI for schools and the community. [ABSTRACT FROM AUTHOR]

School nurses are pivotal to the safety of school-aged children, particularly those who receive medications in the school setting. The purpose of this study was to explore factors associated with medication administration errors in North Carolina school districts between 2012/2013 and 2017/2018. A longitudinal study using repeated measures analysis of school health services data collected in the North Carolina Annual School Health Services and Programs Survey was conducted. Over time, the number of medication errors (p =.001) and number of medication corrective action plans (p <.0001) trended upwards. There was also an increase in medication errors when the number of schools in a district was higher (p <.0001). Conversely, there was a decrease in corrective action plans when school nurses were directly employed by the school district (p =.0471). We implore school disticts to consider the important role of school nurses to keep kids safe, healthy, and ready to learn. [ABSTRACT FROM AUTHOR]

School nurses represent cost-effective investments in students' health and educational success. Alternative high schools (AHSs) serve an understudied population of youth who are at risk for school dropout and face numerous social inequities, heightening their risk for poor health outcomes. In this two-phase explanatory sequential mixed methods study, we examined school nurse staffing in Texas AHSs. Findings suggest Texas AHSs face understaffing for familiar reasons common across districts (e.g., lack of funding), but also reveal potential deeper inequities. Quantitative findings indicate 71% of Texas AHSs have some form of nursing support, most often an on-call or part-time nurse. Qualitative findings support and enrich this finding with insights into the negative consequences of not having a full-time nurse, indiscriminate approaches to staffing AHSs, and how AHSs can be the only school in the district without a full-time nurse. Altogether, our findings reveal opportunities to better support AHSs with adequate nursing support. [ABSTRACT FROM AUTHOR]

The Human Papillomavirus (HPV) vaccine can prevent 90% of cancers caused by HPV. Health care provider recommendations affect vaccine uptake, yet there are a lack of studies examining the impact of the school nurse (SN) in vaccine recommendations. The purpose of this study was to evaluate the impact of adding a SN HPV recommendation to the standard vaccination letter sent to parents/guardians. The rate of vaccination between the intervention and control schools was not statistically significant (Estimate (Std. Error) = −0.3066 (0.2151), p = 0.154). After controlling for age, sex, race, insurance type, and medical practice type, there was no significant difference in the likelihood to receive the HPV vaccine (OR = 1.53, 95% CI: 0.563–4.19 in 2018; OR = 1.34, 95% CI: 0.124–14.54 in 2019. Further work is needed to clarify how school nurses can better promote HPV vaccine, and which adolescent demographic groups (e.g., race, insurance type, provider type) face barriers to HPV vaccine uptake. [ABSTRACT FROM AUTHOR]

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities. [ABSTRACT FROM AUTHOR]

An initiative aimed at empowering school health nurses to provide optimal care within School Health Suites with education and resources. The initiative is collaborative between academic nursing programs and the Baltimore City School system. By leveraging the expertise of doctoral-prepared nursing faculty and institutional resources, school health nurses can be better equipped to address the complex health needs of Baltimore City Schools students. The initiative will provide access to resources such as workshops on professional development, training sessions covering health disparities among the school-age population, and mentorship focusing on degree advancement. This model will provide a foundation for providing efficient healthcare support for school age children and foster advancement for school health nurses. [ABSTRACT FROM AUTHOR]

Introduction: Culture and acculturation influence nutritional beliefs. Little is known about the Arabic population in the United States. In this study, Arabic-speaking Middle Eastern mothers' perceptions of motherhood and childhood nutritional beliefs and practices are explored. Method: Semi-structured interviews with 12 mothers from Arabic-speaking Middle Eastern countries. Results: Food and family are central to everyday life. Mothers worked hard to maintain traditional nutritional practices with their school-age children. Discussion: Findings can enhance school nurses' ability to collaborate with mothers in nutritional education and address any issues in the classroom. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the roles and tasks of school nurses in the UAE, quantify the time spent on each, and identify areas for improvement in school health services. This aligns with the UAE government's initiative to enhance primary healthcare, focusing on illness prevention and health promotion for children and adolescents. Methods: The research adopts an observational study design, utilizing self‐observation through diary recordings by school nurses to collect data on their daily tasks and time allocation. A sample of total of 2024 school nurse activities were recorded and analyzed over 126 days and 1084 h of observation by eight school nurses using self‐report diaries. This method allowed for the collection of detailed information on how nursing time is allocated between core and noncore tasks. Results: In this study a total of 2024 tasks were observed over 1084 h. The findings reveal that core nursing tasks accounted for 78% of activities but only 53% of the total 1084 h observed, while non‐nursing tasks, making up 22% of activities, disproportionately consumed 47% of the hours. This discrepancy highlights the inefficiency of time allocation, with non‐nursing tasks such as administrative duties taking significantly longer than core patient care tasks. Conclusions: The study highlights a significant opportunity to enhance school health services in the UAE by optimizing the allocation of nursing time towards more illness prevention and health promotion interventions. By addressing the identified challenges, including the gaps in nurse competencies and the lack of structured practice frameworks, school health services can be improved. [ABSTRACT FROM AUTHOR]

Objective: Schools are an important setting because students spend much of their time in school and engage in physical activity during the school day that could exacerbate asthma symptoms. Our objective is to understand the barriers and facilitators to implementing an experimental community health worker-delivered care coordination program for students with asthma within the context of the West Philadelphia Controls Asthma study. Methods: Surveys (n = 256) and semi-structured interviews (n = 41) were completed with principals, teachers, nurses, and community health workers from 21 public and charter schools in West Philadelphia between January 2019 and September 2021. Survey participants completed the Evidence Based Practice Attitudes Scale, the Implementation Leadership Scale, and Organizational Climate Index. Semi-structured qualitative interview guides were developed, informed by the Consolidated Framework for Implementation Research. Results: Participant responses indicate that they perceived benefits for schools and students related to the community health worker-based care coordination program. Several barriers and facilitators to implementing the program were noted, including challenges associated with incorporating the program into school nurse workflow, environmental triggers in the school environment, and challenges communicating with family members. An important facilitator that was identified was having supportive school administrators and staff who were engaged and saw the benefits of the program. Conclusions: This work can inform implementation planning for other locales interested in implementing community-based pediatric asthma control programs delivered by community health workers in schools. [ABSTRACT FROM AUTHOR]

To explore school nurses' roles globally through their own perceptions of what they do and how they do it and to compare the realities for the role its representation in professional literature. A comprehensive narrative literature review, using ENTREQ guidelines, with "qualitizing" of the quantitative literature, and athematic analysis was carried out. Findings were reviewed in relation toestablished theory. CINAHL, Medline, Cochrane Library, and Embase were systematically searched from 2000–2021. Included studies focused on school nurses'perceptions of their own practice. Five themes: direct care, health promotion, collaboration,support from school and health authorities and promoting the school nurses'role were found. These themes were closely aligned to the National Associationfor School Nurses' framework for 21st century practice. However, the schoolnurses signposted areas where they need support in carrying out their job tothe highest standard. School nurses are important to support thehealth needs of students while at school. They also, particularly in areas likethe United Arab Emirates where resources are being invested in the role, have a unique role to play in health promotion, leading to improved health literacy,as positive health behaviors tend to be learned young. However, worldwide, thepotential for the school nursing role needs to be recognized and supported by healthand education providers, by families and within the schools for its fullpotential to be achieved. [ABSTRACT FROM AUTHOR]

Menstruation is a key function of the reproductive system and is central to sexual and reproductive health and rights. Menstrual health and hygiene is critical to the well-being and ability of women and adolescent girls to take care of themselves in a healthy way during menstruation. Therefore, they should be explained and considered as an educational and health process. Topic relevance: respondents' attitudes to receiving information about the menstrual cycle from a midwife. Purpose: to provide health information about the nature of menstruation. Materials and methods: A survey was conducted in the month of April 2024 from schools in the city of Burgas, the city of Karnobat, the city of Sungurlare, the village of Ruen. There are 108 mothers of adolescent students who showed interest and desire to participate in the anonymous study. For the purpose of the study, the students, together with a teacher, prepared a multimedia presentation containing health information about the menstrual cycle, menstruation, hygiene care related to it, ways to achieve menstrual health; Results: Students aged 10 to 18 took part in the study. More than half of the girls studied had menarche between the ages of 12-14 (50.80%). The mother is the source of information (87.50%), and at the same time, children want to receive guidance on menstrual health from a doctor (52.50%), a school nurse (37.70%), even a familiar midwife ( 9.80%). A large proportion of mothers recognize the midwife as the appropriate health professional for menstrual health education.Conclusion: The study confirms the need for a premenstrual conversation, which mostly calms and prepares the girl for the upcoming menstruation. Adolescence is the most appropriate period during which an adolescent girl can develop healthy habits, including habits to maintain menstrual health. [ABSTRACT FROM AUTHOR]

In the United States, adolescents suffer from inadequate menstrual health, meaning that adolescents are unprepared for menarche, lack the practical resources they need to comfortably and confidently manage menstruation, and receive inadequate health education and care for menstrual pain and disorders. In this article, we provide a historical analysis of the role of school nurses in addressing menstruation from the early 20th century up to the present day. We contextualize the current realities of school nursing and menstrual health education and clinical support. We argue that the decentralized US school system, a cultural aversion to open discussion about menstruation, and the outsized influence of commercial menstrual product manufacturers have hampered the ability of school nurses to deliver menstrual health education along with menstrual health support. Finally, we discuss implications for today's schooling experiences as well as recommendations for how to support school nurses in aligning our national approach to menstrual health toward the public health perspective of menstrual equity. (Am J Public Health. 2024;114(9):903–908. https://doi.org/10.2105/AJPH.2024.307705) [ABSTRACT FROM AUTHOR]

This is the second in a series of articles highlighting the practice principles of the refreshed School Nursing Practice Framework™. The focus of each article is to provide an in-depth look at each of the principles and emphasize how school nurses can apply them to their daily practice through a Framework Mindset. This article will explore Care Coordination as a practice principle, reflect on how it relates to current practice, and identify examples that illustrate care coordination. With each subsequent article in the series, we will continue to build upon and explore the interconnections between the Framework principles. [ABSTRACT FROM AUTHOR]

Clinical Practice Guidelines (CPGs) are statements informed by a systematic review of research/evidence and provide recommendations for clinical practice to improve healthcare quality and patient outcomes. The National Association of School Nurses (NASN) released School Nursing Evidence-Based Clinical Practice Guideline: Students with Allergies and Risk for Anaphylaxis, in 2023, to provide evidence-based recommendations specific to school nursing practice and support the role of the school nurse in providing high-quality care for school-age children with allergies and risk for anaphylaxis. This article will provide an overview of the CPG and Implementation Toolkit. The implementation toolkit is designed to provide school nurses with tools and resources to implement the recommendations into practice. These tools and resources include school policies; nursing assessments and intake; planning, training, implementing, and evaluating care; and data collection. Examples are discussed, including how to customize the toolkit resources to your current practice needs. [ABSTRACT FROM AUTHOR]

This article shares an updated structure for school nurse evaluation using the School Nursing Practice Framework and the fourth edition of the School Nursing: Scope and Standards of Practice. This evaluation structure is modeled on work originally published in the January 2020 issue of NASN School Nurse. The original linking of the Framework for 21st Century School Nursing Practice and the 3rd edition of the School Nursing: Scope and Standards of Practice allowed the school nurse and their evaluators to understand the complex roles and responsibilities of the school nurse. This updated version incorporates the growing understanding of social issues and complex health concerns impacting school nursing practice. The School Nursing: Scope and Standards of Practice (4th ed.) competencies recognize issues including emerging technologies, structural barriers to health, and the complex health needs of students in an environment of inequities, violence, and underfunding, as well as the impact of natural disasters, public health crises, human migration, and social media on students. The updated School Nursing Practice Framework (Framework) likewise incorporates an understanding of the foundational aspect of the standards and the interconnectedness of the key principles. Our revised evaluation tool accomplishes the integration of the revised Framework with the updated standards of school nursing practice. [ABSTRACT FROM AUTHOR]

Asthma is common among the pediatric population. Exacerbations of this chronic condition can lead to emergency department visits and hospitalizations, resulting in time away from school. Children spend the majority of their day at school, where they may need access to quick relief medication to treat respiratory distress. Students' personal asthma medication is not always available in school. School nurses in Illinois collected data and undertook a quality improvement project to increase the number of schools in North Suburban Cook County with undesignated asthma medication. A toolkit was created and shared, helping to remediate barriers associated with obtaining undesignated asthma medication. With access to undesignated asthma medication, school nurses ensure students with asthma receive prompt treatment and coordination of care. [ABSTRACT FROM AUTHOR]

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Our overarching theme for Creative Nursing Volume 30 is The Impact of Social Forces on Nursing and Health. The theme of this current journal issue was originally called Social Violence. In planning this issue, our Editorial Board had to confront head-on the many ways in which overt violence or the threat of violence pervades our lives, as nurses and as individuals. We broadened the title to Consequences and Disruptive Solutions for Social Violence, choosing to focus on what we can do to recognize the interlocking processes that enable, promote, reward, and sustain violent behavior, and to mitigate those effects when and where we can. The sobering content in this issue is the business of each of us. The realities of domestic violence and gun violence, the impact of othering and marginalization, the effects of substance use on family members and of students' experiences of trauma on the school nurses who care for them, and the lethal legacy of unthinking adherence to policies and procedures that is still relevant today—Awareness of this part of our lives and of our practice is where we must start. [ABSTRACT FROM AUTHOR]

This qualitative descriptive study explored school nurses' experiences of exposure to reports of trauma from those in their care. Online interviews of school nurses practicing in NJ, USA, were recorded and transcribed verbatim. The study found that school nurses were exposed to reports of others' trauma to varying degrees, with those serving in urban settings reporting more stories of exposure than those in suburban settings. Reports included numerous, layered traumas at the community and individual levels, including students' poverty-related adversity and psychological distress. Qualitative content analysis revealed four categories: Health Office as Safe Haven, Challenges Working Within the School Model, Things That We Hear: Reports of Trauma, and The Ripple Effect of Trauma. School-based challenges included a lack of collaboration, misunderstanding of the school nurse's role, and workload issues such as competing demands and limited time and resources. School nurses reported focusing on the individual's immediate needs and processing the experience afterward. They acknowledged they can only do so much, and shared stories of coping and resilience. Additional education, resources, and support in addressing student trauma can enhance the provision of school nursing services and support the well-being of school nurses, students, and staff. Further research is warranted with a larger and more diverse sample of school nurses, including attention to school nurse wellness and resilience strategies. [ABSTRACT FROM AUTHOR]

While schools have become settings for the delivery of mental health supports to students, mental health nursing has not yet described its practice in schools. In the absence of this mental health nursing literature, a quantitative self‐reporting job analysis methodology was used to describe the tasks of mental health nursing in a specialist school as an observant–participator in a single‐case holistic case study. Additional aims were to compare the results with the general school nursing and the disability nursing literatures and interpret these findings for mental health nursing. Categories of tasks from general school nursing were used to deductively interpret the results. Tasks were recorded across all categories of school nursing. The greatest number of tasks were recorded in the professional performance category, followed by planning, then personnel. The least number of tasks were recorded in the health education and promotion category, followed by practice and treatments, assessment and diagnosis, and management. These results differ from tasks in general school nursing but share similarities with intellectual and developmental disability nursing, particularly related to relationships and communication. Practising effectively as a mental health nurse in a specialist school requires capabilities for working with people with disability, particularly communicating and establishing relationships, in addition to clinical mental health skills. Mental health nursing in schools is an area of practice that requires further exploration to capitalise on emerging policy developments to support student mental health. [ABSTRACT FROM AUTHOR]

Background: The sustainability of school‐based oral health programs depends on the utilization of effective, efficient treatments and the availability of a trained clinical workforce. The objective of this study was to determine whether registered nurses are comparable to dental hygienists in the application and effectiveness of silver diamine fluoride (SDF) and fluoride varnish (FV) for the prevention of dental caries. Methods: CariedAway was a school‐based study of SDF and FV versus dental sealants and atraumatic restorations. Within the SDF + FV arm, participants were treated by either a licensed dental hygienist or a registered nurse, both under the supervision of a paediatric dentist. Although initial treatment assignment in CariedAway was randomized, assignment to provider was not. The proportion of children who remained caries free after 2 years was assessed for non‐inferiority using two‐group proportion tests, adjusting for the clustering effect of schools. Results: A total of 417 children with no untreated caries at baseline were analysed including 298 treated by hygienists and 119 by nurses. The proportion of children who remained caries free after 2 years was 0.81 and 0.80 for those treated by hygienists and nurses, respectively, for a difference of 0.01 (95% CI = −0.07, 0.098) and within the pre‐determined non‐inferiority margin. Conclusions: Nurses may be effective in treating children with silver diamine fluoride and other fluoride varnishes in school‐based oral health programs. [ABSTRACT FROM AUTHOR]

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) is an autoimmune disorder associated with sudden onset of behavior changes. The prevalence of PANDAS is increasing in schools and interdisciplinary collaboration, knowledge, and the use of referrals to the school nurse are important for supporting students. This project sought to provide education on PANDAS to the interdisciplinary school team and implement a referral process for students exhibiting behavior changes. A self-directed online educational intervention was employed. A pretest-posttest design was utilized to assess knowledge before, immediately after, and six-weeks after the educational intervention. A referral log was implemented to track the number of referrals to the school nurse. The final sample size included 19 participants. Mean scores increased from pretest to posttest, and the implementation of a referral system produced 12 new school nurse referrals. Further strategies are needed to enhance interdisciplinary collaboration and support students experiencing health-related issues. [ABSTRACT FROM AUTHOR]

School nurses play a key role in supporting student mental health, and many school nurses report the need for additional mental health education. The Mental Health Training Intervention for Health Providers in Schools (MH-TIPS) is a training and implementation support system for school nurses to enhance their skills in promoting student mental health. The current study evaluated the feasibility of the MH-TIPS online curriculum for school nurses, and its impact on their preparedness and ability to support student mental health. Participants included 1,282 registered nurses and nurse practitioners. Descriptive statistics indicated that MH-TIPS online was feasible, relevant, and accessible for school nurses and helped them support student mental health. School nurses reported significant improvements in their preparedness to conduct brief mental health interventions with students and motivate students to seek help. MH-TIPS online is a promising tool to increase the ability of school nurses to support student mental health. [ABSTRACT FROM AUTHOR]

This study identified custodial grandparents' perception of sources of stress that may affect their health and better understand their needs. Findings from this qualitative study are based on thematic analysis of interviews with 10 custodial grandparents. The following themes emerged: 1) grandparents' stress from perceived lack of readiness to care for grandchildren; 2) need for effective communication between and among family members; 3) sufficiency of financial and legal resources; 4) access to community resources, and 5) raising grandchildren reenergizes and revitalizes grandparents' physical and mental health. These findings provide insight into the stressful aspects of the role of raising grandchildren. Understanding stressors affecting custodial grandparents and their grandchildren will help school nurses, social workers, teachers, school administrators and other professionals collaborate to address their challenges. [ABSTRACT FROM AUTHOR]

The coronavirus 2019 (Covid-19) pandemic has affected both the private and public lives of people worldwide. Countries have chosen different strategies to reduce the spread of infection, including school closures and distance learning. This study aimed to describe school nurses' perceptions about the wellbeing of students during the Covid-19 pandemic in Sweden. Interviews in five focus groups and one individual were conducted with 17 school nurses in Sweden. The interviews were analyzed using a qualitative content analysis. According to the school nurses' perceptions, students were concerned about spreading infection, becoming infected themselves, their academic performances, and longing for socialization. The change in the school situation involved a slower pace and less anxiety for some students, more or less physical activity, and an increase in screen time. [ABSTRACT FROM AUTHOR]

The number of school-aged students with diverse linguistic and cultural backgrounds is increasing across the United States. This survey identifies strategies school nurses use for communicating to families with limited English proficiency and describes recommendations to improve language needs. The online survey was completed by K–12 school nurses and data were analyzed using descriptive statistics. Among the 52 participants, only 23% (n = 12) indicated that resources they were currently using to interpret health information always met their language needs, with the most common resource described as school personnel who can speak the language needed for interpretation. To improve communication, most (73%; n = 38) participants described preferences for in-person resources and estimated that if on-demand interpreter resources were readily available, they would use on-demand resources for approximately 3.6 hours per week. By improving linguistic and cultural competencies among students and families with limited English proficiency, school nurses can improve student health outcomes. [ABSTRACT FROM AUTHOR]

This study aimed to describe the profile and practices of school nurses working at a network of educational centers in Spain. This was a descriptive study of the documented actions of 107 school nurses between September 2018 and June 2021 in 54 educational centers (55.6% private and 44.4% subsidized). The profile of the school nurses was young (average age 33.8 [standard deviation (SD) = 7.7] years) and predominantly female (91.6%) with a diverse and multidisciplinary education, primarily at the postgraduate level (specialized mainly in emergency care, nursing/school health, and pediatrics/neonatology). They carried out 256,499 interventions. The most frequent types of incidents they treated were accidents (30.4%) and disease-related episodes (22.2%). The interventions were usually brief (average time 7.7 min) and were resolved by the school nurse (99.1%), and the main recipients were students (87.3%). The highest incidence of interventions occurs during breaks between classes. Acute interventions occupied most of the school nurses' time, leaving little opportunity for health education (0.3%). School nurses played an important role in preserving and promoting the health of school populations and cost-savings to healthcare systems with the actions that they performed. Descriptions of these actions are essential when advocating for the continuation and expansion of school nursing services. [ABSTRACT FROM AUTHOR]

Healthcare Professionals Working in Schools (HPWS) are responsible for providing health services to students and play a role in providing education to prevent illnesses, including tickborne diseases (TBD). Providing TBD education to children has been shown to increase prevention behaviors and knowledge of TBD symptoms, but little is known regarding the current state of TBD awareness among HPWS. In spring 2019 we conducted a cross-sectional knowledge, attitudes, and practices (KAP) survey of HPWS in two states with a high incidence of Lyme disease (LD) to inform design of TBD prevention programs. The survey queried general knowledge of TBDs, school practices regarding TBDs, and availability of TBD resources. Overall, higher confidence, experience, risk perception, prior training on TBD, and more years employed as a HPWS were independently associated with knowledge of LD transmission, symptoms, and correct tick removal practices. State and local health departments should consider prioritizing engagement with HPWS to provide educational opportunities about tickborne diseases. [ABSTRACT FROM AUTHOR]

Asthma morbidity disproportionately impacts children from low-income and racial/ethnic minority communities. School-supervised asthma therapy improves asthma outcomes for up to 15 months for underrepresented minority children, but little is known about whether these benefits are sustained over time. We examined the frequency of emergency department (ED) visits and hospital admissions for 83 children enrolled in Asthma Link, a school nurse-supervised asthma therapy program serving predominantly underrepresented minority children. We compared outcomes between the year preceding enrollment and years one-four post-enrollment. Compared with the year prior to enrollment, asthma-related ED visits decreased by 67.9% at one year, 59.5% at two years, 70.2% at three years, and 50% at four years post-enrollment (all p -values< 0.005). There were also significant declines in mean numbers of total ED visits, asthma-related hospital admissions, and total hospital admissions. Our results indicate that school nurse-supervised asthma therapy could potentially mitigate racial/ethnic and socioeconomic inequities in childhood asthma. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effects of a violence-prevention education program using empathy (VPEP-E) on elementary school students. This quasi-experimental design examined fifth-grade students' (a) empathy level, (b) perception of violence, and (c) permissive and negligent attitudes toward violence, using a pre- and post-test design. A total of 101 students participated: the experimental group (n = 48) received eight sessions of VPEP-E, whereas the control group (n = 53) received violence prevention education through classroom lectures. Significant differences were observed between the groups' empathy level (t = 6.81, p <.001), perception of violence (t = 2.79, p =.006), and permissive and negligent attitudes toward violence (t = -2.21, p =.030; t = -2.02, p =.046). Thus, a school-based VPEP-E may help elementary school students. Long-term studies evaluating behavioral changes from VPEP-E implementation are needed for establishing the effects on violent behavior. [ABSTRACT FROM AUTHOR]

Since 2005, a group of stakeholders in Colorado has collaborated to improve diabetes management in schools and childcare centers by standardizing care and embedding local expertise to support school personnel in this task. This effort has included the development of toolkits for parents, school nurses, and other health care providers; the establishment of a diabetes resource nurses program; and annually updated guidelines titled Standards of Care for Diabetes Management in the School Setting & Licensed Child Care Facilities. This collaboration has fundamentally changed how school nurses and staff in Colorado care for students with diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Type 1 diabetes (T1D) is a disease that primarily occurs in pediatric populations. A school nurse (SN) can provide valuable support in the school setting for minors affected by this condition. Methods: The main objective of this study was to evaluate the impact of nursing care provided to adolescents and children with T1D using technological devices in school. Qualitative and quantitative outcomes considered in the included studies were collected and discussed. A systematic review was conducted in the PubMed, CINAHL, and Scopus databases and reported thought the PRISMA guidelines. Results: Eleven studies were included. The results showed that SNs need to enhance both their skills and organization to effectively manage young patients with T1D using technology. The response of both the pediatric population and their caregivers to the disease management by a SN has been positive. Conclusions: The management of chronic diseases is one of the most urgent public health issues, especially for Western healthcare systems. Proper management of patients with T1D at the school level is definitely an aspect that policymakers and healthcare managers should consider to improve the quality of life of this extremely vulnerable population, particularly those using technological management T1D. [ABSTRACT FROM AUTHOR]

Background: Obesity prevention in adolescents is a public health priority given its increasing prevalence and health impact of obesity. Aim: To evaluate the effectiveness of an educational intervention in overweight and obesity using a mHealth app in improving nutritional and sports knowledge, adherence to the Mediterranean diet, physical activity and anthropometric measurements in adolescents. Methods: A randomised controlled trial with parallel groups that included 305 adolescents. The app includes the use of effective behavioural strategies to achieve habit change. Primary outcome variables were nutritional and sports knowledge score (GeSNK), adherence to a Mediterranean diet (KidMed) and level of physical activity (PAQ-A). Results: The study included 154 participants in the mHealth group and 151 in the control group. The level of nutritional and sports knowledge was significantly higher in the mHealth group, 47 points versus 42 points. Adherence to the Mediterranean diet improved in both groups, 9 points in the mHealth group versus 8 points in the control group. Physical activity was statistically higher in the intervention group, 160 minutes/week versus 120 minutes/week. Conclusions: The mHealth intervention showed a significant improvement in the level of nutritional and sports knowledge, adherence to the Mediterranean diet and time spent on physical activity. [ABSTRACT FROM AUTHOR]

School nurses are in a key position to promote children's physical activity. They engage all children in health dialogues and use different approaches to inform children about physical activity and motivate them to change their physical activity level. In a school context, it is important to explore and problematize school nurses' views of children's physical activity and the influence of these views on their professional practice in the school health service. Identifying and problematizing school nurses' views of physical activity would enable them to create improved guidelines and equivalent ways of working in the future. Therefore, this study aims to discursively explore Swedish school nurses' views on school children's physical activity and its promotion and elucidate them through a discursive framework based on sensitizing concepts. This study uses a qualitative research design with a constructivist grounded theory approach. Semi-structured interviews were conducted with 24 school nurses. The analysis resulted in a core category describing how school nurses use intertwined views to lead children from sedentarity to physical activity. Furthermore, the school nurses' practices were identified in three categories: fostering everyday movement as a tool for health, battling children's sedentarity under difficult conditions, and promoting everyday movement and compensating for unequal access. The results indicate that school nurses lack common and clear guidelines for their mission to promote physical activity to children, which may lead to inequality in access to physical activity for children and young people. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveDesignMethodsResultsConclusionTransformation of healthcare is necessary to ensure patients receive high-quality care. Working with the evidence-based practice (EBP) principles enables nurses to make this shift. Although working according to these principles is becoming more common, nurses base their actions too much on traditions and intuition. Therefore, to promote EBP in nursing practice and improve related education, more insight into nurses’ needs is necessary to overcome existing EBP barriers.To identify the current needs to work with EBP principles among hospital and community care nurses and student nurses.A qualitative, exploratory approach with focus group discussionsData was collected between February and December 2020 through 5 focus group discussions with 25 nurses and student nurses from a hospital, a community care organisation, and nursing education schools (bachelor and vocational). Data were analysed using reflexive thematic analysis, and the main themes were synchronised to the seven domains from the Tailored Implementation for Chronic Diseases (TICD) checklist.Nurses and student nurses experience EBP as complex and require more EBP knowledge and reliable, ready-to-use evidence. They wanted to be facilitated in access to evidence, the opportunity to share insights with colleagues and more time to work on EBP. The fulfilment of these needs serves to enhance motivation to engage with evidence-based practice (EBP), facilitate personal development, and empower nurses and student nurses to take more leadership in working according to EBP principles and improve healthcare delivery.Nurses experience difficulties applying EBP principles and need support with their implementation. Nurses’ and student nurses’ needs include obtaining more EBP knowledge and access to tailored and ready-to-use information. They also indicated the need for role models, autonomy, incentives, dedicated time, and incorporation of EBP in daily work practice. [ABSTRACT FROM AUTHOR]

Objective: Our goal is to examine gaps in self‐carry, asthma emergency protocol, and stock inhaler policy knowledge in Illinois schools. Design: A 30‐item REDCap cross‐sectional survey developed by a team of stakeholders was disseminated. Questions assessed policy knowledge, awareness, and practices regarding asthma emergency protocols, self‐carry, and stock inhalers. Sample: Participants were Illinois school nurses belonging to a governmental organization listserv. Measurements: Analysis utilized Chi‐square tests, descriptive statistics, and t‐tests. Results: Nurses reported 36% of students on average self‐carried asthma medication. Thirty percent of nurses were not aware of their emergency asthma policy and only 60% reported having an emergency asthma protocol in their school(s). Fifty‐four percent of nurses were aware of stock inhaler programming. Of the 10.3% who reported a stock inhaler program, a lower frequency reported calling 911 for asthma emergencies. Perceived school asthma prevalence varied from 0%–87%. Conclusions: Our survey demonstrates large variation in knowledge and implementation of school‐based asthma health policy. This is likely due to variations in health policy education dissemination. Future efforts should focus on the dissemination and implementation of school‐based asthma health policies to improve their more universal adoption and better support school‐based asthma management. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The National School Health Data Set: Every Student Counts! (ESC!) is NASN's data initiative focusing on building data capacity for school nurses, a uniform data set with standardized definitions, and promoting data infrastructure including school nurse access to electronic documentation, interoperability of educational systems and school health records, and build partnerships to increase data collection, storage, retrievable, and utilization. Each year since 2018, states have submitted data to NASN for inclusion in the National School Health Data Set. Participation is built on a tiered programing model to include school nurses at the school, state, and national level. Every state has identified a State Data Coordinator (SDC) who serves as a liaison to NASN to support ESC! but also provides support to school nurses in their state. This article provides an overview of the ESC! data initiative for the 2023–2024 school year, which includes the data from the 2022–2023 school year. [ABSTRACT FROM AUTHOR]

School nurses are more likely to support students' health, safety, and readiness to learn if they approach their practice through the lens of the School Nursing Practice Framework™ (the Framework). Practicing with an intentional focus on the Framework principles is called practicing with a Framework mindset. This article is the first in a 5-part series discussing how to be a school nurse who practices with a Framework mindset. In this article, school nurses will discover the basis for updates to the Framework's Standards of Practice principle, differences between the Standards of Practice principle and the authoritative standards of school nursing practice, activities that exemplify the Standards of Practice principle, and how to address a real-world school nursing challenge with a Framework mindset attuned to the Standards of Practice principle. [ABSTRACT FROM AUTHOR]