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Aim To clarify if Sense of Coherence could be used as an element of primary-focused health services in schools. Background The United Arab Emirates is striving to develop a high-quality, primary focused healthcare system. School healthcare services are well established in the UAE but have not yet been fully used to play a key role in this development. Methods Cross-sectional survey study to explore Adolescents SOC and their behavioral, psychosocial, and clinical outcomes. Results 408 adolescents participated in this study. Compared with others, adolescents with higher SOC had better adherence to treatment, fewer visits to the school nurse, better self-efficacy, fewer hyperactivity problems, fewer emotional problems, more prosocial behaviors, and fewer conduct problems. Conclusion Implementing interventions that improve SOC may support improved well-being among adolescents. The findings also support the use of SOC and salutogenesis as a framework to reinforce primary healthcare services for this population. Implications for nursing management Health service managers can utilize SOC as a framework to focus service on illness prevention and health promotion, they should collaborate with education authorities to include more health-related topics as part of school curricula to promote students SOC, and finally, should assess and build awareness of SOC and associated tools among school nurses and primary healthcare providers.

Sport participation is an important part of the development, both physically and mentally, of children and adolescents in the United States. Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life-threatening illnesses or injuries may occur. It is important for the school nurse to recognize potential life-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider’s office, or directly to the closest emergency department via Emergency Medical Services). This article specifically describes the initial assessment and management of three potentially life-threatening conditions associated with sport and physical activity, namely sudden cardiac arrest, hypovolemic shock, and spinal cord injury.

Background School-based health centers (SBHCs) offer primary and preventive health care for children and adolescents. Using nationally representative data, we aimed to examine which child and family characteristics are associated with using school-based health care providers as the primary source of health care, and whether care received from these providers met the criteria for a medical home. Methods Using data from the 2016-2018 National Survey of Children's Health (NSCH), we analyzed children's usual source of care (school-based provider, doctor's office or clinic, other location, or none), and whether they received care meeting medical home criteria. Results Based on a sample of 64,710 children, 0.5% identified school-based providers as their primary source of health care. Children who were older, uninsured, or living in the Northeast were significantly more likely to report school-based providers as their usual source of care. Children whose usual source of care was a school-based provider were less likely to receive care meeting medical home criteria than children who usually received care at a doctor's office. Conclusions While SBHCs improve access to care, our findings indicate potential challenges with establishing a medical home for children who usually receive health care from a school-based provider.

Asthma is the most common noncommunicable chronic childhood disease, affecting more than 5 million children in the United States. Asthma is the leading cause of school absenteeism. Treatments for asthma are divided into fast-acting medications that are used to relieve symptoms and slower acting (controller) medications that prevent symptoms. Albuterol is the most common fast acting medication for asthma, and it exists in multiple forms, including metered-dose inhaler and nebulized therapy. The use of spacers and holding chambers can further improve medication deposition in the airway. The cornerstone controller therapy for asthma is inhaled corticosteroid. Other medications for asthma include long-acting beta agonists, long-acting antimuscarinics, and antileukotrienes. The newest agents for controller asthma therapies are biologics.

Objective Although the importance of stakeholder engagement (SE) for patient-centered research is recognized, few studies document SE processes and influence on research outcomes in the diabetes field. We applied a research-informed framework to evaluate the impact of SE on a pediatric diabetes study exploring school nurse perspectives on modern diabetes devices. Methods We recruited parents of children with type 1 diabetes, school nurses, and diabetes providers. Stakeholders convened virtually every 2 months for 12 months. Goals for SE included input on research materials, interpretation of findings, and future research directions. Processes were assessed using a validated survey. Immediate outcomes included changes to research materials and satisfaction. Secondary outcomes included research efficiency and value (acceptance by community partners). Results Each role was represented at every meeting. The majority of stakeholders (>70%) completed the survey at study midpoint and end points. All surveyed indicated that they had received all desired information, shared feedback, and felt valued. Stakeholders were satisfied with the meeting frequency. Participants appreciated learning from each other and expressed enthusiasm for continued research participation. They described their role as one of consultant rather than research team members. SE resulted in five additional interview questions. Nearly 70 comments added to the interpretation of qualitative themes. Findings were published within 12 months and recognized by the state school nursing organization. Conclusion SE was well received and led to meaningful changes in content and dissemination of a diabetes study. A systematic approach to evaluating SE can increase scientific rigor and reproducibility and contribute to best practices for SE in diabetes research.

BackgroundThere is an increasing need for the voice of children and young people to be more evident in planning and designing services, including the delivery of higher education, for school nurses to ultimately influence service delivery.AimTo raise awareness of the importance of children's rights by embedding them in postgraduate school nurse education to influence school nurse service delivery.MethodsA model was developed through direct partnership with representatives of the Children's Parliament in Scotland. This model facilitated the inclusion of children and young people's opinions in the co-design of postgraduate nurse education in order to incorporate children and young people's rights and opinions and improve the delivery of the school nurse service in Aberdeen.ResultsIn a supported environment, children and young people were able to negotiate relationships with multiagency professionals on an equal basis, building connections and trust with them in partnership, based on their perceptions of school nurses' daily actions and characteristics. Their negotiation of relationships identified various change management categories for improving the delivery of higher education and services.ConclusionsChildren and young people have clear opinions and views when consulted in an inclusive age-appropriate way through rights-based participation. It is important that listening and taking due cognisance of children's voices becomes the norm in influencing higher education, and that children and young people have a direct influence on improving children's services.

Approximately 470,000 children and adolescents in the United States have epilepsy, 30% of whom experience seizures despite antiseizure drug regimens. School nurses, teachers, caregivers, and parents play integral roles in implementing a care plan that avoids triggers, recognizes signs, and provides supportive care—ideally, guided by a patient-specific seizure action plan, which may include the use of rescue medication. Benzodiazepines are the mainstay of seizure rescue medication; for decades, rectally administered diazepam was the only approved rescue medication for seizure clusters outside the hospital setting. However, rectal administration has limitations that could delay treatment (e.g., social acceptability, removal of clothing, positioning). More recently, intranasal midazolam (for patients ≥12 years) and intranasal diazepam (for patients ≥6 years) were approved for this indication. Training and education regarding newer forms of rescue medication should improve confidence in the ability to treat seizures in school with the goal of increasing the safety of students with epilepsy.

Anaphylaxis is a rapidly occurring allergic reaction that is potentially life threatening. Recognition of the early signs and prompt treatment of anaphylaxis is critical. School nurses are tasked with educating nonmedical school personnel on the recognition and treatment of anaphylaxis and emphasizing that epinephrine is the first line of treatment for anaphylaxis. Fortunately, there is now availability of multiple epinephrine administration devices. However, this also means that there are more devices that school nurses and nonmedical assistive personnel need to learn about to be able to administer in an emergency. Once epinephrine is administered, emergency medical services must be activated. Education regarding what to expect after the administration of epinephrine with respect to side effects and onset of action is also necessary. Though adjunctive medicines, such as antihistamines and inhalers, may also be administered after the injection of epinephrine, they should not be solely relied on in anaphylaxis. School nurses are uniquely situated for this role, as they understand the local environment in a school and can assess and reassess the needs of the faculty and staff.

The arrival of SARS-Co-V-2 (severe acute respiratory syndrome coronavirus 2) has brought not only the COVID-19 (coronavirus disease 2019) pandemic but also the development of a cluster of symptoms known as multisystem inflammatory syndrome in children (MIS-C). Information regarding the long-term implications of COVID-19 infections in children, as well as MIS-C, is scarce and is emerging on an almost daily basis. The purpose of this article is to provide an overview of the recent literature regarding COVID-19 and MIS-C, a Kawasaki-like inflammatory syndrome that developed in children around the same time the COVID-19 pandemic began. Because the school nurse monitors children across a variety of developmental domains, they are in a unique position to identify changes and notice long-term trends related to the health and development of children who contract both COVID-19 and MIS-C.

The National Association of School Nurses supports immunization to reduce the incidence of vaccine-preventable diseases. School nurses have the obligation to discern and understand vaccine strategies to aid in the advocacy and education of their school administrators, faculty, staff, students, and caregivers. Coronavirus disease 2019 (COVID-19) has spread to all continents, and the total number of those infected or immune through effective vaccination is well below the estimated need for herd immunity. To achieve herd immunity against the global outbreak of COVID-19, the rapid development of safe and effective vaccines is essential. Using multiple strategies and vaccine platforms to speed up the vaccine development process will inherently save more lives. Equipped with this knowledge of vaccine strategy, the school nurse can more aptly advocate for the use of the COVID-19 vaccines to move toward herd immunity in their communities.

This article is the second part of a two-part series on mental health in school-age children. The focus of this article is on mental health assessment in the school setting, including the use of screening tools, with a review of common medications prescribed for youth with anxiety and depression. Students with mental health conditions frequently seek refuge in the school health office, many times for psychosomatic complaints such as stomach ache, headache, nausea, and fatigue. School nurses need to be adept to assess mental health and intervene as necessary.

School nurses are seeing increased numbers of children who are living in poverty. The Missouri Community Action Program Poverty Simulation was presented to school nurses to increase their awareness of what it might be like to live in poverty and the related healthcare barriers. Participants shared their reactions and knowledge gained in the simulation in a postparticipation survey with the simulation facilitators. Some participants shared practice changes that they made as a result of their participation in the simulation, which included use of additional referral resources, being less judgmental, and increased empathy.

Objectives To understand how the events of the 1996 formation of a school-based health center (SBHC) both illustrate the concept of civic engagement and embody historic aspects of public health nursing practice. Design Case study design. Sample Interviews, documents, epidemiologic records, and field observations. Results The three themes discovered were collaboration to achieve public good, equity and social justice, creation of a long-term partnership, and demonstration of leadership using grassroots advocacy. Conclusion The SBHC case serves as a contemporary example of public health nurses' leadership in the current practice arena. The experience of nurse leadership evokes the historic mission and practice of public health nursing.

School nursing associations are the professional organizations that help members collaborate with each other, keep up-to-date with trends and advances within the profession, advocate the positions of the profession, and provide a place of connection with stakeholders and government entities. Participation by members in professional associations is waning across the country affecting the work they can do. The Illinois Association of School Nurses took a proactive approach to reorganize and revitalize their organization and membership.

Newly arrived immigrant and refugee children are faced with significant physical and mental health issues and often rely on school nurses for care and connection to healthcare. The purpose of this qualitative phenomenological study was to explore urban public school nurses’ experiences caring for newly arrived children. Data were collected through one-time in-depth semistructured interviews with school nurses ( n = 20). Three relational themes were identified: (1) Trials and Triumphs: Telling Stories About Newly Arrived Children; (2) Walk a Mile in My Shoes; and, (3) Being a Trusted Health Navigator. The Role of School Nurses in the Context of Trauma emerged as the constitutive pattern. The current study enhances our understanding of the unique role played by school nurses as they address the profound needs of newly arrived children and their families, many of whom have survived trauma and face a number of barriers to accessing care.

Children and adults with Type 1 and Type 2 diabetes are at risk for severe hypoglycemia, an unpredictable and potentially life-threatening situation. Severe hypoglycemia creates low blood glucose levels in which a person has an altered mental status or physical symptoms that require assistance from another individual to treat the hypoglycemia. Treatment of severe hypoglycemia is a medical emergency and prompt treatment is important for the well-being of students with diabetes. If left untreated, severe hypoglycemia can lead to death. Glucagon is a medication used to treat severe hypoglycemia outside of a healthcare facility. Recently, more stable and easier to use formulations of glucagon have become available. The purpose of this pharmacology update is to describe two new formulations of ready to use glucagon: an intranasal and subcutaneous, autoinjector formulation.

The purpose of this article is to review and help identify the advantages and disadvantages of different types of thermometers available for use and to provide guidance on fever education for the otherwise healthy child in the community and school health population. The measurement of body temperature is an essential part of standard medical care that monitors patient status, response to treatment, and helps gauge the severity and progression of disease. There are multiple types of thermometers on the market and each has advantages and disadvantages related to infection control measures, cost, and ease of use. Digital thermometers provide quick accurate results and are cost-effective. However, noncontact forehead, tympanic, or temporal scanner may be a better option for some populations of students. The noncontact forehead scanner may be a better choice when large numbers of students need to be screened. After fever has been identified, parent education should be provided, including when to seek further care and comfort measures such as safe, effective antipyretic usage.

For over a century, community health workers (CHWs) have acted as agents of social justice, health care promotion, and change for the underresourced communities they serve and come from. Over 50,000 CHWs are employed in the United States, and this number is growing with the need for CHWs to help fight both the COVID-19 pandemic and social injustice plaguing our nation. Even with many students learning from home, it is crucial that healthcare be integrated into the school system since a child’s health greatly affects their ability to learn. CHWs in schools can help overcome community and cultural barriers to connect families to various community resources and provide important health screenings and education. On return to the traditional classroom, the myriad of tasks such as infection prevention, contact tracing, and temperature screening are not feasible for a school nurse to do alone. CHWs may be just the leaders we need to help schools address the challenges faced in 2020.

Annually, the National Association of School Nurses (NASN) sets advocacy goals. The goals include legislative and policy priorities. The COVID-19 pandemic brought attention to the need to heighten advocacy efforts, specifically to provide for additional school nurses and supplies necessary to meet the challenge of safely returning students to school. While advocating at the national level, NASN also encouraged advocacy at the state and local levels. This article provides a brief summary of NASN’s advocacy efforts as well as providing examples from two different state associations demonstrating the importance of collaboration in advocacy efforts in areas related to the pandemic and in general areas related to school nursing.

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.

Aim: To investigate the prevalence of otitis media with effusion (OME) and related risk factors among primary school children in Mersin.Material and Method: The study was conducted at eight primary government schools in the distinct socioeconomic district between October 2018 and December 2018. Using the combined physical examination and otoscopic evaluations, a total of 960 children included the study. Findings: Of the children who were screened, 53.2% were girls and the mean age was 7.57 ± 0.45 years (min: 5 - max: 11 years). In this study, OME prevalence was 2,6% (20 of 761 children) and all children had bilateral OME. There was no statistically significant difference between the presence of OME and the number of people at home, incoming level, month of birth, birth weight, duration of breastfeeding, age average, class, gender, smoking in the house, presence of hearing loss in the family, history of otitis in the family, use of pacifier, use of baby bottle, presence of allergy, previous history of otitis, the presence of open mouth, snoring and tonsil grades.Conclusion: Although the low prevalence of OME in our study, considering that OME and its possible preventive severe complications, screening for OME should be a part of preventive health services, particularly for primary school children., Amaç: Mersin'deki ilkokul çocukları arasında efüzyonlu otitis media (EOM) prevelansını ve ilgili risk faktörlerini araştırmak.Gereç ve Yöntem: Çalışma Ekim 2018-Aralık 2018 tarihleri arasında farklı sosyoekonomik bölgedeki sekiz ilköğretim okulunda gerçekleştirildi. Fizik muayene ve otoskopik değerlendirmeler birlikte kullanılarak toplam 960 çocuk çalışmaya dahil edildi.Bulgular: Tarama yapılan çocukların %53,2'si kız ve ortalama yaş 7,57 ± 0,45 yıl idi (min: 5 - max: 11 yıl). Bu çalışmada EOM prevalansı %2,6 idi (761 çocuğun 20'si) ve tüm çocuklarda bilateral EOM vardı. EOM varlığı ile evdeki kişi sayısı, gelir düzeyi, doğum ayı, doğum kilosu, emzirme süresi, yaş ortalaması, sınıf, cinsiyet, evde sigara kullanımı, ailede işitme kaybı varlığı, ailede otit öyküsü, emzik kullanımı, biberon kullanımı, alerji varlığı, önceki otit öyküsü, açık ağız varlığı, horlama ve bademcik evreleri arasında istatistiksel olarak anlamlı bir fark yoktu.Sonuç: Çalışmamızda EOM prevalansı düşük olmasına rağmen, EOM ve olası önleyici ciddi komplikasyonları düşünüldüğünde, EOM taraması özellikle ilkokul çocukları için koruyucu sağlık hizmetlerinin bir parçası olmalıdır.

Sugar-sweetened beverages (SSBs) are a major source of calories in the diets of American children and adolescents. These beverages, which contain mainly sugar and few beneficial nutrients, have been linked to overweight, obesity, type 2 diabetes, heart disease, dental caries, and other adverse conditions. Children of all ages consume SSBs, and schools, aided by the knowledge and direction of school nurses, can help students understand the health harms of SSBs, implement programs to discourage SSB intake, and play important roles in school and community efforts to limit SSBs.

Background. School is the place, identified with a noticeable risk of Traumatic Dental Injuries (TDI) in children which have functional, esthetic and psychological effects. Objectives. To assess the preparedness of concerning traumatic dental injuries and their management among school teachers and also to empower the clinician to frame a set of instructions for school teachers to handle the emergencies effectively at the site of the incident. Material and Methods. A cross-sectional study was conducted among 330 school teachers enrolled in government and private schools of 24 randomly selected schools in Bhubaneswar city. A self-administered questionnaire was distributed to collect information on participants demographic characteristics, knowledge, attitude and practice about emergency management of Traumatic Dental Injury. Chi-square test with level of significance set at 5% was used for statistical analysis. Results. Statistically significant (p0.05). All the respondents expressed the need for a training program. Conclusions. This study highlights the instantaneous need for tailor made dental health educational and preventive programs for school teachers in order to effectively manage the Traumatic Dental Injuries.

Mental illness is common, and its severity ranges from subclinical to severe, where the condition affects daily social and academic functioning. Because of its ubiquity, it is necessary that school nurses have an enhanced understanding of some of the mental health conditions that children and adolescents may be facing. As will be discussed, some mental health concerns present with somatic symptoms that may bring the student into the school nurse’s office. If the nurse identifies mental health symptoms, he or she may be able to intervene, provide support, and direct the student for further management if necessary. This article will focus on anxiety in general before focusing on specific anxiety disorders, including posttraumatic stress disorder. We will begin by defining these conditions and then move into discussing potential present-day stressors, such as fear and anxiety associated with the recent coronavirus disease 2019 pandemic, and screening tools before closing with some suggestions for practice and a case wrap-up.

The advantages of continuous glucose monitoring (CGM) and insulin pump systems have increased the popularity of these devices among students in the school setting. The use of diabetes technology at school and school-sponsored activities strengthens the student’s consistent use of the technology and increases the overall beneficial effects. The school nurse has many considerations when supporting the student with diabetes technology. Integrating this technology into diabetes care at school can be complex with collaboration and safety considerations fundamental to success. This is the third article in a three-part series on the use of technology in managing diabetes in youth. The first article described CGM devices and provided tips for the school nurse in incorporating CGM into the student’s individualized healthcare plan. The second article summarized insulin pump technologies, from conventional insulin pump therapy to advance automated insulin delivery systems and described keys to success with insulin pump technologies. The purpose of this article is to address some special considerations for facilitating the use of diabetes technology in the school setting. Topics to be discussed are tips on including insulin pump therapy in the student’s individualized healthcare plan, safe use of diabetes technology during physical activity, and implications for school nursing practice.

As the primary healthcare professionals in the school setting, school nurses field questions about diet and exercise. Nurses’ familiarity with nutrition and dietary patterns can help them respond to student concerns. Plant-based diets, those which promote eating mostly fruits and vegetables with smaller portions of animal foods, have recently gained popularity in the United States. Most plant foods are rich in fiber, antioxidants, and complex carbohydrates, as well as vitamins and minerals that support good health and maintenance of a healthy weight. Most children and adolescents can meet their nutrient needs on a plant-based diet, but should be careful to include a wide variety of foods in the diet in order to achieve nutrient adequacy.

Through a case presentation, this article describes the assessment and management of a student presenting with a history of disordered eating and weight loss. As medical concerns are brought to the attention of the school nurse, it is important for the school nurse to be aware of common signs and symptoms seen in students with undiagnosed or established eating disorders, as well as possible medical complications associated with untreated or poorly controlled eating disorders. Possible signs and symptoms associated with eating disorders that require outpatient referral or emergent management is delineated in this article, and school nurses are provided with a helpful mnemonic called “BONES” to aid in the recognition of eating disorders in the school setting.

An important subgroup of children with special healthcare needs are children with medical complexities that require long-term intensive healthcare interventions and treatments. As medical technology continues to advance and children with complex medical needs survive the neonatal period and progress into school-age, it is essential for school nurses to be able to recognize and acutely manage complications and malfunctions of devices in children requiring assistance from medical devices. An example of a common medical device includes central venous access devices that allow for access to the bloodstream to obtain blood for laboratory testing or to infuse medications or nutrition. These devices put children at serious medical or surgical risk when they malfunction or become infected, so it is important for healthcare providers, especially school nurses who are the first responders in schools, to recognize malfunctions and initiate appropriate care management.

Children with chronic conditions (i.e., asthma) are more likely to have anxiety or depressive symptoms. Comorbid asthma and anxiety in children leads to increased morbidity, causing children to miss instructional time and parent/caregiver (CG) work absences. Asthma educational programs and mental health interventions have been developed, though no scalable programs integrate asthma education and mental health behavioral interventions for school-aged children. This study evaluated the sustained preliminary effects of an integrated asthma education and cognitive behavioral skills-building program, Creating Opportunities for Personal Empowerment for Asthma. Thirty-two children ages 8–12 years with asthma and symptoms of anxiety received the intervention. At 6-weeks postintervention, anxiety and CG-reported behavioral symptoms were significantly reduced, there were fewer missed doses of asthma controller medications, and asthma-related self-efficacy, personal beliefs, and the children’s understanding of asthma significantly increased. Most children ( n = 29, 91%) reported continued use of coping skills.

In response to the novel coronavirus disease 2019 (COVID-19) pandemic, most states in the United States enacted statewide school closures, ranging in duration from 1 month to the remainder of the academic year. The extended durations of these closures present unique challenges, as many families rely on the school as a source of physical activity, mental health services, psychosocial support, child care, and food security. While the school doors may be closed, the school nurse can still play a vital role in emergency management. This article discusses challenges and proposes solutions to maintaining student health and wellness during extended school closures due to the COVID-19 pandemic. Furthermore, it is inevitable that until a vaccine for coronavirus is developed and readily available, many schools will continue to see future closures, though likely for shorter periods of time, as they respond to local outbreaks.

School nurses occasionally deal with students presenting with serious infections associated with common chief complaints. Although rare, the implications of missing the signs and symptoms of these infections are potentially life-threatening and devastating, with both immediate and long-term complications. Rapid recognition and stabilization, with immediate transfer to the closest emergency department via emergency medical services for antibiotic administration, is the key to reducing morbidity and mortality associated with these serious infections. We discuss three students presenting with febrile illnesses associated with chest pain, headache, and back pain, focusing on the initial assessment and management of these students and their common presenting complaints.

Through a presented case scenario, this article describes the assessment and management of the commercial sexual exploitation of children (CSEC), which includes sex trafficking, as relevant for the school nurse. CSEC is a major public health problem globally, nationally, and locally, even infiltrating school hallways. School nurses may be the last point of possible intervention for potential or actual victims of CSEC, therefore, it is vital for a school nurse to be able to recognize, report, and assist with advocacy and prevention efforts in the school community to put the brakes on the exploitation of children.

Teen dating violence (TDV) has become more prevalent in our schools, exacerbated by the omnipotent presence of social media and portals of what dating and gender roles “should be” in Hollywood films and television shows. It is important to recognize that TDV is a threat to mental health, and potentially physical health, and school nurses should develop a framework for recognizing problematic social, physical, and emotional interactions between students. This article describes typical presentations of TDV through a case, providing a mnemonic for recognition and resources for prevention.

Insulin pump technologies are commonly used by youth with type 1 diabetes (T1D) for intensive insulin therapy, the gold standard for T1D care. Insulin pump technologies are advancing rapidly, with new insulin pumps becoming available every year offering improvements in glycemic control. School nurses must understand the basics of insulin pump therapy and distinguish between advanced pump technologies to best support their students with T1D. This is the second article in a three-part series on the use of technology in managing diabetes in youth. The first article described continuous glucose monitoring (CGM) devices and provided tips for the school nurses in incorporating CGM into the student’s individualized healthcare plan. The purpose of this article is to summarize insulin pump technologies, from conventional insulin pump therapy to advanced automated insulin delivery systems and to describe keys to success with insulin pump technologies. Part 3 will focus on special considerations and problem solving related to technology use in the school setting.

School-based health care encompasses a variety of health care professionals and practice models, including school nursing, school-based health centers, and school-based mental health programs. Services can be delivered in person or via telehealth. School-based health care is an important mechanism for removing barriers to health care services and for reaching adolescent patients. This article illustrates the various models of school-based health care, the particular benefit of school-based health care for adolescents, and opportunities and challenges in maintaining and sustaining a school-based health program.

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.

BACKGROUND Asthma can interfere with school attendance and engagement. School health programs are central to asthma management. Case identification is limited by reliance on parent-completed forms, which are often missing. This project tested a low-burden screening algorithm to stratify students based on priority for nurse outreach at 2 large, urban schools with high asthma prevalence. METHODS Students in grades 1-8 completed a 4-item asthma screener. Two-stage stratification incorporated screener responses, school nurse records, and absenteeism. Students were assigned low, medium, or high priority for follow up. Asthma prevalence in the high priority group was calculated for substantiated asthma. Whether stratification was more likely than chance to identify new cases of asthma in the high-priority group was evaluated using chi-square tests. RESULTS Of 1397 students, 69.7% were screened. Secondary stratification decreased the number of students in the high and medium priority groups. New asthma cases were identified in 46.4% of high-priority families reached for follow up. High-priority students were more likely to be identified as having asthma than chance alone (p

School-aged children spend around 1,080 hr at school each year and many of them have chronic diseases; therefore, it is imperative to include school nurses as part of the health care team. Care coordination between health care providers and school nurses is currently hindered by communication that relies on an inadequate system of fax, phone, and traditional mail. Using electronic health records (EHRs) to link school nurses and health care systems is usually limited in scope despite EHRs advancement in these health care systems. No literature is currently available showing the number of hospitals and health care systems that provide EHR access to school nurses. The purpose of this article was to present a literature review on EHR access for school nurses nationally. This review along with the legal and logistical considerations for this type of implementation will be discussed.

Electronic, or “e”-cigarette use has been adopted by an alarming number of teens in recent years. E-cigarettes are neither legal for youth nor considered safe for use by youth. E-cigarette companies have targeted youth in their marketing strategies and developed appealing flavors with high nicotine content to ensure dependence on their products. Schools lack adequate resources and capacity to address e-cigarette use, relying mostly on punitive sanctions for what is essentially a health issue. School nurses can help their districts and schools by navigating appropriate consequences for vaping, providing accurate information and education, providing cessation resources, advocating for student support, and informing stakeholders on population health strategies to prevent initiation and reduce youth e-cigarette use.

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.

Background School going children across the world continue to experience high levels of untreated dental diseases. The South African Oral Health policy documents present measures to address the oral health needs of children in school settings, yet the burden of oral disease in the country is over 50% among primary school children. Methods Our study therefore sought to assess the implementation of school oral health programmes in Tshwane in line with policy recommendations using the Walt & Gilson policy analysis triangle. A qualitative explanatory case study was undertaken using a combination of data from direct observations and interviews. The case analysis involved assessing the processes of providing school oral health programmes that were offered at 10 schools in Tshwane. The measuring tools included process maps and an interview guide. Results The results found that policy implementation was affected by poor prior planning, inadequate resources, poor school infrastructure and lack of support from key stakeholders. Furthermore, inconsistencies in policy interpretation by management, coupled with the fact that the oral hygienists were not conversant with the policy hampered delivery of the policy content. The variations in policy implementation observed were often at the discretion of the oral hygienist in response to contextual challenges. Conclusion There was policy and practice misalignment and variations in the processes of implementing oral health programmes across the 10 schools. Hence regular monitoring, evaluation and root cause analysis is recommended for such programmes in order to make informed decisions on contextually relevant and standardised programme modifications.

This study aimed to compare related factors of depressive symptoms among multicultural adolescents in South Korea. Cross-sectional data were collected from 1,325 students studying in ninth grade (mean age: 14.97 ± 0.36 years) who had one Korean parent and one foreign-born parent. The score of depressive symptoms among girls (1.777 ± 0.550) was higher than boys (1.647 ± 0.512). The regression model—including demographic, psychological, and social factors—explained 38.3% of depressive symptoms among boys and 27.9% among girls. Body image satisfaction was the most powerful factor related to depressive symptoms in both boys and girls. Gender-differentiated factors identified in this study such as demographic, psychological, and social factors need to be studied while planning gender-tailored intervention programs to help relieve depressive symptoms among multicultural adolescents.

Asthma is a leading cause of chronic illness among school-aged children and adolescents. Current trends have led to school faculty and staff becoming increasingly responsible for managing student asthma, often without optimal training or resources. The purpose of this project was to establish whether facilitated access to personalized student asthma action plans (AAPs), education, proper use, and school nurse support improved reported self-efficacy regarding student asthma exacerbation prevention and management in elementary and preschool faculty and staff. Thirty-five participants from an urban, underserved Connecticut school were surveyed to determine perceived self-efficacy regarding student asthma exacerbation prevention and management. AAPs were then placed with students’ asthma inhalers, and all participants were instructed on their use. Three months later, participants were resurveyed. A statistically significant difference after both the initial education and 3-month survey was identified. Providing elementary and preschool faculty and staff with facilitated access to student action plans and education on their use can improve perceived self-efficacy regarding student asthma exacerbation prevention and management.

Although students commonly present to the school nurses’ office with physical chief complaints, there are many mental health concerns in the school-age population associated with emotional and physical consequences. Bullying is considered to be a public health crisis, plaguing students across the nation. It is important to develop a framework for recognizing problematic social and emotional interactions between students, like bullying, given the dire consequences on a student’s physical and emotional well-being. This article describes typical presentations of bullying through a case scenario, providing a mnemonic for recognition and resources for prevention.

The National Association of School Nurses supports pandemic control efforts. School nurses are advocates for their students, caregivers, school staff, teachers, and school administrators. With a clear understanding of how the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus evolves over time and changes transmissibility through mutations, school nurses gain understanding in epidemiologic calculation of herd immunity. To understand why the estimates of herd immunity fluctuate, as often reported in the news, school nurses need to understand how epidemiologist calculate this number. Obtaining herd immunity will protect the most vulnerable in the population. If all countries have access to vaccines and populations choose to receive vaccinations, herd immunity is more likely to be obtained. Equipped with knowledge of how herd immunity is calculated, school nurses are in a position to educate and advocate for the use of vaccines.

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

Since asthma is the most common noncommunicable chronic childhood disease in the United States, school nurses will encounter students with this health condition. The purpose of this article is to present the school nurse as the leader in directing the management of a student’s chronic health condition at school. This article provides a table of resources and discusses many aspects of asthma management, including utilization of the student’s asthma action plan, student-specific school accommodation needs, the importance of developing individualized healthcare plans, providing education to school staff related to asthma management and determining of the family and student knowledge level, as well as strategies to minimize exacerbations. The article also explores school nurse opportunity to advocate for emergency asthma medication access as a part of emergency preparedness. School-based asthma management can be complex and school nurses have a pivotal role in asthma management in a school.