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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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Menstrual hygiene management (MHM) among female students is a neglected public health issue in the U.S. This study documented period product insecurity, school absenteeism, and use of school resources to obtain period products among high-school students in St. Louis, MO. Female students completed an anonymous, self-administered survey in English (n = 119). Descriptive statistics were used to determine the prevalence of period product need, resources used to obtain period products, and period-related absenteeism. The mean age of participants was 15.78 ± 1.28. Nearly two-thirds (64.4% (95% CI 55.1%-73.0%)) reported period product insecurity. Two-thirds (66.9% (95% CI 57.7%-75.3%)) reported using at least one of the school's resources to obtain period products. One-third of the participants (33.6% (95% CI 25.0%-43.1%)) reported missing school due to a lack of period products. School nurses need to be cognizant of how MHM affects their students' attendance at school and what measures they can take to help reduce menstruation-related absenteeism., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Pennsylvania responded to the COVID-19 pandemic by closing schools and moving to online instruction in March 2020. We surveyed Pennsylvania school nurses ( N = 350) in May 2020 to assess the impact of COVID-19 on nurses' concerns about returning to school and impact on practice. Data were analyzed using χ 2 tests and regression analyses. Urban school nurses were more concerned about returning to the school building without a COVID-19 vaccine than rural nurses ( OR = 1.58, 95% CI [1.05, 2.38]). Nurses in urban locales were more likely to report being asked for guidance on COVID-19 ( OR = 1.69, 95% CI [1.06, 2.68]), modify communication practices ( OR = 2.33, 95% CI [1.42, 3.82]), and be "very/extremely concerned" about their safety ( OR = 2.16, 95% CI [1.35, 3.44]). Locale and student density are important factors to consider when resuming in-person instruction; however, schools should recognize school nurses for their vital role in health communication to assist in pandemic preparedness and response.

Youth with disabilities disproportionately experience harsh discipline. Exploring perspectives of behavior and discipline could increase inclusivity, yet school nurses' perspectives are unexplored. Using the Peace and Power Conceptual Model, school nurses' perspectives were explored employing secondary qualitative analysis using Thorne's typology of analytic expansion. Parent study included interviews with school nurses, 24 data files comprised the sample for secondary analysis. Three peace-power versus power-over themes emerged: "having discordant perspectives," "being mislabeled," and "placing at higher risks." School nurses are equipped to build healthy school communities through changes in discipline practices, policies, and understanding of how youth with disabilities are impacted.

Purpose: This study aimed to provide basic data for the future development of school-based sexuality education and school nurse placement policies by examining the sexuality education experience in middle schools according to levels of school nurse placement and identifying factors influencing on adolescent sexual risk behaviors., Methods: This study examined data from the 2018 14 th  Korean Youth Risk Behavior Survey. The raw data from 30,229 middle school students enrolled in 400 schools were analyzed using descriptive statistics, Chi-square test, independent t test, and complex sample logistic regression analysis., Results: It is found that, in Korea, school nurse placement rates varied by region from 37.9% to 114.8%, resulting in different levels of sexuality and alcohol prevention education (p < .001). Sexuality and alcohol prevention education lowered the likelihood of sexual risk behaviors by 0.54 and 0.87 times, respectively. The experience of drinking alcohol increased a student's likelihood of committing sexual risk behaviors by 4.40 and 3.57 times, respectively, whereas the experience of using a drug increased the risk by 9.42 and 5.00 times, respectively. Personal factors (e.g., gender and academic achievement) and socioenvironmental factors (e.g., school type and perceived economic status) were also found to influence on the sexual risk behaviors of adolescents, although, not to the same degree as sexuality education or health risk behaviors., Conclusion: To protect students' sex-related health equity, more elaborate support policies are needed to ensure adequate placement of school nurses able to provide professional sexuality and related health education., Competing Interests: Conflict of interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2020. Published by Elsevier B.V.)

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

The purpose of this study was to investigate associations between school nurses' self-assessed cultural competence in health visits with children of foreign origin and demographic variables, by using a cross-sectional design. A Web-based questionnaire assessing cultural competence and demographic variables was distributed to a nationally representative sample (n = 816) of school nurses in Sweden. Data were analyzed using regression analysis. School nurses assessed themselves as culturally aware and moderately culturally competent, but not as culturally knowledgeable, culturally skilled, or comfortable in cultural encounters. Cultural competence was related to education in cultural diversity, how often nurses encounter children of foreign origin, and nurses' country of origin. In total, these variables explained 23.6% of the variation in school nurses' cultural competence. Because school nurses regard themselves as moderately culturally competent, a foundation for promoting children's health on equal terms in school health care exists. However, education in cultural diversity combined with other additional strategies is needed to further strengthen school nurses' cultural knowledge, skills, and comfort level in encounters with children of foreign origin., (© 2019 John Wiley & Sons Australia, Ltd.)

Background: In general, school nurses are aware that it is important to have knowledge of type 1 diabetes to give adequate care to children with the disease. Many studies assessing diabetes knowledge have found different deficits among nurses. To our knowledge, however, no study has assessed the knowledge of type 1 diabetes among school nurses., Objective: To assess actual and perceived diabetes knowledge among school nurses., Design: Cross-sectional studies., Settings: Seventeen primary care facilities in Warsaw that employed school nurses., Participants: Two hundred and thirty school nurses., Methods: With the Diabetes Knowledge Questionnaire (DKQ), we assessed actual diabetes knowledge. With the Self-Assessed Diabetes Knowledge (SADK), we assessed perceived diabetes knowledge. Both the DKQ and SADK assessed seven domains of diabetes knowledge: general diabetes knowledge; insulin and glucagon; insulin pumps; diabetes complications; nutrition; physical activity, stress, and comorbidities; and glycemia measurements. We related DKQ and SADK scores to each other and to sociodemographic and work-related factors., Results: The rate of correct responses in the DKQ was 46.7%, with the lowest rate regarding knowledge of insulin pumps (36.5%), nutrition (37.4%), and insulin and glucagon (37.9%). Actual and perceived diabetes knowledge were moderately positively correlated (rho = 0.18, p =.009). In six of the seven knowledge domains examined, school nurses perceived their diabetes knowledge better compared with their actual knowledge. DKQ scores were higher in nurses with higher education (p = .024), those who had relatives or friends with diabetes (p = .032), and those who had prior diabetes training (p = .050). Interestingly, DKQ scores were higher among nurses with fewer years of experience (rho = - 0.18, p = .011)., Conclusions: There is a need for additional diabetes training among nursing students and practicing nurses to provide safe and effective care for children with type 1 diabetes., Competing Interests: Declaration of competing interest None declared., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Effective asthma management at school can help students with asthma stay healthy, learn better and participate fully during their school day. This study sought to understand school-based asthma care from the perspective of parents and school personnel to improve asthma care at school. Methods: A cross-sectional study was conducted in Hartford, CT. School personnel from 59 schools and 322 parents/guardians were invited to participate. Four cross-sectional surveys using Likert-type scales assessed parental and school personnel satisfaction, confidence in managing asthma, policy awareness, management of asthma during physical activity, and perceived gaps surrounding school-based asthma care. Results: 263/322 (82%) eligible parents of children with asthma (mean age 8.5 ± 4.3, 56% Hispanic, 30% African American) completed surveys. Thirty six school nurses (62%), 131 teachers (8%), 14 coaches (14%), and 17 school principals (29%) participated. 90% of parents were satisfied with asthma management in school. School nurses were more aware of asthma policies than teachers (74% vs. 24%, p  < 0.001). 34% of school nurses, 30% of teachers and 36% of coaches were unaware of asthma-related absences. 14% of physical education teachers/coaches reported no asthma training. Conclusion: In this convenience sample of parents and school personnel, parents reported overall satisfaction regarding the asthma care their children receive at school, yet a number of gaps pertaining to school-based asthma care were identified. Increased asthma training and enhanced communication among school personnel is needed to address these gaps. National guidelines and resources are readily available to improve asthma care at school.

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

The purpose of this study was to examine the relationship between school nurse presence and graduation rates, absenteeism, and American College Test (ACT) scores. A state-wide survey of all public high schools was undertaken (participation rate of 99.1%). Survey data obtained from individual high schools provided information on the employment status of school nurses. In addition to nurse presence determined by the survey, open-access electronic databases were used to determine graduation rates, absenteeism, ACT scores, money spent per pupil, gender, race-ethnicity proportion, and incarceration data. Study findings showed a possible relationship between students attending schools with a full-time nurse and significantly higher graduation rates, lower absenteeism, and higher ACT scores. The study results suggest that school nurses may contribute not just to health outcomes but to improved academic and economic outcomes as well. Of course, future work is needed to confirm these assertions.

School nurses are expected to advocate for policies and procedures that support student health, safety, and school attendance. An educational activity to improve school nurse advocacy was developed and implemented based on advocacy literature, self-efficacy theory, and continuing education guidelines. A quantitative, repeated measure descriptive project design was used to compare school nurses' advocacy measures before and following an educational activity and 6 weeks after the activity. Immediately after the education, there were significant increases in advocacy knowledge ( p < .001), confidence ( p < .001), and recalled behaviors ( p < .01) for a convenient sample of 51 Massachusetts school nurses. There were no significant differences across pre-, post-, and 6-week survey responses ( n = 6); however, advocacy outcomes from immediately after the education were maintained at 6 weeks. More effective school nurse advocacy may improve youth population health, increase safety for students at school, and improve school attendance.

Universal school health services are expected to offer similar, needs-based services to all students across schools, service providers and students' socio-economic statuses and health needs. This study investigates access to school health nurses in Finland. The objectives were to study the differences in access to school health nurse between service providers, schools, students' characteristics and school health nurse resources. Access was examined through a nationwide School Health Promotion study, which is a self-reporting, voluntary and anonymous survey for 8th and 9th graders (15 to 16-year old, N = 71865). The ethical committee of the National Institute for Health and Welfare has approved procedure for the School Health Promotion study. Data on school health nurse resources and service providers were obtained from the national database (534 schools; 144 service providers). Multilevel logistic regression was used. Of the pupils, 15% of girls and 11% of boys reported difficult access to a school health nurse. The number of adolescents who reported difficult access ranged between service providers (0%-41%) and schools (0%-75%). Students with lower socio-economic background, poorer well-being at school, lack of support for studying and greater health needs reported difficult access more often. School health nurse resources were associated with difficult access only among boys, when resources were under the national recommendations. These findings raise concern about equality and unmet health needs in school health services., (© 2018 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

The increasing prevalence of chronic conditions in children, for both common and rare conditions, over the past 30 years, and the increase in the number and range of medications used to manage these conditions, has contributed to the need to address medication management in schools. The purpose of this article is to present the key findings from a national survey on medication administration in schools. A nonexperimental cross-sectional design was used in this descriptive study. An online survey was sent to school nurses across the country. Responses from a total of 6,298 school nurses were used in the analysis. Results of the survey related to prescription and nonprescription medications, medication storage, student's carrying their medications, delegation of medication administration, documentation, and medication errors are discussed. The article concludes that many different medications are administered during the school day. School nurses must advocate for proper policies and procedures to guard the safety of students.

The National Association of School Nurses (NASN) has launched the National School Health Data Set: Every Student Counts! Building on the success of previous school health data collection, this article describes the steps that the Georgia Association of School Nurses takes to promote the collection of data to support the health of Georgia's school-age children. Building a team, engaging stakeholders, mapping a plan of action, and developing the message are described as ways to build the capacity for data collection. Other states and NASN state affiliates may learn from the ideas presented here.

Background : Teachers are not trained or feel prepared for urgent action. Nevertheless, the presence of children with health problems is relevant. We identified vital health risk problems and complications among students, as well as the related training and perception of teachers. Methods : An explanatory sequential design was employed. The study sample consisted of a cross-sectional study of an intentional nonprobabilistic sample of 3246 teachers in the quantitative phase, and a total of 16 semistructured interviews were conducted in its qualitative phase. Results : 56.6% (1837) of teachers show high concern about facing such situations and only 0.6% (19) feel appropriately trained. For 81.8% (2556), the existence of school nursing would be quite relevant. The presence of nursing professionals in schools could lead to an improvement in the quality of life of both the students and teachers. Conclusions : There is a significant percentage of children with diseases that often require specific care and there is a high probability that teachers, throughout their professional lives, have to deal with situations of vital urgency. The presence of professionals in educational centres seems to be a relevant option. These data suggest that it is necessary for nurses to establish a pilot programme for the incorporation of professional nurses in educational centres to determine its implications, benefits in health prevention and promotion issues, as well as costs.

Well-prepared school nurses are more likely to handle emergencies properly. Thus, assessing crisis management preparedness is important. In August 2014, a questionnaire was sent to 275 nurses in a large Texas school system to collect data about nurse and school characteristics, emergency frequency and management, and equipment availability. Completed surveys (201, 73%) were analyzed. Fisher's exact test was used to evaluate comparisons among nurses' confidence levels, school characteristics, emergencies, and medical emergency response plans (MERP). Logistic regression was used to estimate associations between characteristics and nurses reporting less confidence. Most respondents were experienced nurses. Shortness of breath was the most common event faced. Odds of less confidence were significantly higher among nurses with <5 years' experience, working at elementary schools, schools without a MERP or where it was not practiced, or caring for <10 schoolchildren weekly. Overall, recommended emergency management guidelines were met.

School nursing practice has changed dramatically over the past 20 years, yet few nationally representative investigations describing the school nursing workforce have been conducted. The National School Nurse Workforce Study describes the demographic and school nursing practice patterns among self-reported public school nurses and the number and full-time equivalent (FTE) positions of all school nurses in the United States. Using a random sample stratified by public/private, region, school level, and urban/rural status from two large national data sets, we report on weighted survey responses of 1,062 public schools. Additional questions were administered to estimate the school nurse population and FTEs. Findings reported illustrate differences by strata in public school nurse demographics, practice patterns, and nursing activities and tasks. We estimate approximately 132,300 self-identified practicing public and private school nurses and 95,800 FTEs of school nurses in the United States. Research, policy, and school nursing practice implications are discussed.

Background: Anaphylaxis is a serious and growing concern in the school setting as the prevalence of food allergies and food-induced severe allergic reactions continues to increase., Methods: A cross-sectional, web-based survey was conducted regarding anaphylactic events that occurred during the 2014-2015 school year. Eligible schools were enrolled in the EPIPEN4SCHOOLS ® program (Mylan Specialty L.P., Canonsburg, PA), which provides free epinephrine auto-injectors to qualifying US schools. Participating schools completed a 29-item survey on anaphylactic event occurrence and treatment, epinephrine stock, school policies regarding anaphylaxis, school staff training, and school nursing coverage., Results: Responses were provided by 12,275 schools. Epinephrine was administered on school property for 63.7% of reported anaphylactic events (1272/1998). In 38.5% (235/610) of events for which epinephrine was not used, antihistamines were cited as the reason. Only 59.4% of schools cited epinephrine as their standard first-line therapy for anaphylaxis. School nurses were most likely to be trained in anaphylaxis recognition and permitted to administer epinephrine; however, just 53.6% of schools had a full-time nurse on staff., Conclusions: Process-related barriers to the appropriate use of epinephrine go beyond access to medication. Widespread staff training and review of school policies are needed to ensure that anaphylaxis is appropriately managed in schools., (© 2018, American School Health Association.)

Background: Rates of uncontrolled asthma vary by demographics, space, and time. This article uses data on ambulance-treated asthma attacks in children to analyze these variations so that school districts can improve their asthma management interventions., Methods: Incidence rates of 1826 ambulance-treated asthma attacks for children aged 5-18 years were calculated for school zones for elementary, middle, and high schools in the Houston (Texas) Independent School District (HISD). Zones with rates in the upper quartile were identified as the highest rate zones and were compared with other school zones in the district by demographics, location, and timing of attacks., Results: The ambulance-treated asthma rate was respectively 5, 3, and 2 times greater in the highest rate school zones compared with all other school zones for those school levels. Ambulance-treated asthma attacks in the high-rate school zones occurred most at midday and in the evening and high-rate zones were often geographically contiguous. Schools in the high-rate zones had a higher percent of socioeconomically disadvantaged students and were more often without a school nurse., Conclusion: Spatial and temporal analysis of ambulance data can be valuable tools for schools to focus policy and program interventions for the students in need of improved asthma management., (© 2017, American School Health Association.)

The purpose of this scoping review was to survey the most recent (5 years) acute care, community health, and mental health nursing workload literature to understand themes and research avenues that may be applicable to school nursing workload research. The search for empirical and nonempirical literature was conducted using search engines such as Google Scholar, PubMed, CINAHL, and Medline. Twenty-nine empirical studies and nine nonempirical articles were selected for inclusion. Themes that emerged consistent with school nurse practice include patient classification systems, environmental factors, assistive personnel, missed nursing care, and nurse satisfaction. School nursing is a public health discipline and population studies are an inherent research priority but may overlook workload variables at the clinical level. School nurses need a consistent method of population assessment, as well as evaluation of appropriate use of assistive personnel and school environment factors. Assessment of tasks not directly related to student care and professional development must also be considered in total workload.

This paper describes a user-friendly, Excel spreadsheet model and two data collection instruments constructed by the authors to help states and districts perform cost-benefit analyses of school nursing services delivered by full-time school nurses. Prior to applying the model, states or districts need to collect data using two forms: "Daily Nurse Data Collection Form" and the "Teacher Survey." The former is used to record daily nursing activities, including number of student health encounters, number of medications administered, number of student early dismissals, and number of medical procedures performed. The latter is used to obtain estimates for the time teachers spend addressing student health issues. Once inputs are entered in the model, outputs are automatically calculated, including program costs, total benefits, net benefits, and benefit-cost ratio. The spreadsheet model, data collection tools, and instructions are available at the NASN website ( http://www.nasn.org/The/CostBenefitAnalysis ).

Access to school health clinics and nurses has been linked with improved student achievement and health. Unfortunately, no studies have examined how many students report using school clinics or nurses and for which services. This study addressed this gap with data from a nationally representative sample of 15- to 25-year-olds. Respondents who reported being in high school were provided a list of services and asked whether they had gone to a school nurse or clinic for any of the listed services. Nearly 90% reported having access to a school clinic or nurse. Among students with access, 65.6% reported using at least one service. Non-White students and younger students were more likely to report having access to a clinic or nurse. These results show many students have access to clinics or nurses and are using these services, although not uniformly for all services., (© The Author(s) 2016.)

School nurses cite barriers to collecting comprehensive data on the care they provide. This study evaluated the feasibility of collecting school nurse data on selected child health and education outcomes. Outcome variables included school health office visits; health provider, parent, and staff communication; early dismissal; and medications administered. On an average day, the school nurses cared for 43.5 students, administered 14 medications, and averaged of 17 daily communications. Day 1 data collection times averaged 15 min or less. By Day 5, 6.6 min was needed to complete the survey. Data collection was feasible for 76% of those who elected to participate. Feasibility is enhanced by limiting the number of data points and the number of days for data collection using a data collection web interface. Data collection across large numbers of nurses and a wide range of school nurse delivery models is necessary to measure the impact of school nurse presence and interventions on child health and education outcomes., (© The Author(s) 2016.)

There is a significant gap in meaningful school health data in the current national education and health data sets. Current data sets do not sufficiently capture the number and credentials of school health providers, the health of students who receive care at school, or the outcomes of school nurse interventions. Since 2014, school nurses across the United States have embraced Step Up and Be Counted!: A National Standardized School Nurse Data Set. The goal of Step Up is to collect school nurse data in a standardized, uniform format. Prior to the project, no data were recorded in a uniform manner across states and health services delivery models. Data have been reported for two years on who is delivering health care in school, selected student chronic conditions, and the disposition of students once they leave the school health office. Professional development sessions have been conducted at the national conferences of both the NASN and the NASSNC and at the state level. As the project matures, steps are being taken to increase the number of school nurses and states participating and to assure data accuracy and validity., (© 2016 The Author(s).)

Background: Approximately 15% of children in the United States 6-19 years of age have hearing loss. Even mild, unilateral hearing loss may adversely affect educational success. In 2014, the Pennsylvania Department of Health (PA DOH) began updating the 2001 regulations on state-mandated school hearing screens. To inform the updates, a needs assessment was conducted with PA-certified school nurses (CSNs) regarding current screening practice and potential barriers to making changes., Methods: A 42-item electronic survey of CSNs developed with pediatricians, audiologists, nurses, and the PA DOH was administered in October 2014., Results: There were 536 completed surveys. Most CSNs (50.8%) screened 251-500 students annually. Only 35.8% strictly followed PA DOH protocol, while 51.6% followed protocol and added nonguideline frequencies. Over half of screens (60.2%) were conducted in places where other people were present. Most CSNs (82.5%) reported annual audiometer calibration, but 92.4% were unsure whether the calibration was exhaustive or limited. Reported barriers to change included time, cost, and staffing., Conclusions: As most CSNs added frequencies to the PA DOH hearing screen, an update with added frequencies should be well accepted. Clarification regarding test environment and exhaustive audiometer calibration is needed. Adherence to best practice may be optimized by addressing CSN reported barriers to change., (© 2016, American School Health Association.)

Objective: To determine the compliance of schools and school nurses in the United States with national recommendations for cognitive rest in students who sustain a concussion., Design: Cross-sectional questionnaire based., Participants: Members of the National Association of School Nurses working at the high school level., Intervention: A questionnaire, developed by the authors and based on recommendations for cognitive rest, was electronically distributed 3 times during the 2012 to 2013 academic year., Main Outcome Measures: Self-reported responses were collected regarding demographics and compliance of schools and school nurses with recommendations for the management of the postconcussion student, including the presence of specific guidelines for individualized care and the responsibility of the nurse for the prevention, detection, and management of concussions., Results: Analysis was performed on 1033 completed questionnaires (36% usable response rate). Fifty-three percent of schools have guidelines to assist students when returning to school after a concussion. These guidelines include extension of assignment deadlines (87%), rest periods during the school day (84%), postponement or staggering of tests (75%), reduced workload (73%), and accommodation for light or noise sensitivity (64%). Sixty-six percent of nurses in our sample have had special training in the recognition and management of concussions. Nurses reported involvement in the following roles: identifying suspected concussions (80%), providing emotional support for recovering students dealing with concussion-related depression (59%), and guiding the student's postconcussion graduated academic and activity re-entry process (58%)., Conclusions: We detected a wide variability in compliance of schools and school nurses with national recommendations for cognitive rest., Clinical Relevance: Ensuring that schools have policies established for a student's return to learning, having specific guidelines to provide an individualized approach to return to learning based on postconcussion signs/symptoms, training school nurses in the recognition and management of concussions, and involving school nurses in the re-entry process are identified areas for improvement. Schools in the United States should be aware of these recommendations to guide a student's postconcussion graduated academic re-entry process.

The health and well-being of children who attend school is not collected in any national data sets. To effectively advocate for the health needs of children where they live, learn, and play, it is essential to build a National Uniform School Nurse Data Set. In 2014, school nurses nationwide were invited to join the Step Up and Be Counted! initiative. To prepare nurses for data collection and reporting, an informational website was established, a marketing campaign was launched, and a data collection tool was developed. Trainings were held at the national conferences of both the National Association of School Nurses and the National Association of State School Nurse Consultants, and locally by state school nurse consultants and champions. The goal of the 2014-2015 academic year was to establish the processes for such a large-scale effort. In Year 1, only three initial data sets were collected from participating school nurses from 37 states. The first year yielded much data, and challenges have been identified and addressed., (© 2015 The Author(s).)

This article summarizes the results of the 2015 NASN School Nurse Survey, identifies similarities and differences between this survey and the 2013 NASN School Nurse Survey, and evaluates the possible impacts of this data on the organization., (© 2015 The Author(s).)

There are increasing numbers of children with special health care needs (CSHCN) who require various levels of care each school day. The purpose of this study was to examine the role of public schools in supporting CSHCN through in-depth key informant interviews. For this qualitative study, the authors interviewed 17 key informants to identify key themes, provide recommendations, and generate hypotheses for further statewide survey of school nurse services. Key informants identified successful strategies and challenges that public schools face in meeting the needs of all CSHCN. Although schools are well intentioned, there is wide variation in the ability of schools to meet the needs of CSHCN. Increased funding, monitoring of school health services, integration of services, and interagency collaboration are strategies that could improve the delivery of health services to CSHCN in schools., (© The Author(s) 2015.)

Children with special health care needs (CSHCN) are at risk for school failure when their health needs are not met. Current studies have identified a strong connection between school success and health. This study attempted to determine (a) how schools meet the direct service health needs of children and (b) who provides those services. The study used the following two methods: (a) analysis of administrative data from the California Basic Educational Data System and (b) a cross-sectional online survey of 446 practicing California school nurses. Only 43% of California's school districts employ school nurses. Unlicensed school personnel with a variety of unregulated training provide school health services. There is a lack of identification of CSHCN, and communication barriers impair the ability to deliver care. Study results indicate that California invests minimally in school health services., (© The Author(s) 2015.)

Background: In several countries worldwide, school-based human papillomavirus (HPV) vaccination programs have been successful; however, little research has explored US stakeholders' acceptance toward school-based HPV vaccination programs., Methods: A total of 13 focus groups and 12 key informant interviews (N = 117; 85% females; 66% racial/ethnic minority) were conducted with 5 groups of stakeholders: parents of adolescent girls, parents of adolescent boys, adolescent girls, middle school nurses, and middle school administrators throughout the 5 public health regions of New Mexico., Results: All groups of stakeholders lacked knowledge on HPV and HPV vaccines. Stakeholders were interested in--but apprehensive about--the benefits of HPV vaccination. Despite previous literature showing the benefits of using middle schools as an HPV vaccination site, stakeholders did not deem middle schools as a viable site for vaccination. Nurses reported that using the school as an HPV vaccination site had not occurred to them; parents and adolescents stated they were uncertain about using this type of program. School administrators indicated that they lacked implementation authority., Conclusions: Our study uncovered barriers to using middle schools as a site of HPV vaccination. Resources should be directed toward increased support and education for middle school nurses who function as opinion leaders relevant to the uptake of HPV vaccination., (© 2015, American School Health Association.)

The National Association of School Nurses' research priorities include the recommendation that data reliability, quality, and availability be addressed to advance research in child and school health. However, identifying a national school nursing data set has remained a challenge for school nurses, school nursing leaders, school nurse professional organizations, and state school nurse consultants. While there is much agreement that school nursing data (with associated data integrity) is an incredibly powerful tool for multiple uses, the content of a national data set must be developed. In 1993, recognizing the unique power of data, Massachusetts began addressing the need for consistent school nurse data collection. With more than 20 years' experience--and much experimentation, pilot testing, and system modification--Massachusetts is now ready to share its data collection system and certain key indicators with other states, thus offering a beginning foundation for a national school nursing data set., (© The Author(s) 2014.)

In 2006, the Anchorage School District implemented a school wellness policy to address the problem of obesity among its elementary-aged students. We assessed whether the addition of this policy is effective in protecting or preventing students from becoming overweight/obese over time. The methods involved following two cohorts of students for 5 years, a cohort not exposed and a cohort exposed to the policy. The results show that exposure to the policy does not significantly protect or prevent students from becoming overweight/obese. However, we found that regardless of being exposed to the policy, boys (odds ratio [OR] = 1.12), ethnic minorities, (OR = 1.18), and students from low socioeconomic backgrounds (OR = 1.44) were more likely to remain or become overweight/obese. Our findings suggest that factors outside the school may be impacting students' overweight/obese status. Efforts to curb the problem of childhood obesity should extend to the children's communities and homes., (© The Author(s) 2013.)

Importance: In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services., Objective: To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses., Design, Setting, and Participants: Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year., Interventions: School health services provided by full-time registered nurses., Main Outcomes and Measures: Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers' productivity loss costs associated with addressing student health issues, and parents' productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars., Results: During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents' productivity loss, and $129.1 million in teachers' productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit., Conclusions and Relevance: The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions.

Responding to the psychosocial health needs of the vulnerable population has been considered as a significant public health issue that must be addressed through access to public health professionals. The study adopted a quasi-experimental design to evaluate the impact of a training program on nurses and teachers' knowledge of psychosocial health needs of vulnerable children and the impact this had on children's resilience and psychosocial health outcomes (self-esteem, social connection, anxiety, and depression). The result showed a significant increase in the knowledge mean scores of both nurses and teachers 6 weeks post intervention. Children's depression scores significantly reduced post intervention. Their resilience, self-esteem, and social connection were also significantly improved, while no significant reduction was found in their anxiety scores. The results of the pilot study suggest that a more rigorous study be conducted to further ascertain the effectiveness of the various interventions used in this study while taking into consideration the challenges raised by the authors.

Background: Food allergies affect 2.5% of the US population. Results of studies show that minorities have the highest prevalence of food allergies. The Houston Independent School District (HISD) has an urban, socioeconomically diverse population and the role of ethnicity and socioeconomic status (SES) with availability of epinephrine has not been explored in this population., Objective: This study sought to understand the association of SES and the presence of epinephrine in urban schools., Methods: A 6-item questionnaire about food allergy characteristics was sent by e-mail to one nurse per elementary school in the HISD to identify the number, characteristics and treatment of food allergic reactions, and the presence of epinephrine injectors. The reactions and presence of injectors were assessed for the previous school year. Schools were categorized by socioeconomic variables as "low" or "non-low" based on National School Lunch Program student participation. Poisson, logistic, and linear regression analyses were used for group comparisons., Results: One or more children with food allergies were reported in 97% of responding schools, but only 43% of schools reported having epinephrine injectors. A larger number of injectors in schools were associated with students of higher SES (r(2) = 0.701; P < .001). There were 6 times more injectors in non-low SES schools than in low SES schools (P < .03). Low SES and limited English proficiency were associated with decreased epinephrine injectors in schools., Conclusion: In the HISD, epinephrine injectors were more likely to be found in non-low SES schools versus low SES schools. Because minority students are disproportionately highly represented in low SES schools, there appears to be a disparity in the availability of injectable epinephrine for minority students in HISD schools., (Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

School nurses can play a key role in providing sexual education in schools. However, they often face barriers from the school administration and concerned parents. Additionally, school nurses may have limited formal preparation in managing sexual health issues. This study used a descriptive qualitative method to explore the school nurses' experiences with facilitators and barriers to providing sexual education. Eighteen nurses from 12 Massachusetts high schools were interviewed. Results showed that the school nurses do not provide formal sexual education at their schools but frequently conduct informal sessions. School nurses reported that students needed more sexual health information, yet there was no collaboration with the school health teachers. Common barriers included lack of privacy and time, confidentiality issues, and fear of conflict. Nurses working in communities with high teen pregnancy rates reported more barriers. The findings can inform the development of policies and practices for sexual education by school nurses.

At the end of the 2011 legislative session in California, the California School Nurses Organization (CSNO), a state affiliate of NASN, was looking for a new way that school nurses could garner legislative support, in a visible and positive manner, as strong advocates for pupil health. When California State Assembly Member Susan Bonilla (who currently represents the 14th Assembly District) offered to sponsor a state bill to help improve the student-to-school nurse ratio in California's public schools (which several sources between 2007 and 2011 estimated as being between 1:2,187 and 1:4,000), the CSNO's Government Relations Committee (GRC) sprang into action. The committee reviewed NASN's list of strategic plans for legislative advocacy for guidance. Upon learning that one of NASN's legislative priorities was the passage of H.R. 2229 (C. McCarthy), the Student-to-School Nurse Ratio Improvement Act of 2011, the GRC crafted and subsequently worked to successfully pass a California resolution bill, Assembly Joint Resolution No. 24, in support. Such legislative advocacy efforts may well be viewed as a model for other NASN state affiliate organizations.

School nurses have the ability to enhance the knowledge and tolerance of an entire community and to form more positive and sensitized attitudes to future adults. The aim of this study was to investigate the relationship between the knowledge and attitudes of nurses and the frequency of accidents caused by epilepsy in Greek schools. Our sample consisted of 306 school nurses from all over the country. It was observed that the knowledge of school nurses on epilepsy was quite high, although there were specific aspects that raise concerns on their preparedness to respond to seizure-related emergencies, while their attitudes, although positive, still need improvement. Accidents caused by epilepsy were reported by half of the nurses, and prevention was considered of major importance. Therefore, organized continuous education programs and clear guidelines by the responsible authorities would help school nurses provide better services to students with epilepsy., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The study investigated perceived effectiveness and perceived barriers to health education curriculum targeting school nurses as health teachers in Korea. A total of 741 health teachers participated. The questionnaire included perceived effectiveness and perceived barriers to health education curriculum, future roles of health teachers, and needs for in-service training programs. The most frequently selected perceived barrier was a lack of personnel to serve in the health clinic when the nurse was teaching, although 60.9-61.7% wanted to continue both duties of health education and school health services. Perceived effectiveness of health education was positively associated with duration of teaching career (p < .05). Elementary school health teachers had higher perceived effectiveness than those in middle and high schools, while those with bachelor's degrees had lower perceived effectiveness than those with master's degrees (p < .05). In-service training and efforts to decrease the perceived barriers would help to offer effective health education.

Background:   Wirral University Teaching Hospital is a large district general hospital situated on the Wirral Peninsula, UK. Because of the district's geographical and demographic characteristics, Wirral is an ideal location for population-based studies. Information on community paediatric referrals, case mix and outcomes is scarce. We took advantage of our situation to conduct an epidemiological study of referrals to community paediatrics in Wirral. A companion paper examines referrals to general paediatricians during the same period., Methods:   A prospective observational study of community paediatric outpatient referrals between 1 February and 31 May 2006 for all children under the age of 15 offered a new patient appointment during the study period. The study was conducted using the same methodology as a previous population-based study of community paediatric outpatients in Northampton, UK in 1998. We compared our results with this previous study., Results:   The referral rate was 10.1 per 1000 children under 15 per annum. School nurses and health visitors made nearly half the referrals, with general practitioners referring most of the remainder. Compared with the Northampton study, more children were seen by consultants. Case mix showed a shift towards behavioural and neurodevelopmental disorders, with less general paediatrics. Attention deficit hyperactivity disorder was the commonest disorder seen (28.2%), a significant increase from the previous study (3.4%) (P < 0.01). Autism spectrum disorder showed little change (8.1% vs. 9.6%; NS). The Wirral study showed significantly more follow-up compared with the Northampton., Conclusions:   This population-based study gives a unique insight into the epidemiology of referrals to community paediatricians in the UK in 2006 and how these differ from those recorded in a different UK district in 1998., (© 2011 Blackwell Publishing Ltd.)