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Skin and soft tissue infections (SSTIs) are frequent in student athletes and are often caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). We evaluated the awareness of CA-MRSA among high school coaches and athletic directors in Missouri (n = 4,408) and evaluated hygiene practices affecting SSTI transmission. Of 1,642 (37%) respondents, 61% received MRSA educational information during the past year and 32% indicated their school had written guidelines for managing SSTIs in athletes. Coaches and athletic directors aware of written guidelines reported a lower incidence of SSTIs in student athletes (26%) compared to those without written policies (34%, p = .03). When confronted with SSTIs, 49% of respondents referred student athletes to the school nurse or a physician. A relationship exists between school policies for SSTI management and lower incidence of SSTIs. Educational initiatives by school nurses in conjunction with athletic staff may lead to practices that limit SSTIs in this at-risk population.

School nurses played a key role in Maine's school-located influenza vaccination (SLV) clinics during the 2009-2010 pandemic season. The objective of this study was to determine, from the school district perspective, the labor hours and costs associated with outside-clinic coordination activities (OCA). The authors defined OCA as labor hours spent by staff outside of clinic operations. The authors surveyed a convenience sample of 10 school nurses from nine school districts. Eight nurses responded to the survey, representing seven districts, 45 schools and 84 SLV clinics that provided a total of 22,596 vaccine doses (H1N1 and seasonal combined) to children and adolescents. The mean total OCA time per clinic was 69 hours: out of total hours, 22 (36%) were spent outside regular clinic operation time. The authors estimated the mean cost of OCA to be $15.36 per dose. Survey respondents reported that costs would be lower during non-pandemic seasons and as schools become more proficient at planning clinics.

Elementary school teacher time spent on student health issues and the relationship to school nurse services was the focus of this 2-year study. A cross-sectional design was used to survey traditional and exceptional (special needs) classroom teachers about the time they spent on health issues and their perception of school nurse presence. The school nurses were surveyed regarding the impact of their presence on early releases due to illness. Study findings related to teacher perceptions indicate with school nurse presence there are fewer early releases, increased communication, less time spent on health issues, students with chronic illnesses are safer, and there is a resource available for health information. The data provide the groundwork for discussions to improve the communication of the nurses' schedules, increase teacher confidence in consistent nurse hours at their school and aid the nurse in protecting valuable on-site school hours from other interferences or commitments.

The purpose of this research is to use the reports of school nurses to facilitate the understanding of how schools experience and manage asthmatic, anaphylactic, and diabetic emergencies by quantitative and qualitative analysis of online surveys. E-mails with a link to SurveyMonkey® were sent to all U.S. members of the National Association of School Nurses (13,695). Subjects were asked to describe their self-reported knowledge, opinions, practices, and experiences with such emergencies and the devices used to manage them. Regarding the frequency of emergencies in a given school year, the medians were 8 for asthma, 0 for anaphylaxis, and 10 for hypoglycemia. Twenty-two, five, and one subjects, respectively, reported that events like these resulted in deaths during their careers as school nurses. These diseases create substantial potential for emergencies in schools, and the schools represented by these nurses appear to be somewhat, but not ideally, equipped to handle such crises.

In 2011, NASN conducted a needs assessment to identify and analyze member demographic trends and identify priorities for current members. Ninety-five percent of survey respondents were currently registered nurses, 1% were licensed practical nurses, 3% were advance practice registered nurses, and 1% had other types of licensure. School nurses ages ranged between 21 and 66+ years of age with the highest concentration of school nurses (63%) older than 51 years of age. Thirty-one percent of respondents were nationally certified through the National Board for the Certification of School Nurses. Eighty-three percent had a bachelor's degree or higher. Fifteen percent had a master's in nursing, and another 15% held a master's in another field. Nine percent of respondents had an associate's degree in nursing and 4% had a registered nurse diploma as their highest level of education. The typical NASN member is a female, registered nurse with a bachelor's degree who is over the age of 50.

Young people are likely to experience noise-induced hearing loss (NIHL), as the use of personal listening devices and other damaging factors (e.g., video games) increases. Little research has examined the role of school health personnel in the prevention and early identification of hearing impairment. A 32-item, valid and reliable survey was developed regarding elementary and middle school nurses' practices concerning hearing loss screening and prevention. The survey instrument was based on the Stages of Change theory and the Health Belief Model. A random sample of 800 nurses was obtained from The National Association of School Nurses. A two-wave mailing was used to achieve a 58% response rate. Forty eight percent indicated there were not many educational programs that addressed NIHL in students. Performing hearing screenings routinely can help identify those students at risk. School nurses need to become advocates for policies and programs that mandate hearing screenings and educational programs to help reduce hearing loss.

Objective: To determine whether patterns in student use of school nurse services existed according to poverty, race, and ethnicity., Design and Sample: Cross-sectional descriptive study of 51,767 visits to school nurses made by 12,797 middle and high school students was conducted. Data were collected and analyzed by race, ethnicity, and poverty., Measures: Individual-level quantitative data on student visits to school nurses were collected via the School Nurse Entry Database. Numbers and types of student visits were measured, along with the demographic characteristics of student visitors., Results: Poverty was the largest driver of visits to school nurses among all racial and ethnic groups. Poverty was a larger influence on White students' use of services, suggesting that factors related to race, ethnicity, or culture may have larger effects on promoting visits to school nurses by students of color. Subethnic Asian and Hispanic groups showed visit patterns that deviated from aggregated visit rates., Conclusions: Knowledge of visit patterns among poor, ethnic, and subethnic populations is important-and particularly urgent with the advent of national health reform-in informing and improving public health and school nursing policy and practice., (© 2011 Wiley Periodicals, Inc.)

Objective: To examine how involvement in aggressor-victim interactions is linked to somatic complaints, illnesses, and physical injuries among elementary school-aged children., Study Design: This study was composed of a school-based sample of 590 children in grades 3 through 5. Independent sources were used to assess victimization (self-report) and aggression (peer report) in the fall semester. School nursing logs for the entire school year were collected in May and coded for the number of times each child presented with a somatic complaint, illness, or injury., Results: Both aggression and victimization were significantly related to all 3 reasons for nurse visits, controlling for demographic variables. Higher levels of aggression and victimization each were independently associated with more frequent visits to the school nurse for somatic complaints, illnesses, and injuries. A significant victimization-times-aggression interaction was found for illnesses, with nonaggressive victimized children presenting most frequently for illness visits., Conclusions: Involvement in aggressor-victim interactions, as either aggressor, victim, or both, is associated with more frequent health complaints, based on school nursing logs. Prevention, early identification, and treatment of problems with victimization and aggression may have important health implications for children.

The purpose of the study was to identify Nursing Interventions Classification (NIC) interventions performed by Korean school nurses. The Korean data were then compared to U.S. data from other studies in order to identify differences and similarities between Korean and U.S. school nurse practice. Of the 542 available NIC interventions, 180 were selected as the basis of a questionnaire designed to quantify key aspects of school nursing practice. The data were collected from 131 school nurses working in Korea. The results indicated that Korean school nurses focused on classifications from the Physiological Basic domain. Comparisons to previously reported U.S. data reflect that U.S. school nurses focus primarily on the Behavioral domain. The data reflect important differences between the practice characteristics of Korean and U.S. school nurses. Further, the data support the utility of NICs in quantifying the practice characteristics of school nurses in Korea.

The purpose of this descriptive study was to explore utilization of nurse substitutes in the school setting in Illinois. The literature described personnel who staff the school health office in the absence of the school nurse and the barriers to obtaining nurse substitutes. There were no empirical studies conducted on school nurse substitutes in the literature. Thus, a sample of 148 Illinois school nurses was recruited to complete a 20-item online survey. In the absence of a school nurse, 10.1% of health offices were not staffed, 37.8% were covered by a nurse who was simultaneously responsible for their usual assignment, and 25.7% were staffed by non-licensed personnel. Therefore, 73.6% of the respondents' assignments had no registered nurse immediately available the most recent day the nurse was absent.

Objective: To determine the extent of pharmacist use in medication management, roles of school nurses, and use of other health care providers at elementary schools in North Carolina., Methods: Prospective survey of 153 (130 public and 23 private) elementary schools in four counties of North Carolina. A 21-question survey was e-mailed to the head administrator of each school (e.g., principal, headmaster) containing a Qualtrics survey link. Questions were designed to elicit information on school policies and procedures for medication management and use of health care providers, including pharmacists, in the schools. Responses were collected during a 2-month period., Results: Representatives from 29 schools participated in the survey (19% response rate). All 29 schools reported having a school policy regarding medication administration during school hours. Of those, 27 schools reported consulting with nurses on their policies. Only 1 of 27 respondents reported consulting with pharmacists on medication management policies. The majority of the respondents (93.1%) stated that administrative staff was responsible for medication administration at the schools., Conclusion: Use of pharmacists in creating and reviewing policies for schools and actual medication management at schools was extremely low. The findings in this study reinforce the findings in previous studies that pharmacists are not being used and are not a major presence in elementary school health.

Differences in response rates to a three-wave mail survey were assessed when the covering letters were signed by three versus one researcher. 375 surveys including covering letters signed by three researchers and 375 surveys including covering letters signed by one researcher were sent. A follow-up mailing was used to increase the response rate. 199 surveys were returned (53.5%) in which the covering letter had three researchers, and 218 when the covering letter had one researcher (58.7%), not a significantly different distribution.

The United States has one of the highest unintended pregnancy rates of all industrialized nations in the world, with 13% of those occurring among the adolescent population. In 2005, the adolescent birthrate in the United States was 40.5 per 1,000 women and increased 3% in 2006 (Martin et al., 2009). Unintended pregnancy and motherhood can have a tremendous impact and lifelong implications for adolescents and their children as well as financial and societal costs. Helping make contraception accessible to adolescents is one area where school nurses are able to have an impact. Various contraceptive methods are described. Advantages and disadvantages are summarized along with considerations relative to adolescents. General strategies for counseling and caring for adolescents to encourage successful initiation, use, and continuation of contraception also reviewed.

A significant number of children in the United States have developmental disabilities. Historically, many children with developmental disabilities were institutionalized and rarely seen in public. Currently, children with developmental disabilities are entitled to education and health-related support services that permit them access to public education and community services. To understand current laws related to children with developmental disabilities, it is important to consider past legislation and landmark court cases that have significantly affected the lives of children with disabilities and school nursing practice. This article presents an overview of historical legislation and court cases as they pertain to children and individuals with developmental disabilities and of current issues that require further attention and inquiry.

Objective: To determine whether students with self-reported needs for mental health support used school-based health centres (SBHCs) for this purpose., Method: A secondary analysis was conducted on self-reported data collected from 1629 high school students from Cape Breton, Nova Scotia. Descriptive statistics and logistic regression analyses were employed to determine the influence of sex, grade, sexual orientation, socioeconomic status (SES), school performance, social involvement, and health risk-taking behaviours on need for mental health support and use of SBHC for that purpose., Results: One-half of surveyed students reported needs for mental health support. Risk for depression was the most commonly reported indicator of need. Only 13% of students visited a SBHC nurse for mental health support, and 4 times as many females than males used the SBHC for this purpose (20.4%, compared with 5.3%, P < 0.001). There was a significantly increased likelihood of use of SBHC for mental health support, given the presence of a greater number of need factors. Multivariate logistic regression determined that female sex (OR 5.57, 95% CI 3.07 to 10.09), lower SES factor (OR 1.19, 95% CI 1.11 to 1.28), sexual health risk-taking behaviours (OR 1.72, 95% CI 1.28 to 2.31), and suicidal behaviour (OR 1.83, 95% CI 1.48 to 2.27) were significantly associated with the use of SBHCs for mental health support., Conclusions: Substantial need for mental health support and significant unmet need were observed. In particular, male students underused the services relative to their self-reported need. Implications for SBHCs and directions for future research are discussed.

Unlabelled: Access to health care, including preventive health care for pupils affects the health of society. Equal access to pupils'preventive health care means the same level of preventive services for all children and adolescents regardless of school type, place and region of domicile., Aim: To analyse the quality of preventive health care for pupils in school year 2007/2008 in all school types in Poland, giving special attention to inequalities and access of this healthcare., Material and Methods: Reports from national public statistics filled by school nurses regarding preventive healthcare for pupils were analysed. Special attention was given to inequalites in access to, Result: Disparities in access to preventive health care were observed. They affected more often pupils from rural schools, basic vocational schools and special schools. As a result, 60% rural elementary schools did not have a school health office. School nurses working in these schools were overburdened, each of them had to look after excessive number of pupils. Nearly one-quarter of basic vocational school pupils didn't have periodic check-up. Pupils from these schools less frequently participated in health education conducted by school nurses compared with pupils from other school types. In special schools school nurses were overburdened. One school nurse from these schools had to look after above limit of pupils' number (above 25% in urban and above 75% in rural schools)., Conclusions: 1. Inequalities in access to preventive health care affected pupils from rural, basic vocational schools and special schools. They reflected existing social disparities in Poland. 2. Inequalities exist mainly in the social groups, who are at risk of social exclusion. 3. Equal opportunity for pupils'preventive health care requires systemic solutions in health and educational cooperation at government level.

Background: Research on the adoption of evidence-based practice (EBP) in health care has been focused mainly on hospital settings and primary care; little is known about EBP adoption and implementation among school nurses in the United States (US)., Objectives: The objectives of this study were to (1) describe the prevalence of EBP use among school nurses, (2) describe demographic, individual, and organizational factors associated with EBP use, and (3) identify resources needed to enhance EBP use., Methods: A survey designed for this study was mailed to all school nurses in Iowa in the US, with a response rate of 56.8% (n= 386). Descriptive statistics and t-tests were used to indicate and compare the variables of interest. Multiple regression and analysis of variance (ANOVA) methods were used to identify variables explaining the variance in the use of EBP., Results: Information sources, professional membership, and district size explain 22% of the variance in current use of EBP. Identified resources needed to increase the use of EBP included networking opportunities, predeveloped EBP guidelines, and education on outcome evaluation., Conclusions: This study indicates important information on variables that affect current practice in school nursing and also shows requested resources for increasing EBP use. These results can be used to develop translation strategies to increase the use of EBP in the school setting. Because only 22% of the variance was explained, further research is needed to identify additional variables.

Many students require prescription and nonprescription medication to be administered during the school day for chronic and acute illnesses. School office staff members are typically delegated this task, yet these individuals are unlicensed assistive personnel without medical training. Five school nurses developed and participated in a medication audit providing a glimpse into the administration and management of medications in school health offices. The audit included 154 medications. Results of the audit showed a wide range of errors and discrepancies, including problems with transcription, physician orders or lack thereof, timing, documentation, and storage. Audit results highlight the importance of training in medication administration and management at schools. It also directs attention to view training not as a once-a-year event, but as a process. A process is needed to ensure and sustain the safe and accurate administration of medication. Towards this end, school nurses need to periodically evaluate school office staff, audit school medication records and documents, and conduct refresher classes throughout the school year.

This population-based case-finding study sought to determine asthma prevalence and characterize disease severity and burden among school-aged children in the Little Rock School District. Asthma cases were identified by validated algorithm and parental report of asthma diagnosis. The overall response rate was low. Among schools with greater than 50% response rate, prevalence of physician-diagnosed asthma was comparable to other studies in public school settings. Prevalence of symptoms in cases identified as current is suggestive of poor asthma control. Improved systems for case identification of children with asthma are needed in schools. Efforts should focus on strategies to improve asthma control.

As a result of various health concerns, children are receiving an increased number of medications while at school. In Pennsylvania, the School Code mandates a ratio of 1 certified school nurse to 1,500 students, which may mean that 1 school nurse is covering 3-5 buildings. This implies that unlicensed personnel are administering medications, a violation of licensing laws in Pennsylvania. The purpose of this study was to determine the policies and practices that Pennsylvania public schools have in place regarding medication administration. The sample consisted of 314 state-certified school nurses who returned a 71-question survey. Findings indicated that school nurses are very concerned about issues related to medication administration. Additional findings identified the lack of standing orders to administer over-the-counter medications, the increase in medication errors when the school nurse had responsibility for multiple buildings, and the lack of understanding of the ramifications of the Nurse Practice Act on school nursing practice in regard to delegation. Recommendations for practice include development of detailed policies and procedures and collaboration among all stakeholders in the development of policies that address legal issues.

This study measured the effectiveness of a 9 a.m. nutrition break after it had been implemented for 1 academic year at an inner-city high school. Effectiveness was measured by student participation rates, student and teacher evaluations of hunger-associated symptoms experienced by students, and teacher evaluations of the effects on the learning environment. Sixty-nine percent of students participated. The most frequently cited reason for nonparticipation was dislike of the food offered (53%), with an additional 15% citing problems with food distribution. As the frequency of participation rose, the frequency of inability to focus, tiredness, stomachache, headache, and midmorning hunger fell. All of the associations were statistically significant except for headache. Seventy-four percent of staff stated that the nutrition break had positive effects on the learning environment, and 71% referred fewer students to the school nurse.

Objectives: Because children spend a significant proportion of their day in school, pediatric emergencies such as the exacerbation of medical conditions, behavioral crises, and accidental/intentional injuries are likely to occur. Recently, both the American Academy of Pediatrics and the American Heart Association have published guidelines stressing the need for school leaders to establish emergency-response plans to deal with life-threatening medical emergencies in children. The goals include developing an efficient and effective campus-wide communication system for each school with local emergency medical services (EMS); establishing and practicing a medical emergency-response plan (MERP) involving school nurses, physicians, athletic trainers, and the EMS system; identifying students at risk for life-threatening emergencies and ensuring the presence of individual emergency care plans; training staff and students in first aid and cardiopulmonary resuscitation (CPR); equipping the school for potential life-threatening emergencies; and implementing lay rescuer automated external defibrillator (AED) programs. The objective of this study was to use published guidelines by the American Academy of Pediatrics and the American Heart Association to examine the preparedness of schools to respond to pediatric emergencies, including those involving children with special care needs, and potential mass disasters., Methods: A 2-part questionnaire was mailed to 1000 randomly selected members of the National Association of School Nurses. The first part included 20 questions focusing on: (1) the clinical background of the school nurse (highest level of education, years practicing as a school health provider, CPR training); (2) demographic features of the school (student attendance, grades represented, inner-city or rural/suburban setting, private or public funding, presence of children with special needs); (3) self-reported frequency of medical and psychiatric emergencies (most common reported school emergencies encountered over the past school year, weekly number of visits to school nurses, annual number of "life-threatening" emergencies requiring activation of EMS); and (4) the preparedness of schools to manage life-threatening emergencies (presence of an MERP, presence of emergency care plans for asthmatics, diabetics, and children with special needs, presence of a school nurse during all school hours, CPR training of staff and students, availability of athletic trainers during all athletic events, presence of an MERP for potential mass disasters). The second part included 10 clinical scenarios measuring the availability of emergency equipment and the confidence level of the school nurse to manage potential life-threatening emergencies., Results: Of the 675 questionnaires returned, 573 were eligible for analysis. A majority of responses were from registered nurses who have been practicing for >5 years in a rural or suburban setting. The most common reported school emergencies were extremity sprains and shortness of breath. Sixty-eight percent (391 of 573 [95% confidence interval (CI): 64-72%]) of school nurses have managed a life-threatening emergency requiring EMS activation during the past school year. Eighty-six percent (95% CI: 84-90%) of schools have an MERP, although 35% (95% CI: 31-39%) of schools do not practice the plan. Thirteen percent (95% CI: 10-16%) of schools do not identify authorized personnel to make emergency medical decisions. When stratified by mean student attendance, school setting, and funding classification, schools with and without an MERP did not differ significantly. Of the 205 schools that do not have a school nurse present on campus during all school hours, 17% (95% CI: 12-23%) do not have an MERP, 17% (95% CI: 12-23%) do not identify an authorized person to make medical decisions when faced with a life-threatening emergency, and 72% (95% CI: 65-78%) do not have an effective campus-wide communication system. CPR training is offered to 76% (95% CI: 70-81%) of the teachers, 68% (95% CI: 61-74%) of the administrative staff, and 28% (95% CI: 22-35%) of the students. School nurses reported the availability of a bronchodilator meter-dosed inhaler (78% [95% CI: 74-81%]), AED (32% [95% CI: 28-36%]), and epinephrine autoinjector (76% [95% CI: 68-79%]) in their school. When stratified by inner-city and rural/suburban school setting, the availability of emergency equipment did not differ significantly except for the availability of an oxygen source, which was higher in rural/suburban schools (15% vs 5%). School-nurse responders self-reported more confidence in managing respiratory distress, airway obstruction, profuse bleeding/extremity fracture, anaphylaxis, and shock in a diabetic child and comparatively less confidence in managing cardiac arrest, overdose, seizure, heat illness, and head injury. When analyzing schools with at least 1 child with special care needs, 90% (95% CI: 86-93%) have an MERP, 64% (95% CI: 58-69%) have a nurse available during all school hours, and 32% (95% CI: 27-38%) have an efficient and effective campus-wide communication system linked with EMS. There are no identified authorized personnel to make medical decisions when the school nurse is not present on campus in 12% (95% CI: 9-16%) of the schools with children with special care needs. When analyzing the confidence level of school nurses to respond to common potential life-threatening emergencies in children with special care needs, 67% (95% CI: 61-72%) of school nurses felt confident in managing seizures, 88% (95% CI: 84-91%) felt confident in managing respiratory distress, and 83% (95% CI: 78-87%) felt confident in managing airway obstruction. School nurses reported having the following emergency equipment available in the event of an emergency in a child with special care needs: glucose source (94% [95% CI: 91-96%]), bronchodilator (79% [95% CI: 74-83%]), suction (22% [95% CI: 18-27%]), bag-valve-mask device (16% [95% CI: 12-21%]), and oxygen (12% [95% CI: 9-16%]). An MERP designed specifically for potential mass disasters was present in 418 (74%) of 573 schools (95% CI: 70-77%). When stratified by mean student attendance, school setting, and funding classification, schools with and without an MERP for mass disasters did not differ significantly., Conclusions: Although schools are in compliance with many of the recommendations for emergency preparedness, specific areas for improvement include practicing the MERP several times per year, linking all areas of the school directly with EMS, identifying authorized personnel to make emergency medical decisions, and increasing the availability of AED in schools. Efforts should be made to increase the education of school nurses in the assessment and management of life-threatening emergencies for which they have less confidence, particularly cardiac arrest, overdose, seizures, heat illness, and head injury.

Current policy places much emphasis on public health and care outside hospital. To provide this requires a qualified work force but a large number of community nurses are approaching retirement. While there is a commitment to recruit and retain such nurses, there is little information available on community nurses' career trajectories, or on why staff choose to work in the community and why they undertake community specialist practice (CSP) programmes. This paper reports the findings of a survey of community specialist practice students--community children's nurses (CCNs), community mental health nurses (CMHNs) district nurses (DNs), health visitors (HVs), practice nurses (PNs), school nurses (SNs)--in a large London based programme. They were asked why they had entered community practice and why they had undertaken a community specialist practice programme. Findings were not categorical; the reasons for entering community work included increased initiative, more autonomy and preferred hours. Scope for initiative, autonomy and increased independence were reasons for undertaking the CSP programme, as well as better promotion prospects. Differences were evident in response by age of respondent and by whether they had dependent children. All types of respondents saw themselves as public health practitioners. Practice nurses stood out as different from the others, seeing hours as significant, but not promotion prospects despite expecting higher grades on completion of the programme. The study raises various questions, which could be explored after refinement of the study tool and using students in different locations throughout the country.

Adolescents with type 1 diabetes are likely attending most middle and high schools. These youth often do not receive the support needed to manage their diabetes during or after school. Nurses (n=110) from 3 states responded to a survey examining perceptions of barriers to and supports for diabetes management during school and after school activities. Results indicated that adolescents need more support at school. Support could be facilitated by education of school staff; improved communication among youth, parents, school nurses, teachers, and physicians; and more communication from adolescents to others about what they need to manage well in school. Open-ended questions allowed nurses to provide recommendations for supporting youth and ideas for addressing barriers to management at school. Future studies should address ways to enable adolescents to communicate about their diabetes and ways to educate the school team.

The purpose of this study was to investigate to what extent school nurses in Sweden inform adolescent men about testicular cancer (TC) and testicular self-examination (TSE). A questionnaire was completed by 129 school nurses from 29 randomly selected municipalities. All respondents were women, with a mean age of 42 years. The results showed that about 6% of the school nurses had provided information on TC and 9% on TSE; however, the majority was open to presenting such information. The major reason reported for not providing this guidance was insufficient knowledge about the subject. The nurses who had given information were knowledgeable about both TC and TSE and more often informed young men about TC and TSE, whereas those who had only received information about TC were not as likely to provide information about TC or TSE. The results of this study highlight the need to educate school nurses about TC and TSE so they can include this information in their health teaching to adolescent males.

Asthma is the most common chronic disorder in American schoolchildren, and school nurses play a valuable role in its management. A study was conducted in which school nurses were asked to describe their role in caring for students with asthma and their use of Asthma Action Plans (AAPs). The nurses indicated that they frequently provided direct care and education. They were comfortable with providing care to students with asthma and familiar with AAPs. Having an AAP increased their confidence in managing students with asthma. This emphasizes the need for continued education regarding the AAP and the development of policies that direct care and encourage use of an AAP at school.

Anecdotal reports suggest school nurses and staff treat increasing numbers of public school students with chronic diseases. However, professionals know little about actual disease burden in schools. This study measured prevalence of chronic disease medication administration rates in a large, urban midwestern school district. Data from daily medication logs were recorded by school nurses during a single week. Medications and administrations were sorted by disease type. Prevalence rates were calculated for six chronic diseases: asthma, diabetes, seizures, attention deficit/hyperactivity disorder, other mental/behavioral disorders, and other diseases/conditions. Separate rates stratified by school grade, poverty level, and type of school were calculated. Overall, 3.12% of students received medication for chronic diseases, including 2.13% for psychiatric/mental disorders and 1.91% for attention deficit/hyperactivity disorder alone. These rates were lower than estimates from other states. Factors that contributed to this finding are reviewed.

This study explored job satisfaction and changes needed to help boost levels of job satisfaction. Self-reported job satisfaction data were collected from 71 school nurses employed in elementary, middle, and high school settings via interactive focus groups. The subjects participated in a 30- to 45-minute focus group session that was audiotaped and transcribed by the principal investigator. Beliefs about job satisfaction were identified and classified into exclusive categories or themes. While the majority of school nurses expressed contentment with their jobs, certain factors that would increase job satisfaction, such as salary and control issues, were discussed. Overall, 83% of school nurses in this study were satisfied in their present positions; however, issues of coping and role strain were identified as major contributors to low morale. Only 17% of the school nurses voiced job dissatisfaction, primarily attributed to low salaries and lack of trust and support from administration. As school nurses face a diverse community with complex needs, adaptation is needed for job satisfaction to be maintained. For this to occur, school nurses must take the initiative to educate administrators, parents, and communities about their role in the school setting.

Although job satisfaction has been widely studied among registered nurses working in traditional health care settings, little is known about the job-related values and perceptions of nurses working in school systems. Job satisfaction is linked to lower levels of job-related stress, burnout, and career abandonment among nurses. This study evaluated the level of job satisfaction among a convenience sample of school nurses practicing in California. The Index of Work Satisfaction (IWS) was the instrument used. Although the sampled school nurses rated autonomy and interaction as the most important and satisfying factors contributing to job satisfaction, the overall findings indicated that school nurses are relatively dissatisfied with their jobs.

The School Nurse Impact Committee of the Columbus Public Schools in Columbus, Ohio, initiated a survey to determine staff satisfaction with the delivery of health services. School nurses need the cooperation and support of the staff to successfully deliver school health services, therefore, the staff's satisfaction with school health services is crucial to the school nurses' ability to fulfill their role. The objectives of the survey were to (a) determine staff satisfaction with school nurse interventions, (b) determine staff satisfaction with the effectiveness of interventions, (c) identify areas of health service delivery which may need improvement, and (d) determine areas of school health services where school nurses may need to more effectively communicate their involvement. Critical elements of school nurse practice included staff health, safety and environment, classroom education, medication, school system collaboration, and program management. Several key issues were identified through the survey. School system collaboration issues need more school nurse involvement. School nurses also need to improve their visibility regarding school system collaboration, and in classroom and individual pupil education. Traditional school nurse functions were adequately covered. Results indicate that staff would be more satisfied if they had more nursing support in the classroom and more nurse time in their building.

Teaching sex education to school pupils in Scotland continues to be a controversial issue. In reality there is lack of leadership, strategy and an uncoordinated approach to delivering this important topic. The school nurse is frequently identified as a suitable professional to lead the way because it is assumed that school nurses are well educated in the field of sexual and reproductive health. Nationally, little is known about the educational status of Scottish school nurses and there is no research evidence available from which generalisations can be made. This study aims to explore the educational preparation of school nurses that underpins teaching sex education to school pupils in Scotland. A cross-sectional descriptive study was completed in September 1998. The results confirmed that school nurses in Scotland are predominantly female and 70% of the respondents (n=117) were over the age of 40 years of age. No common basic nursing qualification was identified. The majority of school nurses in Scotland perceive sex education to be part of their role and 39% (n=65) testified that specific sexual health training had been undertaken. Many lack confidence in this area of practice and are aware of extensive educational needs in relation to teaching sexual health and reproductive health. Despite these findings 75% (n=126) were actively involved in teaching sex education to school pupils.

The purpose of this study was to examine school nurses' knowledge and beliefs about the management of children with attention deficit disorder (ADD). Seven hundred eighty-six school nurses responded to mailed surveys regarding their attitudes and knowledge about the management of children with attention deficit disorder. Surveys were mailed to school nurses randomly selected from the membership of the National Association of School Nurses. School nurses' knowledge of school management of ADD and their attitudes about physicians' participation as part of a team effort in this care were explored. School nurses responded that physicians should increase their efforts to educate children and parents about ADD. Recommendations for school nurses in the management of children with ADD are offered.

Most public health departments do not have enough public health nurses to adequately respond to a bioterrorist attack or other large-scale health emergency and would need to look to volunteers to help with staffing needs in an emergency. The National Association of School Nurses supports the use of school nurses, a skilled workforce, as responders in a mass casualty event, whether it is naturally occurring or as a result of bioterrorism. This article explores the use of school nurses to supplement public health staff during an emergency. A Likert-scale survey was used to assess the preparedness and willingness of school nurses to respond to a health threat. Although school nurses are willing to respond, the findings highlight the importance of continued education on risk and personal protection.

This article reports school nurses' experiences with medication administration through qualitative analyses of a written survey and focus groups. From a random sample of 1000 members of the National Association of School Nurses, 649 (64.9%) school nurses completed the survey. The quantitative data from the survey were presented previously. However, 470 respondents provided written comments on the survey. Comments on the eight items that had the most written comments were qualitatively analyzed. In addition, to clarify information obtained from the surveys, two focus groups with local school nurses were conducted. A constant comparative method of analysis was used, and results were combined from the two data sources. The combined analyses resulted in six final categories of concern: (a). delegation of medication administration, (b). comfort with delegation, (c). self-administration of medication, (d). medication administration errors, (e). storage of medication, and (f). administration policies. The findings suggest that school nurses across the country have similar concerns regarding the administration of medications in the school setting.

The health practices of school nurses affect our role as advocates and educators to promote the health of youth. This study describes the health practices of a convenience sample of 388 school nurses who attended the business meeting at an annual school nurse conference. A self-administered, 40-item questionnaire identified health practices of school nurses in the following areas: (a). health promoting behaviors, (b). exercise, (c). nutrition, (d). relaxation and well-being, (e). safety, and (f). substance use. The subjects most often avoided tobacco and wore seatbelts. The majority did not maintain their weight or exercise consistently. Statistical relationships were explored among the subscales and background items. These data document the need to design strategies to narrow the gap between actual school nurse health practices and the important health messages being delivered in our schools.

School nurses are on the front lines of health care in public schools. The integration of students' health care needs as components of educational programs has become increasingly important as medically fragile children rely on school nurses to deliver or coordinate their health care services. The purpose of this descriptive study was to determine which school nurse services special day class teachers perceive as very important, important, somewhat important, or not important. Perceptions were surveyed via the School Nurse Services Data Collection Tool. The data were analyzed using percentages, mean values, and frequencies. The data were then aligned to match the role concepts set forth in the California Commission on Teacher Credentialing (CTC) standards for school nurse preparation. The findings of this survey suggested that most of the services provided by school nurses were rated as important or somewhat important.

This study analyzed the impact of school nurses on economic efficiency. Public schools must provide resources such as books, teachers, and buses necessary to accommodate all enrolled students even if all students do not come to school every day and even if some leave school before the end of the school day. To the extent that resources are allocated but unused, there will be an increase in what is termed X-inefficiency. To investigate this phenomenon, data related to student absences and student checkouts were collected from 22 schools with a total student population just over 10,000 students during a 20-day period in the fall of 2001. This study found that fewer children checked out of school for medical reasons when a full-time school nurse was available at the school. Additionally, this study supports the contention that full-time school nurses might have a positive impact on the percentage of children with health care insurance coverage. However, a large number of students did check out for what appeared to be less than valid reasons. Thus, although the presence of a school nurse reduced the X-inefficiency, school policy and procedures allowed a degree of X-inefficiency to remain.

Objectives: We investigated school factors associated with successful implementation of a seventh grade vaccination requirement., Methods: The proportion of students vaccinated with hepatitis B vaccine and measles containing vaccine was determined from records of schools in San Diego County, California. A school survey identified compliance strategies. Analysis identified factors associated with coverage., Results: In October 1999, 67.2% of 38,875 students had received the required vaccine doses. Of 315 schools, coverage was less than 40% in 60 schools and exceeded 80% in 111 schools. Factors associated with high coverage included private schools, early and frequent notice to parents, and, for public schools, higher overall socioeconomic status of students., Conclusions: In preparation for a middle school vaccination requirement, early and frequent notification of parents improves coverage. Schools with a high percentage of low socioeconomic status students may require extra resources to support implementation.

Related factors of low back pain (LBP) among school personnel were investigated. We designed a cross-sectional study employing questionnaires, which included a Japanese version of the Job Content Questionnaire. Subjects consisted of 3306 male and 3184 female school personnel in all public schools and kindergartens operated by Nagoya City, Japan. Prevalence of LBP in each work category was compared to that in general teachers of each gender after adjusting for age. Male teachers at schools for the handicapped and in classrooms for the handicapped showed significantly higher LBP prevalence. Among female participants, teachers at schools for the handicapped, physical education teachers, kindergarten personnel and school nurses displayed higher LBP prevalence. In work categories which demonstrated high LBP prevalence, low social support and low job satisfaction were related to LBP of school nurses despite low physical loads. High job demand and physical loads correlated to LBP in kindergarten personnel.

Objective: A statewide school survey was performed to provide naturalistic data on the prevalence of medication administered to Maryland public school students for the treatment of attention deficit hyperactivity disorder (ADHD) to clarify the concern of some state legislators about stimulant treatment for youths., Methods: In April 1998, school nurses supervised a survey of all Maryland public school students medicated during school hours for ADHD. The data collected on these students included: type of medication administered, gender, school level, race/ethnicity, special education and Section 504 status, and the specialist of the prescriber., Results: Of the 816 465 students surveyed, 20 050 (2. 46%) received methylphenidate and 3721 (0.46%) received other medications for ADHD. Other major findings were: 1) methylphenidate constituted 84% of all the medication administered for ADHD; 2) the male:female ratio of the medication's recipients was 3.5:1 and 4.3:1 in elementary and secondary school, respectively; 3) black and Hispanic students received methylphenidate at approximately half the rate of their white counterparts; 4) 45% of all students receiving methylphenidate had special education status and an additional 8% had Section 504 status; and 5) nurse practitioners were the prescribers of 3% of the methylphenidate prescribed to Maryland students., Conclusions: This large, population-based, point prevalence study of medication administered to students for ADHD adds new and updated findings on prevalence variations, rates for minority and special education/Section 504 students, and specialty prescriber rates.