Students With Chronic Conditions: Experiences and Challenges of Regular Education Teachers.

Incorporating Academic and Health-Related School Needs into Pediatric Nursing Practice

PROTOCOL: Education Support Services for Improving School Engagement and Academic Performance of Children and Adolescents with a Chronic Health Condition: A Systematic Review

OF DISSERTATION THE ROLE AND IMPACT OF SCHOOL NURSES AND INTENTIONS TO DELEGATE DIABETES-RELATED TASKS AMIDST BUDGET CUTS AND LEGISLATIVE CHANGES As the percentage of school children with chronic conditions such as diabetes continues to rise, funding for school nurses to keep those students healthy and safe is decreasing. This dissertation includes three studies: (1) a systematic review of the literature on the role and impact of American elementary school nurses, (2) a focus group study that further examined the role of Kentucky school nurses and described their reaction to a new regulation that necessitates delegation of diabetes-related nursing tasks to unlicensed assistive personnel (UAP), and (3) a quantitative study that examined Kentucky school nurses’ past behaviors and future intentions regarding the delegation of diabetes-related tasks. A systematic review of the literature revealed that activities of school nurses can be conceptualized into four major areas: (a) health promotion and disease prevention; (b) triage and treatment of acute issues (e.g., injuries and infectious diseases); (c) management of chronic conditions; and (d) psychosocial support. School nursing activities are associated with increased attendance, higher quality schools, and cost savings. Focus groups in three regions of Kentucky found that Kentucky school nurses fulfill the same major roles as their counterparts across the nation, and face similar challenges such as lack of time, limited resources, language barriers, and communication issues with families. School nurse participants described their biggest impact on students as identifying and addressing students’ physical and psychosocial barriers to learning. While recent legislation was passed in Kentucky necessitating the delegation of insulin administration to UAP, school nurses had not experienced many changes at the time of the focus groups. However, some nurses said that their districts were not planning to delegate insulin administration and intended to keep a nurse in every school. Others appreciated the prospect of having more trained staff in schools to recognize signs of distress in chronically ill students. A statewide survey of 111 Kentucky school nurses indicated that nurses’ past delegation behaviors and future intentions related to delegation are rooted in the level of skilled decision-making that must occur and the risk to the student if the wrong decision is made. Unfortunately, school nurses’ intentions to delegate higher-stakes tasks (e.g. carbohydrate counting, insulin dose verification, and insulin administration) were significantly stronger than their support for (attitude related to) delegation of those tasks, which is disconcerting both for the safety of students as well as for the liability retained by delegating nurses. This disparity between support and intentions indicated that school nurses anticipate that they will have to delegate certain tasks to UAP despite their discomfort with delegating them, most likely due to high workload and lack of resources. Additional studies should be undertaken to determine the impact of legislative changes on the delivery of school health services in Kentucky and other states, particularly once school districts and nurses have had adequate time to adjust to new laws. Such studies should investigate to whom nurses are delegating health services, what tasks are being delegated, and the extent and process of training that UAP receive. Future surveys should utilize perceived behavioral control items that assess situational control (e.g. policy, workload) over delegation rather than, or in addition to, efficacy of individual skills required for delegation of nursing tasks. Researchers must further explore the discrepancies between attitude and intentions; that is, why are nurses planning to delegate tasks to UAP if they do not support the delegation of those tasks? Kentucky school nurses are champions of health promotion for children, not only in their provision of health services and health education, but also in the area of school health policy. School nurses should train UAP so that more school staff can recognize signs of distress in students with diabetes, but at the same time should continue to advocate and seek funding for a nurse in every school with the help of the Every Student Succeeds Act.

Is help really on the way?

More children and adolescents who have chronic illnesses are being included in regular education classrooms today than ever before. However, teachers may not feel confident about being able to meet these children's educational, social, or emotional needs in the classroom. School psychologists are able to assess children's functioning in these areas and can provide information to teachers on a case‐by‐case basis to ensure that children with chronic illnesses receive appropriate and comprehensive services at school and are included in regular education settings to the fullest extent possible. This study assessed special education and regular education teachers' perceptions of their knowledge about and confidence in meeting the academic and social needs of children with chronic medical conditions. Two‐hundred and forty‐seven teachers from 15 midwestern elementary schools completed a survey rating their knowledge and confidence in meeting the academic and social needs of children with 13 chronic medical conditions. Special education teachers reported being more knowledgeable than regular education teachers about cerebral palsy, epilepsy, hemophilia, spina bifida, renal failure, and allergies. However, overall, special education teachers were not more confident than regular education teachers in meeting the academic needs of children with chronic medical conditions. Future research should focus on whether experience affects teacher knowledge and confidence and should examine the effectiveness of interventions to improve teacher knowledge for working with children with medical conditions. © 2008 Wiley Periodicals, Inc.

School Readiness Among Children With Congenital Heart Disease.

The purpose of this scoping review was to describe and map the literature available on the participation of young people (0-21y) with disabilities and/or chronic conditions living in low- and middle-income countries (LMICs). A systematic search and selection process identified 78 publications. Descriptive data were extracted using a data-charting form, and studies were mapped using the family of participation-related constructs framework. The findings demonstrated that, although the published evidence is steadily increasing, the participation research on this vulnerable population is still either absent or very scarce in the majority of LMICs, and very little is known about the participation of children with chronic health conditions. Most studies included in this review focused on attendance or 'being there'. Although attendance is an important aspect, more needs to be done to understand children's experiences or involvement while attending, thus capturing both dimensions of participation. There is an increasing trend in research on participation patterns of children with disabilities in low- and middle-income countries. Most research focuses on children's attendance, or 'being there'. We know very little about children's involvement, or experience, while attending daily activities.

Citation: Nwabuzor, O. (February, 2007). Legislative: Shortage of Nurses: The School Nursing Experience. Online Journal of Issues in Nursing. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Legislative/SchoolNursingExperience.aspx The purpose of this column is to examine problem of a shortage of school nurses in public schools in United States. Areas of focus include role of school nurses in schools, definition of 'school nurse,' major reason for school nurse shortage, use of Unlicensed Assistive Personnel (UAP) to provide nursing services in schools, and recommendations for alleviating shortage of school nurses. Recent articles indicate that there is a critical shortage of school nurses in public school districts across nation. Horovitz and McCoy (2005) reported analysis of 2004 census data by USA TODAY showed roughly 56,000 nurses worked full time at schools. That's one for every 950 students, a ratio that fails to meet federal guidelines that call for one nurse for every 750 (p.1). According to Magnuson (2002), the United States Department of Health and Human Services (USDHHS) recommends at least one nurse per 750 students in well populations (that ratio changes when students with disabilities are considered). Similarly, National Association of School Nurses (NASN) recommends a maximum of one school nurse to 750 regular education students (Green, 2006). A look at individual states may reveal an even grimmer picture. In California, for example, school nurse to student ratio can be as high as one nurse to 5,000 students or more, as is case with this author who has a work load of approximately 5,000 students. The Role of Nurses in Public Schools According to NASN (2006), association adopted following definition of school nursing in 1999: School nursing is a specialized practice of professional nursing that advances well being, academic success, and life-long achievement of students. To that end, school nurses facilitate positive student responses to normal development; promote health and safety; intervene with actual and potential health problems; provide case management services; and actively collaborate with others to build student and family capacity for adaptation, self-management, self-advocacy, and learning (para. 2). The importance of school nurses in nation's public schools cannot be over-emphasized. School nurses play a vital and multi-faceted role in school settings. In low-income, public school districts, for example, school nurses are more often than not initial health care personnel with whom students who are without health insurance yet require medical attention come into contact. The role of school nurse has expanded tremendously over years since introduction of school nursing over a hundred years ago by Lillian Wald, a public health nurse and social reformer. The initial focus of school nursing was prevention of communicable diseases and treatment of ailments related to compulsory school life (Clark, 2003). School nursing has since evolved over time to include such services as case management, providing health education to students and staff, health promotion, first aid and emergency services, medication administration, advocacy, initiating emergency and individualized health plans for students with chronic medical conditions, and tracking immunizations. Other services include reporting cases of child abuse; providing assessment for and attending Individualized Education Plan (IEP) meetings for students with special educational needs; conducting and supervising state mandated screenings, such as vision, hearing and scoliosis screenings; referring students to appropriate agencies after screening; and providing families with information on available resources for procuring free or low-cost services. The School Nurse The definition of a school nurse varies from state to state. …

To examine competencies, attitudes, barriers and factors that influence the provision of mental health services by nurses in schools and higher education institutions in the post COVID-19 era in Taiwan. This cross-sectional study used nationwide proportionate stratified random sampling to recruit nurses from K-12 schools and higher education institutions. Data were collected through an online survey administered between July and December 2024, with 305 responses received (response rate = 46.4%). Among the respondents, 55.1% provided advanced mental health services, while 38.3% delivered basic mental health services. The main barriers to the delivery of mental health services were lack of mental health-screening training (63.3%), insufficient brief screening tools (46.2%) and time constraints (42.6%). Nurses in junior and senior high schools were 5.78 and 3.07 times more likely, respectively, to provide advanced mental health services compared to those in universities. Furthermore, significant predictors of the provision of advanced mental health services included working in junior or senior high school, higher competence, and more positive attitudes; perceiving time constraints was a significant barrier. Working in junior and senior high school settings was the most significant predictor of delivering advanced mental health services. These results underscore the need for targeted professional training, enhanced resources, and inter-professional collaboration to improve the quality of school-based mental health services. Enhancing the attitudes and competencies of nurses in schools and higher education institutions towards mental health care is essential. Training should target nurses working in junior and senior high schools. Administrators must improve workflows, provide better tools and address barriers such as time constraints and limited referrals to support students' mental well-being. This study adhered to the relevant cross-sectional EQUATOR STROBE guidelines. No Patient or Public Contribution. This study examined the barriers to mental health service delivery among nurses in schools and higher education institutions and identified key determinants influencing their provision of such services. Nurses in schools and higher education institutions face challenges in providing mental health services due to a lack of mental health training, insufficient brief screening tools and time constraints. Advanced services were more common in junior and senior high schools, with competence and attitude being key predictors of their delivery.

Children with chronic conditions: Educators' views

All About Asthma: Top Resources for Children, Adolescents, and Their Families

The Pediatric Nurse Practitioner Workforce: Meeting the Health Care Needs of Children

To identify new and accelerated modes of practice used by school nurses during the COVID pandemic. To create a quick reference infographic bringing together experiential evidence on the range and considerations regarding different modes of practice for use by the school nursing community of practice. A descriptive qualitative secondary data analysis of open-ended questions in a survey, and focus groups with school nurses. The pragmatic aim was to focus on changes in school nurse modes of practice to ensure continued engagement with children and young people, and school nurses' experience of the benefits and challenges of these modes of practice. Data were collected from 98 school nurse participants across a United Kingdom-wide survey (n78) in April to May 2022, and focus groups (n20) in June to July 2022, within the School Nursing in the Time of COVID project. Data from the seven open-ended questions in the survey and four questions from the focus group were analysed using the framework approach. Modes of practice fell into two categories: individual assessment and support (video-calling platforms, telephone contact, virtual messaging, walk-and-talks and home visits) and group support (wellbeing approaches, social media). Considerations for these modes rooted in school nurses' experience are described. Interpretations were used to create the summarising evidence-based infographic as a quick reference resource for school nurses. There was no 'one size fits all' approach. The modes used by school nurses were adopted or developed out of necessity or resource availability and in response to the specific needs of individuals or groups. The developed infographic provides a quick reference guide to deliver the expressed need for knowledge exchange within the school nursing community by participants in the original studies and can be used to inform current school nurse practice. The developed evidence-based infographic has stand-alone value. It has the potential to raise awareness of the range of different strategies that can be used to facilitate and/or enhance engagement with children and young people, equip school nurses with knowledge to foster innovative and responsive practice and aid critical reflection in a complex post-pandemic landscape. The infographic is a unique resource and is a first step in knowledge exchange based on experiential learning. The resource will be used as the foundation for future work to develop a co-created training resource for school nurse students (undertaking the Specialist Community Public Health Nurses course) and/or continuing professional development resource for established school nurses. This study has been conducted and reported in accordance with COREQ guidelines for qualitative research. A consultation group was closely involved with the planning, conduct and analysis of the original studies. This group consisted of representatives from professional organisations SAPHNA (School and Public Health Nurses Association) and the CPHVA (Community Practitioners' and Health Visitors' Association), a school nurse and a member of the public. SAPHNA have continued in their consultative role for this study and has provided content and usability feedback regarding the infographic. Early findings have been presented to the SN community of practice, and feedback invited, through presentation separately at the CPHVA and SAPHNA annual conference.

A roadmap toward equitable, coordinated, quality reproductive care for women with chronic conditions.

Background: Adolescents and young adults (AYA) with chronic conditions should acquire self-management skills as part of their healthcare transition (HCT) from pediatric to adult-focused care. HCT/self-management skills have the potential to help mitigate health disparities among minority AYA with chronic conditions. This study investigated school nurses' practices promoting HCT/self-management skills in urban public schools. Methods: Seventy-nine nurses from three urban school districts in Massachusetts completed a survey of 32 Likert-type questions on HCT/self-management skills, eight demographic questions, and five open-ended practice questions assessing how often they have asked students with chronic conditions about HCT/self-management skills, based on the UNC TRxANSITION IndexTM. Results: Among the 79 school nurses who participated (response rate 76%), 67% never or rarely assessed students' knowledge of HCT/self-management, and 90% would use a tool that promotes/measures HCT/self-management skills. Conclusion: In our study sample, most school nurses acknowledged the importance of assessing HCT/self-management skills. The majority favored using a tool to promote these skills.