21st Century School Nursing Practice Research Articles

Development of a School Health Policy Implementation Survey: A Delphi Study.

Data on school health policy implementation are limited due to the absence of a validated measurement tool. The purpose of this study was to create and pilot a school health policy implementation survey. A modified, four-round Delphi process was used to achieve consensus on content and format of the survey. The final 76-item survey was piloted in 655 schools with a return rate of 57.1% (n = 378). Seven schools participated in environmental audits. Based on the audits, survey responses represented an accurate description of school practices for 84.2% (n = 64) of questions. The remaining 15.8% (n = 12) of survey items were eliminated or revised. This measurement tool begins to fill the research gap between the evaluation of written school health policy and implementation. Further, this tool may be used by school nurses in alignment with the Framework for 21st Century School Nursing Practice.

A Qualitative Exploration of School Nurse Continuing Education Needs.

Continuing education (CE) can help school nurses achieve the unique competencies required for the challenges of an academic health setting. A comprehensive understanding of school nurse learning needs is necessary to guide CE development. The purpose of this study was to describe school nurse perceptions of their learning needs according to the Framework for 21st Century School Nursing Practice ™. The researchers analyzed data from 24 interviews with practicing school nurses using descriptive coding to identify perceived learning needs. Learning needs relevant to all areas of the framework were identified, with clinical judgment and team development emerging as priority areas for CE. These results illuminate school nurse perceptions of their own learning needs and can help guide the development of meaningful CE opportunities.

School Nurse Perspectives on Addressing Chronic Absenteeism.

Chronic absenteeism is associated with poor health and educational outcomes. School nurses have great potential to address the health and educational needs that contribute to absenteeism. Through qualitative analysis of interviews with school nurses, we characterize their current role in reducing absenteeism and identify barriers 3 that limit their capacity to meet this goal, organized by the Framework for 21st Century School Nursing Practice. Interviewees (n = 23) identified actions perceived to reduce absenteeism aligned with domains of care coordination, leadership, quality improvement, and community and public health. Barriers perceived to limit the capacity of school nurses to address absenteeism were identified within these domains and ranged from student- and family-level to federal-level barriers. Specific healthcare system-level barriers included insufficient communication with community-based healthcare teams and the need for coordinated approaches across health and education sectors to address absenteeism. Strategic opportunities exist to address barriers to comprehensive school nursing practice and reduce absenteeism.

A Case Study in Academic and School Nursing Partnerships.

School nurses play a vital role in the lives of children and are guided by The National Association of School Nurses' Framework for 21st Century School Nursing Practice and its five major principles. School nurses practice independently and are often the sole healthcare provider at their designated schools, requiring them to be accomplished clinicians utilizing evidence-based practice in the care of children. When compared with nurses practicing in healthcare settings, school nurses may lack access to evidence-based continuing education and skill enhancement. One strategy proposed is the forming of partnerships with an academic institution, giving school nurses access to academic faculty and resources. This article highlights the collaboration and partnership between Baylor University Louise Herrington School of Nursing and the Dallas Independent School District, demonstrating that an academic partnership for the training of school nurses improves outcomes.

Future of Nursing 2030: The Future Is Bright for School Nursing.

The National Academies of Sciences, Engineering, and Medicine recently released The Future of Nursing 2020-2030: Charting a path to achieve health equity. The 2021 report emphasized the role of nursing in addressing social determinants of health and inequities, as well as the need for nurses at all levels to work to their full scope of practice. The report harmonizes with the scope of practice outlined in the National Association of School Nurses' Framework for 21st Century School Nursing Practice. This article outlines how frontline school nurses, state affiliates, and school nurse leaders will adopt the recommendations in their practice and in the schools and communities they serve.

Cultivating Student Belonging and School Connectedness.

The effect on students from the COVID-19 pandemic, violence related to racism, and loss of customary school routines may cause loss of both school connection and a sense of belonging. School nurses can positively influence student belonging and school connection as they encounter students throughout in-person school and virtual school environments. School nurses build connections with students whom they know and outreach to students whom they identify as vulnerable in the areas of belonging and school connectedness. With a mind-set of the Framework for 21st Century School Nursing Practice and in collaboration with a school team implementing a multitiered system of support, school nurses intentionally outreach and cultural sensitivity to grow positive school climate that benefits students.

Through the Looking Glass: Reflections from Three School Nurses Amid the COVID-19 Pandemic

School nurses play a critical role as public health nurses and are guiding school communities through a global pandemic unlike anything seen in the past 100 years. Due to the coronavirus pandemic and worldwide shutdown, remote education became a necessity. In this article, three New Jersey school nurses share reflections about the COVID-19 pandemic. We illustrate the roles included in the National Association of School Nurses Framework for 21st Century School Nursing Practice, to describe school nurse contributions to address the COVID-19 community spread via contact tracing and care coordination. We describe school nurse advocacy through promotion of legislative inclusion in the state of New Jersey and efforts to mirror vaccine confidence. Our conclusion offers action steps to increase the presence of school nurses in key areas and build a more robust public health infrastructure.

Addressing Stress in High School Students During the COVID-19 Pandemic.

Safety isolation protocols in response to the COVID-19 (coronavirus disease 2019) pandemic have had the unintended consequence of social isolation for adolescents, youth who have a developmental need for autonomy and peer connection. Social isolation alone can lead to various psychological effects such as anxiety, stress, low mood, fear, frustration, and boredom. School nurses serve a vital role in addressing stress among adolescents by initiating early interventions, ensuring positive school experiences for students, and providing support surrounding the development of mental health disorders. Through implementation of NASN's Framework for 21st Century School Nursing Practice, school nurses address stress among high school students during the COVID-19 pandemic. Innovative interventions can include recognizing signs and symptoms of stress on physical and emotional health, advocating for mental health literacy curriculums, social prescribing, incorporating anticipatory guidance related to health promotion lifestyle practices into each school health encounter, and creating a virtual school health office to reach students while COVID-19 safety isolation continues.

Public health nurses in Canadian schools: An opportunity to build capacity and nursing scholarship.

Public health nurses (PHNs) in Canada have the potential to significantly benefit the health and academic outcomes of school age children with its impact lasting into adulthood. Unfortunately, cuts in government funding over the years have diminished the presence of PHNs in schools and their ability to practice to their full scope. In the midst of a pandemic, having a strong nursing presence in schools may facilitate public health efforts and reduce the burden on teachers and administration. This discussion paper will explore the current role of nurses in Canadian schools in relation to school nurses in other parts of the world. An overview of the literature looking at the impact of the school nurse on school health (i.e., student health and academic outcomes) will be presented to provide evidence in support of rebuilding nursing capacity in Canadian schools. Finally, the Framework for 21st Century School Nursing Practice will be introduced as a viable nursing theory to facilitate rebuilding PHN capacity in schools.

School Nurse Job Descriptions in Urban Districts: Alignment With the Framework for 21st-Century School Nursing Practice.

It is recommended that every student has daily access to a school nurse and that school nurses work in alignment with the Framework for 21st-Century School Nursing Practice (Framework). Little is known about Framework alignment with school nursing practice. The purpose of this study is to describe the alignment between the Framework and school nurse job descriptions in large, urban school districts across the United States. Using content analysis, with a directed approach, researchers used the Framework to analyze school nurse job descriptions for 16 school districts, analyzing 375 individual job responsibilities. The majority of job responsibilities reviewed (86%) were related to principles within the care coordination and community/public health nursing component, while job responsibilities within the key principles of leadership and quality improvement components were limited (14%). The Framework can be a useful tool to guide school nurse practice and however needs to be intentionally brought into job descriptions.

Care Coordination: A Principle of 21st Century School Nursing Practice With a Focus on Case Management.

The Framework for 21st Century School Nursing Practice™, created by the National Association of School Nurses (NASN), explains school nursing practice, providing guidance, organization, prioritization, and meaning. This is the second article in a series for The Framework for 21st Century School Nursing Practice. This article focuses on case management, one of the practice components in the principle of care coordination. Case management focuses on school nurse support of individual at-risk students and collaborative actions to reduce barriers to their academic success. This article will clarify how the terms care coordination and case management are used in context of the Framework and provide an example to help the reader apply the concept to practice. Washington's School Nurse Case Management Program will serve as a model. The program outlines evidence for effective practice and shares practical examples of how school nurses can implement case management into their daily work. Any school nurse, no matter how large or small their workload, can provide case management.

Celebrating 21st-Century School Nursing Practice.

During May we celebrate School Nursing Day. We are often asked-What does a school nurse do? This article is a response to a recently asked request and describes the role of the school nurse in the 21st century, working in one school. The description is not meant to be all inclusive-but rather give examples of the complex role and need for a school nurse.

The Role of the School Nurse in Suicide Interventions: An Integrative Review.

Suicide rates among children and adolescents have continued to rise over the past decade indicating the need for school-based suicide prevention programs. School nurses (SNs) are well positioned to assist in assessment, early identification, and intervention of at-risk students. This integrative review aimed to (1) critically examine the role of the SN in school-based suicide interventions, (2) explore potential barriers preventing the SN from participating in suicide interventions, and (3) recommend strategies to build capacity for principles of school nursing practice in suicide intervention. The National Association of School Nurses' Framework for 21st Century School Nursing Practice was used to categorize interventions and outcomes related to suicide prevention. Findings demonstrate a lack of reported nursing interventions directly linked to student outcomes and suggest obscurity in the role of the SN. Recommendations for future research and strategies to build capacity for principles of school nursing practice are provided.

The Double Bind of School Nurses and Policy Implementation: Intersecting the Street-Level Bureaucracy Framework and Teaching Sexual Health Education.

As described in the Framework for 21st Century School Nursing Practice, school nurses bridge the realities of health and education policy within the school community every day. This role is inclusive of helping teach sexual health education (SHE) to students. We were interested in characterizing how school nurses navigate requirements of health education policy to provide their students with the SHE content that they need. Using data from a larger study, we organized a subset of school nurse data within the street-level bureaucracy framework to better understand the many challenges school nurses face in implementing SHE policy. School nurses' involvement in SHE policy implementation was congruent with characteristics of the framework. This included using their professional discretion to manage dilemmas, working with inadequate resources, unclear policy expectations, lack of support, and ambiguous policy goals. Trusted relationships with teachers and students helped school nurses with their SHE policy implementation responsibilities.

An Integrative Review of School-Based Mental Health Interventions and Implications for Psychogenic Nonepileptic Seizures.

Millions of students with mental health concerns attend school each day. It is unknown how many of those students experience psychogenic nonepileptic seizures (PNES); however, quality of life, academic, and mental health outcomes for students experiencing PNES can be bleak. Currently, no authors have addressed potential school nurse interventions for students with PNES. Because PNES is a mental health condition and is often influenced by underlying anxiety and/or depression, an integrative review of school nurse interventions and outcomes for students with general mental health concerns was conducted. An integrative review resulted in the identification of 13 quantitative and 2 qualitative studies that met inclusion criteria. The findings from this review suggest school nurses, following principles from the Framework for 21st Century School Nursing Practice, play an active role in mental health interventions and should be involved in replicating and testing known mental health interventions to investigate their effectiveness for students with PNES.

What Does an Optimal District Standard For School Nursing Look Like?

As a district, Mansfield Independent School District wanted to validate that Health Services was performing at the highest level possible, implementing evidence-based practices, and achieving the highest outcomes with our students and staff. NASN (2016) had developed the Framework for 21st Century School Nursing Practice to illustrate the practice of school nurses; and sought ways to operationalize the Framework for local school nurses and district level use. This article will explain how the two groups partnered together to develop a tool and assessment program. The article will discuss the approach, challenges, and perspectives of both Mansfield Independent School District and NASN, lessons learned, outcome, and future/potential changes within health services.

Exploring School Nurse Interventions and Health and Education Outcomes: An Integrative Review.

School nurses intervene with students, parents, and school staff to advance the health and academic success of students. We conducted an integrative literature review of published research to describe the types of school nurse interventions and health and education outcome measures and to examine how school nurse interventions were linked to student outcomes. Sixty-five studies met the inclusion criteria. We used the National Association of School Nurses' Framework for 21st Century School Nursing Practice to categorize school nurse interventions and health and education outcome measures. The majority of interventions were categorized under the care coordination principle, most commonly, motivational interviewing and counseling. In 17 studies, school nurse interventions were linked to improved student outcomes. Most studies (80%) were descriptive. To advance school nursing science, researchers can build on this foundation with more rigorous research methods to evaluate the impact of school nurse interventions and activities on student health and education outcomes.

Framework for 21st Century School Nursing Practice: Framing Professional Development.

The NASN Code of Ethics upholds that it is the responsibility of the school nurse to maintain competency and pursue personal and professional growth. Designing professional development activities that are relevant and support the needs of the school nurse can be a challenge. The Framework for 21st Century School Nursing Practice provides a model rooted in evidence-based standards of practice that can be utilized to assess an existing professional development program and identify gaps in learning opportunities. Nurse leaders can use the Framework for 21st Century Nursing Practice to provide a roadmap toward a professional development program that will be meaningful to school nurse staff, help restore or maintain joy in their practice, and allow them to achieve the goal of advancing the well-being, academic success, and lifelong achievement and health of students.

Redesigning School Nursing Education in New Jersey to Address the Challenges and Opportunities of Population Health.

School health is a specialty practice of nursing positioned at the intersection of public health and population health. This article discusses the redesign of a program's curriculum with the hope of advancing and elevating the practice of school nursing. The redesign is based on NASN's Framework for 21st Century School Nursing Practice and is the result of a New Jersey Nursing Initiative grant awarded to a trio of adjunct faculty from Rutgers University Camden in July 2016.

Using the Framework for 21st-Century School Nursing Practice in Daily Practice

NASN recently developed a Framework for 21st-Century School Nursing Practice (Framework) to guide school nursing activities. The principles and components of the Framework can be used as a guide in achieving high-quality school nurse practice. The purpose of this article is to share how school nurses can use the Framework in their daily practice, invite nurses to identify one new way the Framework can be used in your practice this school year, and implement and evaluate the change.