21st Century School Nursing PracticeTM Research Articles

A Contemporary Framework Update for Today's School Nursing Landscape: Introducing the School Nursing Practice Framework™.

School nursing is a unique nursing specialty that benefits from a practice framework that aids school nurses in explaining and accomplishing their role. In 2016, the NASN debuted its Framework for 21st Century School Nursing Practice™, which has shaped school nursing practice as well as education, leadership, research, and collaboration with stakeholders. However, practice frameworks are not meant to remain the same indefinitely. Therefore, NASN evaluated and updated the Framework to ensure its continued alignment with the education and healthcare landscape. The purpose of this article is to share the history of the Framework for 21st Century School Nursing Practice™ development, provide the rationale for the update, and discuss the strategic process NASN used to update its Framework now entitled the School Nursing Practice Framework™.

Recognizing the 2023 Fellows of the National Academy of School Nursing.

Membership as a Fellow in the National Academy of School Nursing (FNASN) is the NASN's highest recognition award. At the 2023 NASN Conference, five new Fellows were inducted and now add FNASN to their credentials. This group of exemplary school nurse professionals contributes to school nursing practice in many ways that crisscross NASN's Framework for 21st Century School Nursing Practice™. They each have chosen unique pathways to provide service. The 2023 NASN Fellows are: Eileen Gavin, New Jersey; Jenny Gormley, Massachusetts; Lynne Meadows, Georgia; Kathy Reiner, Colorado; and Sharonlee Trefry, Vermont. The following article outlines each Fellow's unique path to attaining FNASN.

An Integrative Review of College Readiness Programs for Black High School Students; Opportunities for School Nurse Involvement.

Education is associated with improved health outcomes. However, fewer non-Hispanic Black Americans earn high school diplomas, baccalaureate, or advanced degrees than White Americans, placing them at higher risk for poor health outcomes. Racial disparities in education have been linked to social injustice and structural racism. Through the Framework for the 21st Century School Nursing PracticeTM, school nurses can impact academic success and college readiness for Black youth. An integrative review of the literature was conducted to describe programs to promote college readiness for Black high school students and evaluate school nurse involvement. Findings of the eighteen unique studies included in this review were: programs included mostly female participants, and most yielded improvements in students' non-cognitive skills (i.e. sense of belonging/confidence) and college knowledge. None of the programs included school nurse involvement. School nurses can advocate for anti-racist college readiness programs with intentional, asset-based approaches to position youth for success in college.

Using Local School Wellness Policies to Build a Culture of Health for Students With Chronic Health Conditions: The School Nurse Role.

Local school wellness policies (LWP) guide school districts' efforts to establish school environments that promote students' health, well-being, and ability to learn that include school U.S. Department of Agriculture nutrition and physical activity requirements. Looking through the lens of the Whole School, Whole Community, Whole Child model and NASN's Framework for 21st Century School Nursing Practice™, LWP can be expanded beyond the tradition focus of nutrition and physical activity to address the health and academic needs of students with chronic health conditions. School nurses need to be actively involved on district wellness councils as schools prepare to conduct their required triennial assessment of current LWP equipped with an understanding of the Alliance for a Healthier Generations' updated model wellness policy and NASN's supplemental wellness policy language to address management of students with chronic health conditions.

Show Me the Evidence: COVID-19 and School Nursing in the 21st Century.

The emergence of COVID-19 and how to control its spread has highlighted the importance of understanding and applying evidence-based decisions into school nursing practice. This is the fifth and final article in NASN’s series on how the Framework for 21st Century School Nursing PracticeTM is a mind-set that can be applied to everyday school nursing practice and will focus on the principle of Standards of Practice, and particularly how evidence-based practice decisions are made during COVID-19.

How a School Nurse Can Reduce Student Stress Using Systems-Level Thinking.

School nurses are essential members of the school community. Their ability to collaborate with other school team members promotes a system's approach to the identification and management of students' mental health thereby promoting students' academic success. By enhancing the students' abilities to cope with the long-term impacts of chronic medical conditions as well as academic stress and other contributing factors that affect their mental health, school nurses are in a unique position to positively affect the long-term health of students. This article is the fourth in a series focusing on the Framework for the 21st Century School Nursing PracticeTM (Framework) and describes the practice component of systems-level leadership, in the principle of Leadership. This article describes the process to institute systematic change after identifying a need to improve nursing care for the students who frequented the health office for mental health issues during the school year. While utilizing the National Association of School Nurses' (NASN) Framework, this nurse created a program to address the mental health needs of the students while focusing on the essential selfmanagement and self-awareness skills required to manage and cope with the stress of childhood today.

Identification of Workload Measurement Indicators for School Nursing Practice.

Many school districts rely on caseload or student to school nurse ratios that are not grounded in evidence-based research. There is a need for a comprehensive workload instrument to describe the work of school nurses that incorporates the complexities of the role and includes acuity, care processes, and social determinants of health. The purpose of this qualitative study was to identify workload activities from a previous Delphi study that can be empirically measured as items for a workload instrument. A nationally representative sample of 27 school nurses participated in four focus groups, describing activities important to the measurement of workload. Focus group input resulted in identification and confirmation of workload activities that impact school nurse workload. Use of the National Association of School Nurses' Framework for 21st Century School Nursing Practice™ was integral in capturing gaps and important workload activities for a potential workload instrument.

The Role of the School Nurse in Increasing Instructional Time Using Multi-Tiered Systems of Support for Behavior (MTSS-B): A Quality Improvement Project.

Frequent visits to the health office can lead to considerable time spent out of the classroom along with affecting relationships and health office resources and staffing. This article features the practice component of continuous quality improvement in the principal of quality improvement in the Framework for the 21st Century School Nursing Practice™ and is the third in a series focusing on the Framework. The article discusses how using multi-tiered systems of support for behavior (MTSS-B) to create expectations for the health office environment, along with intense, individualized plans for specific students, were successful in decreasing health office visits across the school district, with the ultimate goal of increasing instructional time. Outcome data revealed reductions in health office visits with a district-wide decrease of 4.1% one-year postimplementation of the project. More importantly, school nurses are providing better trauma-informed care with intentionality while still meeting the needs of students.

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.

Framework for 21st Century School Nursing Practice™: Clarifications and Updated Definitions.

The National Association of School Nurses developed the Framework for 21st Century School Nursing Practice™ (Framework) to guide school nursing practice and help school nurses articulate their role to educators. Since its introduction, the Framework has been accepted and adopted by many. At the same time, several misunderstandings and misinterpretations of the Framework have come to light. The purpose of this article is to clarify the terminology in order to create a common understanding among practicing school nurses to be able to implement the Framework more fully and with integrity.

Engaging the School Community in a Nutrition and Physical Activity Program: The Role of the 21st-Century School Nurse.

Childhood obesity is an important public health issue that can affect child health and academic outcomes. Schools are essential in promoting healthy childhood behaviors through the implementation of programs that reach the whole school community. School nurses can play a key role in designing, implementing, and evaluating feasible strategies, including school-based nutrition and physical activity messaging programs, that meet school-specific needs. This article will explain how school nurses can utilize principles of the Framework for 21st Century School Nursing Practice™ to design programs that engage the whole school community while addressing implementation barriers.

Moving Upstream From the Individual to the Community: Addressing Social Determinants of Health.

School nurses are often the primary health professional promoting children's health-and address not just individuals, but communities. This article, featuring the key principle of community/public health, is the first in a series focusing on The Framework for 21st Century School Nursing Practice™ and presents a case study on asthma and air quality issues comparing the more traditional individual approaches to health (labeled downstream and midstream) with population-level approaches (labeled upstream). Through collaboration with key community stakeholders, school nurses can successfully implement policies and programs to address social determinants of health and, in turn, improve the health of the entire community. As we look to advance school nursing and support best practices, concentrating on population-level, upstream approaches align with recommendations outlined in the Framework for 21st Century School Nursing Practice™.

Use of Licensed Vocational Nurses in California Schools: A Descriptive Study.

The demand for schools to provide complex health-care services for students with chronic conditions has induced districts to hire licensed vocational nurses (LVNs). Questions remain about how overlapping responsibilities and skills of nursing staff works to facilitate care. The purpose of this mixed-methods descriptive study was to examine the use of LVNs to identify factors related to the supports and impediments to school nurse (SN) practice. The sample consisted of members of the California School Nurse Organization, and methodologies consisted of an online survey and one-on-one interviews. LVNs perform duties within their scope of practice, allowing SNs time for activities related to the Framework for 21st Century School Nursing PracticeTM, confirming appropriate use, and alignment with National Association of School Nurses guidance on the utilization of LVNs. Identified areas of concern included role definition and orientation and supervision of the LVN. Insights into best practices for the effective addition of the LVN to the team are provided.

Addressing Illness-Related Chronic Absences.

School attendance is a predictor of academic achievement. Chronic absenteeism, defined as missing 10% or more school days affects 14% of all students nationwide. District attendance processes, policies, and data were analyzed in a demographically diverse southern California high school. A review of the attendance history of 117 ninth and tenth graders, who missed at least 10% of days in school, showed that 66% of the absences were due to illness. Prior to the project, these students were not referred for nursing intervention. Results of this quality improvement project supported the adoption of a specific code for absences due to illness. A district procedure for illness chronic absence was adopted to allow early nursing intervention for students with chronic absences prior to the development of illness-related academic underperformance. This project demonstrates nursing roles in the quality improvement and care coordination aspects of the NASN's Framework for 21st Century School Nursing Practice™.

A New Framework for School Nurse Self-Reflection and Evaluation.

The purpose of this article is to demonstrate how the Framework for 21st Century School Nursing Practice™ can provide a structure for evaluation using the School Nursing: Scope and Standards of Practice (3rd ed.), thus allowing the school nurse and school nurse evaluators to gain a better understanding of school nursing practice. According to NASN's Position Statement Supervision and Evaluation of the School Nurse, standards should be used to evaluate the clinical practice of school nurses. Our project accomplishes this integration of the Framework, the standards, and the evaluation of school nursing practice.

Advocating for Oral Health Through Fluoridation.

Eight school nurses attended the American Academy of Pediatrics' Campaign for Dental Health meeting in March 2018, which focused on community water fluoridation programs. Because of aging infrastructure and antifluoridation community activists, some communities are considering stopping fluoridation programs. The benefits of water fluoridation have been demonstrated since the 1950s. School nurses can play a vital role in advocating for evidence-based fluoridation programs within their community. This article informs the school nurse on the benefits of water fluoridation for promoting community health and methods to advocate for those measures-key practice components of the leadership and community/public health principles of "Framework for 21st Century School Nursing Practice™."

Power of the Past, Celebrate the Present, Force of the Future Part 4: 50 Years of School Nursing Practice—From Then Until Now

This article is the fourth in the series examining 50 years of NASN's history. It looks at the needs of our students and the practice of school nursing from 1968 through 2018 using the structure provided by NASN Framework for 21st Century School Nursing Practice™. The article examines the destiny of school nursing practice as determined by the needs of our students, the strength and resolve of school nurses, and the education and resources provided by NASN.

Finding Fit: School Nurses Lead the Way in the Development of Employee Wellness Program.

School nurses are in a unique position to monitor and influence not only the health of students but also the health of school employees. The National Association of School Nurses (NASN) provides support and evidence-based best practice guidelines for the specialty practice of school nursing. NASN's Framework for 21st Century School Nursing Practice™ provides a road map for a healthy and safe school environment. With a focus on student health and academic success, the framework also aligns with the whole school, whole community, whole child model to provide a collaborative structure to learning and health. Both models are student centered and include family, the school community, and school employees. A group of school nurses from the Alexandria City Public Schools (ACPS) in Alexandria, Virginia, attended the Johnson and Johnson School Health Leadership Program and were challenged to create sustainable change in their community. Their goal was to develop a plan for the school division that would affect employee wellness and ultimately improve student achievement and educational outcomes. This article will describe the current ACPS Employee Wellness Program, Finding Fit, and the strategies and tools used to develop the program.

Clarifying the Framework for 21st Century School Nursing Practice™ in Research

Clarifying the <i>Framework for 21st Century School Nursing Practice™</i> in Research

Shaping Your Practice and Changing Mindsets: Framework for 21st Century School Nursing Practice™.

NASN's Framework for 21st Century School Nursing Practice™ (the Framework) provides a graphic illustration of the key principles of professional school nursing practice, reflects NASN's stance for evidence-based best practice and provides a focus when prioritizing school nursing activity. In order to ensure fidelity of the Framework and to provide professional development for school nurses, NASN is embarking on an exciting new project: Focus on the Framework, a series of five Continuing Nursing Education (CNE) modules, along with a certificate of proficiency in the Framework, which will be earned after the completion of all five modules and the successful completion of a culminating activity. We invite your feedback and suggestions as the certificate process is developed.