Trained School Nurses Research Articles

U.S. School Nursing Job Analysis.

The complexity and demands of the school nurse role have changed greatly over time. Our aims included determining tasks and knowledge relevant to modern school nursing in the United States, identifying continuing education needs of school nurses, and describing anticipated changes to the professional role. A secondary analysis of a cross-sectional web-based survey of 750 school nurses was performed. The study team evaluated calculations of mean importance and frequency for school nursing task and knowledge statements. Conventional content analysis was used to analyze open-ended responses. School nurses rated most tasks and knowledge as relevant to practice, underscoring the great depth and breadth of education and training school nurses need to meet the demands of students today. The results of this secondary analysis may be leveraged to accurately describe the school nurse role, advocate for nursing services, and support school nurses as they strive to better the health of school communities.

Training school nurses in pain assessment benefits students with learning disabilities

If not recognised and addressed, learning disabled students’ experiences of pain can cause absenteeism and reduce their ability to engage in and benefit from educational activities.

Impact of a Behavioral Sleep Intervention on New School Entrants’ Social Emotional Functioning and Sleep: A Translational Randomized Trial

ABSTRACTObjective/Background: Determine the effects and costs of a brief behavioral sleep intervention, previously shown to improve child social-emotional functioning, sleep, and parent mental health, in a translational trial. Participants: Three hundred thirty-four school entrant children from 47 primary schools in Melbourne, Australia, with parent-reported moderate to severe behavioral sleep problems. Methods: intervention group received sleep hygiene practices and standardized behavioral strategies delivered by trained school nurses in 2013 and 2014. Control group children could receive usual community care. Results: Outcome measures: child social-emotional functioning (Pediatric Quality of Life Inventory 4.0 psychosocial health summary score—primary outcome), sleep problems (parent-reported severity, Children’s Sleep Habits Questionnaire), behavior, academic function, working memory, child and parent quality of life, and parent mental health. At six months post randomization, 145 (of 168) intervention and 155 (of 166) control families completed the primary outcome for which there was no difference. Intervention compared with control children had fewer sleep problems (35.2% vs. 52.7% respectively, OR 0.5; 95% CI 0.3 to 0.8, p = 0.002) and better sleep patterns (e.g., longer sleep duration). Their parents reported fewer symptoms of depression. All differences attenuated by 12 months. There was no difference in other outcomes at either time point. Intervention costs: $AUS 182/child. Conclusions: A brief behavioral sleep intervention, delivered by school nurses to children with behavioral sleep problems, does not improve social emotional functioning. Benefits to child sleep and parent mental health are evident at 6 but not 12 months. Approaches that increase intervention dosage may improve outcomes.

Obesity status trajectory groups among elementary school children.

BackgroundLittle is known about patterns in the transition from healthy weight to overweight or obesity during the elementary school years. This study examined whether there were distinct body mass index (BMI) trajectory groups among elementary school children, and predictors of trajectory group membership.MethodsThis is a secondary analysis of 1651 elementary school children with complete biannual longitudinal data from kindergarten to the beginning of 5th grade. Heights and weights were measured by trained school nurses using standard procedures at the beginning and end of each school year for 11 consecutive assessments. Group-based trajectory clustering and multinomial logit modeling were conducted.ResultsWhen using BMIz score, six trajectory groups were identified revealing substantial consistency in BMIz score across time. When using a categorical variable separating overweight/obese children (BMI ≥ 85%ile) from the rest, five developmental trajectories (persistently non-overweight/obese weight: 51.1 %; early-onset overweight/obese: 9.2 %; late-onset overweight/obese: 9.7 %; becoming healthy weight: 8.2 %; and chronically overweight/obese: 21.8 %) were identified. When using a categorical variable separating obese children (BMI ≥ 95%ile) from the rest, three trajectories (persistently non-obese: 74.1 %, becoming obese: 12.8 %; and chronically obese: 13.2 %) were identified. For both cutoffs (≥ BMI percentile 85 % or 95 %), girls were more likely than boys to be classified in the persistently non-overweight and/or obese group (odds ratios (OR) ranged from 0.53 to 0.67); and Hispanic children and non-Hispanic Black children were more likely to be chronically overweight and/or obese than non-Hispanic White children (OR ranged from 1.57 to 2.44). Hispanic children were also more likely to become obese (OR: 1.84) than non-Hispanic White children when ≥ BMI percentile 95 % was used.ConclusionsBoys, Hispanic and non-Hispanic Black children were at higher risk of being overweight or obese throughout their elementary school years, supporting the need for obesity treatment. Post kindergarten and post second grade summer months were times when some children transitioned into overweight/obesity. It will be important to identify which behavioral factors (e.g., diet, physical activity, sedentary behaviors, and/or sleep) predisposed children to becoming overweight/obese, and whether these factors differ by time (Kindergarten versus second grade). If behavioral predisposing factors could be identified early, targeted obesity prevention should be offered.

Return to Learning After a Concussion and Compliance With Recommendations for Cognitive Rest.

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

Obesity status transitions across the elementary years: use of Markov chain modelling.

The objective of this study was to assess overweight and obesity status transition probabilities using first-order Markov transition models applied to elementary school children. Complete longitudinal data across 11 assessments were available from 1494 elementary school children (from 7599 students in 41 out of 45 schools in a Southeast Texas school district) from kindergarten to the beginning of the fifth grade. Heights and weights were measured by trained school nurses using standard procedures at the beginning and end of each school year for the 11 consecutive assessments. To estimate the transition probabilities, first-order three-state (healthy weight, overweight and obese) Markov transition models were fit to the longitudinal weight status data of all assessment periods. While there was a gradual shift to more children in the overweight or obese category over 5 years, children were most likely to stay in the same weight category as the previous assessment. A consistent seasonal difference in the probability of changing weight status category was seen, with a greater probability of becoming overweight and obese during the summer compared with the school year. The transition probabilities to obesity were higher among boys, Hispanic and non-Hispanic Black, and lower socioeconomic status children. This study provides the first application of a Markov transition model to child weight status data. The transitions into the overweight and obese categories were small, but persistent, with smaller percentages transitioning out of overweight or obese. Early monitoring and summer intervention strategies are needed to prevent the slow, but relentless, transition into the overweight and obese categories.

Downward trends in the prevalence of childhood overweight in two pilot towns taking part in the VIASANO community-based programme in Belgium: data from a national school health monitoring system.

SummaryBackgroundMultilevel approaches involving environmental strategies are considered to be good practice to help reduce the prevalence of childhood overweight.ObjectivesThe objective of this study was to evaluate the effects of VIASANO, a community‐based programme using the EPODE methodology, on the prevalence of overweight in two pilot towns in Belgium.MethodsWe analysed data from a national school health monitoring system to compare changes in the prevalence of overweight and obesity over a 3‐year period (2007–2010) in children aged 3–4 and 5–6 years in the pilot towns with those of children of the same ages from the whole French‐speaking community of Belgium. Heights and weights of all participants were measured by trained school nurses using a standardized method.ResultsThe prevalence of overweight (−2.1%) and overweight + obesity (−2.4%) decreased in the pilot towns, but remained stable in the comparison population (+0.1% and +0.2%, respectively). After adjustment for lack of homogeneity between the study populations, there was a trend towards a decrease in overweight (P = 0.054) and overweight + obesity (P = 0.058) in the pilot towns compared with the general population.ConclusionsThese results suggest that a community‐based programme, such as VIASANO, may be a promising strategy for reducing the prevalence of childhood overweight even over a short period of time.

Overweight and television and computer habits in Swedish school-age children and adolescents: a cross-sectional study.

The aim of this cross-sectional study was to investigate the prevalence of overweight and obesity in children and adolescents (6–16 years), and relationships between being overweight and sleep, experiencing of fatigue, enjoyment of school, and time spent in watching television and in sitting at the computer. Trained school nurses measured the weight and height of 2891 children aged 6, 7, 10, 14, and 16, and distributed a questionnaire to them regarding television and computer habits, sleep, and enjoyment of school. Overweight, obesity included, was present in 16.1% of the study population. Relationships between lifestyle factors and overweight were studied using multivariate logistic regression analysis. Having a bedroom television and spending more than 2 h a day watching television were found to be associated with overweight (OR 1.26 and 1.55 respectively). No association was found between overweight and time spent at the computer, short sleep duration, enjoyment of school, tiredness at school, or difficulties in sleeping and waking up. It is recommended that the school health service discuss with pupils their media habits so as to promote their maintaining a healthy lifestyle.

SOCIOECONOMIC STATUS, BODY MASS INDEX AND PREVALENCE OF UNDERWEIGHT AND OVERWEIGHT AMONG POLISH GIRLS AGED 7–18: A LONGITUDINAL STUDY

The aim of this paper was to establish whether the influence of socioeconomic factors on BMI and the prevalence of underweight and overweight changes with age. The data were obtained from 1008 schoolgirls aged 16-18 years for whom earlier data on weight and height were available. Their height and body mass were measured and their BMIs calculated. Height and weight in early life were assessed by medical records review. The girls were measured by trained school nurses at 7, 9, 14 years of age. Socioeconomic differences in BMI were found to increase with age. Parents' higher education and urban environment were associated with smaller BMI gain between the ages of 7 and 18 years. Among subjects whose mother and/or father had higher education the prevalence of underweight increased with age, and in other groups it remained at a similar level. In the younger age categories (7- and 9-year-olds) underweight was less frequent in subjects from towns than those from rural areas, while in the older categories (14, 16-18 years of age) the opposite tendency was found. As subjects grew up, there was a decline in the prevalence of overweight and obesity in all groups. Parental education and place of residence seem to influence weight status in a different way in childhood than during adolescence.

BODY HEIGHT AND SOCIOECONOMIC STATUS OF FEMALES AT DIFFERENT LIFE STAGES

Adult height reflects long-term nutritional status and exposure to infectious diseases, both of which are influenced by socioeconomic factors. Very little research has been done on these inequalities from a longitudinal perspective. This paper explores the links between body height at different life stages and socioeconomic characteristics. Data were obtained from 1008 Polish schoolgirls aged 16-18 years for whom earlier data on height were available. The height of each subject was measured. Socioeconomic status and age at menarche were assessed based on information received from the surveyed girls. Girls' heights in early life were ascertained from medical records. All girls were measured by trained school nurses at 7, 9 and 14 years of age. Socioeconomic status was found to be related to body height, but not to the rate of height gain during childhood and adolescence. Girls of a higher socioeconomic status were taller than girls of a lower socioeconomic status. On dividing the research material into homogeneous groups by maturity status, the same relationship was observed. No significant relationships were found between socioeconomic status and rate of height gain between ages 7 and 16, 17, 18 years. The findings suggest that socioeconomic variation in height is the result of living conditions during the first years of life.

Nursing Professional Development

The specialty of nursing professional development (NPD) has evolved over the years. The first educational focus in nursing started with the establishment of the first national nursing organization, the American Society of Superintendents for Training School Nurses in 1893. In 1971, the American Nurses Association established the Council on Continuing Education, and in 1974, Helen Tobin, often referred to as the Godmother of Staff Development, published The Process of Staff Development: Components for Change. The first standards related to nursing professional development were the Standards for Continuing Education in Nursing, also published in 1974. The Journal for Nurses in Staff Development was first published in 1985, and in 1989 Belinda Peutz spearheaded the establishment and incorporation of the National Nursing Staff Development Organization (NNSDO). NNSDO has now become the Association for Nursing Profesional Development (ANPD). The Association for Nursing Professional Development advances the specialty practice of nursing professional development for the enhancement of healthcare outcomes. There was tremendous increase in NPD publications and activities in the 1990s. ANPD published the latest Scope and Standards of Practice for Nursing Professional Development in 2016. The standards define Nursing Professional Development as a specialized nursing practice that facilitates the professional role development and growth of nurses and other healthcare personnel along the continuum from novice to expert.

Universal and targeted computerised cognitive behavioural therapy (Think, Feel, Do) for emotional health in schools: results from two exploratory studies

Computerised Cognitive Behaviour Therapy (cCBT) offers the potential to make evidence based interventions more available and accessible for children and young people. Research is currently limited and proof of concept studies are required to explore the viability and possible therapeutic benefits of cCBT as a universal or targeted intervention in schools. In Study 1, cCBT was provided as a universal intervention to 13 participants who were assigned to either group cCBT or a matched computer gaming condition. In Study 2, cCBT was provided as a targeted intervention by trained school nurses to 12 participants with mild or moderate emotional problems. Both studies found cCBT to result in immediate post intervention benefits and feedback about the programme was very positive. This study provides proof of concept that cCBT provided as a universal or targeted emotional health intervention in schools is viable and may result in immediate therapeutic benefits. These findings are limited by the small sample size and absence of follow-up but suggest that more methodologically robust evaluations should be pursued.

The FRIENDS emotional health prevention programme

A universal cognitive behaviour therapy emotional health programme, FRIENDS, was provided in schools by trained school nurses to 106 children aged 9/10. Anxiety and self-esteem were re-assessed in 63 children one year after completing the programme. The significant improvements in emotional health identified 3 months after FRIENDS were maintained 12 month after completing the programme. Of the 9 children identified at baseline as high risk, 6 (67%) had moved into the low risk category by the 12 month follow-up. Of the low risk children, none had become high risk by follow-up. The study conclusions are limited by a small sample size and the absence of a comparison group. They are however consistent with previous studies and suggest that FRIENDS delivered in schools as a universal intervention can have a significant medium term effect upon emotional health.

Training School Nurses

This field project focused on training school nurses to do screening and brief interventions for tobacco use. Needed resources were organized in a kit.

Validity of vision screening by school nurses in seven regions of Oman

We tested the validity of vision screening in schools in 7 regions of Oman in 2003. Two researchers tested 1719 randomly selected students in 4 school grades using the Snellen E acuity test. Trained school nurses had previously screened 182 233 students. The visual status recorded in the 2 screenings was compared. Sensitivity of screening by nurses was 68.34% (95% CI: 67.30-69.38) and specificity 99.23% (95% CI: 99.19-99.27). The positive predictive value was 85.42% (95% CI: 84.63-86.21) and negative predictive value was 97.93% (95% CI: 97.87-98.00). The sensitivity of the vision test was significantly higher in females, older students and in North Sharqiya region. In general, the vision screening of school students in Oman has satisfactory validity. Periodic training of nurses and supervision of the screening procedures could improve its sensitivity. Underlying causes of the high numbers of false negative cases should be further investigated.

Redesigning a school health workforce for a new health care environment: training school nurses as nurse practitioners.

Diminishing financial resources for school health dictate the most efficient possible deployment of the school health workforce. School nurses trained as nurse practitioners could help resolve the common problems of ready access to and appropriate use of primary care, early detection of potentially costly medical problems, and efficient use of school health staff. To determine how best to use existing resources to meet the increasingly varied and complex health care needs of children and adolescents, a pilot project was conducted in Denver from 1994 to 1996. With physician back-up and health aide support, school nurses were trained as nurse practitioners to provide in-school diagnostic and treatment services. Based on their evaluation study of this pilot project, the authors suggest ways to solve problems in role transition, including well-balanced training; clear role definition and assignment of responsibilities; appropriate back-up and mentoring support; and issues of sustaining long-term programs.