Annually, over 80,000 refugees enter the United States as a result of political or religious persecution. Of these, approximately 35% to 40% are children and adolescents. Refugees are faced with challenges associated with living conditions, cultural and social norms, and socioeconomic status due to problems occurring in their homelands. These challenges include but are not limited to malnutrition, communicable disease, questionable immunization status, lack of formal education, sexual abuse, violence, torture, human trafficking, homelessness, poverty, and a lack of access to health care. Moreover, the psychological impact of relocation and the stress of acculturation may perpetuate many of these existing challenges, particularly for refugee youth, with limited or underdeveloped coping skills. School nurses are uniquely poised to support refugee youth in the transition process, improve overall health, and facilitate access to primary health services. The purpose of this article is to provide an overview of the unique refugee experience, examine the key health care needs of the population, and present school nurses with timely and relevant resources to assist in caring for refugee youth.
School nurses perform a crucial role in the prevention, identification, intervention, and reporting of child maltreatment. The purpose of this article is to share the highlights of a research project conducted to (a) examine the effectiveness of an educational intervention program in increasing the knowledge, confidence, and self-efficacy in school nurses regarding children at risk of maltreatment; and (b) discover issues surrounding the comfort level engaging with children, communicating with teachers and other personnel, and ethical issues. The study consisted of two phases. Phase 1 was a face-to-face evidenced-based educational intervention. Focus groups implemented in Phase 2 discovered specific concerns of school nurses. Results indicate a significant increase in school nurse knowledge, confidence, and self-efficacy related to children at risk. Five themes were identified from the focus groups: the importance of interprofessional collaboration, identifiers of children at risk of maltreatment, the role of the school nurse as a mentor and leader, the importance of advancing one’s knowledge and skill set, and constraints faced by school nurses.
Adolescents are at higher risk for suicide attempts than other age groups. Suicide is now the second leading cause of death in the United States for ages 12 to 18; moreover, the risk of suicide is significantly higher for adoptive teens. In fact, adoptive teenagers have a four times higher rate of suicide attempts than biological children, perhaps due to the underlying nature of adoption, which can involve a pervasive sense of grief and loss for the adoptee. Unresolved anger and sadness from feelings of abandonment—especially when transitioning to adolescence—can cause a seemingly functional child to dissociate through self-harm and eventually demonstrate suicidal behavior. Little evidence-based research exists on the risk factors for adoptive teens who resort to suicidal behavior. Thus, it is vitally important for school nurses to understand the emotional stressors that adolescent adoptees face throughout life to help identify teens at risk for suicide. School districts and registered nurses are well positioned to address this critical health issue through education, assessment, and intervention.
This paper describes a user-friendly, Excel spreadsheet model and two data collection instruments constructed by the authors to help states and districts perform cost-benefit analyses of school nursing services delivered by full-time school nurses. Prior to applying the model, states or districts need to collect data using two forms: "Daily Nurse Data Collection Form" and the "Teacher Survey." The former is used to record daily nursing activities, including number of student health encounters, number of medications administered, number of student early dismissals, and number of medical procedures performed. The latter is used to obtain estimates for the time teachers spend addressing student health issues. Once inputs are entered in the model, outputs are automatically calculated, including program costs, total benefits, net benefits, and benefit-cost ratio. The spreadsheet model, data collection tools, and instructions are available at the NASN website (http://www.nasn.org/The/CostBenefitAnalysis).
A substantial amount of U.S. teenagers experience physical or sexual abuse within their romantic relationship. With recent technological advances, teenage dating violence can also be perpetrated digitally by harassing or controlling a romantic partner through the Internet or mobile phone. School nurses are naturally positioned to act as first responders for victims of an abusive romantic relationship. As online and offline forms of dating violence are often intertwined, it is imperative that school nurses are able to identify different types of digital dating violence as this could signal the presence of offline forms of dating abuse. Therefore, being able to interpret potential warning signs could help school nurses to play an active role in prevention and intervention of different types of dating violence. In this article, we provide an overview of the recent research on the context and consequences of cyber dating abuse and outline several suggestions for prevention and intervention.
In 2016 the National Association of School Nurses released an updated framework for school nurse practice. One highlight of the new framework is 21st century care coordination. That is, moving beyond basic case management to a systems-level approach for delivery of school health services. The framework broadly applies the term care coordination to include direct care and communication across systems. School nurses are often engaged in efforts to create school health care homes that serve as an axis of coordination for students and families between primary care offices and the schools. Effective care coordination requires that the school nurses not only know the principles of traditional case management but also understand complex systems that drive effective care coordination. The outcome of a system-level approach is enhanced access to services in an integrated health care delivery system that includes the school nurse as an integral member of the school’s health care team. This article presents a comprehensive, system-level model of care coordination for school nurse leadership and practice.
The Whole School, Whole Community, Whole Child model released in 2015 as a collaboration between associations focuses renewed attention on the importance of improved physical, emotional, and social health to student learning. The model replaces and expands upon the Coordinated School Health Model that has been widely implemented in schools since the late 1980s. NASN celebrates this new model and calls school nurses to action in advocating for the implementation of this model in their communities. This article not only introduces this new model to school nurses but shares examples of school nurse advocacy initiatives.
School nurses, as leaders, are able to exhibit leadership skills through embracing, advocating for, and demonstrating a commitment to lifelong learning. With the continual changes in healthcare and technology, continued education is essential to maintain a high standard of expertise and practice. School nurses have many opportunities for continuing education. This article will briefly explore various levels of continuing education, as well as relating ongoing learning to leadership principles.
Care of the Student With Special Healthcare Needs is a free resource that can assist school nurses in ensuring they are providing the most up-to-date, evidence-based care to children. Although the training module was developed to improve the care provided to Wisconsin children, the module can be accessed by school nurses and unlicensed assistive personnel (UAP) across the United States and internationally. School nurses in other states would need to review their state’s nurse practice act and school district policies to evaluate which procedures they are allowed to delegate.
School nurses collect voluminous amounts of data in a variety of ways and use the data to describe trends in students’ health and patterns of illness in the student population or to identify ways to improve care. NASN identified years ago that a national school nurse data set was needed to enable data-driven decision making for the millions of children who attend school each day across the United States. Informal work has been done in the past 5 years in preparation for the current joint NASN/National Association of State School Nurse Consultants workgroup. This article is the first of a two-part series related to the importance of data and national efforts to develop a uniform data set that all school nurses can collect. Collecting data, and collecting it in the same way as other providers, will demonstrate what school nurses do as well as provide the data necessary for robust research on the impact of school nurses on students’ health.
NASN, with a newly adopted strategic plan, is energized, committed, and positioned to be the connecting point for all things concerning school health. The July issue of the NASN School Nurse is utilized to provide an update to our membership on the health of our organization and the past year’s major initiatives. The 2014-2017 strategic plan has five areas of emphasis: membership, advocacy, financial stability, research, and governance. The purpose of this article is to discuss NASN’s member resources and connections and how they can be utilized to strengthen and mold school nursing practice.
Cyberbullying is one of many online risks that affect an increasing number of children and teenagers. This form of abuse often occurs under the radar of adults as it usually takes place outside of school and away from adult supervision. Moreover, bystanders and victims are often reluctant to report what they have experienced. School nurses might be among the first to witness the real-life consequences of this virtual behavior, as involvement in cyberbullying is often correlated with psychological and behavioral problems. For this reason, school nurses should know how to recognize the warning signs so that they can respond and intervene appropriately. This article provides a discussion of what cyberbullying is and a summary of research on factors associated with cyberbullying, in terms of both victimization and perpetration. It also provides school nurses with evidence-based strategies for responding effectively.
A school health registered nurse identified medication administration documentation errors by unlicensed assistive personnel (UAP) in a system of school health clinics in an urban setting. This nurse applied the Lean Six Sigma Define, Measure, Analyze, Improve, Control process of improvement methodology to effectively improve the process. The UAP of medication administration documentation error rate improved from 68% to 35%. This methodology may be used by school nurses to collaboratively look at ways to improve processes at the point of care.
The transition from home or daycare to preschool can be a stressful time for both parent and child. Through advance planning and preparation, the school nurse can begin to establish a trusting relationship with the family and provide the educational team with critical information that will shape school programming for the child with disabilities. This investment will ease family stress and facilitate a successful launch to preschool.
At the end of the 2011 legislative session in California, the California School Nurses Organization (CSNO), a state affiliate of NASN, was looking for a new way that school nurses could garner legislative support, in a visible and positive manner, as strong advocates for pupil health. When California State Assembly Member Susan Bonilla (who currently represents the 14th Assembly District) offered to sponsor a state bill to help improve the student-to-school nurse ratio in California’s public schools (which several sources between 2007 and 2011 estimated as being between 1:2,187 and 1:4,000), the CSNO’s Government Relations Committee (GRC) sprang into action. The committee reviewed NASN’s list of strategic plans for legislative advocacy for guidance. Upon learning that one of NASN’s legislative priorities was the passage of H.R. 2229 (C. McCarthy), the Student-to-School Nurse Ratio Improvement Act of 2011, the GRC crafted and subsequently worked to successfully pass a California resolution bill, Assembly Joint Resolution No. 24, in support. Such legislative advocacy efforts may well be viewed as a model for other NASN state affiliate organizations.
Staff development is an important role of the school nurse, yet little is written to assist the nurse in this role. Though some obtain advanced degrees in education, most school nurses are not prepared for the staff development role without further education in pedagogy, teaching strategies, and evaluation methods. This article presents discussion as one of many active teaching strategies that can engage learners and promote critical thinking. More work is needed in the area of course design and implementation, as well as additional research to help identify the most effective teaching strategies for school employees.
Health literacy promotion techniques are important for the school nurse’s toolkit. Health literacy, an Institute of Medicine objective, is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." Forty-three percent of the adult population has difficulty understanding basic health information. This article is the first of two articles that will describe techniques for improving verbal (part 1) and written (part 2) health communication.