This study investigated the factors related to the delivery of health care services by school nurses. The purposes of the study were divided into three categories. The first was the nurses' identification of the handicapping conditions of children in their caseloads and their perceptions of the children's health problems. The second involved data about the nurses' educational background and preparation they felt as useful in their work with children with handicaps; data on barriers which limit or prevent nursing care of these children was also solicited. Third, information was sought about future plans of nurses for obtaining more education, barriers perceived which hindered their plans, and special considerations in program planning that would facilitate their educational goals. Institutional guidelines were written based on findings of the study and the review of literature.

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.

This study investigated the needs assessment phase of the health education process for school children. The objectives of the study were to identify health education needs of school children using three approaches, namely, the epidemiological, consumer and social science approaches. In the social science approach, a PRECEDE model has been used. Time taken in using each approach and the skills of PHC nurses necessary to use each, were investigated in order to determine the most effective and efficient approach. A comparative case study design has been used, whereby each approach was considered as a case, hence, an embedded case study. One rural administrative area in the district of Umtata, which has a health centre in its catchment area, was selected. The population for the sudy were school children aged 12 to 16 years doing standard five. Four out of ten Junior Secondary schools in the area were randomly selected. In the epidemiological approach, records from the health centre and three of the four selected schools were analysed. In the consumer approach, focus group interviews (two groups of boys and two groups of girls) were conducted. In the social science approach, focus group interviews of school children(four groups) from the other two remaining schools, focus group interviews of mothers as carers( four groups), and in-depth interviews of standard five teachers from each of the four schools were conducted. Data analysis was done using Tesch's method of qualitative data analysis.A time activity sheet was used to estimate time used in each approach. A questionnaire was distributed among PHC nurses to determine their skills in relation to the approaches used. Results showed that the social science approach was the most comrehensive approach but used the longest time. The consumer was balanced and efficient though the least time was used. The epidemiological was found to have identified physical problems to the exclusion of the social and psychological problems. / Thesis (Ph.D.)-University of Natal, Durban, 1998.

This study explored school nurses knowledge of the diagnostic criteria and secondary conditions related to Autism Spectrum Disorders (ASD), their involvement in the identification and treatment of ASD, their knowledge of medication used to treat ASD, and their overall medication management of children with ASD. Participants included 100 school nurses, representing 18 states, who completed a survey on ASD. The response rate was 16.45%. The majority of school nurses were aware Autism and Asperger’s Disorder should fall under the classification of ASD within the school setting. They were less sure on whether PDD-NOS should be included as an ASD. A high percentage indicated they received training in the area of ASD from self-study rather than from formal coursework or supervised clinical experiences. Results found limited involvement of school nurses during the assessment and evaluation process. However, there was more involvement after children had been classified with an ASD, which was primarily limited to the administration of medication and medical treatments. School nurses reported being qualified to administer medication to children with ASD. They also reported being knowledgeable regarding the potential side effects of the medication they administered. The most common medication administered to children with ASD was stimulants. One anti-psychotic medication, Risperdal, appears to be administered fairly frequently by school nurses to children with ASD. Eighty percent surveyed did not report making any medication errors. The majority of school nurses were responsible for supervision of un-licensed personnel in the administration of medication. Besides nurses, secretaries/administrative assistants were the most common school employees administering medication within schools. / Department of Special Education

The landscape of the United States public school system was greatly improved upon with the creation of The Individuals with Disabilities Education Act of 2004 (IDEA 2004). This act established a standard that allowed all school aged children living with chronic illnesses to integrate into public school systems. This mandate currently impacts over 12 million children living with chronic illness including and not limited to asthma, seizure disorders, developmental delay, cystic fibrosis, traumatic brain injuries, anxiety and cancer. IDEA 2004 extended healthcare into public school systems and as a result, increased the average acuity of students that school nurses (SNs) care for. It is estimated that 15% of school-aged children miss 11 or more school days per year because of illness or injury demonstrating evidence of increased student acuity and a need to provide more appropriate care for these students in order to increase their time spent in the academic setting. Adequate SN and primary care provider (PCP) communication is essential to reduce absenteeism for this population and to ensure that students are safe during their time spent away from home and healthcare clinics. From this quality improvement project, more is understood pertaining to the communication patterns between SNs and PCPs and recommendations are provided in order to increase effective SN and PCP communication.

Bakgrund: Forskning visar att barn och unga med funktionsnedsättning trivs sämre i skolan och skattar sin hälsa sämre än andra barn. Skolan utgör en viktig miljö och kan ses som en potentiell skyddsfaktor mot ohälsa. Syfte: Syftet var att beskriva skolmiljöns betydelse för upplevelsen av hälsa hos elever i särskolan. Metod: Data användes från en kvantitativ tvärsnittsstudie utförd av Region Jönköpings län, Folkhälsoenkät ung 2020. Enkäten låg till grund för föreliggande studie som var av kvantitativ design. Datamaterialet baserades på 204 enkätsvar och analyserades genom deskriptiv statistik och Chi-två-test. Resultat: Resultatet visade att elever på särskolan upplever sin hälsa som god. Könsskillnader framkom där killar i högre utsträckning upplevde en bättre hälsa och en högre självkänsla än tjejer. Skolmiljön var av betydelse för elevers upplevelse av hälsa, elever som upplevde arbetsro, lärarstöd och hade möjlighet att föra fram sina åsikter skattade sin hälsa bättre. Slutsats: Skolmiljön kan främja elevers hälsa och upplevelse av sammanhang genom att understödja arbetsro, delaktighet och lärarstöd. Skolsköterskan kan vara en resurs i att utveckla särskolemiljön, genom att skapa en omsorgsfull relation i mötet med eleven, där människan bakom diagnosen synliggörs. / Background: Research shows that children with disabilities thrive less in school and value their health less than other children. School is an important environment and can be seen as a potential protective factor against illness. Aim: Was to describe the importance of the school environment for the experience of health in students in the special school. Method: Data were used from a quantitative cross-sectional study, Public Health Survey young 2020. The questionnaire was the basis for the present study, which was of a quantitative design. The data material was based on 204 questionnaire responses and analyzed by descriptive statistics and Chi-two tests. Results: The results showed that students experience their health as good. Gender differences emerged, where boys experienced better health and a higher self-esteem, than girls. The school environment was important for health, students who experienced peace of mind, teacher support and participation, rated their health better. Conclusion: The school environment can promote students' health and experience of coherence by supporting peace of mind, participation, and teacher support. The school nurse can be a resource in developing the special school environment, by creating a´ caring relationship in the meeting, where the person behind the diagnosis is made visible.

As new approaches to practice become available for school nurses, urban school districts must address the need to provide facilitators for the dissemination and adoption of new evidenced based practice models. With instructional capacity, curriculum challenges, and school climate at the center of the decision making of educational leaders, the needs of school health become neglected. As new innovations become available, school nurses working in urban school districts often rely on individual continuing education to access new ideas due to barriers that exist in urban schools with limited funding and resources. This dissertation research had two primary aims: (1) expand current research regarding specific barriers and facilitators to practice, and (2) to better understand the school nurses’ adoption of the Framework for the 21st Century School Practicing Nurse in an urban school district. This framework addresses the specific needs of the school nurse working in an evolving educational health setting. Using a descriptive and inferential quantitative design with a convenience sample of school nurses in the School District of Philadelphia (SDP), participants completed an online survey designed to examine awareness, agreement, and alignment with the framework, as well as barriers and facilitators of adoption. The results revealed differences in level of awareness of the framework across various demographic groups within the SDP. After presenting the framework to participants, school nurses agreed with the importance of fully aligning practice. Further, there were variations in level of importance regarding specific practice components of the framework. Participants identified facilitators and barriers that impacted their ability to fully align school nursing practice with the framework. / Urban Education

Problem: Because of the complex nature and autonomy of school nursing practice, multiple professional organizations recommend a Bachelor of Science in Nursing as the minimum level of education for entry into this specialty. Despite research demonstrating benefits to patients and nurses with this level of education, school nurses across the U.S. vary widely in their educational and experiential preparation for this critical role. Benner's Novice-to-Expert Framework emphasizes the importance of experience in nursing or in a specialty practice to developing the skill needed to provide expert nursing care. This study investigated what knowledge school nurses considered important to competent practice when responding to the National Board for Certification of School Nurses 2007 Role Delineation Survey and whether there are differences in how school nurses responded to these questions based on their educational and experiential backgrounds. Methods: This was a quantitative, non-experimental exploratory study involving secondary analysis of the survey data. Demographics were analyzed using descriptive statistics. Non-parametric statistical procedures (Fisher's Exact Test) were used to see if the 399 subjects' answers to 32 knowledge questions on the survey differed based on education level, years of general nursing experience, and years of school nursing experience. Results: Most subjects indicated that 27 of the 32 knowledge areas were moderately or extremely important for competent school nursing practice. Results of Fisher's Exact Test indicated differences on two items based on the education level of the respondents and differences on two items based on years of experience in school nursing, but no significant differences were found based on years of overall nursing experience. Communication skills in counseling had a significant difference based on both education level and years of school nursing experience; but it was impossible to tell which was more significant. Conclusions: This study contributes to the body of knowledge about school nursing and what this sample of school nurses perceived as important knowledge for competent practice. However, this analysis of differences in answers given to the survey knowledge questions does not settle the debate of whether there are differences in nurse perceptions based on education level or experience. / Ph. D.

Background: The proportion of young people with mental health problems increases within the school, which places greater demands on school nurses and their ability to meet these pupils. Upbringing, family social position and living conditions are factors that affect the health of individuals. School nurses are included in student health and has an important role in mental health problems, both in terms of early identification and provide support to students as well as the promotion of health. School nurses are often alone in their profession within the individual school, which places high demands on the ability to work independently, make their own decisions and be confident in their area of expertise. Through their accessibility, the school nurse has a central position to identify and capture pupils with mental health problems and early provide of support to foster students' development and learning. Aim: The aim of this study is to describe the school nurse's work with young people's mental health problems within the school. Method: A systematic literature review. Searches conducted in Cinahl, PsycInfo, PsycArticles and ERIC resulted in six articles for review and analysis underlying the results. Results: The result presents four themes with related categories that emerged through analysis. These consist of: identification of mental illness, measures in mental health, health promotion of mental health/illness and collaboration around pupils with mental illness. Conclusion: By their position at the school, school nurses constitutes a key figure in identifying mental health problems among pupils through their accessibility, communication skills and the use of screening tools. Prevention and health promotion are important, but the time and the conditions specified for this purpose are lacking. / Bakgrund: Andelen ungdomar med psykisk ohälsa ökar inom skolan, vilket ställer högre krav på skolsköterskor och deras kompetens att möta dessa elever. Uppväxt, familjens sociala ställning och levnadsvillkor är faktorer som påverkar hälsan hos individer. Skolsköterskor ingår i elevhälsan och har en viktig roll i arbetet med psykisk ohälsa, både vad gäller att tidigt identifiera och ge stöd till elever samt arbeta hälsofrämjande. Skolsköterskor är oftast ensamma i sin profession inom den enskilda skolan, vilket ställer höga krav på förmågan att kunna arbeta självständigt, fatta egna beslut och vara trygg inom sitt kunskapsområde. Genom sin tillgänglighet har skolsköterskan en centrala position för att kunna identifiera och fånga upp elever med psykisk ohälsa och tidigt kunna erbjuda stöd för att främja elevers utveckling och lärande. Syfte: Syftet är att beskriva skolsköterskans arbete med ungdomars psykiska ohälsa inom skolan. Metod: Systematisk litteraturstudie. Sökningar som utförts i Cinahl, PsycInfo, Psycarticles och ERIC resulterade i sex artiklar som efter granskning och analys ligger till grund för resultatet. Resultat: I resultatet presenteras fyra teman med tillhörande kategorier som framkommit genom analys. Dessa består av: av identifiering av psykisk ohälsa, åtgärder vid psykisk ohälsa, hälsofrämjande arbete kring psykisk hälsa/ohälsa samt samverkan runt elever med psykisk ohälsa. Konklusion: Skolsköterskor utgör, genom sin position på skolan, en nyckelperson vad gäller att identifiera psykisk ohälsa hos elever genom sin tillgänglighet, kommunikativa färdigheter och användning av screeningverktyg. Förebyggande och hälsofrämjande arbete är viktigt, men både tid och förutsättningar saknas för detta ändamål.

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