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The importance of research to school nurses and school nursing practice.

Historically, school nursing has not documented sufficiently the health issues in schools, nor has it prioritized these issues for school nursing interventions or evaluated the effectiveness of nursing interventions. The National Association of School Nurses (NASN) is strongly committed to the advancement of children's health. Thus, NASN is developing an infrastructure to support research that articulates the health conditions affecting children's school success and the contributions of school nursing to children's health and academic success. In 1999, NASN participated with the National Center for School Health and the National Nursing Coalition for School Health at a Research Summit to set a school nursing research agenda. Needs and issues were identified for future research activities. The primary outcome was the identification that school nurses must practice the standards of care pertaining to research. These standards specify that clinicians be informed about, supportive of, and participate in the conduct and use of research.

Humans↗

A differentiated practice model for school nursing.

School nursing is notable for autonomous practice and independent decision-making. School nurses practice within a complex school health services environment that is subject to constant change, the influence of multiple stakeholders, and a chronic state of uncertain resources. Other professional challenges faced by school nurses are a lack of standardized entry education requirement, inadequate theoretical research with practice application, and expanding role responsibilities. Administrative restructuring of school nursing services using a differentiated practice model could be a method to address the challenges of school nurse practice. A model of differentiated school nursing practice is proposed as a starting point for the national school nurse audience to consider this alternative to the master's entry requirement. School nurse role responsibilities are divided among three levels of practitioners: generalist, master's prepared, and school nurse policy analyst. Each level features an increased scope of responsibility based on higher educational attainment. Research regarding how differentiated practice has been implemented in other health care settings is described. Implications for the implementation of differentiated practice in school health services are discussed, including the need for cooperation among stakeholders, possible cost considerations, and how school nurse education might be affected.

Humans↗

Evidence-based practice and school nursing.

School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by carefully reviewing the available evidence on a topic and synthesizing this information into recommendations for practice. This article defines evidence-based practice and best evidence, describes the development of evidence-based practice guidelines, discusses factors that affect the use of research and evidence-based practice guidelines in school nursing, and reviews current sources of evidence-based practice guidelines for school nurses. Strategies that school nurses can use to incorporate evidence into their practice are discussed. One recommendation is that school nurses partner with nurse leaders and nurse researchers to develop evidence-based practice guidelines relevant to school nurse practice.

Diffusion of Innovation↗

Special day class teachers' perceptions of the role of the school nurse.

School nurses are on the front lines of health care in public schools. The integration of students' health care needs as components of educational programs has become increasingly important as medically fragile children rely on school nurses to deliver or coordinate their health care services. The purpose of this descriptive study was to determine which school nurse services special day class teachers perceive as very important, important, somewhat important, or not important. Perceptions were surveyed via the School Nurse Services Data Collection Tool. The data were analyzed using percentages, mean values, and frequencies. The data were then aligned to match the role concepts set forth in the California Commission on Teacher Credentialing (CTC) standards for school nurse preparation. The findings of this survey suggested that most of the services provided by school nurses were rated as important or somewhat important.

California↗

Making the transition from acute care to school nursing.

School nursing is an interdisciplinary specialty demanding diverse nursing skills. Many of these skills might best be acquired through experience in other settings. The school population presents many nursing challenges, and there may be no supportive circle of specialists and peers readily available to the new school nurse. Further, in some states there is a shortage of educational opportunities and practicums specific to school nursing; therefore, most school nurses enter school nursing with education that is not specific to the school setting and with skills acquired in other settings, often in acute care. The main challenge for many new school nurses is effectively transferring those skills to an educational setting. This article shares observations and ideas on ways that the new school nurse can effectively make the transition.

Career Choice↗

The impact of school nursing on school performance: a research synthesis.

School nurses work in an educational setting. Due to budget cuts, different goals, and confusion between educators and nurses regarding the school nurse role, school nurses are being asked to demonstrate their effectiveness and justify their presence in elementary and secondary schools. Although school nursing was first initiated 100 years ago, a review of the literature published since 1965 indicates that 15 studies have been conducted that examine the impact of school nurses on academic performance. However, today many articles have recommended more research linking school nursing to educational outcomes. This article synthesizes the results of 15 research articles. Findings from these studies indicate that nursing interventions targeted at specific populations, including parents, have had significant effects. A relationship between school nurses' interventions and absenteeism is also suggested. Limitations of these studies are discussed, along with suggestions for future research.

Absenteeism↗

School nursing.

School nursing has been in a process of transition since its inception. This role evolution parallels the growing complexity of the health, education, and social needs of America's youth. The workplace within which school nurses practice is equally complicated because health and education administrators often hold differing philosophies of management, and school health programs are ill-defined. Fortunately, there is growing support for an integrated services approach and the development of school health systems with nurses joining an interdisciplinary team rather than continuing to function as "boundary dwellers." The roles of the school nurse as primary care provider, school health coordinator, case manager, and epidemiologist are emerging and replacing outdated nursing functions. As the role of the school nurse shifts and expands, it produces a cascade effect. The role of the school health assistant to aid the nurse surfaces as the next logical step in planning. Numerous model school health programs exist today. The emphasis, and rightfully so, is preventive in nature and should be targeted at the preparation of a new generation of health consumers who are more self-reliant than their predecessors. Unfortunately, all these programs are plagued with financing problems that could be alleviated with the right plan for health care reform, such as an expansion of maternal and child health funds (Title V) to health departments and the introduction of school nursing leadership into the DASH office at the Centers for Disease Control and Prevention, a health education unit largely run by health educators, to reallocate some of these resources to the clinical preventive services needed in schools to reduce health risk behaviors. Finally, total quality management is the next issue on the horizon for this nursing specialty; benchmarking would be the place to start. In summary, systems development in the school health field is now underway, and it will not be easy, but this sort of work never has been simply. It must be remembered that there is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institution and merely lukewarm defenders of those who would gain by the new ones.

Delivery of Health Care↗

Problem solving styles of school nurses.

School nurses are challenged on a daily basis to solve complex problems and generate creative solutions to meet the health needs of children. This study focused on how school nurses go about solving problems in the delivery of school health services. The results showed that school nurses' problem-solving style allows them to act as "bridgers" within the educational environment and to promote collaboration among many types of school personnel.

Humans↗