The Changing Landscape of Substitute School Nursing A School Nurse Administrator Roundtable.

School nurse administrators increasingly express concerns over the availability of substitute school nurses with return to in-person learning after the height of the COVID-19 pandemic. While healthcare staffing concerns and shortages are not unique to the school setting, the increasing health acuity of the student population, delegation principles, and staffing models complicate the issue. Traditional methods of covering absences may no longer suffice. In this article, five school nurse administrators share strategies, comparing pre-pandemic to current day facilitation of providing coverage for the absences of their healthcare staff.

Ethical challenges for school nurses during COVID-19

School nurses balance ethical challenges with the moral responsibility to students and the public health of the school community during a global pandemic. This balance reveals the critical role of the school nurse. We encourage school nurses to harness lessons learned during this pandemic to make proactive changes and eliminate structures that did not support practice. School nurses must use their voices and demand change;school systems have a moral responsibility to all stakeholders. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Effects of COVID-19 on School Nurse Mental Health Intervention Practices.

Mental health issues have been exacerbated by COVID-19; therefore we examined how the school nurses' role in addressing mental health changed during the pandemic. We administered a nationwide survey in 2021, guided by the Framework for the 21st Century School Nurse, and analyzed self-reported changes in mental health interventions by school nurses. Most mental health practice changes after the start of the pandemic occurred in the care coordination (52.8%) and community/public health (45.8%) principles. An overall decrease in students visiting the school nurse's office (39.4%) was seen, yet the frequency of students visiting with mental health concerns had increased (49.7%). Open-ended responses indicated that school nurse roles changed due to COVID-19 protocols, including decreased access to students and changes in mental health resources. These insights into the role of school nurses in addressing student mental health during public health disasters have important implications for future disaster preparedness efforts.

A NEW MODEL FOR SCHOOL NURSING?: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

During the pandemic, many school nurses brilliantly flexed their service to ensure they continued to support students. Here, Scott discusses the practices that have continued.

Champions for School Health-An NASN Initiative to Increase Vaccine Confidence, Equity, and Uptake in COVID-19 and School-Required Vaccinations: Part 1.

The National Association of School Nurses (NASN) received a U.S.$2 million grant from Kaiser Permanente in January 2022 to increase confidence, equity, and uptake in the COVID-19 vaccine and other school required vaccinations in children ages 5 to 11 in Kaiser's nine markets (eight states and the District of Columbia). NASN was partnered with the Institute of Educational Leadership (IEL) in this initiative to examine ways both organizations could learn how school nurses (SNs) and community schools (CSs) could collaborate to address the goals of this project. NASN gave 54 Implementation Grants in two funding cycles in 2022 and is co-funding two SN-CS collaboration projects with IEL. The Part 1 article provides an overview of the project's goals, grant strategy and processes, grantee information, NASN created tools that resulted from this funding, and successful implementation of the project, which demonstrates NASN's capacity for future similar projects.

Piloting a clinical mental health process in the intermediate school setting

The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Impact of COVID-19 on the Mental-Emotional Wellbeing of Primary Healthcare Professionals: A Descriptive Correlational Study

The present study aimed to examine work environment related factors and frontline primary healthcare profes-sionals' mental-emotional wellbeing during the COVID-19 pandemic in school communities of Hong Kong. A total of 61 (20%) school health nurses (frontline primary healthcare professionals) participated in a cross-sec-tional online survey from March to June 2020. Outcomes of mental-emotional health were measured using the Mental Health Continuum-Short Form (14-item scale with three subscales related to emotional, social and psychological wellbeing);the Perceived Stress Scale (10-item scale with two subscales related to perceived help-lessness and lack of self-efficacy;and the Coping Orientation to Problems Experienced Inventory (Brief COPE), a 28-item inventory with two subscales related to adaptive and maladaptive strategies. Almost half (42.6%) of participants experienced mental health problems. Those employed in government subsidized schools had significantly lower scores in mental health wellbeing than those who worked in private schools. Factors relating to increased mental health problems included lack of emotional support, inadequate training relating to infection prevention and control measures, disengagement and self-blame. A variety of factors influencing school health nurses' social, emotional and psychological wellbeing in their work environment during the COVID-19 pandemic were also reported. The mental-emotional wellbeing of school nurses may relate to their subjective feeling of loneliness as participants were the sole frontline primary healthcare professional working in the school community during the COVID-19 pandemic. Study findings provide relevant evidence for management teams to build a culture of psychological and social support into workplace policies and procedures. Continuous staff development and adequate social support are important to promote the mental-emotional wellbeing of primary healthcare professionals in school communities as they play a significant role in safeguarding resources during pandemics. © 2023, Tech Science Press. All rights reserved.

The school nurse's experience of secondary exposure to trauma

The school nurse (SN) is often the sole health care expert in the school setting, providing for the physical and socio-emotional needs of others. SN may be exposed to reports of trauma, a widespread and costly public health issue. This study sought to explore the experience of the SN when exposed to reports of trauma from those in their care. Seven N.J. certified school nurses participated in two online interviews via Microsoft Teams, spaced one to two weeks apart between June 2021 and September 2021. Interviews were recorded & transcribed verbatim and thematic analysis applied. This study found that SN receive reports of trauma to varying degrees, with those in high-poverty urban settings relaying more frequent exposure than those in suburban settings. The SN identified the health office as a safe haven where students are welcome, accepted as they are, can share concerns, and seek comfort from their ailments. SN reported challenges working within the school model, and experienced obstacles to receiving reports of trauma including a lack of school-based collaboration, a lack of understanding of the SN role, and SN workload. In the eye of the storm, while receiving traumatic reports, SN focus on immediate needs. Later, while mitigating the aftermath, they process the experience and apply coping strategies, such as self-care and social support, to restore and replenish. While weathering the storm, they share concern and frustration, but acknowledge that they can only do so much. The SN in this study did not demonstrate secondary trauma but instead shared stories of resilience. Effects of the COVID-19 pandemic on the SN receipt of reports of trauma were explored. Further research is needed regarding the role of the SN, SN workload, and their experience in receiving reports of trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The school nurse talks about how to keep your body healthy. Doesn't really talk about food allergies. I'd like to change that

Food allergies are increasingly common and affect approximately one in thirteen students in the United States (US). Anaphylactic reactions can be unpredictable, severe, and sometimes life-threatening if not treated quickly and appropriately. School health policies and education surrounding food allergies vary substantially within and between states, as do guidelines that influence policy, and influence students' experiences of school with food allergies. Additionally, the COVID-19 pandemic has influenced students' experiences of their school communities. There is a limited research exploring student perspectives regarding food allergy policies, and none published to-date reflecting perspectives during the pandemic. Students' voices are not always included in food allergy management and policy research. The current study was conducted to elicit elementary students' voices during a unique moment in world history, the beginning of the COVID-19 pandemic. Elementary school students' stories, attitudes, and perspectives regarding food allergy management and school policies in New England were explored through semistructured, individual interviews (n = 7). A descriptive phenomenological approach was applied to the conceptualization of this project and thematic analysis of views shared. Parent (n = 29) and student (n = 11) questionnaire data were collected to supplement interview findings. Questionnaire results reflected student and parent experiences of variability in school-based food allergy policies and attitudes. Interview findings reflected that many students experienced COVID-19 precautions as protective against opportunities for exposure to allergens in school, wished that others knew more about food allergies, and reflected the general sense that food allergies were usually met with respect in school. Some called for increased education to promote awareness and practical knowledge within their school communities. Student impressions of food allergy management have diverse implications for policy. Student openness to improvements to education, in combination with the shared comfort expressed in others knowing about their unique food allergies, suggests that elementary school could be an appropriate place to integrate food allergy education. Additionally, food-allergy related comfort afforded by COVID-19 precautions indicates room for development in food allergy policy development and education to enhance perceptions of safety at school among students with food allergies. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Accessible mental well-being intervention for adolescents in school settings: a single-group intervention study using a pretest-post-test design.

BACKGROUND: A growing number of adolescents seek treatment for mental health problems, a circumstance that stresses the importance of implementing accessible treatment options. This study evaluates the impacts of brief, mental well-being intervention for adolescents in a school environment. As mental health interventions are often targeted at specific disorders, we sought a comprehensive approach to reach adolescents with a range of mental health symptoms. METHODS: Single-group intervention study with a pretest-posttest design was utilized and conducted in lower, upper secondary, and vocational schools on adolescents ages 12-18 who sought medical attention for mental health symptoms. The cut-off point for inclusion was ≥ 14, for the Young Persons Clinical Outcomes for routine Evaluation (YP-CORE) measurement. The intervention included six face-to-face visits implemented by psychiatric nurses who received a 3-day training course. The impacts were evaluated after 6 weeks (n = 87) and again at 6 months (n = 68) and assessed using the YP-CORE, Beck Depression Inventory (BDI-II) and Overall Anxiety Severity and Impairment Scale (OASIS). RESULTS: The participants reported significant levels of mental distress at baseline with a YP-CORE mean score = 21.48, a BDI-II mean score = 23.60, OASIS mean score = 10.98. Post-intervention results at 6 weeks for the primary outcome YP-CORE showed a significant (p < .001) mean score decrease of - 3.82, a medium effect size d = .627. For participants attending upper secondary and vocational schools the YP-CORE scores changed significantly from baseline to 6-weeks (p = .005) and from baseline to 6-months (p < .001). Long-term outcomes at 6-months showed a - 1.14 decrease (p = non-significant), effect size d = .175. After the 6-week intervention, 12% of the participants were assessed as not requiring additional visits. CONCLUSIONS: This easily accessible intervention in a school setting indicated improvement for those participants with mild to moderate mental disorder symptoms and attending upper secondary and vocational schools. After the 6-week intervention, significant positive effects were observed. Participants reported substantial levels of mental distress at the baseline, which could contribute to the decline of symptoms and need for extended care during the 6 months follow-up. Trial registration Retrospectively registered with Clinicaltrials.gov identifier NCT05356949.

Development and Evaluation of a Blended Learning Mindfulness Program for High School Students During the COVID-19 Pandemic.

Many adolescents worldwide suffer from stress or unhealthy emotional states such as depression. There is a trend toward limited physical contact via social distancing practices that developed during the coronavirus disease 2019 (COVID-19) pandemic. An experimental study aimed at investigating the effects of a mindfulness program on stress, concentration, self-esteem, and self-control in high school students. A 10-week mindfulness intervention was provided to the experimental group (n = 89) from September-November 2020, while the control group (n = 89) received general health education. Four weeks after the program, the experimental group showed reduced stress and improved concentration, self-esteem, and self-control compared to baseline.The blended learning mindfulness program is effective improving concentration and should be incorporated into the formal high school curriculum.

Effects of the COVID 19 Pandemic on School Nurses' Resiliency and Ability to Cope: A Mixed Methods Study in the State of Hawaii.

This mixed-method study examined school nurses' experiences during the Coronavirus Disease 2019 pandemic related to role change, psychological feelings, and coping/resiliency in the State of Hawaii. A total of 30 school nurses completed a Brief Resilience Coping Scale plus a series of open-ended questions in January 2022. On the coping scale, over 40% of participants scored high, 52% scored medium, and 7% scored a low resilient/coping level. We did not identify any association between coping level and participant characteristics. Three qualitative themes emerged: 1) school nurses experience chronic negative emotions related to the pandemic, 2) school nurses demonstrate attributes of resilience, and 3) school nurses utilize positive coping techniques. The pandemic created significant stresses and negative emotions among school nurses. Yet, school nurses reported effective coping strategies and demonstrated strength/resilience. Support and open communication between school nurses, their employers, and other school-based stakeholders is needed to provide continued support for school nurses.

School Nurses' Perspectives on Health among School-Aged Children and Adolescents During the COVID-19 Pandemic.

The aim of this study was to investigate school nurses' perspectives on students' health during the COVID-19 pandemic in Sweden in 2021. A cross-sectional survey design was used with school nurses (n = 225) working in schools in Sweden from elementary to upper secondary levels. The Clausson School Nurse Perception Questionnaire was used with two additional questions about the COVID-19 pandemic. The school nurses rated students' physical health as very good or good in 78% of the cases and their mental health as very good or good in 64%. There was also a negative trend in mental health during the pandemic, especially among girls. School nurses working in vulnerable areas (i.e., areas with a high proportion of immigrants and those receiving financial assistance) rated students' physical and mental health significantly worse compared other areas.

A preceptorship programme for school nurses and health visitors

A preceptorship programme for health visitors and school nurses in Highland, Scotland, was developed, delivered and evaluated from 2015 until 2021. The programme used video-conferencing technology to connect remote and rural preceptees, particularly during the Covid-19 pandemic. Preceptees' feedback about the programme was positive;the key benefits highlighted were better networking and peer support capabilities and reduced isolation. As well as describing the programme and its development, this article provides recommendations for other organisations about how to develop a preceptorship programme in their field of practice.

Burnout and Mental Health and Well-Being of School Nurses After the First Wave of the COVID-19 Pandemic: A National Cross-Sectional Survey.

The aim of this study was to examine the associations between job stressors, COVID-19-related concerns, burnout, and mental health and well-being among school nurses, and whether any of these associations are mediated by burnout. Based on stratified proportional sampling, data collection was conducted by an online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 participants aged between 27 and 62 years (mean = 47.08; standard deviation = 7.28) returned questionnaires. Results showed that burnout was the main mediating variable that fully mediated the relationship between COVID-19-related concerns and mental health and well-being. The effects of job stressors on mental health and well-being included direct negative effects (ß = -.29) and indirect negative effects (ß = -.67) through mediating factors. School health managers should be more aware of burnout and mental health and well-being among school nurses under the impact of COVID-19.

Health needs of vulnerable children and young people: the role of health in child protection conferences and representation in child protection plans

ObjectivesOver 50,000 children and young people in England are subject to a child protection plan.1 It is well established that abuse is detrimental to many aspects of child health in the short-, medium- and long-term.2 This project sought to build on existing knowledge to further understand the role health plays in child protection conferences. Specifically it sought to understand the health needs of vulnerable children and young people subject to child protection plans, how health needs are discussed at child protection conferences and which professionals are advocating for children and young people's health through the child protection process.MethodsRetrospective cohort study of case notes relating to 24 families (40 children) who underwent initial and review child protection conferences from January 2019-February 2021 in one local authority. This included accessible NHS notes and minutes from child protection meetings. Conference notes were reviewed to understand why conferences were taking place, which professionals were present, what health needs were discussed and what steps were taken in child protection plans to address health needs.ResultsHealth needs were almost universally addressed in child protection plans (23/24), with plans most commonly reporting on the need for school nurse assessment or health visitor monitoring. Health visitors and school nurses attended almost all conferences. Only seven children in this cohort were offered a Child Protection Medical Assessment with a paediatrician. High BMI and emotional distress were the most common health needs discussed. Emotional health was regularly commented on in conferences, particularly when domestic abuse was a factor. Plans commented on the need for CAMHS referral or to access emotional support in school. Access to emotional support in school was limited by school closures due to Covid-19 restrictions.Eighteen adolescents (10–17 years old) were involved in the analysis, many of whom had emotional health needs (14/18) or physical health needs (13/18);3 had contextual safeguarding needs. School nurses played an important role during and between conferences in identifying and managing the health needs of this vulnerable cohort of young people. Fourteen adolescents had school nurse assessments as part of their child protection plan, which provided an opportunity for health promotion and enabled identification of new health needs. School nurses were also able to offer psychosocial support, particularly to young people with contextual safeguarding concerns.ConclusionsHealth was well addressed in child protection conferences and plans. Health needs were almost exclusively represented by health visitors and school nurses. Emotional health needs were recognised and discussed in conferences, with limited avenues for children and young people to access support, particularly when support available through school was affected by Covid-19-related school closures. School nurses played a particularly important role for vulnerable adolescents subject to child protection plans as they were able to identify health needs, take appropriate steps to ensure management was in place and provide psychosocial support in the school setting.ReferencesChild protection plan statistics: England 2017–2021. NSPCC, 2021.State of Child Health. Royal College of Paediatrics and Child Health, 2020.

Piloting a clinical mental health process in the intermediate school setting

The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

IN IT FOR THE LONG HAUL: THE JOURNAL OF THE HEALTH VISITORS' ASSOCIATION

It is three years since a cluster of cases of pneumonia of unknown cause was reported in Wuhan in China. Little did many know how soon lives around the world would be upended. Many people now feel that the pandemic is behind them, and very few are still testing regularly, but in reality, Covid is still with them. In fact, a spike with new variants is predicted with some unease by researchers in the field for this winter: quite possibly combined with influenza, to constitute a 'twindemic'. Alongside this, there is an increasing awareness that 'long Covid' can keep people ill or disabled for a considerable length of time. So for any clients sinking into Covid vaccination apathy, it's worth reminding them of the realities, and that studies have suggested vaccination can reduce the risk of long Covid. Research into the immunity required to protect against long Covid, as well as the role of new variants, continues.

The school nurse's experience of secondary exposure to trauma

The school nurse (SN) is often the sole health care expert in the school setting, providing for the physical and socio-emotional needs of others. SN may be exposed to reports of trauma, a widespread and costly public health issue. This study sought to explore the experience of the SN when exposed to reports of trauma from those in their care. Seven N.J. certified school nurses participated in two online interviews via Microsoft Teams, spaced one to two weeks apart between June 2021 and September 2021. Interviews were recorded & transcribed verbatim and thematic analysis applied. This study found that SN receive reports of trauma to varying degrees, with those in high-poverty urban settings relaying more frequent exposure than those in suburban settings. The SN identified the health office as a safe haven where students are welcome, accepted as they are, can share concerns, and seek comfort from their ailments. SN reported challenges working within the school model, and experienced obstacles to receiving reports of trauma including a lack of school-based collaboration, a lack of understanding of the SN role, and SN workload. In the eye of the storm, while receiving traumatic reports, SN focus on immediate needs. Later, while mitigating the aftermath, they process the experience and apply coping strategies, such as self-care and social support, to restore and replenish. While weathering the storm, they share concern and frustration, but acknowledge that they can only do so much. The SN in this study did not demonstrate secondary trauma but instead shared stories of resilience. Effects of the COVID-19 pandemic on the SN receipt of reports of trauma were explored. Further research is needed regarding the role of the SN, SN workload, and their experience in receiving reports of trauma. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

A School Nurse and a Technology Specialist: Partnering for Improved Processes During COVID-19.

School nurses have worked tirelessly during the COVID-19 pandemic. At times, the workload has been unsustainable and there were not enough hours in the day for school nurses to complete their duties. In one school district, the high school nurse and instructional technology specialist collaborated on improving the process of collecting COVID-19 information. This resulted in dramatically reducing the amount of time it took to process information and improved the way the data were collected and shared. This article describes the steps in pandemic-related data collection and communication used before and after implementation of the improved tools and processes. The authors also provide forms, email templates, and the resulting district COVID-19 metric figures helpful to school nurses desiring to replicate the process.