Strategies to Address Unmet Needs and Facilitate Return to Learn Guideline Adoption Following Concussion.

BACKGROUND: Many students do not receive return to learn (RTL) services upon return to academics following a concussion. METHODS: Using a mixed-methods approach, we conducted a survey of RTL practices and experiences in Washington State schools between January 2015 and June 2015. We then held a statewide summit of RTL stakeholders and used a modified Delphi process to develop a consensus-based RTL implementation model and process. RESULTS: Survey participants included 83 educators, 57 school nurses, 14 administrators, and 30 parents, representing 144 schools in rural and urban areas. Unmet need domains and recommendations identified were (1) a current lack of school policies; (2) barriers to providing or receiving accommodations; (3) wide variability in communication patterns; and (4) recommendations shared by all stakeholder groups (including desire for readily available best practices, development of a formal school RTL policy for easy adoption and more training). Using stakeholder input from RTL summit participants and survey responses, we developed an RTL implementation model and checklist for RTL guideline adoption. CONCLUSIONS: Washington State children have unmet needs upon returning to public schools after concussion. The student-centered RTL model and checklist for implementing RTL guidelines can help schools provide timely RTL services following concussion.

The future of school nursing: banishing band-AIDS to improve public health outcomes.

This article provides analysis and commentary on the cultural roots that promote the provision of minor first aid in schools by school nurses. Using the Institute of Medicine's Future of Nursing report as a lens, this article illustrates how the focus on provision of first aid by school nurses dilutes larger public health contributions that school nurses could make if they were able to work to the full extent of their education, training and licensure. The article concludes with recommendations designed to support fuller use of nurses' scope of practice in schools.

Use of school nurse services among poor ethnic minority students in the urban Pacific Northwest.

OBJECTIVE: To determine whether patterns in student use of school nurse services existed according to poverty, race, and ethnicity. DESIGN AND SAMPLE: Cross-sectional descriptive study of 51,767 visits to school nurses made by 12,797 middle and high school students was conducted. Data were collected and analyzed by race, ethnicity, and poverty. MEASURES: Individual-level quantitative data on student visits to school nurses were collected via the School Nurse Entry Database. Numbers and types of student visits were measured, along with the demographic characteristics of student visitors. RESULTS: Poverty was the largest driver of visits to school nurses among all racial and ethnic groups. Poverty was a larger influence on White students' use of services, suggesting that factors related to race, ethnicity, or culture may have larger effects on promoting visits to school nurses by students of color. Subethnic Asian and Hispanic groups showed visit patterns that deviated from aggregated visit rates. CONCLUSIONS: Knowledge of visit patterns among poor, ethnic, and subethnic populations is important-and particularly urgent with the advent of national health reform-in informing and improving public health and school nursing policy and practice.

Increasing minority representation in the health professions.

Research indicates that health disparities may be reduced by increasing the number of ethnic minorities working in health occupations. Establishing health career pathway programs for immigrant and ethnic minority students is one way to address this problem. One such program, Cross-Cultural Education in Public Health (CCEPH), was developed, implemented, and evaluated to determine whether participants expressed greater interest in pursuing health care careers after program completion. A sample of 72 immigrant students in two high schools participated in the program, which was based on Bandura's theory of self-efficacy. Data were gathered using pre- and postprogram surveys that measured academic self-efficacy and career consideration. Results for academic efficacy were not statistically significant, but interest level in health care careers rose substantially. Although further research needs to be conducted to determine whether such programs increase self-efficacy, programs such as CCEPH can increase the consideration of health careers among immigrant and ethnic minority students.