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School Health Nursing Services progress review: report of 1996 national meeting.

In September 1996 the Division of Adolescent and School Health (DASH) at the Centers for Disease Control and Prevention (CDC) and the National Center for School Health Nursing at the American Nurses Association (ANA) convened an invitational meeting School Health Nursing Services: Progress Review 1996 in Washington, DC. Representatives from nearly 20 national organizations and agencies participated. The meeting's purposes were to 1) review progress in implementing priority actions identified at the 1994 conference on School Health Nursing Services: Exploring National Issues and Priorities, and 2) identify additional priority actions that need to be implemented to advance school health nursing.

BACKGROUND

Given the physical and mental health needs of students and the increasing responsibilities of schools to address these health needs in a time of declining resources, the National Nursing Coalition for School Health sponsored the School Health Nursing Services: Exploring National Issues and Priorities conference in Reston, Virginia in 1994 in collaboration with the Division of Adolescent and School Health (DASH), Centers for Disease Control and Prevention (CDC); the Maternal and Child Health Bureau and the Bureau of Primary Health Care, Health Resources and Services Administration (HRSA); and the Office of Elementary and Secondary Education, US Dept. of Education.

The original conference convened representatives from nearly 50 national nongovernmental and governmental organizations to identify critical issues that should be addressed collaboratively by national health and education organizations to assure that school nurses are able to meet the needs of students. The conference objectives were to 1) describe the state of school health nursing services, 2) describe federal agency efforts to help school health nurses meet the needs of students, and 3) identify key priority needs that relevant governmental and nongovernmental agencies can address to help school nurses meet the needs of students. A detailed report of the results of the 1994 conference was published in the Journal of School Health,[1] and reprinted in the Journal of School Nursing[2] the following year.

In response to recommendations made at the 1994 conference, CDC/DASH provided initial funding to the American Nurses Association (ANA) to work with the National Nursing Coalition for School Health in the establishment of a National Center for School Health Nursing to assist organizing the collaborative efforts of interested nongovernmental and governmental organizations. The National Nursing Coalition for School Health with representatives from the American Nurses Association, American Public Health Association, American School Health Association, National Association of Pediatric Nurse Associates and Practitioners, National Association of School Nurses, and the National Association of State School Nurse Consultants serves as the advisory board for the new Center.

The mission of the National Center for School Health Nursing is to advance excellence in school health nursing practice in order to optimize the health and learning of all children and youth. The Center's goals evolved from seven key needs that are critical to advancing school health nursing which were identified by the participants of the 1994 conference. These include the need to:

* define and advance the role of the school nurse in the comprehensive school health program,

* implement school health nursing standards,

* address pressing legal and ethical concerns,

* inform policymakers about the nature of contemporary school health nursing services,

* provide more appropriate preservice and inservice professional preparation for school health nurses,

* conduct research about school health nursing services, and

* secure adequate funding for school health nursing services.

SCHOOL HEALTH NURSING SERVICES: PROGRESS REVIEW 1996

Participants at the School Health Nursing Services: Progress Review 1996 conference reviewed the priority actions identified for each of the seven needs delineated in 1994. The participants provided information on the progress made towards achieving each need over the past two years, came to consensus on actions that should be taken, and identified specific strategies by various organizations or agencies in order to achieve these goals. Prioritization for importance or urgency of the actions is reflected by the order of the listing under each goal. Following the generic priority actions for each goal is a plan of specific strategies to achieve the goal and suggested leadership as proposed by the participants at the 1996 meeting. Acronyms or titles used for suggested leadership of specific strategies: AAP - American Academy of Pediatrics; ASHA - American School Health Association; Center - National Center for School Health Nursing at the American Nurses Association; Coalition - National Nursing Coalition for School Health; NAPNAP - National Association of Pediatric Nurse Associates and Practitioners; NASN - National Association of School Nurses; NASBHC - National Assembly of School Based Health Centers; NASSNC - National Association of State School Nurse Consultants; NEA - National Education Association; and OSH - Office of School Health at the University of Colorado Health Science Center.

Goal 1.

Define and advance the role of the school nurse in the comprehensive school health program.

Priority Actions

1. Generate cross-agency discussion about the definition and role of school nurses.

2. Petition the federal Interagency Committee on School Health (ICSH) and the National Coordinating Committee on School Health (NCCSH) to target school health services improvement as a priority.

3. Encourage local, state and federal agencies to dedicate a position in both health and education to support school health services.

Strategies to Achieve Goal (Suggested Leadership)

* Develop a paper describing model(s) for school health services that improve outcomes for students and distribute to policymakers and state and national organizations. (NASN, NASSNC, NASBHC, Coalition)

* Publish articles in professional journals on the school nurse as: coordinator/manager of the inter-disciplinary team, a provider of GAPS and Bright Futures, a manager for staff wellness, a liaison with the community-school health coordinating council, or having a potential to improve students' health and educational performance. (NASN, NASSNC, ASHA, Nursing schools' contracts with writers)

* Develop a marketing kit to promote: the role of school nurse, the need for a school health coordinating council and for a school health coordinator, and the potential for improved student heal th/education outcomes. (NASN, ASHA)

* Have individual members of national organizations write Congress, the Administration and the Public Health Service asking for more funding, staff and resources for the federal Interagency Committee on School Health and (ICSH) and the National Coordinating Committee on School Health (NCCSH). (All school nursing organizations)

* Solicit support from ICSH and NCCSH to target improving health services nationwide. (All school nursing organizations)

* Encourage membership organizations in health and education to launch advocacy initiatives with policymakers to promote school health nursing. (Center)

* Develop resolutions/letters/issue briefs encouraging policymakers to take action on improving the health of students by the continuation or expansion of funding for health services at federal/state/local level. (ASHA, NASN, NASSNC)

* Seek endorsement for school health services from state and national medical societies and education agencies. (Center, NASN/NEA, NASSNC/AAP)

Goal 2.

Implement school health nursing standards.

Priority Actions

1. Translate school nursing standards into practice.

2. Initiate a proactive campaign for school nursing standards.

3. Differentiate practice among school health professionals.

Strategies to Achieve Goal (Suggested Leadership)

* Focus school nursing standards on outcomes and competencies as related to: case management, quality assurance, and funding resources. (NASN, NASSNC)

* Formulate a practice framework for delivery of school health nursing services. (NASN)

* Review literature for evidence of negative impact when school nursing services are limited or absent. (Center, Coalition)

* Identify commonalties of competencies among nursing and other professions. (Coalition)

* Review research on student outcomes related to school nursing services. (Center, Coalition)

* Determine "critical pathways" for preparation of school nurses that are population based, focus on consumer outcomes, and relevant to environmental health. (Coalition)

Goal 3.

Address pressing legal and ethical concerns.

Priority Actions

1. Address the issues of delegation of nursing care by collaboratively developing recommendations for safe nursing care in schools.

2. Address the legal and ethical issues related to reimbursement for school health services.

Strategies to Achieve Goal (Suggested Leadership)

* Focus on the consumer(student/family) aspects of: 1) a student's right to nursing care in school, 2) the quality of nursing care provided at school, and 3) special issues, such as, do-not-resuscitate (DNR) and inclusion. (Coalition)

* Convene a summit of representatives from educational, nursing, and medical organizations and families or advocates of students with special needs to develop national recommendations on delegation of nursing care in schools. Seek funding to support several meetings and the preparation of a document outlining recommendations. (Center, Coalition)

Goal 4.

Inform policymakers about the nature of contemporary school health nursing services.

Priority Actions

1. Develop a public relations campaign to articulate and promote the role of the school nurse.

2. Increase the political advocacy activities of school nursing organizations.

Strategies to Achieve Goal (Suggested Leadership)

* Collaborate with national organizations and federal agencies to assure that the school nursing role is integral to their activities. (Center)

* Collaborate with CDC infrastructure states on indicators for success of school health programs. (Center)

* Develop a position paper on the school nurse as school health coordinator. (Coalition)

* Develop and disseminate widely a three-page publication titled Every Child (Student) Deserves A School Nurse that includes: a fact sheet on school nursing, the health problems of students, special burdens and opportunities, and stories or quotes from families. (NASN, Coalition)

* Initiate working with new organizations and agencies on evolving issues. (Coalition)

* Document and disseminate benefits of school nursing: cost effectiveness, outcomes/impact evaluation, and benefits to stake holders, such as families, teachers, and community. (Coalition)

* Establish a "home page for school nursing on WWW. (Center)

* Expand policymaker list to include foundations and corporations. (Center)

* Identify interested legislators (local, state, and federal) and thoroughly inform them of school nursing services so that they can become a better spokesperson for school nursing. (Center)

* Identify parents, family groups and others to speak for school nursing interests. (Coalition)

* Join with existing coalitions to promote school health nursing and school health issues. (Center, Coalition)

* Develop preservice and continuing education programs for educational administrators that present the risks, issues and benefits related to the provision of school health services. Use language common to both health and education as well as articulating the relationship to achieving the national education goals. (Coalition)

Goal 5.

Provide more appropriate preservice and inservice professional preparation for school health nurses.

Priority Actions

1. Identify/develop competencies for school health nursing.

2. Increase enrollment in graduate school nursing and practitioner programs.

Strategies to Achieve Goal (Suggested Leadership)

* Review school nurse certification programs. (NASN, ANA, Coalition)

* Contact Education Development Center (EDC) for information on entry skills/competencies for school nurses from a study of comprehensive school health. (Center)

* Explore skills identified by National Skills Survey Board of University Affiliated Programs. (OSH)

* Review curricula of school health nursing preparation programs. (OSH SHARE network)

* Review nurse preparation programs at all levels for school health content. (OSH SHARE network, Coalition)

* Improve access to programs with non-traditional scheduling of classes, enrollment, modern teaching techniques and the use of computers. (Coalition)

* Work with Schools of Nursing to develop a model core curricula. Promote school nursing in traditionally black colleges. (Coalition)

* Encourage the matching of CE with college credit. (Coalition)

Goal 6.

Conduct research about school health nursing services.

Priority Actions

1. Draft a research agenda for school health nursing.

2. Expand and improve access to the useable school health nursing research information/data resources.

Strategies to Achieve Goal (Suggested Leadership)

* Use the Institute of Medicine report as a basis to set a research agenda for school health nursing. (Center, Coalition, ASHA, NASN)

* Convene an invitational conference of researchers to frame a research agenda working in conjunction with the NASN and ASHA research initiative. (Coalition, Center, ASHA,NASN)

* Establish a network of individuals in school health services, school nursing, and educational research. (Coalition, Center)

* Promote school health services research as a priority for national nursing and education organizations, such as, the editors of their professional journals encouraging school nursing research and its publication. (Coalition)

* Link school health services research with activities that are occurring in School Based Health Centers. (Coalition)

* Identify, collect and catalogue unpublished school health nursing research completed by graduate students. (Center)

* Explore means by which school nurses could access resources for research via technology. (OSH, Coalition)

* Work with Sigma Theta Tau to develop and expand existing resources. (Coalition)

* Explore the role of the American Academy of Nurses in promoting the research efforts of the Center and the Coalition. (Center, Coalition)

* Identify funding sources to support school nursing research studies. (NASN)

Goal 7.

Secure adequate funding for school health nursing services.

Priority Actions

1. Increase knowledge of the availability of resources.

2. Expand and improve information being disseminated to constituencies.

Strategies to Achieve Goal (Suggested Leadership)

* Demonstrate that services are important for all children, not just those with special needs or who are poor. (Coalition)

* Identify the changes that are being considered and initiated under Health Care Reform in the public arena (laws) and private arena (managed care). (Center, NASH, ASHA)

* Encourage school nurses to become involved at the state level (eg, 1115 Waivers prior to December 1996). (NASN, ASHA)

* Identify cost shifts and the move away from a fee-for-service model. Identify other options. (Coalition)

* Develop an "issue" paper for school administrators and school nurses on: access to federal Title (I, II, IV, VI, and XI) program funds for school health services, and how such funds can be used for school health services/activities. Secure funding for the writing of the paper. (Coalition)

* Establish a "home page" for quick dissemination of current/new funding information. (Center, Coalition)

* Increase efforts to work with diverse groups, eg, pediatricians, Council of Great City Schools, Health Care Financing Administration, Consortium of Citizens with Disabilities and others relative to reform, disabilities and funding issues. (Center)

* Promote coordinated services by the health and education sectors through federal, state and local infrastructure systems. (Coalition)

* Encourage school nurses to move beyond the nursing arena through active collaboration with health and education agencies and organizations. (Coalition)

INTERIM ACTIVITIES

In the interim period following the meeting on September 17, 1996, to the development and publication of this report, initiatives have been undertaken by a variety of national school health services organizations and governmental agencies. Examples of activities that address the identified needs of school health services are:

1. Focus Group: Establishing a Research Agenda for School Nursing, November 1996 met at the ASHA annual conference in St. Louis. This was a collaborative effort by ASHA and NASN to establish a priority list of research topics in school nursing.

2. National Task Force to Develop Guidelines for Handling Confidential Student Health Information held its first meeting May 23, 1997. This is a collaborative project with leadership from ASHA, NASN and NASSNC to explore issues surrounding the protection and/or release of confidential student health information. Guidelines due to be published in 1999.

3. School Health Leadership Training Conference, June 7-8, 1997, sponsored by the American Academy of Pediatrics' Comprehensive School Health - Capacity and Policy Initiative (CSH-CAP).

4. Healthy Outcomes Project, August 1997 is an initiative of the National Association of School Nurses in collaboration with a local school district to measure educational outcomes related to the health of students.

5. School Health and Managed Care: A Unique Partnership for Child Health, September 20, 1997, a symposium sponsored by the National Association of School Nurses with funding from the Robert Wood Johnson Foundation.

6. Articles published in the journal of School Health:

Adams E, Shannon AR, Dworkin P. The Ready-to-Learn program: a school-based model of nurse practitioner participation in evaluating school failure. 1996;66(7): 242-247.

Allensworth, DD, Bradley B. Guidelines for adolescent preventive services: a role for the school nurse. 1996;66(8):281-285.

Burt C, Beetem N, Iverson C, Hertel V, Peters DA Preliminary development of the School Health Intensity Rating Scale. 1996;66(8):286-290.

Werch CE, Carlson JM, Pappas DM, DiClemente CC. Brief nurse consultations for preventing alcohol use among urban school youth. 1996;66(9):335-338.

Bradley B. The school nurse as health educator. 1997;67(l):3-8.

Lia-Hoagberg B, Nelson P, Chase RA. An interdisciplinary health team training program for school staff in Minnesota. 1997;67(3):94-97.

Mitchell I, Laforet-Fliesser Y, Camiletti Y. Use of the healthy school profile in the Middlesex-London, Ontario, schools. 1997;67(4):154-155.

Costante C, Smith E. Beyond band aids: school health nurses as program developers and coordinators. 1996;67(7):290-291.

Bradley BJ. Establishing a research agenda for school nursing. In press.

7. Articles published in the journal of School Nursing:

Zimmerman BJ, Wagoner EF, Kelly LE. A study of role ambiguity and role strain among school nurses. December 1996.

Hootman J. Nursing diagnosis - a language of nursing; a language for powerful communication. December 1996.

Spanier AL, Slater P. Development of a school nurse education model. February 1997.

Armstrong ML, Gurke B. Gang membership and student behavior: nursing's involvement with prevention, intervention, and suppression. April 1997.

Gurke B, Armstrong ML. D-TAG: Erasing the tag of gang membership. April 1997.

Fryer GE, Igoe JB, Miyoshi TJ. Considering school health program screening services as a cost offset: a comparison of existing reimbursements in one state. April 1997.

Duquette AM. Adaptation: a concept analysis, August 1997.

Adelman H, Taylor L, Bradley B, Lewis KD. Mental health in schools: expanded opportunities to school nurses. August 1997.

Henry SB. A nursing informatics approach for addressing national issues and priorities for school nursing services. October 1997.

Ackerman PL. Research in school nursing practice: basic steps in nursing research (Continuing Education Feature). October 1997.

Bradley BJ. Establishing a research agenda for school nursing. In press.

8. Article to be published in 1998 in a Special Issue of the journal of Health Education:

Brener ND, Vernon ME, Bradley B, Santelli JS, DuShaw ML, Lewis PJ, Brainerd E. Assessment of School Health Nursing Services in the United States. In press.

CONCLUSION

During the meeting on School Health Nursing Services: Progress Review 1996 participants reviewed progress made on the seven previously identified critical needs that, if met, would help school nurses meet the health needs of students. Although some work had been accomplished over the two years, there was still much to be done. Participants updated the priority actions identified for each need, arrived at consensus on strategies to implement the actions, and then prioritized each action. A number of organizations were suggested to assume leadership on specific strategies during the next two years.

During the interim period of the past year, specific activities have been identified that show leadership from national organizations. There is, however, a great need for involvement from other organizations and agencies that were not identified at the conference. Collaborative partnerships at the federal, state and local levels are needed to assist school nurses in meeting the school-related health needs of all students.

References

[1.] National Nursing Coalition for School Health. School health nursing services: exploring national issues and priorities. J Sch Health. 1495;65(9):369-389.

[2.] National Nursing Coalition for School Health. School health nursing services: exploring national issues and priorities. J Sch Nursing. 1996;12 (3):23-26.

Elaine Brainerd, RN, MA, CSN, Director, National Center for School Health Nursing, American Nurses Association, and School Nurse Consultant, EB Associates, P.O. Box 3115, Branford, CT 06405-1715.
COPYRIGHT 1998 American School Health Association
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1998 Gale, Cengage Learning. All rights reserved.

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Author:Brainerd, Elaine
Publication:Journal of School Health
Date:Jan 1, 1998
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