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School Nurses’ Roles in Promoting Population Level Health in an Urban School District M. Kathleen Murphy, DNP, RN, FNP-BC Mary Jo Baisch, PhD, RN Teresa.

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Presentation on theme: "School Nurses’ Roles in Promoting Population Level Health in an Urban School District M. Kathleen Murphy, DNP, RN, FNP-BC Mary Jo Baisch, PhD, RN Teresa."— Presentation transcript:

1 School Nurses’ Roles in Promoting Population Level Health in an Urban School District M. Kathleen Murphy, DNP, RN, FNP-BC Mary Jo Baisch, PhD, RN Teresa DuChateau, DNP, RN, PNP-BC TSNO Annual Conference November, 2012

2 History of School Nursing Roots of school nursing in community/public health nursing 1900-1930: –Communicable disease management –Home visits 1940-1960: –Polio prevention and vaccination –Vision and hearing screening –Communication disease management 1970-2010 –Communicable disease management –Medically fragile students, Complex health conditions –School nurse focus on reducing and eliminating health related behaviors to learning

3 1900s School Nurse One month demonstration with first US School Nurse Lina Rogers Outcomes 9/1902 – 10,567 exclusions 9/1903 – 1101 exclusions (89.6% reduction) Most exclusions for minor illnesses: pediculosis, ringworm, scabies Source: Kalisch & Kalisch. (1978). The Advance of American Nursing

4 1920 School Nurse—Lice Check!

5 1930 The School Nurse as Superhero

6 1940 Lice Check and Castor Oil

7 1950 Mary Dempsey School Nurse and Attendance Supervisor

8 Recent Challenges Value added to educational setting often not understood Funding Wide variability in school nurse to student ratios across the country No common language for intervention documentation

9 Problem Statement The school nurse role has evolved over time Variability in understanding the school nurse role among the education community No common and consistent language and documentation methodology to articulate school nurse impact

10 Academic Success Requires Health Children can’t succeed academically if they are not healthy School age children come to school with many health issues –Most are generally healthy Episodic illness Family/emotional issues –Others come with chronic illnesses

11 Conceptual Frameworks for SN Basic assumptions –Primary goal of schools is education –Education and health are linked –School can be a part of health care delivery systems for children CSHP Public health nursing Background

12 Coordinated School Health Program GOALS Increase health knowledge, attitudes, and skills. Increase positive health behaviors and health outcomes. Improve education outcomes. Improve social outcomes. (Washington Office of Public Instruction, 2011)

13 Wheel of Public Health Interventions (Minnesota Department of Health, 2001)

14 Coordinated School Health and the Wheel (Minnesota Department of Health, 2001) C OUNSELING AND S UPPORT S ERVICES H EALTH S ERVICES F AMILY AND C OMMUNITY I NVOLVEMENT

15 Wheel of Public Health Interventions Introduced in 1998 as evidence based model defining public health nursing as a population based practice Articulates public health nurse practice at the individual, community and system level Broad range of interventions (17) Specific categories allow for clearer articulation of the public health nursing role

16 Demonstrating the Value of School Nursing MPS Title I School Nurse Program Evaluation Team members Mary Jo Baisch, PhD, RN, Sally P. Lundeen, PhD, RN, Lynn K. Carey, PhD, RN, Frank Stetzer, PhD, Sheryl Kelber, MS, Betsy Holmes, BA Program Director: M. Kathleen Murphy, DNP, RN, FNP-BC

17 Demonstrate the value of school nurses to their schools and the school system Identify key outcomes of school nurse practice in Milwaukee Public Schools –Using Appreciate Inquiry (AP) as an evaluation framework –Underlying practice framework: CDC Coordinated School Health Program Goals

18 Evaluation Process 1.Review literature to determine 1.School nurse role recommendations 2.Nurse-sensitive outcomes 2.Based on goals, establish evaluation questions and objectives 3.Identify data available to analyze 4.Identify additional data to be collected 5.Analyze data 6.Report results

19 Identifying and using nurse-sensitive interventions and outcomes helps us to articulate our practice and its value ANA has recognized Standard Terminologies to articulate nursing roles

20 To Identify Major Outcome Indicators Student Medication management Attendance Health improvement and management of chronic health conditions, e.g. asthma Satisfaction Nursing practice activities Parent Understanding/management of student health concerns Satisfaction with health services Participation in school health activities School Community Satisfaction Value of the nurse to the school Literature Review

21 Mixed Methods Design Retrospective Analysis Quantitative Data –Matched cohort design Compared Title I and matched MPS elementary schools –Matched on race/ethnicity –Free/reduced lunch rates –School location –Enrollment including special education –Analyzed data in ESIS (Electronic Student Information System) –Surveyed school staff Teachers, principals, clerical staff Qualitative Data: Interviewed nurses (18/22) University of Wisconsin-Milwaukee IRB Approval

22 ESIS – Matched Cohort School attendance Immunization rates Student health records –Completeness –Accuracy

23 School Health Program Annual Reports Description of school nurse activities –# and type of screenings –# and type of visits from children Disposition of referrals to the nurse

24 Survey of Principals/Assts., Teachers, and Clerical Staff Time required to address health issues daily Satisfaction with the nurse in their schools Outcomes reported in: Baisch, M.J., Lundeen, S.P., & Murphy, M.K. (2011) Evidence-based research on the value of school nurses in an urban school system. Journal of School Health 81(2):78-84.

25 Interviews Descriptions of - School nurse role –How they support children with chronic illness –How medication management is handled Nurses’ contribution to the CSHP in their schools Population-based activities of nurses

26 Interviews (n=18) Nurses are a critical link between students, caregivers and school staff. Nurses supported the academic mission of the schools Nurses struggled with issues of family poverty Nurses supported the CDC Coordinated School Health Program model in their schools and in some cases, are leaders this effort Continued analysis to link to nursing interventions to the Public Health Interventionheel (Keller, et al 1998).

27 Analysis of Population-based Interventions Interviews

28 Specific Questions Population-based interventions 1. Are school nurse interventions provided at individual, community, and/or system levels? 2. What are school nurse interventions (case-finding, surveillance, advocacy, etc.)? 3. What is the effect of nursing professional education and experience on school nurse practice? 4. Is the Wheel of Public Health Interventions valuable in articulating the school nurse role in a Comprehensive Coordinated School Health Model?

29 Data Collection Population-based Interventions Coding tool developed to document: –Nurse’s background –Nurse quotes –Intervention levels (individual, community, and/or system) –Intervention type Interventions identified were coded according to: –Individual, community or system level and could be coded on more than one level –In one or more of the 17 intervention categories on the Wheel of Public Health Interventions Investigators compared interviews for inter-rater reliability, any discrepancies in coding were discussed until consensus was obtained

30 Interventions School Nurses Provided by Levels of Practice* School nurses directed health services toward individual students, their school communities and systems. –Individual – 997 Interventions –Community – 695 Interventions –System – 144 Interventions *Interventions could have been coded at more than one level.

31 Interventions by Level of Practice Level#% Individual816 52.54 Individual/Community122 7.9 Individual/Community/System57 3.7 Individual/System2 0.1 Community471 30.3 Community/System44 2.9 System40 2.6 Total1553 100

32 Interventions by Wheel Categories

33 Interventions by Public Health Nurse Experience Intervention Level#% Individual31649% Individual/Community6110% Individual Community/System 406% Individual/System2<1% Community18729% Community/System142% System223% Intervention Level#% Individual50055% Individual/Community617% Individual Community/System 172% Individual/System00% Community28431% Community/System313% System182% Public Health BackgroundNo Public Health Background

34 Intervention Type by Nurses’ PH Experience Case Finding Collaboration Health Teaching Advocacy Policy Development and Enforcement Referral and Follow up/Outreach (only those with no PH experience) Top 5 Interventions – Few differences

35 Identifying and using nurse-sensitive interventions and outcomes helps us to articulate our practice and its value ANA has recognizes Standard Terminologies that better articulate our roles

36 Nursing Specific Items from the Nursing Minimum Data Set Terminology Nursing Problem Nursing Intervention Nursing Outcome Nursing Intensity NANDA (1992)*x NIC (1992) x NOC (1997) x The above three terminologies must be used together to obtain information about the nursing problem (diagnosis), intervention and outcome. The below terminologies all have terms for the nursing problem, intervention, and outcome. Omaha System (1992)xxx CCC (HHCC) (1992)xxx PNDS (1997)xxx ICNP (2000)xxx ANA Recognized Standard Terminologies Supporting Nursing Practice *Parentheses indicate the year the terminology was first recognized.

37 Recommendations Integrate public health nursing frameworks into school nursing orientation Ensure nurses are at the table when developing school wellness plans Conduct school health assessments on a regular basis Integrate the CMS quality measures into new research/evaluations of school health programs Link interventions with outcomes Interventions ? Outcomes

38 We would like to acknowledge the wonderful nurses who helped with this study. They support children and families in a multitude of ways every day and make us very proud to be nurses.


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