Virginia School Age Health Needs Assessment: 2013 Survey Responses Janet Wright BSN, RN, NCSN Jyoti Gupta MPH Shahid Hafidh MPH

Survey Purpose: Describe Virginia School Age Health Care Providers Assess School Nurses’/ Unlicensed Assistive Personnel’s Knowledge of Available Resources for Education, Training and Professional Development Identify Additional Training Needs Identify Useful Information to Enhance School Health Practice Survey Recipients: Virginia School Nurses and Unlicensed Assistive Personnel (UAP) Coverage across 132 Public School Divisions Included Private Parochial School Nurses (PPSN) Survey Respondents: 679

2008 N=723N=

N=723N=678

Elementary Schools Middle and High Schools Primary and Non-School Settings Work Settings were Similar in 2008 and % (approx.) 3-6% (approx.) 17-19% (approx.)

High School Some College AAS/ADBA/BS/ BSN MA/MS/ MSN/ MPH PhD

Oriented to Job-Role (Yes Response) Orienting Person

Orientation Resources

Most Helpful Orientation Topics Clinic Practices/ Nursing Activities School Health Policies School Health Guidelines First Day Laws/ Regulations ResourcesOther Orientation Topics

Most Helpful Orientation Topics (2013 Data (N=115) CLINIC PRACTICES / NURSING ACTIVITIES: --Tasks & Responsibilities --Day-to-Day Clinic Flow --Medical Procedures --Documentation --Immunizations & Screenings SCHOOL HEALTH POLICIES: --State/County/School District Policies --Medication Policies --Training, certifications, licensure VA SCHOOL HEALTH GUIDELINES: --Overview of Guidelines --Immunization & Medication --Day-to-Day Guidelines --Emergency Protocols --Computer Systems OTHER: --Health Conditions/Diseases --First Aid

Receive Annual Employee Evaluation

Annual Employee Evaluator

N=677N=723 Similar Responses in 2008 &

Attended Virginia Department of Education Summer Institute for School Nurses (SISN)

Access/Support/Feasibility Access to Webinars & Teleconferences Able to Travel to Trainings / Conferences Financial Support from School/School Division

Interest in Leadership Development Training

Source of Knowledge/Information VDH School Age Health Newsletter CDC Website Private/Parochial School Nurse List Serve VASN Website School Nurse Coordinator List Serve (DOE) Note: DOE School Nurse Coordinator Meetings Number Held Annually: 3 Perceived Need for 3 Annual Meetings: 99.1% (2013 Data, N=116)

Research

Program Planning And Implementation

Community Collaboration/Partnership Building

Comfortable to Perform Health Screening Skills

Coordination Of Care More than 60% Respondents (2013; N=642) knew how to:  Create/Use: Individualized Healthcare Plans (IHPs) : Emergency Care Plans (ECPs)  Use Section 504 plans for Students with Disabilities  Work with Physicians Under “Standing Orders” in the School Setting  Maintain Student Confidentiality & Legal Issues More than 60% Respondents (2013; N=642) were aware of :  School Nurse Role in Special Education  School Nurse Role in Child Study Team (Special Education)  School Nurse Role in Individualized Education Program (IEP) Team 59% were aware of HIPAA & FERPA Note: HIPAA=Health Insurance Portability and Accountability Act of 1996; FERPA=Family Education Rights and Privacy Act

Understand HIPAA and FERPA Note: HIPAA=Health Insurance Portability and Accountability Act of 1996; FERPA=Family Education Rights and Privacy Act

Respiratory System Circulatory System Gastrointestinal System 2013: 70-72% 2008: 80-81% 2013: 52-61% 2008: 76-81% 2013: 65% 2008: 82% (Physical Assessment, Allergies, Asthma) (Physical Assessment, HTN, Blood Disorders) (Physical Assessment) Interest Seems Lower in 2013 than in 2008 Note: 2013 N=627; 2008 N=584

Nervous System Endocrine System Musculoskeletal System 2013: 66-72% 2008: 84-87% 2013: 71% 2008: 88% 2013: 64% 2008: 85% ( Physical Assessment, Seizure Disorders) (Diabetes)(Physical Assessment) Interest Seems Lower in 2013 than in 2008 Note: 2013 N=627; 2008 N=584

Behavioral Health

 Manuals  Journals  Texts  Websites  Additional Resources Note:  Greater Use of Websites and Journals in 2013 (N=627) compared to 2008 (N=573)  Slightly Lower Use of Manuals in 2013 compared to 2008

Manuals 2008 (53-80%)2013 (58-71%) VDH Guidelines for Managing Asthma in Virginia Schools-A Team Approach VDH Guidelines for Specialized Health Care Procedures Virginia School Health Guidelines Helping Student with Diabetes Succeed-A Guide for School Personnel (NDEP Guide) Manual for Training of Public School Employees in Administration of Medication (DOE) Manual for Training of Public School Employees in Administration of Insulin and Glucagon (DOE) Homebound Instructional Services Guidelines (DOE) (17%)

Journals 2008 (35%)2013 (39%) NASN Journal of School Nursing (Research-based) NASN School Nurse (Clinical)

Texts 2013 (25-36%) School Nursing Scope and Standards of Practice, 2nd Edition (NASN) Managing Chronic Health Needs in Child Care and School, A Quick Reference Guide (AAP) Managing Infectious Diseases in Child Care and Schools, A Quick Reference Guide, 2nd Edition (AAP) Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition School Nursing: A Comprehensive Text by Dr. Janice Selekman, Editor AAP Red Book 2009 Report of the Committee on Infectious Diseases, 28th Edition

Websites 2008 (39-44%)2013 (47-51%) NASN: National Association of School Nurses Virginia Department of Education (VDOE) School Health Specialist VASN: Virginia Association of School of Nurses VDH School Age Health Specialist

Additional Resources

HEALTH CONDITIONS / DISEASES: --Asthma --Diabetes --Allergies --Health System Disorders (e.g. arrhythmias, seizures, rashes) --Health & Hygiene MENTAL HEALTH: --ADD/ADHD --Anxiety/Panic/OCD Disorders --Autism Spectrum --Behavioral & Emotional Health --Bullying HEALTH SCREENING / ASSESSMENT: --General Assessment Skills --Health Systems Assessments --Ear Examinations --Assessments of Autistic and other Special Needs Children CLINIC PRACTICES / NURSING ACTIVITIES: --Medical Care at School, IEP --Continuing Education --Communication with Parents --Medical Alert Problems --Leadership TRAINING & EDUCATION: --Professional School Nurse Evaluation Tools --Resources: Research, Finance --Grant & Policy Writing --Collaboration Skills --Nurse Management Issues OTHER: -- Policies & Legal issues --Injuries --Nutrition/Weight --First Aid

 School Health Professional Profile in Virginia: Most work in Public Schools, are RNs, have a Bachelor’s degree, have >5 years’ School Health Experience  Improvements from : –Almost All Nurses Have Internet Access –Increased use of Websites (e.g. VASN/NASN) and other Resources (e.g. VDH First Aid Guide, Handwashing Poster) in clinical setting –Increased interest in being more active in Community Partnerships –Increased interest in Leadership Development Training –Increased attendance at SISN (VDOE) –Increase in awareness of HIPAA and FERPA (still <60%)  Low Engagement in Professional Development Activities: –Less than Half (42%) Attended SISN Conference –35% Attended VASN Conference and Participated in SHAB –27% are VASN/NASN Members  Low Access/Support for Capacity Building: –Not All (84%) Have Access to Webinars/Teleconference –Less than Half (39%) Receive Financial Support from Schools  Not All Nurses Receive Annual Employee Evaluations (86%)

 Gaps in Orientation: –Only 73% were oriented to the Nursing Role (N=164)  Gaps in School Health Practice: –Only 55% applied Research-Based Interventions in nursing practice –Less than 40% understood Program Planning Process –Less than half (48%) were comfortable to implement New School Health Programs –Only 44% knew where to access help with Planning and Implementing new programs –Less than half (46%) actively participated in Community Partnerships –Less than 60% were aware of HIPAA and FERPA –While 97% of UAPs Administered Medication, only 84% of UAPs’ Medication Administration Skills were tested annually  Perceived Orientation Needs: –Clinic Practices / Nursing Activities –Job Issues (e.g. nursing roles, duties, protocols, time management, legal issues)  Perceived Training Needs:  Health Conditions / Diseases  Clinic Practices / Nursing Activities  Mental Health  Training & Education

 Improve Access to & Awareness of: –Webinars / Teleconferences for professional development –Resources for professional development: Improve financial support to school health professionals and time available to engage in professional development –Resources for planning and implementing new school health programs –Opportunities to participate in community partnerships  Enhance Training & Education in: –Applications of research-based interventions in nursing practice –Planning & implementation processes in school health programs –HIPAA and FERPA –Clinic practices / nursing activities; ie., daily workflow expectations, collaboration skills, nurse management issues –Health conditions / diseases, including mental health  Ensure Appropriate Orientation for School Health Professionals (RN/LPN/UAP)  Increase % of school health personnel who receive an annual employee evaluation using an evidenced-based school health professional self- evaluation tool (Example: School Nurse (RN) Self-Evaluation Form)  Increase Annual Medication Administration Competencies for Unlicensed Assistive Personnel (UAPs)

Thank you Contact: Janet Wright, BSN, RN, NCSN School Age Health Specialist Office of Family Health Services Virginia Department of Health