West Long Branch, NJ - Monmouth University was the site of the 15th biennial School Nurses International (SNI) conference that took place July 27-31, 2009 with the theme "The Universality of School Nursing: The Privilege of Caring for the World's Children". WHF executive director Bonnie Arkus was a featured speaker to present on the Teen Esteem program - a holistic health and fitness program for 10th grade girls - and on how to create wellness communities in schools. Other nurse speakers and participatns arrived from Japan, Sweden, Denmark, the Netherlands, New Zealand, the U.K. and from all parts of the U.S.A. to discuss critical needs of school children. Top concerns were
- More students are engaging in high risk sexual behaviors;
- An increasing number of students are affected by ADD/ADHD, depression, emotional problems, obesity and Type 2 (non-insulin dependent) diabetes;
- School violence.
In response to the growing needs of children in the school setting, many school nurses feel under-supported. They must make a tremendous number of autonomous decisions each day. The nurses felt they would
benefit by more collegial and administrative support. Another challenge is the lack of standardized communications to document children's health, which leads to redundancy in record keeping, in both electronic and paper formats. All agree that establishing wellness and prevention programs in school communities is a priority.
Delivering the keynote presentation was Mary Vernon-Smiley, MD, MPH, Senior Medical Officer, Division of Adolescent and School Health, Centers for Disease Control (CDC) and Prevention, who discussed "Strategies for Improving Health and Education Outcomes through Coordinated School Health Programs". Dr. Vernon-Smiley said that the CDC provides funding to build state education and state health agency partnerships and capacity to implement coordinated school health programs across agencies and within schools. The system for strengthening school health includes eight components:
- Health education
- Health services
- Nutrition services
- Health promotion for school staff
- Physical education
- Mental and social services
- Healthy and safe school environments
- Family/community involvement.
The CDC cannot recommend curriculum, she said. She encourages school nurses to use the Youth Risk Behavior Surveys available on the CDC website as school health tools (to monitor risk and outcomes). There are six risk behaviors that have been identified by the CDC researchers as having a direct correlation on academic achievement:
- Sex risk behavior
- Tobacco use
- Physical inactivity
- Poor eating habits
- Intentional and unintentional injuries
Dr. Vernon-Smiley indicated that there is no funding available to conduct surveys of risk behavior for alcohol /drug use or mental health.
Dr. Vernon-Smiley said there needs to be a school health council and team. "We must work together with high level persons (serving) on a committee. A high level coordinator from the Department of Education. The superintendent must attend. The school nurse. (You'll need to) conference with school board members and come up with an Action Plan", she said. "Are you at the table for health care reform, and as part of Healthy People 2020? You know what they say -- 'If you're not at the table then you're on the menu'", she chided the nurses. Dr. Vernon-Smiley pointed out that there are slides, subscales to monitor risk and articles available on the CDC website for fostering healthier schools, and proceeded to outline goals:
- Establish collaborations
- Collect data using CDC Youth Risk Behavior survey tools
- Strengthen school health policies
- Improve curriculum and institute (the changes)
- Implement professional development for school staff
- Foster collaboration at the state, district and school levels
Sharon Yearous, PhD, ARPN, NCSN of Mount Mercy College in Iowa discussed the need to standardize nursing language to simplify the documentation process, and design school health records that align with the national movement to create an electronic health record. More accurate and efficient documentation practices by school nurses will give the school nursing practice more visibility, she said, and avoid redundancy in record-keeping. It is important to use the three established standards in nursing language: NANDA, NIC and NOC.
Dr. Yearous cited a study she conducted in Iowa whereby twenty-five school nurses tracked the medications they were giving to school children and found that 6,000 medications were given over a 4-week period of time. "If twenty-five nurses do this, then what do 400 nurses do?" Armed with this new knowledge, Dr. Yearous helped author a legislative bill in the state of Iowa to mandate a nurse be present in every school.
Software is always changing, which can be part of the problem. Dr. Yearous said there are currently ten software packages available and only three are useful. "There are narratives, but then you need to code the data and do something with it. None of them capture all the data that is needed" she said. Dr. Yearous believes teaching needs to take place in nursing schools on software use. Dr. Yearous, a former school nurse herself, said she liked the SNAP software template for school nursing, and she was displeased when her school decided to switch to another vendor. A downfall of SNAP is that the information is not printed in a retrievable format that includes the nursing assessment and nursing diagnosis in columns, and as it relates to the nursing process. The nursing process includes five phases or steps: Assessment (of patient's needs), Diagnosis (of human response needs that nurses can deal with), Planning (of patient's care), Implementation (of care), and Evaluation (of the success of the implemented care). "We must use the nursing process… it is our standard!" she said. Dr. Yearous stated she created 50 templates using SNAP, including one for menstrual cramps, basketball injury, sadness, moodiness and irritability. "We need to capture mental health (symptoms)". She jokingly said that there needs to be a nursing diagnosis for "Not Feeling Well" or "NFW" because it's the number one reason why children visit their school nurse. "Admittedly, many kids are escaping a test by their teacher and may not have completed their homework assignment the night before, so the school nurse needs to quickly assess 'NFW' and, if appropriate, send the child right back into the classroom." Using this example, Dr. Yearous said there is a lack of clear policy for documentation. Dr. Yearous also briefly touched upon HIPAA (Health Insurance Portability and Accountability Act) versus FERPA (Family Education Rights and Privacy Act) and conflicts on how people interpret the rules for sharing health information (in the school setting). In closing, Dr. Yearous encouraged nurses to use innovations in technology and to be involved in the process of improving nursing language communication tools by submitting new language as needed to NANDA.
Women's Heart Foundation director Bonnie Arkus, RN presented to school nurses on "Raising the Bar for Girl Health" whereby Ms. Arkus reported on the Teen Esteem Health and Fitness program for 10th grade girls. The all-girl gym-alternative class at Trenton Central High School is part of creating a healthy school community. The intervention was associated with a health study that took place September 2004 to June 2007. The instruments used were the CDC Youth Risk Behavior Surveillance Survey (YRBSS) for physical activity and nutrition the Multidimensional Self-Concept Scale (MSCS) developed by Dr. Bracken. The data show improved health choices being made. Ms. Arkus said that the Women's Heart Foundation is expanding the program, by making it available to 8th grade boys and girls at a middle school in Trenton and hopes to begin the program in late fall or early spring. The organization is calling the intervention "Heart Fit Kid" and is launching a website by the same name: HeartFitKid.org, to promote it as a turn-key licensed program for schools to invest in children's health.
School nurses Alies Dorenbos and Karin Verhorst of the Netherlands presented at the poster session on "Joining Forces around the Children at Risk". Communities of wellness and free fitness activities for families have been established throughout the country. This imperative was set forth by Prime Minister Jan Peter Balkenende in 2007. The Prime Minister is head of government and Chair of the Dutch cabinet. As such, he coordinates the policy of the government.
Nurses from Denmark discussed a development project for school children with offering new and exciting ways to interest children in learning about health.
Nurse Gunilla Fagerholt from Sweden reported how the Swedish Association of School Nurses and the Swedish Association of School Doctors formed a team to examine quality indicators for school health care. They discovered that quality indicators did not exist, and there is insufficient research on methods used in school health care to make it possible to find quality indicators.
Nurses from Japan presented on school nurses in Asia: a comparison with Yogo teachers. According to the Fukuoka University website, "Like other school teachers, a Yogo teacher must have a teaching certificate for Yogo teacher as stipulated in the laws for Certification of Educational Personnel. There are different types of certificates for Yogo teacher: specialized certificate", 1st class certificate" and "2nd class certificate". Students will receive different certificates depending on the number of credits earned.
The Yogo teacher is so called a school-nurse teacher. Yogo teachers care for the mental and physical health of school children, and teach the subject of physical education. With the times, in addition to children with physical difficulties, more and more children with emotional ailments complain about health problems and thus visit the school nurse's office. As such, broad knowledge and perspectives are required of a Yogo teacher."
The endnote address was delivered by Sandi Delack, RN, BSN, M ED, NCSN of Rhode Island, president of the National Association of School Nurses, with an uplifting "Many Cultures, One Voice". Ms. Delack called upon representatives of each community of nurses from around the world to repeat in their native language the phrase: "I am a school nurse and I am privileged to be caring for the world's children". NASN is a nonprofit organization consisting of 14,000 nurse members. In a 2009 report, the US Department of Education, National Center for Education Statistics, states there are 66,171 school nurses in the United States.
Karen Farrell and Madalyn Schultz-Petit served as conference co-chairs.
For a listing of all presenters, Click here to download a conference brochure.
The next biennial School Nurses International conference is set for 2011 and will take place in Hong Kong.
The School Nurses International (SNI) conferences are organized and managed entirely by volunteers. The group, formerly named "Anglo American School Nurses", came together through the sponsorship of the California School Nurses Organization, Southern Section, U.S.A. and the Hampshire School Nurses Association, U.K., spearheaded by school nurse Mary Henley, formerly of the U.K. who is the Founder. The first meeting was held in 1981 at St. Hilda's College, Oxford, England and there was no intention to hold another conference. The purpose was to share ideas and encourage the British counterparts to join together and form their own national organization. Many friendships were formed in Oxford and before leaving, an invitation was extended to hold a second conference in California in 1983. In 1985 at Derwent College, York University a group of Scandinavian school nurses joined. The name of the group changed to School Nurses International. There is no official membership. Committees on both sides of the Atlantic jointly plan and implement the biennial conferences. School Nurses International provides a forum for nurses around the world working with school children to come together in stimulating, intellectual and happy environment to share their knowledge and understanding of the emotional, social and physical needs of the school aged child. The intention is to share the caring of children in each nurse's educational system, knowing that it will make a difference in the lives of children. Mary Henley has attended each conference as an opening presenter to welcome the nurses. Mary is 88 years old and now resides in California.
The Women's Heart Foundation (WHF), the only non-governmental organization that implements heart disease prevention projects, is dedicated to prevention and improving survival and quality of life.
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